CARE HOMES FOR OLDER PEOPLE
Nettlestead 19 Sundridge Avenue Bromley Kent BR1 2PU Lead Inspector
Wendy Owen Announced 16 August 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Nettlestead G01G51s6959Nettlesteadv233332.16.8.2005.Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Nettlestead Address 19 Sundridge Avenue Bromley Kent BR1 2PU Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8460 2279 020 8464 3683 Nightingale Retirement Care Ltd Kim Thomas CRH 22 Category(ies) of Op 22 registration, with number of places Nettlestead G01G51s6959Nettlesteadv233332.16.8.2005.Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 22 Elderly men or women Date of last inspection 21/02/05 Brief Description of the Service: Nettlestead is a large, detached three-storey Victorian house, converted for residential living, providing care and accommodation for twenty-two older people. The house is set within its own well-kept grounds, with a secluded rear garden. Off-road parking is located to the front of the property, with an in and out drive. The home is situated in a quiet residential area within walking distance of local shops and public transport links. The house has retained some of its original features, particularly the wood panelling in the lounge. Service users accommodation is on all three floors, accessed by stairs or lift. Central heating is provided to all areas of the home. Specialist bathing equipment and lifting aids are also available. There are telephones accessible to service users. There is one pay phone and one mobile phone for incoming calls to allow privacy. A few service users have a phone in their own room at their own expense. The residents are cared for 24 hours a day by a team of care staff; ancillary staff and a management team. Nettlestead G01G51s6959Nettlesteadv233332.16.8.2005.Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The announced inspection took place over one day and included a tour of the premises, discussion with residents and staff and viewing a number of records. The inspector received twelve feedback cards from residents; one GP and three from relatives. What the service does well: What has improved since the last inspection?
Good progress has been made regarding making radiators safe throughout the home. The home has also implemented the medication requirement from the last inspection and the lack of hot water in one bedroom has now been resolved. Other health and safety issues, including infection control and food hygiene training have also seen some progress. The external masonry work has been painted and looks good.
Nettlestead G01G51s6959Nettlesteadv233332.16.8.2005.Stage 4.doc Version 1.40 Page 6 The last report identified the need for more accurate records, specifically ensuring receipts are maintained for all expenditure on behalf of residents. This is now being completed, as far as the home is able. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Nettlestead G01G51s6959Nettlesteadv233332.16.8.2005.Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Nettlestead G01G51s6959Nettlesteadv233332.16.8.2005.Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3,4 & 5 The admission process must be improved upon to ensure all residents have, in place, an assessment of their needs. Without this there is no assurance that the care needs will be met. The homes terms and conditions of residency must be improved upon to enable residents to have the full information on which to base their decision of the suitability of the home and what they can expect for their money. EVIDENCE: Three files viewed in relation to the admission and assessment and process. The assessment in relation to one of the last residents to be admitted could not be located whilst the assessment for a second resident was in place. There was no evidence of the home writing to the service user or their representative that, following the assessment, the home is able to meet the individual’s needs. (See requirement 1) Residents spoken to stated that they had an opportunity to view the home prior to making any decision about its suitability.
Nettlestead G01G51s6959Nettlesteadv233332.16.8.2005.Stage 4.doc Version 1.40 Page 9 Terms and conditions of residency have been produced and need some amendment so that the amount and method of payment of fees; what is included in the fees and the room to be occupied. (See requirement 2 and recommendation 1) Nettlestead G01G51s6959Nettlesteadv233332.16.8.2005.Stage 4.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8,9 &10 The health needs of residents are being well met but improvement is required in relation to the care plans, risk assessments and medication procedures. These improvements will ensure that care staff have full details of the residents’ needs to enable them to provide the care required. EVIDENCE: The three care plans viewed covered many of the areas required by the Commission but need more details in some areas. There is also a need to complete care plans and risk assessments in relation to residents with pressure sores, identifying the role of the home and District Nurse in the care. Not all care plans fully reflected the residents’ current needs or care provided. There was a good process for reviewing the individual needs, with the manager recording any changes and updating the care plans. Residents spoken to said that staff are aware of their individual needs and a member of staff spoken to demonstrated a good understanding of a particular resident’s needs. (See requirement 3, 4 & 5) Falls risk assessments are completed and appropriate action taken to refer to the specialist when required. Nettlestead G01G51s6959Nettlesteadv233332.16.8.2005.Stage 4.doc Version 1.40 Page 11 All residents are registered with a GP and the home has good recording of health professional visits and treatment provided, including any changes in medication. The medication procedures were good but require some improvement to minimise risks. This includes changing “as directed” to full administration guidelines. The home must also ensure all medication is recorded into the home, including those residents on respite care. The home must also produce procedures for “on leave” medication. (See requirement 6) Discussions with residents and observations made, during the inspection, showed residents are treated with respect and dignity. Nettlestead G01G51s6959Nettlesteadv233332.16.8.2005.Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 Social activities are adequately organised to provide an interesting and stimulating environment for residents. Meals are nutritious and balanced and offer a varied and healthy diet for residents. EVIDENCE: An activity schedule is available within the home and on the day of the inspection a quiz was well attended by residents. Those residents spoken to who did not take part had done so out of choice, preferring their own company or were undertaking their own interests. Care plans must reflect such individual interests and hobbies. (See requirement 3) Residents spoken to told the inspector that their family members were made very welcome by the staff who often spent time to chat and laugh with residents and visitors and so providing a warm, friendly and relaxed environment. The staff also made visitors welcome though ensuring refreshments were offered. Whilst there is no dedicated visitors’ room, this was not raised as a concern by residents. Most feedback expressed that a good standard of food is provided with staff having a good understanding of residents’ individual needs and caters for these. The inspector suggested that the manager and staff have a more
Nettlestead G01G51s6959Nettlesteadv233332.16.8.2005.Stage 4.doc Version 1.40 Page 13 formal method of relaying individual needs to the kitchen staff, rather than relying on word of mouth. The home maintains a record of individual choices for lunch and tea. Meals are taken in the dining room, which offers a pleasant and comfortable environment or they may be taken in the individual’s room, if residents prefer. Nettlestead G01G51s6959Nettlesteadv233332.16.8.2005.Stage 4.doc Version 1.40 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 & 18 The manager’s approach to complaints is open and residents feel they are able to raise complaints or concerns. They feel they will be listened to and such concerns acted upon. The home has developed a vulnerable adults procedure and staff are provided with training to ensure they are aware of what to report and how these incidents must be reported in order that residents are protected. EVIDENCE: A complaints procedure has been developed with the details included in the Service Users’ Guide and displayed in the entrance hall. There have been no complaints made within the home or through the Commission over the last twelve months. Feedback shows that the manager is approachable and listens actively to any concerns or issues raised and responds to these. One resident said how happy they were, that the manager responded speedily and without issue, to a request to change rooms. Adult protection procedures are in place, although there was no evidence that the recommendation raised at the previous inspection had been implemented. (See recommendation 2) Staff receive training on the home’s procedures as part of induction and a staff member and the manager demonstrated adequate knowledge of these procedures and what they report. In order that staff are fully aware of the role of the various agencies in managing and investigating such incidents, the inspector suggests some form of external training is provided.
Nettlestead G01G51s6959Nettlesteadv233332.16.8.2005.Stage 4.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 23, 24, 25 & 26 Improvements have been made to the external and internal areas with progress continuing. Internal decoration is of a good standard and well maintained, ensuring the home provides a warm, clean, safe and comfortable environment. EVIDENCE: A tour around the home showed it to be clean, tidy, homely; comfortable and well -decorated. This was also reflected in feedback. Resident spoken to were “more than happy” with the way their bedrooms were decorated and furnished, even though they did not contain all the furniture specified in the standards. The inspector suggests where a room does not meet the standard and the resident does not wish for the furniture specified, a record is made on the individual care plans. The bedrooms were comfortable with possessions and mementoes providing a more individual feel. The maintenance man has made good progress with the making safe of the radiators throughout the home and should continue with this. The masonry
Nettlestead G01G51s6959Nettlesteadv233332.16.8.2005.Stage 4.doc Version 1.40 Page 16 work has also recently been repainted to a good standard. However, the back of the house still needs attention with the sash windows still requiring replacement. (See requirement 10) The grounds are secluded and well maintained with adequate garden furniture located throughout. The laundry has been repainted and made a little difference to the environment. Adequate procedures are in place for the control of infection. This could be further improved if domestic and laundry staff are included in the action plan for infection control training. (See recommendation 3) Nettlestead G01G51s6959Nettlesteadv233332.16.8.2005.Stage 4.doc Version 1.40 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 & 30 The home is making good progress in the training of staff and this must be continued to ensure residents understand the needs of individuals and are in safe hands at all times. EVIDENCE: The staff roster shows an adequate number of care staff on duty and also reflects an increase in numbers of weekend staff. Ancillary staff are also on duty at key times of the day. However, the inspector raised concerns regarding care staff undertaking kitchen tasks such as the preparation of the evening tea and associated clearing up. Discussions with the manager, staff and residents showed that this is not an issue with the routine of the home making this a relaxed and unhurried time and with staff allocated specific tasks. Five of the care staff have achieved NVQ 2 in Care with six registered currently. If staff complete this award the required standard will have been reached but is very unlikely to be achieved by December 2005. residents spoken to said care staff have an understanding of their needs and that they feel safe and well-cared for. Induction and foundation training is provided for all new staff with the manager and assistant manager assessing competency of staff. The assistant manager, although with many years experience, does not have qualifications in care or management. An appropriate qualification must be obtained in line with her role in the home and to supplement her experience. There is evidence of core training taking place (See standard 38 ) and more specific training, such as caring for residents with Parkinsons’ Disease.
Nettlestead G01G51s6959Nettlesteadv233332.16.8.2005.Stage 4.doc Version 1.40 Page 18 However, the manager must also ensure staff receive stoma care training in order that residents receive appropriate care. (See requirements 7 & 8) Nettlestead G01G51s6959Nettlesteadv233332.16.8.2005.Stage 4.doc Version 1.40 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32,33 & 38 The manager is well organised and provides leadership, guidance and direction to staff to ensure residents receive consistent care. EVIDENCE: The home keeps organised and well-maintained records in line with Schedule 4 of the Care Home Regulations 2001. The manager has recently achieved the Registered Manager’s Award and is now required to obtain a care qualification to NVQ 4 level. Residents and staff feedback shows the manager is approachable and open and has a positive approach to improving the quality of care within the home. This was also evident in her approach to the inspection process and the progress made in implementing the previous requirements and recommendations. (See requirement 9)
Nettlestead G01G51s6959Nettlesteadv233332.16.8.2005.Stage 4.doc Version 1.40 Page 20 The quality of care is monitored through regular auditing, review of the service including service user feedback and meeting regularly with residents. The Commission also receives monthly reports on the service undertaken by the registered person. The last inspection identified the need to ensure all service users’ monies were complete with receipts for purchases made whenever possible. Whilst the inspection did not include an audit of the finances , the inspector noted the home has now addressed this shortfall. The manager also actively promotes the safety and welfare of residents through regular health and safety audits; ensuring regular servicing of the equipment used and training of staff in procedures such as accident reporting. The home now sends the Commission notification of any events in the home which affect residents. Health and safety procedures could be improved with regular moving and handling training and continuing the progress made in training staff in food hygiene and infection control. (See requirement 11) Nettlestead G01G51s6959Nettlesteadv233332.16.8.2005.Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 2 2 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 3 3 x 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 x x x x x x x Nettlestead G01G51s6959Nettlesteadv233332.16.8.2005.Stage 4.doc Version 1.40 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 Regulation 14 & 17 Schedule 4 Requirement The Registered Person must ensure that a copy of the residents assessment is kept home. The home must confirm in wirting, following the assessment, that they are able to meet the indivudals needs. The Registered Person must ensure the homes terms and conditions must state the amount of fees and the method of payment. Residents must be provided with a copy of these terms and conditions. The Registered Person must ensure the care plans accurately reflect the assessed needs of residents in sufficient detail to enable care staff to provide appropriate care. The Registered Person must produce risk assessments and a pressure care plan for those residents at risk or identified with pressure sores. The Registered Person must produce a risk assessment for the use of bed-rails. The assessment must detail the Timescale for action 16/09/05 2. 2 5 1/12/05 3. 15 15 1/11/05 4. 8 13 16/09/05 5. 8 13 16/09/05 Nettlestead G01G51s6959Nettlesteadv233332.16.8.2005.Stage 4.doc Version 1.40 Page 23 6. 9 13 7. 28 18 8. 30 18 9. 10. 31 19 7 23 11. 38 13 decsion making process regarding the risks involved and the indivudals involved in the decision making. The Registered Person must ensure medication procedures are safe. Specifically, All medication is recorded into the home. Full adminsitration details must be recorded for all medication. The home must produce procedures for on leave medication. The Registered Person must ensure training is provided for and undertaken by the Assistant Manager. Any training provided must be determined by the job role. The Registered Person must ensure care staff are provided with stoma care training. This training must be provided by a competent person. The Registered Manager must undertake a qualification in care equivalent to NVQ 4. The Registered Person must provide the Commission with an action plan detailing the timescale for the replacement of the sash windows at the rear of the home. The Registered Person should ensure all staff, including kitchen and domestic staff are provided with regular moving and handling training or updates in training. 16/09/05 1/12/05 1/11/05 1/12/05 1/10/05 1/12/05 Nettlestead G01G51s6959Nettlesteadv233332.16.8.2005.Stage 4.doc Version 1.40 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 5 13 13 & 18 Good Practice Recommendations The Registered Person should amend the terms and conditionsof residency to detail what is included fees. The Registered Person should investigate external training for staff in relation to the Protection of Vulnerable Adults. The Registered Person should ensure all staff, includig domestic staff, are provided with infection control training. Nettlestead G01G51s6959Nettlesteadv233332.16.8.2005.Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Riverhouse 1 Maidstone Road Sidcup Kent DA15 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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