Inspection on 27/09/07 for Nettlestead

This inspection was carried out on 27th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Nettlestead 27/10/09

Nettlestead 04/08/06

Nettlestead 28/12/05

Nettlestead 16/08/05

Nettlestead 21/02/05

Nettlestead 21/05/04

Nettlestead 16/12/03

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Nettlestead Nettlestead 19 Sundridge Avenue Bromley Kent BR1 2PU Lead Inspector Wendy Owen Unannounced Inspection 27th September 2007 10:00 X10015.doc Version 1.40 Page 1 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 Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 2 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 DS0000006959.V344597.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nettlestead Address Nettlestead 19 Sundridge Avenue Bromley Kent BR1 2PU 020 8460 2279 020 8464 3683 Nettlestead@Nightingales.Co.UK www.Nightingales.Co.UK Nightingale Retirement Care Limited Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Kim Thomas Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 22 Elderly Men and Women Date of last inspection 4th August 2006 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 many of its original features, particularly the wood panelling in the lounge. Service users accommodation is on all three floors, accessed by stairs or lift. There are fourteen single and four double rooms. 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. Current scale of charges range between £523 and £732 with shared rooms at the lower end of the scale. This includes accommodation, food and staffing. It does not include hairdressing; private healthcare; newspapers, clothing; toiletries and other personal expenditure. The home has a Statement of Purpose and Service Users Guide providing information on the home and copies of inspection reports are available directly from the home. A copy of the inspection report is available on request from the home. Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection included a visit over one and a half days with the support of an “Expert by Experience” on the first day. The inspection also took into account information sent by the home prior to the inspection, information already held by the Commission, viewing of records, discussions with residents, staff, manager and Provider and a tour of the home. Residents were supported to complete written feedback by a volunteer who helps in the home. Seven relatives provided feedback; five staff and ten residents. A random inspection took place in March 2007 and the outcome of this is referred to in this report. The “Expert by Experience” asked people using the service what they wished to be called in this report. The outcome of this was that they favoured “residents.” All residents currently living in the home are female. What the service does well: The quality of care is good with residents being well supported ensuring their needs are met through a sound assessment and care planning process. One relative wrote “Nettlestead is proving to be far more satisfactory than we had anticipated”. Most of the feedback received commented on the warm and happy environment for people living there ensuring they felt safe and valued. The environment is clean, welcoming and homely with comfortable rooms. The quality of food is good with choice and variety and taken in a relaxed environment. Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 6 It is clear from those spoken to and from the written feedback that any concerns or issues affecting residents are dealt with without delay ensuring residents feel confident that they will be listened to and issues acted upon. Staff are competent and well trained and all the people living in the home who provided feedback thought staff to be warm, pleasant and very caring. One relative wrote of staff: “Nettlestead staff have bottomless wells of patience, kindness and humour.” “It is run…….with an acknowledgement and celebration of the individuals, both residents and staff.” The home is well run with an effective management team ensuring residents are safe and protected and that they look to continually improve the care provided. The manager and Provider are committed to improving the quality of care and therefore ensure any requirements raised during the inspection process are addressed. What has improved since the last inspection? Since the last inspection the home has addressed the requirements raised. They now write to prospective residents to say they are able to met their needs, meaning residents who are admitted are confident that they will get the support they require and know what to expect. The care planning, risk assessment and medication records have improved which means staff have clear information on the residents’ needs ensuring their health needs will be met. It is a positive step to have employed an activity co-ordinator to structure some activity and stimulation for residents to ensure their overall well-being is meet. Examination of wheelchairs to show they are fit for use now takes place withinthe home between annual servicing by the outside providers. Resident’ monies are further safeguarded through ensuring records are in place and receipts are provided for expenditure. Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 7 What they could do better: This inspection has raised a few requirements and a number of recommendations. A Service Users Guide has been developed but not provided to individual residents, which means they do not have the information on hand about what the service offers. It is important to individual’s health that staff are more proactive where there are concerns. Medication received into the home must be fully recorded to ensure risks to health are limited. Whilst the home is comfortable and well furnished there are areas of the home that are in need redecoration and refurbishment which the Providers are currently in the process of addresssing. Appropriate infection control resources must be provided to minimise the risk of cross infection. Supervision of staff is integral to continued good practice and quality of care provision. This must be addressed with records of formal supervision in place for care staff. There are a number of areas where the inspector recommends improvement as a matter of good practice which will improve the overall care and support received. Whilst the home has developed information required for residents these are all in the written format. The manager should consider residents’ individual needs and provide information in other formats eg larger print, signs, symbols and pictures. A system should be developed to ensure all details of a residents’ admission are maintained and all records should have the full dates and signature of the person making the record. Care plans have improved but mainly reflect action to be taken in the performance of tasks. The plans should include social and leisure interests and what the home is doing to ensure residents are supported in this way. It is positive to note the employment of an activity co-ordinator. However, records of what activities individuals are involved in each day. Staff should also be encouraged to be proactive in their interaction. Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 8 Staff often seem stretched with domestic duties and therefore have less time to spend with residents. The manager should consider increasing the number of domestics. 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. The summary of this inspection report can be made available in other formats on request. Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 9 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 Outcomes Statutory Requirements Identified During the Inspection Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides good information to those wishing to use the service enabling them to make a decision on whether the service is right for them. The staff are provided with core information to enable them to meet the individual’s needs. The home does not offer rehabilitative care. EVIDENCE: Information is provided for those wishing to know what the home has to offer. It comes in the form of a written Statement of Purpose and Service Users Guide. However, the residents are not provided with individual copies of the “Guide” on entering the home, as required. The manager is now arranging for Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 11 each resident to be provided with a copy and investigating the different formats that are needed for individuals. When the home receives a referral, arrangements are made for the prospective resident or their representative to be provided with information on the home, including a copy of the terms and conditions of residency. The written feedback and individual discussions within the residents show that residents are not always aware of the information they receive either through poor memory or, as in most cases, due to family making the arrangements on their behalf. The home’s referral form details this together with the arrangements for visiting the home. The referrals forms are filed separately and therefore the information is not always at hand in the individual’s file (if they have been admitted). This would be beneficial as it would support the good practices. (See recommendation) Two residents’ files were viewed to determine the pre-admission processes. The random inspection in March 2007 identified the need for the home to obtain the Care Manager’s assessment, where arrangements are by the Local Authority. At this inspection one of the files was found to contain Care Manager’s core assessment, together with the home’s assessment information. In the second case, the resident is privately funded and a care assessment had been carried out by one of the management team. The management team ensure that they visit the prospective resident to carry out an assessment. This was seen in one case where they travelled to Brighton to visit one person. One member of staff spoken to said that they are provided with information on residents before they are admitted and so are able to have a good understanding of their needs. The home’s assessment form is basic but covers the areas required. This could be improved to ensure more detailed information is provided which would not only give a good picture of the residents’ needs but also be beneficial at a later stage when developing the care plans. The people completing must also ensure that they fully date and sign all information. (See recommendation) Terms and conditions have been developed and there is evidence that residents or their representatives have received a copy of these. In one viewed, the terms and conditions had been signed by the resident. In the other case the contract had been sent to the individual’s Power of Attorney and was awaiting return. The terms and conditions include a trial period and it is positive that they provide the first week’s stay free of charge. Where Local Authorities have made arrangements to place residents in the home a copy of the placement agreement is obtained, although there are often Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 12 delays in this due to the time taken for the authorities to produce the document. Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have the information to ensure residents’ receive the care and support ensuring their personal and healthcare needs are met. The staff working in the home treat residents with respect and dignity. EVIDENCE: Care plans are developed for each resident and, since the last inspection in March 2007 where improvements were required, these have now been made. The care plans and risk assessments were more detailed and reflected the individuals’ needs and routines and, where risks were identified, the actions for interventions were well documented. Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 14 There were some gaps, although these were minor, except in the case where one resident had lost a significant amount of weight but the home had not been as quick in taking action as the inspector believes was required. The written feedback showed 60 of residents believe they get the care and support they need, whilst 40 said “usually”. However, all residents said that staff listen and act upon what they say. This shows a very good standard of care by staff. The care plans could be improved further by providing clear information on the social care needs of the individual and particularly what action the staff are taking to address this area of need. (See recommendation) There was good evidence that reviews are taking place with any changes to support required clearly documented and discussed with the resident and relative, where possible. The manager should also encourage staff to be more involved in the care planning process including the development of the plan. The written feedback when asked: Do you receive the medical attention you need? Showed 70 believe they do whilst 30 stated usually. Relatives and residents were happy about the medical support provided. One relative wrote that their relative had been recently admitted to hospital and: “ I was delighted with the efficiency with which the staff handled the situation.” Another wrote that: “the standard of care has been better than expected.” Records viewed showed residents to be weighed regularly and, as stated above, where there are significant differences, the home needs to act more quickly to address concerns. (See requirement) The manager has, since the last inspection, developed a new document for recording healthcare professional visits and there was evidence of visits taking place, particularly GP and District Nurse visits, although optical and chiropody is less well documented. Privacy and dignity of residents is respected. The “expert” observed that each resident was discretely asked by the care assistant if she wanted to visit the toilet prior to lunch. “This was very well done and caused no embarrassment to anyone.” Wrote the individual. Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 15 From the information provided it is clear that all residents currently living in the home are female and all staff members are also female. This therefore does not present any gender issues. Medication practices were audited and found to be generally satisfactory with records fully completed, except in the case of one medication that had been received in but no records made. It would also be good practice for the records to show the medication carried over each month. Administration of medication was not observed. However, discussions with one member of staff who has yet to take responsibility for this task, demonstrated a clear understanding of what is required. A number of staff have or are in the process of undertaking a distance learning course “Safe handling of Medication”. This now, according to the manager, includes observation of practice to ensure competency. Controlled Drugs (CDs) are prescribed for residents and the recording and storage systems meet with the Regulations. The inspector noted one medication that had not been signed for, as they should be. However, all CDs were audited and found to be correct. (See requirement) Medication requiring storage in the fridge is correctly stored and those medications viewed such as eye drops, had the date of opening recorded so they can be disposed of within the time limits required, once opened. The fridge used to store the medication required defrosting, although the records viewed showed the fridge to be working within the maximum and minimum temperatures. (See recommendation) Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Progress has been made in the way residents are stimulated through a limited range of activities. Further improvement is required in relation to individual interactions and needs to ensure a positive well-being for all. Meals provided are varied, healthy and nutritious and take place in a relaxed environment, ensuring the continued health of residents. EVIDENCE: The expert by experience observed what was going on in the home and spoke to a number of residents. One resident said there was a weekly church service on Sundays, an outing out by coach and quizzes which she enjoyed, she told me the television was always on but she didn’t really enjoy it and found it boring. Some residents had newspapers and I asked if they ordered their own Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 17 or were provided by the home. The resident said that she could order one if she wanted but wasn’t exactly sure how she would. There did not appear to be a TV guide in the room and a care assistant came in several times and turned the television volume up and down. No-one appeared to notice this. A piano was in the room but one resident said it wasn’t used, although another resident said it was occasionally. I asked if they had a sing song or played cards but was told no. This may be, in part due to lapses of memory for some. At one point a cookery programme was shown on the television making muffins. This led to a conversation actioned by the care assistant on favourite things to cook. Most residents joined in remembering things they used to make themselves. This type of interaction is really beneficial and should take place more often rather than be part of a task. Some staff did enter the lounge to chat a little to some residents but many were not included. One relative and one member of staff felt staff should spend more time with residents, as did the “expert”. Since the last inspection last inspection the home has employed an activity coordinator for two hours each afternoon. When asked Are activities arranged by the home that you can take part in- 10 yes; 30 usually; 60 sometimes. An activity schedule is in place, although this is not always adhered to. Where the changes this should be identified on the schedule. There is no record of what activities take place and who partakes. The “expert” spoke to five other residents, regarding the activity programme, one lady hated quizzes but said there was nothing else. Two other ladies told me about the church service and outing. One lady wanted dancing, another said she would like a sing along. Church services take place regularly for those who wish to continue with their faith with currently all those following the Christian faith. It is positive to note that activities are discussed at residents’ meeting sn therefore they have some say in what is offered. Feedback showed 50 of residents who always liked the meals and 50 who usually did. On the day the “expert “ took lunch with the residents. Meals choices are offered on the same day, although this process could be a bit more informative. For example: lunch was a choice of liver and onions or ham. However the “expert” had to ask if there were vegetables and if it was a ham salad. Time was taken to ensure a choice was made by each resident. The residents are involved with menu choices during discussions at residents’ meetings. However, the initial reaction was not good to the liver and onion option, until they knew that vegetables were also being served. Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 18 The dining room was nicely laid out with tables of various sizes to accommodate two, three or four people. Lunch was a quiet affair, and without exception, the meal was eaten by everyone but there was no encouragement to interact with the others sitting at the table. This would have been a good opportunity for the residents to chat. A little light soft music may have been helpful. All staff were very attentive and friendly, cutting food where necessary but in general enabling people to take their time and ask for help if needed. Condiments were on the table and a choice of orange, lemon or water was offered to everyone. The portions of food were generous and well cooked. A dessert of apple and rhubarb crumble was offered after the first course. All appeared to enjoy their meal. Refreshments were served during the day with elevenses offering a choice of hot drinks and biscuit or fruit. There are no residents who require alternative meals as part of their culture or faith. It is clear from the relatives’ feedback that they are always warmly welcomed when visiting the home with opportunities to speak in private or in the conservatory. One relative spoke of visiting their family member and drinking wine whilst sitting in the conservatory or the garden in the summer. There are good relationships between residents, relatives and staff. Residents’ meetings are held to discuss the provision of care and there are opportunities to take part in the planning of their individual care. Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents feel safe in the knowledge that their concerns will be listened to and acted upon to ensure individual care is improved. Formal procedures are understood by staff, ensuring vulnerable residents are protected. EVIDENCE: The written complaints procedure is on display in the hallway. It covers the areas required by the regulations. A summary of the procedures is also in the Statement of Purpose and Service Users Guide. As stated previously, individual residents do not have a copy of the Guide, although the manager said that she would address this. It would also be beneficial to produce this in a large print format for those who vision difficulties. (See recommendation) The feedback from residents was positive in that they knew who to speak to if they weren’t happy stating they would speak to the manager or staff. 66 stated they knew how to make a complaint. One resident wrote, “I’m lucky, I’m happy here. I would speak to staff. (if unhappy)” Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 20 Another wrote “I would start by seeing the manager and go from there.” The relatives who provided written feedback all had some idea of what they would do to raise a concern. The issuing of the “Guide” with the complaints procedure included, would address this, as would including a discussion during residents’ meetings. Adult protection procedures are in place and a copy of the Inter-agency guidelines for Bromley, are used for guidance. The manager was made aware of the need to obtain Inter-Agency Guidelines from other Local Authorities who have made arrangements for residents to live in the home. This was addressed immediately with telephone calls to those Authorities requesting the Guidelines. The protection of people from abuse is included in the induction training with staff also provided with training by the local authority. Staff spoken to felt that this training was not always appropriate to older people and felt they would benefit from guidance more appropriate to the people they provide care for. The manager was informed of this and agreed to look at other ways in which staff could receive information and guidance, particularly relevant to the home and their procedures. The two staff spoken to were clear about how they would act if they suspected abuse or bad practice and were aware of other agencies that are involved in protecting vulnerable people. The recruitment procedures were found to be satisfactory with risks minimised to people living in the home. Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Nettlestead is a comfortable and homely environment, although some areas of the home need to be updated to provide residents living there with a pleasant environment. There are areas of the home that would benefit from more regular in depth cleaning to ensure risks to residents are reduced. EVIDENCE: This is a very pleasant and comfortable home with a bright spacious lounge, leading into a conservatory and rear patio and garden. Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 22 Communal areas on ground floor include lounge with wooden panelling; conservatory and dining area. Bathrooms, WCs, kitchen and bedrooms are also located on ground floor. Bedrooms are also located on first floor and office area is in the basement where storage areas are also located. Bedrooms were personalised and overall the home is maintained to a good standard save for the kitchen, toiet and laundry areas which are soon to be redecorated. Some residents have telephones in rooms. The laundry, kitchen and toilet/bathroom areas are tired and worn, so it is positive to note the Providers are planning a number of changes. They include renovating these areas as well as fitting bedrooms with en-suite WCs. This is good news and will ensure the home is brought up to date. The Provider is to provide the Commission with details of the planned changes. There were issues with the hot water in one bathroom. The part has been ordered and is due to be fitted on 2/10/07. Confirmation that the work has been completed is required. Radiators are all covered except in the main hallway. Hoists and equipment had been serviced to ensure safety. Wheelchairs are serviced through wheelchair clinic annually with regular examination taking place between times. As stated earlier the laundry area is looking tired and worn with limited room. Hand towels are in place but no soap dispenser or soap required for hand washing and infection control purposes. This was ordered immediately. (See requirement) Two staff spoken to had a good knowledge of infection control and both commented on the lack of appropriate clinical waste bin in the home. This was discussed with the manager who agreed to order a foot-operated bin without delay. (See requirement) Whilst all the feedback felt the home to be very clean the inspector observed some poor areas, particularly in the ground floor WCs with grime where the toilet seat is attached to the WC bowl. These areas had been cleaned by the second day and the manager has organised that there is a regular cleaning of these areas. One staff member also said that they felt one cleaner is not enough for such a big home. The domestic arrangements should be reviewed. (See recommendation) Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 23 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from competent and well-trained staff who are able to provide the care and support individuals require. Recruitment practices are robust and ensure people in the home are protected. EVIDENCE: On the day of the inspection there were three care staff, one domestic and one cook working in the home along with the manager. The number of residents is currently 18 and therefore staffing levels were appropriate. The number of staff who have achieved the NVQ 2 qualification has increased over the last twelve months with six currently qualified and eight near completion, leaving four care staff without the award. The variety of training provided ensures staff are able to provide appropriate care to those people living in the home. There is a need to ensure gaps in training for some staff are addressed, particularly in the core areas of moving and handling, food hygiene and Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 24 infection control. The development of individual training and development plans and an record of overall training provided would be beneficial to ensure training is prioritised. (See recommendation) The feedback received from residents and relatives was very positive with 100 of residents stating in the written feedback that there listened to by staff and 90 stating they were usually available when they were needed. One resident felt that they found night-time care “more difficult”. Another said there are sometimes staff shortages. Relatives were very complimentary of staff with one the following comments being a fair reflection of the feedback. “they are always friendly and polite and welcoming. They care “with kindness” “They(staff) have unlimited patience.” Five staff feedback forms were received in respect of this inspection and no concerns were raised about the care provided, although one staff member felt that more quality time could be spent with residents. New members of staff are provided with induction training in line with TOPSS specifications and are orientated into the home. The manager was reminded of the changes to the induction training that should be implemented. Staff spoken to told the inspector of training in a number of areas and demonstrated a sound knowledge of infection control, dealing with accidents and issues of abuse. The manager demonstrated a sound knowledge of recruitment practices and ensures staff do not commence employment until the required checks have been made. The staff files viewed showed the procedures to be satisfactory. Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 25 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home ensures residents’ needs are being met and that they are continually looking to improve the service. There is an open and inclusive environment enabling people to contribute to improvements in care. Residents are kept safe through sound systems for managing the health and safety. EVIDENCE: Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 26 The manager is registered with the Commission and has experience of management, having worked in the home for a number of years. She is qualified with the Registered Managers Award and has commenced the NVQ four in care and is progressing well with this, despite a personally difficult year. Feedback from residents, relatives and staff were all positive about the management of the home, finding the manager to be accessible, approachable and open in their dealings with individuals. Overall people felt the home provided a good caring environment which is warm and friendly. In order to ensure the quality of care continually improves there are a number of systems in place including regular staff and residents meetings, regular visits by the Providers with reports written and sent to the Commission. Over the last year there has been a review of the care that included written surveys. A report detailing the outcome has been written and sent to the Commission with positive comments on the quality of care and areas for improvement recorded. Core training is taking place that includes moving and handling, first aid and food hygiene. Some staff have also received infection control training. The comments in the staffing outcome group requires the manager to prioritise moving and handling for members of staff whose training need to be updated without delay and infection control for more staff. The systems for managing service users’ were also audited. These were found to be appropriate with records in place and regular audits taken place. Since the last inspection receipts for money received have been provided along with receipts for expenditure. Discussions took place with staff regarding formal supervision. Whilst they confirmed annual appraisals taking place they were vague about regular formal supervision. The individual files viewed showed evidence of some monitoring of practice but not of the formal supervision process where the line manager and staff meet together to discuss various aspects of the job role and training and development for each individual. (See requirement) The manager maintains good systems for the health and safety of the home with servicing of equipment and services taking place regularly. There is a need to ensure a new fixed wiring certificate is obtained reflecting the remedial work completed to make the wiring in the home satisfactory. The manager agreed to send in a copy of the completed certificate as soon as received. Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 27 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 2 3 3 3 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 X 3 Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? no 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 OP1 Regulation 5 Requirement Each resident must be provided with a copy of the Service Users Guide to ensure they have information on the service. Staff must be more proactive in taking action where a resident’s weight changes significantly to ensure their health needs are addressed. Records must be maintained at all times where controlled drugs are prescribed. The Provider must provide a plan of action for refurbishing the downstairs bathrooms and WCs to provide residents with a pleasant environment. All areas of the home must be kept clean and resources to prevent cross infection in place. Specifically a foot operated clinical waste bin be provided and soap dispenser located in the laundry area. Formal recording processes must be implemented to ensure staff receive regular supervision. Timescale for action 01/12/07 2 OP8 12 01/12/07 3 4 OP9 OP21 13 23 01/11/07 01/12/07 5 OP26 13 01/12/07 6 OP36 18 01/12/07 Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 29 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. Refer to Standard OP3 OP37 Good Practice Recommendations The manager should implement a system for recording pre-admission information on individual files. Records should show clearly the actual dates completed including day, month and year as well as signature of the person completing the record. Information should be made available to those living in the home in other formats. Care plans should reflect the social care needs of the residents. The manager should review the routines of the home to ensure residents are provided with stimulation and interaction throughout the day. Activity schedules should be developed in consultation with residents. Activities undertaken by residents should be recorded. The manager should consider increasing the number of domestics on duty. 3 4. 5. OP1 OP7 OP12 6 7 OP12 OP27 Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Sidcup Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Nettlestead DS0000006959.V344597.R02.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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