Inspection on 28/12/05 for Nettlestead

This inspection was carried out on 28th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Nettlestead 27/10/09

Nettlestead 27/09/07

Nettlestead 04/08/06

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 28th December 2005 14:00 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.V268699.R01.S.doc Version 5.0 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.V268699.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Nettlestead Address Nettlestead 19 Sundridge Avenue Bromley Kent BR1 2PU 020 8460 2279 020 8464 3683 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) Nightingale Retirement Care Limited 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.V268699.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 22 Elderly Men and Women Date of last inspection 16th August 2005 Brief Description of the Service: Nettlestead is a large, detached three-storey Victorian house converted for residential living. The home provides care for twenty-two older people. The house is set within its own well kept grounds with a secluded rear garden. The front of the premises has good space for off-road parking with plenty of on road parking also available. The home is located within a quiet residential area with good transport links. Service users’ accommodation is located on all three floors accessed by stairs and a lift. Some rooms have steps into their individual rooms and therefore may not be suitable for those with mobility problems. The kitchen, laundry, lounges and dining room are all located on the ground floor. Toilets are located throughout the home with specialist equipment in place to assist residents. Nettlestead DS0000006959.V268699.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one afternoon with two inspectors involved in the process. The inspection included discussions with residents and the Manager, viewing of records and a tour of the building. The requirements raised at the last inspection were also monitored. What the service does well: What has improved since the last inspection? What they could do better: Care plans and risk assessments have improved since the last inspection but further progress is required to ensure they fully reflect residents’ individual needs and the interventions required. There needs to be a more robust Nettlestead DS0000006959.V268699.R01.S.doc Version 5.0 Page 6 accounting system for service users monies, which must include receipts of monies spent and also in the documentation and checks in relation to recruitment procedures Medication and healthcare practices also require some improvement. There are outstanding requirements from the last inspection, including Assistant Manager receive training specific to their role and moving and handling for all staff. The Manager must also plan how they are going to meet the care qualifications required by the Commission. 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 DS0000006959.V268699.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Nettlestead DS0000006959.V268699.R01.S.doc Version 5.0 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 the following standard(s): 2&3 The pre-admission procedures have improved since the last inspection with assessments now in place. This ensures that the home admits service users whose needs they are able to meet. EVIDENCE: The last inspection required improvement in the pre-admissions procedures, especially the assessment of prospective service users service users. The file of the last service user admitted was viewed and found to contain the Care Manager assessment and the assessment completed by the home. However, the written confirmation agreeing the home is able to meet the service user’s needs is still not being completed. (See requirement 1) The Provider, has since the last inspection, received an amended copy of the contract issued to residents. This now covers areas required at the last inspection. There is no intermediate care provided by the home. Nettlestead DS0000006959.V268699.R01.S.doc Version 5.0 Page 9 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 the following standard(s): 7,8 & 9 Care plans and risk assessments have improved since the last inspection. Although further improvement is required to ensure staff have the full information and guidance to ensure care staff provide the appropriate care to meet their needs. Medication procedures also require some further improvement to ensure the health needs of residents are fully met and potential risks minimised. EVIDENCE: Care plans have improved since the last inspection. The two care plans viewed contained contain basic guidance on core areas and on how to care for the individual’s needs. Further improvement is required to ensure they fully reflect current needs. One service user, who is anaemic and requires regular blood transfusions, did not have this identified on the care plan nor the intervention or monitoring required by care staff. The second care plan contained some good information but could be improved further with information, such as details of the slings used for individuals and number of care staff required to assist in certain tasks The health care needs of the residents are being met with pressure care equipment in place and diabetic service users monitored by the District Nurse. Nettlestead DS0000006959.V268699.R01.S.doc Version 5.0 Page 10 Risk assessments are in place in relation to pressure care and the use of bedrails. However these are very basic and do not fully document the interventions required. One resident whose assessment had highlighted risk of falls did not have the risk assessment in place nor were moving and handling assessments in place. Care plans also need to ensure interventions by health professionals, including the District Nurses are documented. In the case of a diabetic service user, there is a need to ensure full details of interventions by the DN and by care staff in relation to where blood sugars are taken including, staff training and understanding of when to contact health professionals. (See requirements 2 & 3) The medication systems were inspected. Medication storage is located on the ground floor in one room. The room itself is internal and compact. It felt warm. This may become too hot in the summer months to suitably store medications at their optimum temperature. It is recommended that the room temperature be monitored. The medication systems are supplied through Boots monitored dose systems. Medication charts had resident’s photographs in place, although the allergies section on many charts was incomplete. In some cases the medication received into the home had not been recorded, particularly when hand transcriptions had been used. Hand transcriptions on medication charts did not have two signatures in place. This should be actioned. One some medication charts, alterations in the information had been made. In the event that this happens then two staff need to sign to confirm the accuracy of the information recorded. The administration charts were generally well completed, with the exception of when medications had been refused. In the event that medications are refused over a period of time, this should be referred to the GP for review. The back of the medication administration sheets should be used to record more detail for home leave and refused medications. Eye drops need to be dated on opening, as does the sharps disposal bin. The controlled medications were inspected. On signature was in place for receipt of Controlled Drugs, two are required. It was noted that when a controlled drug is given to a resident, who is going on home leave, a letter is attached to confirm this has been given to the resident. (See requirement 4 and recommendation 1) Nettlestead DS0000006959.V268699.R01.S.doc Version 5.0 Page 11 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 the following standard(s): 12 & 15 Meals are nutritious and balanced and offer a varied diet for residents in pleasant surroundings. EVIDENCE: The inspector met with several residents .All confirmed that they had stayed in the home for Christmas and commented that they had enjoyed this. Relatives had visited through out the festive period. Other activities had included the Christmas parties, a visit by the Salvation Army, a Carol Service by the local school and a pantomime planned for January 2006. All residents looked well care for with tidy hair, nails clean and cut with staff in the vicinity chatting to residents. Positive comments were received in respect of the staff and the care that they provided. Food was another topic, which received favourable comments. Routines some service users in lounges, whilst some in own rooms enjoying own company. Nettlestead DS0000006959.V268699.R01.S.doc Version 5.0 Page 12 Nettlestead DS0000006959.V268699.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 17 Service users’ rights are promoted ensuring they participate in the political processes. EVIDENCE: The core standards were inspected at last inspection with no requirements made. There have been no incidents or complaints since this time. Service users on the electoral register and vote if they choose to do so and advocacy services are also available if required. Nettlestead DS0000006959.V268699.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 19,20, 23,24,25 & 26 The home is reasonably maintained, well decorated and furnished provided a homely and comfortable environment for residents. EVIDENCE: Many of the residents were sat in the lounge as the inspectors arrived. The area was decorated with a Christmas tree and other novelties. The area was warm and comfortable the TV was playing. A pleasant atmosphere prevailed. The bedrooms were personalised with individual bedding and curtains. Of those bedrooms inspected they all had photographs and other personal items. One resident commented on how comfortable her bed was and the fact she had difficulty getting out it. One bedroom was quite chilly this was evident as the inspector walked into it, and very evident once sat down in a chair. This was referred to the manager for action. (See requirement 5) Nettlestead DS0000006959.V268699.R01.S.doc Version 5.0 Page 15 The dining room a nicely laid in preparation for the evening meal. The parts of the home viewed were clean, pleasant and hygienic The last two inspections have required that the sash windows be replaced in some cases and in others the frames re-painted; external masonry to be repainted and radiators covered to protect residents. The home is progressing with these and an action plan is in place for the completion of this work in 2006. Nettlestead DS0000006959.V268699.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 29 Recruitment procedures must be more robust to ensure vulnerable residents are fully protected. EVIDENCE: There were three members of staff on duty during the afternoon of the inspection. This included the Manager who was working as part of the care team. The staff team is consistent with few changes and limited use of agency staff. There were twenty service users in residence with two vacant rooms. One service user is currently bed ridden and needs a lot of staff attention. The Manager was advised to review the needs of service users who may require more care than the current staffing levels provide for and increase these as appropriate. The last report identified the need for care staff to be provided with stoma care training. This has been provided for approximately five staff with the Manager stating that further training is to be arranged for the remainder. This is to be monitored at the next inspection. The Manager was also advised to ensure staff are provided with training in how blood sugars are to be taken and identifying when to request health professional advice. Recruitment practices were adequate with Criminal Records Bureau and POVA checks in place, interview notes and application forms were also viewed along with proof of identity. However, the Manager must be more robust in ensuring Nettlestead DS0000006959.V268699.R01.S.doc Version 5.0 Page 17 application forms are fully completed; exploring any gaps in employment and ensuring two references are provided which are also appropriate ie: from last employer rather than personal referees. One file viewed only had one personal referee, whilst another file had a referee from a place of work, which had not been recorded on the application form. This was not written on headed paper nor did it have a stamp or compliment slip to provide evidence that this was a bona fide reference (See requirement 6 & recommendation 2) Nettlestead DS0000006959.V268699.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35 & 38 Whilst the home is managed satisfactorily by an experienced and qualified Manager, providing leadership to the staff team to ensure residents receive a good standard of care from a consistent staff team, this could further be improved, by the Manager undertaking the required care qualification. However, the procedures for safeguarding residents’ monies must be improved to ensure their financial interests are protected. EVIDENCE: The Registered Manager has been in post for a number of years-and has over the last two years achieved the Registered Manager’s Award. The standards require that Managers also obtain a care qualification equivalent to NVQ 4. However, the Manager does not have a care qualification at present and this needs to be addressed to ensure care practices are monitored closely and in line with guidelines for best practice. (Requirement 9) She regularly works as Nettlestead DS0000006959.V268699.R01.S.doc Version 5.0 Page 19 part of the care staff team and therefore has a “hands on” approach, which also allows her to monitor staff practices. The last inspection required that the Assistant Manager undertake training appropriate to her job role. The Manager stated that she is to be registered for the Registered Manager’s Award in the New Year. To be monitored at the next inspection. Service users’ finances were checked and cross- referenced with monies and records maintained. Whilst monies checked with the amounts recorded on individual records there was a lack of receipts for the outgoings monies. There is a need for a more robust system to account for monies spent to include receipts for hairdressing, newspapers, purchasing of toiletries from the home and chiropody. (See requirement 7) The last inspection highlighted the need for staff to be provided with moving and handling training for all staff. This remains outstanding and must be made a priority over the next few months. (See requirement 8) Nettlestead DS0000006959.V268699.R01.S.doc Version 5.0 Page 20 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 X 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 X 2 3 x x 3 3 2 3 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 2 X x 2 Nettlestead DS0000006959.V268699.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? yes 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 OP3 Regulation 14 Requirement The Registered Person must, after assessment, they confirm in writing that they are able to meet the needs of the prospective service user. Previous timescale expired. The Registered Person must ensure care plans reflect the current needs of residents with all areas of need identified in the individual plans. The Registered Person must ensure risk assessments include interventions and actions to minimise risks and are reviewed regularly, as determined by the risk. The Registered Person must ensure that; • the home records the receipt of all prescribed medication. • Regular refusal of medication by a resident must trigger a review by the GP. • Medication which must be used within a expiry time must have the date of DS0000006959.V268699.R01.S.doc Timescale for action 01/03/06 2 OP7 15 01/03/06 3 OP8 12 & 13 01/02/06 4 OP9 13 01/02/06 Nettlestead Version 5.0 Page 22 5 OP24 23 6 OP29 17 & 19 7 OP35 17 8 OP38 13 9 OP31 7 opening recorded. Two signatures must record the receipt and administration of controlled medication. The Registered Person must ensure that the temperature of individual’s rooms is maintained to a comfortable standard. The Registered Person must ensure that recruitment procedures are more robust. Specifically, gaps in application forms must be explored fully and two references must be provided. The Registered Person must ensure that accurate records are maintained in relation to service users’ monies. Specifically, the home must ensure that receipts are in place documenting residents’ expenditure. The Registered Person must ensure that all staff are provided with regular updates in moving and handling training. This is a previous requirement and the timescale has expired. The Registered Manager must provide the Commission with an action plan as to how they are likely to achieve the care qualification required as a Manager. • 01/02/06 01/02/06 01/04/06 01/04/06 01/03/06 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 Refer to Standard OP9 Good Practice Recommendations Medication practices should ensure that allergies are DS0000006959.V268699.R01.S.doc Version 5.0 Page 23 Nettlestead 2 OP29 recorded onto medication records or where there are none, “none noted” recorded for clarity; two signatures should be in place where there are any hand transcriptions or changes to medications; the temperature of the storage room should be monitored to ensure medication is stored within the required temperature for storage. References should be supplied on headed notepaper, be stamped or be provided with a compliment slip. Nettlestead DS0000006959.V268699.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 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. 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