Inspection on 12/02/07 for Nevetts

This inspection was carried out on 12th February 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

Nevetts 19/02/09

Nevetts 12/01/06

Nevetts 05/05/05

Nevetts 02/12/04

Nevetts 11/08/04

Nevetts 18/03/04

Similar services:

Henrietta House

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Nevetts Bowling Green Lane Buntingford Hertfordshire SG9 9DF Lead Inspector Mrs Jan Sheppard Unannounced Inspection 9.30 12 February 2007 th 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 Nevetts DS0000019479.V319137.R01.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. Nevetts DS0000019479.V319137.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nevetts Address Bowling Green Lane Buntingford Hertfordshire SG9 9DF 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) 01763 271737 01763 275741 www.quantumcare.co.uk Quantum Care Limited Mrs Ann Clay Care Home 41 Category(ies) of Dementia - over 65 years of age (41), Old age, registration, with number not falling within any other category (41), of places Physical disability over 65 years of age (41) Nevetts DS0000019479.V319137.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th January 2006 Brief Description of the Service: Nevetts is a care home that accommodates up to 41 residents who require care due to old age, dementia and physical disability. It also offers respite facility for up to one service user. It is a two-storey purpose built home that was constructed for the Hertfordshire County Council but has since transferred to the independent/voluntary sector and was completely refurbished at that time. The ground floor comprises an entrance lobby, two lounges, a kitchenette and dining room, the main kitchen, the laundry, two offices and two staff rooms. There are also seventeen single occupancy bedrooms, two assisted bathrooms and four toilets. The first floor is served by a passenger lift. This floor comprises a kitchenette and dining room, two lounges, twenty-four single occupancy bedrooms, three assisted bathrooms and six toilets. The home has ample off-road parking places at the front of the building and gardens at the back and side. It is located in a quiet residential area of Buntingford, and is within walking distance of the main shopping area and other amenities. The current fees range from £400 to £490 per week. Information about the home and the services it offers are contained in its Statement of Purpose and Service Users Guide. Nevetts DS0000019479.V319137.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted over one day by one inspector during which the manager, deputy manager, staff on duty and a number of residents, relatives and other visitors to the home were spoken with. A tour of the building was made and care and administration records were checked. This report reflects the observations made in the home on that day and also takes account of the information gathered from the pre-inspection questionnaire recently completed by the homes manager, details given in some thirty four questionnaires completed by the residents and relatives and of other information periodically sent to the Commission from the home. This was a positive inspection. Requirements and recommendations made following the previous inspection were found to have been met. Four requirements are made following this inspection. What the service does well: What has improved since the last inspection? Since the last inspection the planned programme of refurbishment and redecoration works has continued. An activities organiser with hours specifically dedicated for this role has commenced duties and the improvement in the range and numbers of activities was favourably commented on by several of the residents and also by some relatives. Nevetts DS0000019479.V319137.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Nevetts DS0000019479.V319137.R01.S.doc Version 5.2 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 Nevetts DS0000019479.V319137.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable, as this home does not accept residents for intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care needs of all prospective service users are fully assessed by one of the managers to ensure that these needs could be met in the home. This is done before any visits to the home or decisions about admission are made by the prospective resident. EVIDENCE: The care plans examined for recently admitted residents evidenced that a through care needs assessment is carried out for every prospective new resident and that they are given the opportunity to visit the home and to have as much time as the need to adjust to the prospect of entering residential care. Information offered to prospective residents and their relatives in the form of the homes Statement of Purpose and Service Users Guide is comprehensive Nevetts DS0000019479.V319137.R01.S.doc Version 5.2 Page 9 and informative enabling them to make an informed decision about admission to the home. Recently admitted residents spoken with confirmed that their admission process had been handled sensitively and had been managed at a pace that suited them. One relative who was helping her mother to move into the home on the day of this inspection commented very favourably on the help and support that her family had received from the staff who visited to assess their mother in hospital. It was noted that this relative spent several hours in the home helping to settle her mother and assisting the arrangement of personal items in her room her room and that she also had an in depth discussion with the manager. Nevetts DS0000019479.V319137.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All the residents care needs are set out in their individual care plans. Prompt access to health professionals is available when needed. The homes policy and procedures for the storage of medication were found to be being followed. However one repeated omission found in the administration records could put the residents at risk. Residents are treated with dignity and respect. EVIDENCE: Personal care was seen to be being delivered in a kindly manner by staff who clearly knew their residents well, understood their care needs and were endeavouring to meet these in a manner that retained their dignity and Nevetts DS0000019479.V319137.R01.S.doc Version 5.2 Page 11 respect. It was noted that the staff worked well together as a team and that they promoted the calm and relaxed atmosphere within the home. All the care plans examined were found to be very well maintained with clear instruction as to how care needs should be met to have appropriate risk assessments and to be regularly reviewed. Good social histories giving an insight into the life story of each resident were also present. Visits by the Doctor were recorded and the District Nursing notes were easily accessible and gave clear instruction as to the care processes to be continued on a daily basis between the nurses visits. The home manager explained that the proximity to the home of the GP surgeries and the village pharmacy had contributed to the establishment of the close working relationships that now existed. She said that the Doctors and district nurses always visit promptly if we call them, thus ensuring the good care of the residents. The home has good medication storage facilities and medication was seen to be being administered discretely in a manner which best suited the needs and wishes of the individual residents. Staff allowed time for one resident to digest her lunch before administering her medication, this said to be her preferred way. The medication administration records were neatly kept and evidence was seen to show that these are checked on a daily basis by one of the managers. However one intermittent error was found in these records where no administration code was recorded when a medication could not be given and a written explanation for this was not always made. To ensure the safety of the residents, mediation records must be consistently and accurately recorded. The records made by the managers who check these records must evidence more clearly what actions have been taken when errors are found. Nevetts DS0000019479.V319137.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a variety of activities which meet the needs of the service users. Relatives and visitors are always welcome in the home. Good quality and nutritious food is provided. EVIDENCE: With only one exception all residents spoken with were complimentary about the food. “ We get good choices, there is always plenty of it and if it is meant to be hot then it is served hot “ was one comment made to the inspector. One resident explaining that she was a fussy eater said, “ food here will never be fully to my liking as I cannot prepare it for myself like I used to at home”, however she then went on to acknowledge that meals were tasty and there was always a choice. Staff were observed to be assisted residents who needed help with feeding in an appropriate manner and individually assessing the speed at which they liked to eat. Staff were seen to be encouraging residents Nevetts DS0000019479.V319137.R01.S.doc Version 5.2 Page 13 to do as much for themselves as they could comfortably manage in a manner which enabled them to retain their dignity. A varied weekly activities programme was seen to be advertised around the home. Several residents spoke very positively about the increased range of activities that have been put in place since the employment of an activities organiser. The manager explained that an audit of each weeks activities is currently being undertaken, recording the residents likes and dislikes. Ffrom this it is hoped to learn which activities are popular and what new varieties may be introduced to better meet the residents needs. Nevetts DS0000019479.V319137.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a robust complaints procedure and follows the Safeguarding Adults procedures as set out in the Hertfordshire Councils Joint Agency Guidelines. EVIDENCE: Complaints made to the manager since the last inspection were seen to have been dealt with properly following the company guidelines. No complaints have been made to the Commission. There have been no incidents concerning Safeguarding Adults since the last inspection. Staff all attend training on the protection of vulnerable adults and whistle blowing procedures Staff spoken with during this inspection were familiar with what action they should appropriately take if they ever had suspicions concerning possible abuse. Nevetts DS0000019479.V319137.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is spacious and generally well appointed giving an overall homely feel. However in some areas decorations are poor and bathrooms in need of refurbishment. EVIDENCE: Although the home has an on going maintenance programme which the manager could evidence to the inspector, that programme, particularly in respect of redecorations, is not keeping pace with the needs of the home. Many of the communal areas, corridors and lounges, and some of the residents bedrooms had a worn appearance due to the flaked and scuffed paintwork and peeling wallpaper and borders. This deficiency is unfortunate because the home was found to be exceptionally clean, tidy and well ordered and the Nevetts DS0000019479.V319137.R01.S.doc Version 5.2 Page 16 personalization of the residents bedrooms with their own possessions and coordinated soft furnishings was very good. Ways in which the bathrooms could be made to look less institutional were discussed with the Manager. Works to refit the lounge kitchenette on the ground floor were seen to be nearing completion and the involvement of the residents in the choosing of colours and carpet for this area were described to the inspector. Specialist equipment is provided for each resident to meet their particular needs following an OT assessment. This promotes the residents ability to retain their independence for as long as possible. Residents spoken with were generally happy with the home and the facilities offered. Several commented that they felt it to be a homely and happy place. One or two, along with several staff mentioned the need for redecorations. Nevetts DS0000019479.V319137.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is adequately staffed with experienced and qualified carers who seemed to be very positive about their work and to work well together as a team. The home has robust policies and procedures for the recruitment of staff, which were seen, with one minor exception, to be properly carried out to ensure the proper protection of the service users. EVIDENCE: Staff were seen to be working well together as a team and to be providing support for the residents in a kindly unhurried manner allowing them to do as much for themselves as it is safely possible for them to do. Staff were found to be familiar with the needs of the residents and a good rapport was seen to exist between them. The home continues to retain a very stable core group of dedicated and welltrained staff, many of whom have worked at the home for many years. Staff who spoke to the inspector during this inspection all said that they were happy Nevetts DS0000019479.V319137.R01.S.doc Version 5.2 Page 18 working at the home, happy with the manner in which they were managed and the training opportunities offered to them. The home has a robust recruitment policy and does not employ staff until the statutory identity and security checks have been carried out. The three files of recently recruited staff examined evidenced that these checks had been undertaken but not all of the references had been signed or adequately authenticated; this could render the residents at risk. The home offers good training opportunities with each staff member having an individual annual training needs profile with mandatory repeat training courses being monitored closely. The number of staff having attained NVQ level 2 has increased over the past year and considerably exceeds the minimum required percentage. Nevetts DS0000019479.V319137.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run in the best interests of the service users. The registered manager provides strong leadership within the home. The health and safety of the residents is promoted by the homes good maintenance of its safety checks and procedures. However the financial records of the residents monies must be accurate to ensure that the residents interests are fully safe guarded. EVIDENCE: A supervision matrix was seen to be in place to ensure that all staff receive formal supervision at least six times a year. Staff spoken with confirmed to the Nevetts DS0000019479.V319137.R01.S.doc Version 5.2 Page 20 inspector that they felt themselves to be well supervised and managed and that they could always speak to a manager at any time. Regular staff meetings are held these with appropriate agendas and minutes. Without exception residents, relatives and visiting professionals consulted for this inspection confirmed that the manager and her team are always very approachable and make every effort to sort out any problems quickly. One commented…” the manager either sits with an open door or is out on the floor amongst the residents “. The records relating to fire testing, the monitoring of water temperatures, risk assessment for the environment and safety checks for the homes equipment were seen to be well maintained. The records relating to the residents monies were neatly kept and up to date but two out of the three records checked were inaccurate with the purses holding more monies that was stated in the records. Although both these were for very small amounts the accuracy of these records needs to be maintained to ensure full protection for the service users. Nevetts DS0000019479.V319137.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 Standard No Score 16 3 17 X 18 3 2 X X X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 Nevetts DS0000019479.V319137.R01.S.doc Version 5.2 Page 22 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 OP9 Regulation 13 (2) Requirement Medication records must include the code to indicate the reason why medication has not been administered as prescribed. All areas of the home must be maintained. Refernces must be validated to ensure authenticity. Financial records must be accurately maintained. Timescale for action 12/04/07 2. 3. 4. OP19 OP29 OP35 23 (2) (d) 19 (10)(c) 17 (2) 12/04/07 12/04/07 12/04/07 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 OP7 Good Practice Recommendations The cultural and religious needs of the service user should be woven in their care plan. (A previous recommendation) This has been met. Monthly review notes should be in greater details, in order to reasonably reflect the changing needs and requirements of each service user. (A previous recommendation) 2. OP7 Nevetts DS0000019479.V319137.R01.S.doc Version 5.2 Page 23 This has been met. 3. OP12 An Activities Coordinator should be recruited, in order to ensure that service users receive an adequate level of stimulation for their general wellbeing. This has been achieved. 4. OP27 A review of the night staffing levels should be undertaken and remedial action taken as appropriate. This has been carried out. The frequency of staff formal supervision should be increased to once every 2 months, at minimum. This has been achieved. 5. 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