CARE HOMES FOR OLDER PEOPLE
Nevetts Bowling Green Lane Buntingford Hertfordshire SG9 9DF Lead Inspector
`Neil Fernando Unannounced Inspection 12th January 2006 10:30 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.V277791.R01.S.doc Version 5.1 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.V277791.R01.S.doc Version 5.1 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.V277791.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1) That respite care is only provided in the agreed and identified Primary Health Trust bed. 2) That service users with dementia shall also be over 65 years of age. 3) That service users with a physical disability shall be over 65 years of age. Date of last inspection 5th May 2005 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, but within walking distance of the main shopping area and other amenities. Nevetts DS0000019479.V277791.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the second inspection for the year 2005/6 under the National Minimum Standards for Care Homes for Older People and the Care Homes Regulations 2001. The last inspection (Unannounced) was carried out on 5.05.05. The establishment is registered to accommodate a maximum of 41 service users of both genders who are 65 years and over, who require care due to old age, dementia and physical disability. In addition, the home provides respite facility for one resident. Nevetts is one of many care homes managed by Quantum Care Limited in the Hertfordshire area. At the time of this inspection, there were 38 service users accommodated. The inspection took place over half a day in January 2006. It found that a majority of the standards assessed on this occasion meet the National Minimum Standards. A total of 9 service users, 7 staff members including the Deputy Manager and Registered Manager were spoken to, in order to seek their views regarding the quality of life at this establishment. What the service does well:
All admissions are subject to a pre-admission assessment. Senior Staff determine whether the home can meet the individual’s needs. Prospective service users and their relatives and friends have good opportunities to assess the care principles and facilities of the home, prior to admission. The health and personal care requirements are being identified and addressed, and monitored through a care planning process and review system, respectively. The service user and significant others are involved in the above process as appropriate. Service users appeared to be comfortable and received care and attention in a timely and sensitive manner. The ordering, storage, administration and disposal of unused medication are satisfactory. Residents’ interests, expectations and aspirations are being sought by staff members and fulfilled as appropriate. In spite of the mental frailty of the current service users, it is positive to note that they are being proactively encouraged to exercise choice and autonomy. Overall, service users expressed a great deal of satisfaction regarding the services they receive. The complaints system appears to be managed satisfactorily. There are a number of monitoring systems in place and these should offer adequate protection to a service user. The premises are accessible, clean, comfortable, safe and maintained to a good standard. Service users have good opportunities to personalise their Nevetts DS0000019479.V277791.R01.S.doc Version 5.1 Page 6 bedrooms to promote a homely effect. Staff members receive mandatory training and they appear to respond well to health and safety matters. Staff members spoken to are keen and committed to their work. Some of the staff members have been working at this home for a significant period of time and this appears to promote consistency and continuity in the quality of service delivery for the residents. Overall, good evidence is available to suggest that the quality of care has been consistently maintained to a good standard. What has improved since the last inspection? What they could do better:
There are five recommendations (2 outstanding from the last inspection report dated 5.05.05) arising from this report, which need addressing. The Manager should ensure that monthly review notes adequately reflect relevant development for each resident. Further improvement is needed so that the cultural and religious needs of the service user are reflected in their care plan. Consideraton should be given to recruit an Activities Coordinator so that an adequate level of social and recreational activities for service users is facilitated, in order to maintain a reasonable degree of stimulation for their general wellbeing. In view of the size and structure of the building, and the increasing dependency levels of a significant number (50 ) of service users, a review of the night staffing levels should be undertaken and remedial action taken as appropriate. The frequency of staff formal supervision needs some attention. Nevetts DS0000019479.V277791.R01.S.doc Version 5.1 Page 7 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. Nevetts DS0000019479.V277791.R01.S.doc Version 5.1 Page 8 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.V277791.R01.S.doc Version 5.1 Page 9 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): 3, 5 and 6. The home’s assessment and admission process is adequately robust thus ensuring that the residents’ needs could be met on admission to the home. It is also very positive that service users and their relatives are central to the decision-making process regarding matters that affect them. Intermediate care is well managed. EVIDENCE: The case files for eight service users were examined and these include comprehensive details of the completed pre-admission assessment undertaken by a member of the home management team. Records examined and information gained from two new service users and staff members including the Deputy Manager and Manager provides good evidence that the arrangements to enable service users and their relatives/friends the opportunity to visit and make an informed decision about the facilities offered at this establishment is satisfactory. They would spend time looking around, speaking to other service users and a meal is offered if required. Nevetts DS0000019479.V277791.R01.S.doc Version 5.1 Page 10 Service users are admitted on a trial basis for mutual assessment. A meeting is held at the end of the trial period with the service user, relatives and social worker (where applicable) and if all are agreed a permanent place is offered. The home accommodates one service user for intermediate care. Records examined indicate that their identified needs are woven in their short - term care plan. Their independence appears to be appropriately promoted. Nevetts DS0000019479.V277791.R01.S.doc Version 5.1 Page 11 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 and 9. Service users’ needs and requirements, including health and personal care are being identified and addressed through a care planning process and monitored through a monthly review system. Minor improvements are needed on care planning and the quality of monthly review notes. The administration and control of medication is safe and satisfactory. EVIDENCE: Good evidence is available from a sample of 8 care plans viewed and information gained from nine service users, and staff members to demonstrate that the needs of residents are being identified and addressed satisfactorily. A record of the care given, progress made and interactions with service users is maintained. Staff members reported that residents are always encouraged to sign their care plans where this is appropriate. Service users provided some good examples of how staff members assist them to address their needs on a day today basis. However, minor improvements are required. For example some of the care plans viewed did not reflect the identified cultural and religious needs of the particular service users. Care plans are being reviewed by designated Care Team Managers on a monthly basis to reflect changing needs and objectives for health and personal
Nevetts DS0000019479.V277791.R01.S.doc Version 5.1 Page 12 care. Monthly review notes should however be in greater details, in order to reasonably reflect the changing needs/requirements of each service user. Once the above issues are addressed, this standard would be fully met. The procedures on administration and control of medication are available and accessible to staff members. All staff members authorised to administer medicines have received training on the administration and control of medication. The current service users are mentally frail and they are therefore not able to administer their own medication. Staff members are however clear that residents would be encouraged to self-medicate where appropriate but a risk assessment would always be carried out first. Medicines are stored in a locked cabinet. Medication charts viewed are noted to be in order. Nevetts DS0000019479.V277791.R01.S.doc Version 5.1 Page 13 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 and 14. Service users’ interests, expectations and aspirations are being sought and addressed to an extent. However, an Activities Coordinator should be recruited to improve the level of activities for the more dependent residents, in order to provide an adequate level of stimulation for their general wellbeing. Social contact with family and friends is being encouraged. In spite of the mental frailty of the current service users, it is positive to note that they are being proactively encouraged to exercise choice and autonomy. EVIDENCE: Service users are being assisted to follow the lifestyle of their choice as discussed and agreed during assessment. Most of the care plans viewed for eight service users reflect their identified social, cultural, religious and recreational needs, and in the main, these are being addressed. Service users spoken to generally expressed satisfaction in this area. Evidence shows that a dedicated care staff group are doing their best to facilitate some activities for residents. Information available indicates that residents are encouraged to participate in social and recreational activities to suit their taste and preference. A number of service users reported that there is no pressure to participate and they are free to withdraw from any activity to spend time in the quiet of their own room. However, considering the dependency levels of a significant majority of residents, an Activities CoNevetts DS0000019479.V277791.R01.S.doc Version 5.1 Page 14 ordinator should be recruited to facilitate a programme of activities, in order to maintain an adequate level of stimulation for service users. The new Activities Co-ordinator will also need to oversee the support that care staff members provide in this area. Contact with family, friends and significant others are being pro-actively encouraged and many service users were seen to be entertaining their relatives and friends in the course of this visit. Residents are encouraged to express their opinions regarding how their expectations and preferences are being met and there is good evidence to demonstrate that remedial actions are taken to remedy dissatisfaction, if any. Nevetts DS0000019479.V277791.R01.S.doc Version 5.1 Page 15 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): 16 and 18. Information on how to make a complaint is available and service users feel confident that any complaint they make will be listened to and acted upon by the Manager. Complaints records show that matters raised are dealt with speedily and satisfactorily. Adult protection policies and procedures are in place that should ensure the safety of service users. EVIDENCE: The home’s policy and procedures on complaints are available and accessible to all staff members. The Deputy Manager and Manager demonstrated a good understanding of the procedures and ensuring that any complaint is dealt with quickly and satisfactorily. Information regarding how to make a complaint is also included in the statement of purpose and service users’ guide. Service users spoken with reported that they had no wish to complain but felt confident to raise any concern or complaint they might have about the services they receive. The complaints record indicated that there had been two complaints made to the home since the last inspection in May 2005. Records examined show that each had been dealt with and responded to quickly and satisfactorily. The home has comprehensive procedures on The Protection of Vulnerable Adults, which include forwarding the names of unsuitable staff for inclusion on the Protection of Vulnerable Adult Register. The “Whistle Blowing” policy is also available to the staff team. Staff members spoken with demonstrated some understanding of the above procedures. The Registered Manager reported that all staff members, bar two have received training on Adult
Nevetts DS0000019479.V277791.R01.S.doc Version 5.1 Page 16 Protection, a subject also included in their NVQ assessment. The two new staff members have this subject included in their training and future development programme. Nevetts DS0000019479.V277791.R01.S.doc Version 5.1 Page 17 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 and 26. This establishment continues to provide good living conditions to its service users. The standard of cleanliness was high and furnishings are suitable for the individual and collective needs of the service users. EVIDENCE: The home is suitable for the use of the service users. There is a rolling programme for maintenance in addition to quick response to any problem arising. The communal areas and bedrooms are decorated and furnished in a style to reflect the period features of the building. Furniture and fittings are of a good standard and bedrooms viewed are comfortable. Overall, the home and gardens are well maintained, which service users appear to appreciate. There is a high standard of housekeeping throughout those areas viewed during this visit. Considering the high level of incontinency with the current service users, there were no mal-odours present. This is quite an achievement and consistent with the last inspection report, the ancillary staff team are to be commended for their hard work and achievement. Liquid soap and paper towels are provided in areas where personal care is carried out and in high-risk
Nevetts DS0000019479.V277791.R01.S.doc Version 5.1 Page 18 areas such as the laundry. Staff members are conversant with infection control procedures. There were no health and safety hazards noted. Nevetts DS0000019479.V277791.R01.S.doc Version 5.1 Page 19 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 and 30. Whilst the establishment continues to provide the staffing levels required by day and night, it would be helpful for night staffing arrangements to be reviewed. The training needs of the staff team are being given a high profile and no doubt, this ensures an improved level of service delivery for service users. EVIDENCE: This establishment is registered to accommodate up to 41 service users who are 65 years and over. It also provides respite facility for up to one resident. On the day of the inspection there were 38 service users in residence. Examination of the staff rota for a period of four weeks, and discussions with the Manager, staff and service users indicates that day and night care staffing levels are adequate to care for the current service users in the home. The staff members on duty also reconciled with the rotas for the day. Given the size and structure of the building, and the increasing dependency levels of a significant number (50 ) of service users, it is recommended that a review of the night staffing levels are carried out and remedial action taken as appropriate. Sufficient ancillary staff members are provided for catering, laundry and housekeeping. Information gained suggests that staff members have adequate experience and skills to enable them deliver a good quality service to residents. The Deputy Manager and Manager work on a full time basis and their times have not been included in the care staff calculation.
Nevetts DS0000019479.V277791.R01.S.doc Version 5.1 Page 20 Training and development profiles are maintained for each staff member. Staff members interviewed, expressed a great deal of satisfaction with respect to training they receive. Information available indicates that staff members have received all mandatory training to assist them to do their work competently. There are 13 staff members who have completed NVQ Level 2 or equivalent. Another 13 members are currently undertaking the same assessment. On completion, the home would achieve a ratio of 86 of care staff with an NVQ Level 2 or equivalent. This is quite significant and the Organisation and staff members are to be commended for their hard work in this area. Training for staff appears to be given a high profile. Nevetts DS0000019479.V277791.R01.S.doc Version 5.1 Page 21 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, 36 and 38. This establishment continues to be managed well, which therefore means that care and staff management systems including health and safety matters are being implemented to good effect. Formal supervision of staff needs some attention. Evidence gained indicates that Nevetts is a safe home for service users to live in. Records viewed are maintained in good order. EVIDENCE: The Manager has over 12 years management experience in a care setting, is the holder of a City & Guilds 325.2 award and has undertaken periodic training to update her skills and knowledge whilst managing the home. She has completed the NVQ 4 in Management and Care in early 2005. She is therefore very well qualified to manage the home meets the aims and objectives of the Home. Information gathered from seven staff members including members of the management team shows that arrangements are in place for staff members to
Nevetts DS0000019479.V277791.R01.S.doc Version 5.1 Page 22 receive formal one to one supervision. Details of supervision sessions are recorded. The frequency of supervision should be increased to once every two months, at minimum. All staff spoken with said they felt well supported by management and found the Manager approachable. The home has robust and detailed procedures to ensure the health and safety and welfare of service users and staff. Staff members receive on going mandatory training that ensures safe working practice. The fire alarm system and extinguishers are serviced as appropriate. Fire drills and weekly test of break glass points have been carried out within the required frequency and a record maintained. Hot water temperature is monitored regularly, in order to ensure a safe limit of 43 degrees centigrade at the point of outlet. Windows have been fitted with restrictors for the safety of service users and security of the building. Portable electrical appliances are checked, tagged and a record maintained. Nevetts DS0000019479.V277791.R01.S.doc Version 5.1 Page 23 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 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X 2 X 3 Nevetts DS0000019479.V277791.R01.S.doc Version 5.1 Page 24 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP7 OP7 OP12 OP27 OP36 Good Practice Recommendations The cultural and religious needs of the service user should be woven in their care plan. (A previous recommendation) 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) An Activities Coordinator should be recruited, in order to ensure that service users receive an adequate level of stimulation for their general wellbeing. A review of the night staffing levels should be undertaken and remedial action taken as appropriate. The frequency of staff formal supervision should be increased to once every 2 months, at minimum. Nevetts DS0000019479.V277791.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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. Extracts may not be used or reproduced without the express permission of CSCI Nevetts DS0000019479.V277791.R01.S.doc Version 5.1 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
