Inspection on 03/01/07 for Neville Williams House

This inspection was carried out on 3rd January 2007.

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

Neville Williams House 31/10/07

Neville Williams House 21/06/06

Neville Williams House 23/01/06

Neville Williams House 03/05/05

Neville Williams House 12/11/04

Neville Williams House 21/07/04

Neville Williams House 15/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Neville Williams House 8 Greenland Road Selly Park Birmingham West Midlands B29 7PP Lead Inspector Amanda Lyndon Unannounced Inspection 3rd January 2007 09:30 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 Neville Williams House DS0000024870.V324757.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. Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Neville Williams House Address 8 Greenland Road Selly Park Birmingham West Midlands B29 7PP 0121 472 4441 0121 415 5045 nevillewilliams.house@bcop.org.uk www.bcop.org.uk Broadening Choices for Older People 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) Acting Home Manager Ann Rainsford Care Home 50 Category(ies) of Dementia (50), Old age, not falling within any registration, with number other category (50) of places Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 21st June 2006 Brief Description of the Service: Neville Williams House is a large 2-storey purpose built Care Home that provides general nursing care for 50 people aged 60 and over, including people with dementia. It is decorated to a very high standard, is well maintained throughout and is set in a quiet residential area of Selly Park, within easy access to bus routes. There is ample off road parking to the front of the building and a large secure, private garden to the rear and this is suitable for wheelchair users. The Home is owned and operated by Broadening Choices for Older People, a local charity whose head office is based in Birmingham. Neville Williams offers 42 single en-suite rooms, 2 double en-suite rooms and a 4 bedded high dependency “ward” area. There are lounges and dining rooms situated on both floors, with a passenger lift access to the upper level. Suitable aids, adaptations and equipment are provided to meet the needs of residents with physical disabilities and dementia. There are two assisted spa baths available for communal use and staff are provided to support residents in these areas. A designated facility is provided within the Home for residents that choose to smoke and this is not permitted within communal area or bedrooms for reasons of health and safety. An interesting in-house and external activities programme had been introduced in to the Home. There is a notice board displaying forthcoming events and other information of interest to residents and their visitors. A copy of the most recent CSCI inspection report is available. The weekly charge per person to live at the Home is £625 Items not included within the weekly fee include hairdressing, toiletries, newspapers/magazines and private chiropody. Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report reflects the findings of a one day unannounced field work visit undertaken by two Inspectors when there were forty eight residents living at the Home, two residents were due to come to live there in the near future and there was a list of prospective residents waiting to come to live at the Home. Information was gathered by speaking with eight residents, one visitor and a number of staff, case tracking, examining care, medication and health and safety records and observing the staff perform their duties. A tour of the Home was undertaken. The Inspectors were assisted throughout the field work visit by the General Manager and Head of Care and both were friendly, approachable and keen to review care practices to continually improve the standard of service provided. Prior to the field work visit five residents had returned comment cards to CSCI about the service provided at Neville Williams and most of the feedback was positive. One visitor to the Home stated that the services provided there had greatly improved in recent months and that the new management structure was effective. A negative comment was received about the time taken for residents’ call bells to be answered by the staff team, however residents met during the visit stated that staff response times were satisfactory. A negative comment was made by a relative of a resident living at the Home regarding the cleanliness at the Home and that this had been resolved. Prior to the field work visit the Home Manager had completed a pre inspection questionnaire, giving some information about the Home, residents and staff which was taken into consideration. No immediate requirements were made on the day of the visit and it was apparent that positive progress had been made in order to address requirements made during the last key inspection undertaken at the Home. What the service does well: Prospective residents are encouraged to spend time at the Home in order to sample what life would be like to live there. Residents know before admission that their care needs could be met whilst living at the Home. Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 6 One resident who had recently come to live there said “ I came to look here with my son and the staff asked questions” Residents have access to a range of Health and Social Care Professionals and staff provide support for residents in this area so that their health and welfare needs are met. A comprehensive system for the management of medication is in place and this safeguards residents if they choose for the Home’s staff to administer this to them on their behalf. Residents are generally cared for in a respectful manner and this ensures that their dignity and self esteem are maintained. One resident said “ The staff always knock my door before they come in and they call me the name that I like to be called”. Residents are able to exercise control over their daily lives and the activities that they choose to participate in which promotes their individuality and independence. One resident said “ The staff leave me to get up at whatever time I want to” Visitors are made to feel welcome. One visitor said “ If anything needs doing you only have to ask and it’s attended to” Residents’ individual religious beliefs and cultural preferences are respected. There are opportunities for religious worship and support is provided by staff in this area. Residents are served a choice of wholesome and nutritious meals that meet any special dietary requirements for reasons of health, taste or religious/cultural preferences. One resident said “ The food is very nice, I never grumble” Another resident said “ The staff always ask me what I would like to eat” There is a comprehensive complaints procedure accessible to residents and visitors should they need to make a complaint and any complaints are investigated in a timely and appropriate manner. Staff receive training about the protection of vulnerable adults and this safeguards residents. Residents are provided with a clean, comfortable and well maintained living environment in which they feel safe and secure and their privacy is maintained. The living environment is suitable for people with dementia, physical disabilities, sensory impairments and aids and adaptations are provided to promote the independence of these residents. Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 7 Residents can personalise their rooms to reflect their individual tastes, cultural choices and interests and this ensures that they feel comfortable in their surroundings. Staff receive appropriate training to ensure that they have the knowledge to work competently within their job roles. Residents stated that the staff team were helpful and approachable. One resident said “ The staff answer any questions that I may have” Another resident said “ The staff are good, they come and help me when I need them” Residents and relatives are invited to regular meetings to discuss the service provided at the Home and this ensures that residents are involved in the running of the Home and the facilities on offer. Staff meetings are held regularly ensuring that important information about residents’ care and the services provided are conveyed and discussed amongst the staff team. There is a robust system for the management of residents’ personal allowances should they choose for the Home to hold this on their behalf. The management team is approachable and friendly and ensure that the Home is run in the best interests of the residents living there. There were regular maintenance checks and servicing of equipment used at the Home and this ensured that they were safe to use. What has improved since the last inspection? Care records identified that the nursing staff monitor the health care needs of residents living at the Home in order to identify any potential health concerns. Care records were stored securely and this upholds residents’ confidentiality. Residents are encouraged to maintain their independence and staff assess the risks involved in activities that residents are engaged in so that they are safeguarded. There was a wide variety of activities on offer at the Home for the residents to participate in should they choose. Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 8 The reception area of the Home had been redecorated and refurbished and provided residents with an alternative seating area. An activity room had been created on the ground floor of the Home and it was apparent that this was frequently used and displayed residents’ art work. Residents are able to use this facility to meet with their visitors in private New staff do not commence employment at the Home without two satisfactory references being obtained and this safeguards residents. Copies of the reports of visits to the Home by External Senior Managers were available in order to monitor the quality of service provided at Neville Williams. Wheelchairs were checked regularly to ensure that they are safe to use and were not used without footrests being in place in order to reduce the risk of injury to residents. What they could do better: Service user guides were not available in all residents’ bedrooms and this may prevent important information about the Home from being conveyed. Positive progress had been made in respect of the care planning system used at the Home however further developments are required in respect of this to ensure that residents’ preferred routines are maintained whilst living at the Home, the specific support required by staff is identified, acute health care needs are monitored and so that residents and/or their representatives are involved in this process. On occasion lack of attention to basic care needs of residents did not uphold their health, dignity or welfare. Menus were not available on dining tables and this may prevent residents from choosing meals or being reminded of what they had chosen to eat. The skill mix of staff on duty during late evening and night times is inadequate on occasions and does not safeguard residents. Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 9 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. Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 10 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 Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 11 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 adequate. This judgement has been made using available evidence including a visit to this service. Admission processes are generally thorough so that prospective residents have enough information to make an informed decision about whether they would like to live at the Home. Residents’ care needs were being met living at the Home. EVIDENCE: The statement of purpose and service user guides were comprehensive and gave good detail about the services provided at the Home. The Registered Manager stated that plans were in place for these to be available in a large print format to assist people with poor eyesight. Service user guides were not available in all bedrooms and this included the bedroom of a resident who had recently come to live at the Home. Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 12 Prospective residents are encouraged to visit the Home in order to sample what life would be like to live there. Pre admission assessments were undertaken by senior nursing staff for all prospective residents using a comprehensive pre admission assessment document that included all information required. One assessment had not been signed or dated. One resident who had recently come to live there said “ I came to look here with my son and the staff asked questions” Contracts of terms and conditions of residency are issued to residents or their representatives on admission to the Home and these were signed as confirmation of the content of these. Contracts were not available in two care files sampled. A number of residents living at the Home had dementia care needs and some had high dependency general nursing care needs. The Home were meeting the needs of the residents living there. Intermediate care is not provided at Neville Williams Neville Williams House DS0000024870.V324757.R01.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 adequate. This judgement has been made using available evidence including a visit to this service. Care delivery and health care provision are generally good. Residents are generally cared for in a respectful manner and this ensures that their self- esteem is maintained. On occasion lack of attention to basic care needs of residents does not uphold their dignity or welfare. EVIDENCE: Much positive work had been undertaken in respect of the care planning system used at the Home since the last field work visit. On admission to the Home, assessments were undertaken of residents’ individual care needs and care plans were derived from this information. Most of the care plans sampled identified the specific support required by staff in Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 14 order to meet residents’ individual care needs however some care plans required further development in this area. Life histories had been completed and these included interesting information about residents’ past interests, hobbies and people most important to them and these were incorporated in to the care planning system. Care plans identified the social care needs of residents so that residents were encouraged to maintain links with the community and be socially stimulated whilst living at the Home. Methods used to promote effective communication between residents and staff were identified within care plans and this is important to ensure that residents are encouraged to express their needs and enhance their quality of life. Care plans included information about the support required by staff regarding residents’ health care needs for example the management of continence and oral health. A care plan had not been written in respect of a resident being prescribed a course of antibiotics for an infected cyst and this may prevent the effectiveness of the treatment prescribed from being monitored. One care plan identified that a resident had good hearing, however it was very apparent that the resident was very hard of hearing when engaged in a conversation with him. This may prevent him from receiving appropriate support from staff in this area. Care plans were reviewed monthly so that they identified residents’ current care needs. There was however no evidence that care plans were agreed or reviewed with the involvement of residents and/or their representatives. This must be undertaken to ensure that individual residents’ preferred routines are maintained whilst living at the Home. Personal risk assessments had been undertaken in order to reduce the risk of individual residents from developing sore skin and staff audit the number of residents with this condition in order to monitor the effectiveness of the care provided at the Home and the availability of pressure relieving equipment provided. These are areas of skin that are sore or have broken due to a number of reasons for example immobility and poor nutrition. The incidence of pressure sores at the Home was very low. Nutritional risk assessments had been undertaken and residents were weighed regularly so that any abnormalities could be identified and remedial action could be taken. Moving and handling risk assessments had been undertaken so that residents could be assisted in to their chair, bed, bath or around the Home in a way that safeguards both themselves and staff from injury whilst maintaining their dignity. These did not include detail of the action to be taken should a resident fall. Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 15 Risk assessments had been undertaken about the use of bed safety rails and the risks involved in the use of these. The use of these should be agreed with residents and/or their representative and the risks involved with the use of these should be explained. Food and fluid intake charts were maintained as deemed necessary in order to monitor the health of residents and daily reports were comprehensive and included good detail of nursing care received, emotional support provided. Residents generally received a good standard of care and were comfortable and safe living at the Home. Attention to basic care needs was required at times, for example, staff had not assisted a resident to put on her spectacles in order to watch the television, a resident was attempting to eat vegetables with a spoon instead of being given a fork and a resident was in his bedroom without a drink or glass, despite his care plan identifying that he must be encouraged to drink an adequate amount of fluid each day. Two residents had dirty fingernails and this did not uphold their dignity or health. Residents were well groomed and supported by the care staff to choose clothing and jewellery appropriate for their age, gender, culture and time of year. An exception to this was that at 11.15 hours a resident was found to be in his bedroom without trousers or socks on, a blanket was covering his legs and he still had his pyjama top on. Whilst he stated that he was warm enough, this does not uphold his dignity. Residents had access to a range of Health and Social Care Professionals and there was evidence that residents are well supported by staff to receive access to these in order to protect their health and welfare. Care reviews were undertaken regularly involving the resident, their family, Home’s staff and Social Worker and this provided all involved with the opportunity to discuss the care being received by the Home and any suggestions for changes or improvements regarding this could be put forward. One care plan stated that a resident “does not want resuscitation”. This was signed by the resident’s next of kin however there was no information about how this decision was reached, who was involved in the decision, the reasons for the decision and when the decision was made and this does not safeguard the identified resident. The system for the management of medication was robust, including Controlled and “as required” medication, and a good working relationship had been built up with the Community Pharmacist in order for an effective system to be in place. All staff responsible for the administration of medication had recently undertaken training regarding this. Since the last visit a hygienic and safe procedure had been implemented regarding the use of single use syringes for the administration of medication. Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 16 One resident chose to administer his own insulin and appropriate staff support, facility for the storage of this and the disposal of needles was provided. This ensured that his independence was promoted whilst maintaining his safety. Regular drug audits were undertaken by the Head Of Care to monitor staff competence in this area. Prescription creams were dated on opening, however two tubes of steroidal cream had been left out in a resident’s bedroom and these must be stored safely. One medication identified on a medication administration chart (MAR) was no longer required however the MAR chart did not reflect this and may result in a medication administration error. Staff were supporting residents in a respectful manner. A number of residents had chosen to have a private telephone line installed in their bedroom and in addition to this a pay phone located in a private area of the Home was available for residents’ use. Two residents had chosen to hold the key for their bedroom doors and these could be overridden in the event of an emergency. The preferred term of address was recorded within residents’ care plans and care records were stored securely. One resident said “ The staff always knock my door before they come in and they call me the name that I like to be called”. Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. The activities and opportunities for social and religious interests meet the needs and expectations of all residents living at the Home. Residents can exercise their control over their daily lives so that their individuality and independence are maintained. The choice of wholesome and well presented meals meet any special dietary needs of residents for reasons of health or cultural/religious beliefs. EVIDENCE: Since the last field work visit the Organisation had recruited an activities co ordinator, employed to work thirty hours a week at the Home. It was apparent that much positive work had been undertaken by this person for all residents living at the Home and this enhanced their quality of life. There was a variety of activities on offer for residents to participate in both in – house and outside of the Home should they choose including arts and crafts, musical entertainers, poetry and book reading, quizzes, film groups and board games. Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 18 Records of activities arranged were kept and these identified that activities were also provided for residents who were unable to participate in group activities. A record of the success of each event was kept and this assists in the planning of forthcoming events. One resident said “ I like to speak to the other people that live here and ask if they are all right” The hair salon was open weekly and plans were in place for beauty treatments to be offered to residents living at the Home. Interesting life histories had been undertaken and included good detail about residents’ interests and hobbies so that they could be maintained whilst living at the Home. Forthcoming events were displayed on the residents’ and relatives’ notice board so that residents could choose the activities that they wished to participate in. Holy Communion was available at the Home and the Home’s staff were aware of how to access opportunities for residents of other faiths to practice should the need for this arise. Visitors were made to feel welcome and one visitor met during the field work visit confirmed that communication between the Home’s staff and relatives was very good. There was an open visiting policy and one visitor said “ If anything needs doing you only have to ask and it’s attended to” There were no rigid rules or routines at Neville Williams and residents were able to go out side of the Home with their friends and families as they chose which was important to maintain their independence and individuality. Residents were able to exercise control over how they spent their day. One resident said “ The staff leave me to get up at whatever time I want to” At the time of the last field work visit meals were prepared by an external catering company, however the Organisation has now taken back the responsibility for this and residents met during the visit expressed their satisfaction about the quality and choice of meals provided. Weekly menus identified a variety of wholesome and nutritious meals and alternatives to these were available. Breakfast times were flexible and a variety of cereals, fruit and toast were available at this time. A cooked breakfast was also offered and residents had the choice of being served this in either their bedroom or dining room. A snack meal was available at bed time and during the night so that residents were not hungry and residents had regular meals for reasons of health. Special diets could be prepared for reasons or health, taste or religious/cultural preferences. The portions of soft diets were served separately and this ensured that residents could choose how much of each portion they wished to eat. A tea party is held every fortnight and residents confirmed that they enjoyed this social event. Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 19 One resident said “ The food is very nice, I never grumble” Another resident said “ The staff always ask me what I would like to eat” The lunch time options on the day of the visit were meatballs in a red wine sauce or cauliflower and broccoli cheese served with a selection of vegetables. The lunch time meal was relaxed and unhurried and cold drinks were served. Dining tables were laid attractively however condiments were not available on all tables and menus were not available on the tables. There were an adequate number of staff assisting residents with their meal in a sensitive and discreet manner and second portions were offered. A menu was on display on the notice board in the dining room however this was in a very small print so that a number of residents were not able to read it and it did not accurately reflect the flavour of soup available for the day. Melamine dishes were being used and a number of these were stained and scratched and may harbour infection. Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. The complaints procedure is accessible to residents and their visitors and complaints are investigated in an appropriate and timely manner. Systems are in place to protect residents from harm. EVIDENCE: A number of compliment and “thank you” cards were on display in the Home from residents and their visitors. The complaints procedure was on display in a prominent position and included all relevant information. A suggestions box was available in the reception area of the Home in order for residents, visitors or staff to raise any concerns that they may have about the service provided. Since the last field work visit CSCI had received one complaint in respect of the lack of supervision of vulnerable residents in the ground floor lounge area of the Home and inadequate monitoring of a resident’s health care needs. This was investigated by the Home’s management team and was not upheld. During the field work visit a staff member was present in the ground floor lounge at all times and care staff met during the visit confirmed this. Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 21 Record keeping in respect of nursing care provided at the Home had improved since the last field work visit in response to the second element of the complaint raised. One element of the complaint was in respect of a resident who had undressed in the ground floor lounge. The complaint response stated that the support required by staff in order to maintain this residents’ dignity had been discussed with Health and Social Care Professionals, however there was no evidence of this within the resident’s care plan. Detail of this complaint or the investigation undertaken was not recorded in the complaints register however was available in a separate complaints’ folder within the Home. Two complaints had been made directly to the Home since the last field work visit and the complaints register identified that these had been investigated by the management team in a timely and appropriate manner to the satisfaction of the complainants. One recent daily report pertaining to a resident living at the Home identified a concern raised by a resident about an agency staff member and the management team stated that they will be informing the agency and the resident’s Social Worker about this. On further discussions it appeared that the concern raised had been due to a misunderstanding, however the Registered Manager stated that she would continue to inform the relevant people. Ten staff members had recently undertaken training about the protection of vulnerable adults and this safeguards residents. Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence including a visit to this service. The premises are designed to promote the comfort and dignity of residents. Aids and adaptations meet the needs of residents living at the Home EVIDENCE: The internal environment of the Home was furnished to a good standard and in a generally good decorative order. Plans were in place for a number of doors to be replaced as they had become damaged by wheelchairs over a period of time. The Home was well lit with attractive domestic style lighting and it was clean and fresh throughout. The spacious reception area of the Home was warm and inviting and had been recently redecorated. The carpet had been replaced with an attractive floor Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 23 covering. There was a bench available for residents’ and visitors’ use and leather furniture had been ordered for this area. An activity room had been created on the ground floor of the Home and it was apparent that this was frequently used and displayed residents’ art work. Residents were able to use this facility to meet with their visitors in private should they choose to do so. The main dining room was located on the ground floor and this was adjoining the main lounge. This area was homely in style and furniture was of a good standard in order to enhance the comfort of residents when using this facility. The first floor dining room had been converted in to a lounge, one reason for this was in response to residents’ concerns that food was served late in this area on some occasions so now the majority of residents chose to eat together in the main dining room with the option of smaller alternative dining areas being located elsewhere in the Home. New, circular dining tables had been ordered to promote social interactions between residents at mealtimes. There were smaller seating areas throughout the Home that residents could use if they chose. The assisted bathing facilities met the needs of residents living at the Home and were found to be clean. There was a large crack on the toilet cistern in one of the bathrooms located on the first floor of the Home and this was brought to the attention of the Registered Manager. Aids and adaptations provided included five transfer hoists so that residents could be safely assisted in to their bed, chair or bath without fear of falling whilst maintaining their dignity and pressure relieving mattresses and cushions so that residents did not develop sore skin. The Home provided a number of specialist nursing beds so that the health and safety of the nursing staff could be maintained whilst caring for residents who were in bed. The Organisation were currently fund raising for an additional two specialist nursing beds in order to enhance the comfort of residents who were nursed in bed. Pictorial aids were available in order to communicate with residents with cognitive impairments and a resident that was registered blind had a “talking clock” so that he could independently find out what the time was. The corridors throughout the Home were wide to accommodate wheelchairs and hand rails were provided in corridors and near to toilets so that residents’ independence was promoted whilst maintaining their safety. There was a four bedded “ward” area within the Home and the General Manager stated that this was primarily for higher dependency residents for reasons of dementia. A staff member was allocated to this area each shift in order to supervise the vulnerable residents. The residents currently in this area Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 24 spent some of their day in the communal lounges with the other residents living at the Home and this ensured that they were socially stimulated. The Registered Manager stated that a number of Health Care Professionals and relatives had expressed their views about the benefits of this area of the Home however proposed building plans may have a different use for this area. Forty two of the bedrooms were for single occupancy and all had an en suite facility consisting of a toilet, hand basin and shower. Bedrooms were personalised to reflect the interests, age, culture and tastes of individual residents so that they were comfortable in their surroundings. There was ample storage within bedrooms for residents’ belongings and a lockable storage facility was provided in each bedroom for the safekeeping of valuables and items that residents may wish to keep private. A nurse call system was provided in each residents’ bedroom and this was heard clearly throughout the Home when activated in order for residents to summons assistance from staff. Room numbers were clearly displayed on residents’ bedroom doors so that they were easy to read. There was a spacious and secure garden to the rear of the building for residents to enjoy in warmer weather. This was well maintained, easily accessed and was suitable for wheelchair users. The temperature within the Home was comfortable on the day of the visit. There were suitable sluicing facilities available and a hygienic system for the cleaning of residents’ personal clothing and bed linen was in place. Hygienic hand washing facilities were appropriately located throughout the Home. Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 25 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 adequate. This judgement has been made using available evidence including a visit to this service. Day time staffing levels are adequate to meet the needs of residents however the staff skill mix during evening and night time hours is inadequate on occasions and may be a risk to residents’ health and safety. Residents are supported by appropriately trained and vetted staff. EVIDENCE: There were no staff vacancies at the time of the field work visit however agency staff were utilised on a number of occasions in order to cover periods of extended holidays of permanent staff. One resident said “ The staff answer any questions that I may have” Another resident said “ The staff are good, they come and help me when I need them” Staffing rotas identified that on a number of occasions there were two registered nurses on duty until 22:00hours however the Head Of Care stated that they were experiencing problems with covering all evenings due to staff availability. CSCI consider that having just one registered nurse on duty from 20:15 hours does not meet the needs of the residents living at the Home and may not safeguard their health, safety and welfare. Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 26 The Head Of Care stated that plans were in place to ensure that there were two registered nurses on duty every evening until 22:00hours. On call support is provided by the Head Of Care however the system for this should be formalised as deemed necessary by the Organisation and identified on the staffing rotas. One registered nurse who had recently commenced employment at the Home expressed her satisfaction and enthusiasm about working there. Staff recruitment files sampled contained all information required by regulations and this safeguards residents. All staff working at the Home were deemed to be safe to work with vulnerable residents and all registered nurses had a current registration and were eligible to work. Interview notes were kept in keeping with good practice. New staff were issued with a contract of terms and conditions of employment and these were signed by staff as confirmation that they agreed to the content of these. New staff undertake in house induction training and this included health and safety and personal care training so that staff had the appropriate knowledge to work in a competent manner. Staff training certificates were available confirming that staff had undertaken recent training relevant to their job roles including dementia care, customer care, the safe administration of medication, care planning, key working, nutrition, wound care and care of older people. The Home had good links with the local Primary Care Trust (PCT) and the Home’s staff accessed relevant training from this source. 48 of staff had completed NVQ Level 2 in care qualification and six staff were currently working towards this to ensure that they had the appropriate knowledge to work in a competent manner. Four staff had completed NVQ Level 3 and one staff member was working towards this. Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 27 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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This is a well managed Home, run in the best interests of the residents living there. The systems for resident and relative consultation are good. Equipment at the Home is safe to use, thus maintaining the health and safety of residents. EVIDENCE: The General Manager had been in post for four months and had previously worked within this role on an “acting” basis, had a good knowledge of her job role, had a good oversight of all aspects of the running of the Home and had a NVQ Level 4 qualification in management. She was in the process of Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 28 completing her application to register with CSCI as Registered Manager of Neville Williams. As she does not hold a nursing qualification, a Head Of Care is employed on a full time basis, in addition to the nursing staff on duty in order to ensure that the clinical aspects of the Home are managed. Both have designated roles and responsibilities and it was apparent that this management structure was working well for the benefit of the residents living at the Home. The Head of Care had recently been appointed and there was already evidence that improvements in respect of the clinical care provided at the Home had improved. External Senior Managers visit the Home regularly in order to monitor the quality of service provided at Neville Williams. Comprehensive reports of the findings of these visits were available, including details of discussions with residents and staff in order for them to put forwards their views about the service provided. Residents’ and relatives’ meetings were held regularly so that their suggestions about the services provided at the Home could be put forward and so that they were involved in the running of the Home. A copy of the minutes of the last residents’ meeting was on display for all interested parties to refer to. The Registered Manager stated that plans were in place for this to be available in a large print format to assist people with poor eyesight. Staff meetings were held regularly and comprehensive minutes of these were available. This ensured that staff were informed about any new procedures or services provided for residents living at the Home. A newsletter had been produced and this included interesting information for residents and their representatives about the Home, it’s services, staff and forthcoming events. A comprehensive formal quality assurance audit had recently been undertaken using an external source. The outcome of this was that Neville Williams was providing a high standard of care. A copy of the findings of this must be accessible to residents. The staff do not manage the personal finances of residents and this is the responsibility of the residents’ families as residents’ money is not held on the premises for safekeeping. A computerised debit system is in place in which individual residents are invoiced each month for hairdressing and chiropody. There is a separate transaction record for each resident and monies are accepted by cash or cheque. Staff had undertaken recent training about health and safety issues including infection control, health and safety, food hygiene, moving and handling and fire safety. A fire drill had been undertaken recently so that staff knew what action to take in the event of an emergency, thus safeguarding residents. Good Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 29 systems were in place to ensure that all of the staff team undertook refresher training in these areas as required in order to ensure that residents received a good standard of care. An annual staff training programme was on display in the Home. A colour coded system for identifying the support required by staff in order to assist individual residents to safety dependent on their care needs in the event of a fire had been introduced. Health and safety checks of equipment used at the Home were undertaken in order to safeguard residents. Accident records were well maintained and identified that appropriate medical advice was sought in the event of an emergency. Audits of accidents and falls involving residents were undertaken so that the risks of further incidents of the same could be minimised. Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 30 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 2 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 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 2 17 x 18 2 3 3 2 3 2 3 3 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x 3 2 3 3 Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 31 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 2 Standard OP1 OP2 Regulation 5(2) 5(1)(c) Requirement A service user guide must be supplied to each resident Contracts of terms and conditions of residency must be signed as agreed by residents and/or their representative. (time scale of 01/11/06 not met) 3 4 5 OP3 OP7 OP7 14 12(1)(a) 15 13(5) Pre admission assessments must 01/03/07 be signed and dated on completion Short term care plans must be 14/02/07 written about acute health care needs Moving and handling risk 28/02/07 assessments must be further developed to identify any specific detail of equipment used and the action to be taken should a resident fall. These must be reviewed regularly. (Time scale of 15/07/06 and 01/11/06 not met) 6 OP7 15 The care planning system must be further developed: 30/04/07 Timescale for action 01/04/07 01/03/07 Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 32 Care plans must identify the specific support required in order to meet the care needs of individual residents Care plans must be agreed and reviewed with the involvement of the resident and/or their representative (Although improvements have been made in this area, previous timescales of May 2005, 04/02/06, 31/08/06 and 15/12/06 not met in full) 7 OP7 12(1) 13(4) Bed safety rail risk assessments must be signed by residents and/or representatives and evidence of a multi disciplinary decision being reached in respect of the use of these must be available The Home must be conducted so as to promote and make proper provision for the health and welfare of residents (this refers to some occasions only as the general standard of health care provided is good) A review of the Home’s policy about resuscitation must be undertaken in order to safeguard residents Medication no longer required must be identified as discontinued on the medication administration chart Prescription creams must be stored safely (timescale of 15/10/06 not met) 12 13 OP10 OP16 12(4)(a) 22(8) The Home must be conducted in a manner which respects the privacy and dignity of residents A record of complaints and DS0000024870.V324757.R01.S.doc 28/02/07 8 OP8 12(1)(a) 14/02/07 9 OP8 12 01/04/07 10 OP9 13(2) 14/02/07 11 OP9 13(2)(4) 14/02/07 14/02/07 01/03/07 Page 33 Neville Williams House Version 5.2 14 OP18 13(6) action taken in response to these must be kept The adult protection policy must 31/03/07 include local multi agency guidelines (This requirement was not assessed on this occasion) 15 16 OP21 OP23 23(2) 12(4)(a) The large crack in the toilet cistern located in the first floor bathroom must be repaired Plans must be forwarded to CSCI in respect of the future of the multi occupancy room (Timescales of May 2005, 01/06/06, 01/10/06 and 31/12/06 not met) 01/03/07 01/04/07 17 OP27 18(1)(a) The appropriate skill mix of staff must be maintained during evening/night time hours. (Timescales of May 2005, 01/04/06 and 15/0/06 not met) This requirement has been met for the majority of the time. To be reassessed during next visit. 01/02/07 18 OP28 18(1) A minimum of 50 of care staff should be trained to NVQ Level 2 in Care or equivalent (timescale of 01/12/06 not met) 01/05/07 19 OP33 24(2) 20 OP36 18(2) A report based on the findings of the quality of care reviewing system used at the Home must be accessible to residents. All care staff must receive formal supervision a minimum of six times a year and a record of this must be maintained This requirement was not assessed on this occasion. 01/05/07 01/04/07 Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 34 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 OP15 Good Practice Recommendations Menus should be available for residents to refer to and condiments should be available on the dining tables at meal times. Melamine bowls no longer fit for purpose should be replaced. All documentation in respect of complaints received about the service provided at the Home and investigations undertaken should be stored together in the complaints register Arrangements for on call support provided for the nurse in charge of the shift should be reviewed, formalised and identified on the staffing rotas. 2 OP16 3 OP27 Neville Williams House DS0000024870.V324757.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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. 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