CARE HOMES FOR OLDER PEOPLE
Nicholson House 97 Mirfield Grove Sutton Way Kingston upn Hull HU9 4QR Lead Inspector
Kishion Dee Unannounced 19 July 2005 @ 9:30 am
th 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 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. Nicholson House J54_S34679_Nicholson House_v228395_190705_Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Nicholson House Address 97 Mirfield Grove Sutton Way Kingston upon Hull HU9 4QR 01482 782266 01482 708883 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Kingston upon Hull City Council Care Home 30 Category(ies) of OP Old Age (30) registration, with number DE(E) Dementia - over 65 of places Nicholson House J54_S34679_Nicholson House_v228395_190705_Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 7th December 2004 Brief Description of the Service: Nicholson House is a large two storey building situated in a residential area. It is a pre-existing care home owned and managed by Hull City Council. There is reasonable access to local shops and public transport is available nearby.The home provides care for 30 service users, in the category of older people who may also have some form of dementia. A lift is available for access to the upper floor.Various other services are located in the same building including a 10 place day centre. Presently the home accommodates 23 permanent service users, 4 on a respite basis and 2 intermediate beds where referrals are made by a health authority team. Nicholson House J54_S34679_Nicholson House_v228395_190705_Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out with the registered manager, a manager from another of the council’s homes, shift team leaders, staff, residents and visitors at Nicholson House. The inspection took 8 hours and included a tour of part of the premises, examination of resident files and records relating to the service. Five of the staff on duty and four visitors were spoken to during the inspection. A lot of the people who live at Nicholson House have memory problems and as a result only four service users were spoken to. The inspector observed how staff and service users worked together throughout the day. The views of people spoken to have been included in this report. What the service does well:
Nicholson House is a home where the majority of residents have severe memory loss and have complex needs. The staff team are experienced and enthusiastic and work very hard to meet the needs of the people who live in the home. They encourage individuality and the service offered is personalised to each resident. The home offers residents the opportunity to make decisions about their daily lives. One individual said that she likes to be independent and staff respect her choices and decisions around her care. Resident’s comments indicate that they think a lot of the staff, one individual said ‘nothing is ever too much trouble for them.’ The home is welcoming and has a relaxed and homely atmosphere. Residents said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. The home is clean and the staff work hard to make sure the building is odour free. The home is well managed. In addition to the registered managers the home has shift team leaders who are on duty 24 hours a day and it is their responsibility to manage the shift. They each have one other thing they have to do such as developing and managing the activities within the home. The home are always looking for ways to make the service a better one for the people who live there. The home work well in partnership with other agencies particularly health staff. Nicholson House J54_S34679_Nicholson House_v228395_190705_Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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. Nicholson House J54_S34679_Nicholson House_v228395_190705_Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Nicholson House J54_S34679_Nicholson House_v228395_190705_Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Most residents have a full needs assessment carried out and are given enough information about the home and its facilities before admission, for them to be confident that their needs can be met by the service. This is not the case for all emergency admissions. EVIDENCE: The admission process is adequate for planned admissions to the home and ensures that new residents are properly assessed and cared for. Two relatives provided detailed information about the care needs of two residents and this was available within the assessment documentation. The home do take emergency admissions and the file was examined for the last emergency admission. This was not adequate and could have repercussions for the health and safety of the individual concerned. The managers are currently developing a new emergency admission procedure. Three relatives spoken to confirmed that they were given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their relatives needs could be met by the service.
Nicholson House J54_S34679_Nicholson House_v228395_190705_Stage 4.doc Version 1.40 Page 9 Four case files were examined and the residents have full assessment documentation. The information from the assessment process is used to develop the individuals care plan. Nicholson House J54_S34679_Nicholson House_v228395_190705_Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 & 8 & 9 The health, personal and social care needs of the residents are clearly documented and the service and staff are meeting the majority. Residents are encouraged to be independent within their daily lives using a risk assessment approach to care. EVIDENCE: Individual care plans are in place for all residents and set out the health, personal and social care needs identified for each person. Theses are reviewed on a monthly basis. Four files were requested but one could not be located. A Doctor visited to see this person and the shift team leader was unable to provide up to date information because of this. The quality of information and organisation within the files was not the same, some where better than others. Two residents and three relatives said that there is good access to their GP’s, chiropody, dentist and opticians, with records of their visits being written into their care plans. They all attend outpatient appointments at the hospital and records show that they have an escort from the home if wished. Staff informed the inspector of the work done with one service user who has some challenging behaviour. There was clear evidence of involvement from the health service and staff had implemented the treatment plans . One service user discussed
Nicholson House J54_S34679_Nicholson House_v228395_190705_Stage 4.doc Version 1.40 Page 11 access to information held about her and this is an area that should be developed. Two relatives said that the home always accessed healthcare and always kept them informed of appointments and changes to health. Service users are weighed however staff informed the inspector that the current scales are not adequate for all service users. The home are looking into the cost of scales which would be suitable for all people who live at the home. One of the shift team leaders has taken on responsibility for the medication practises and procedures in the home. All service users have an assessment to determine if they are able to self medicate. There are infrequent occasions when medication is not been accurately recorded and this does not ensure the health of people who live at the home. The inspector noted however that medication systems have improved significantly since the last inspection. Nicholson House J54_S34679_Nicholson House_v228395_190705_Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 13 & 15 Social activities are well organised, creative and provide stimulation for people living in the home. Service users maintain contact with family and friends as they want to. The home does not provide sufficient contact with the community. Meals are nutritious and balanced and offer a healthy and varied diet for residents. EVIDENCE: One of the shift team leaders has taken on responsibility for organising the activities and there is a different activity going on at the home each day. The home have a ten bedded day centre which service users can access when open. Many of the day centre users socialise with the permanent residents and the manager is looking at integrating the two services to develop the activities further for all people at the home. Part of this development is to look at community involvement and activities available in the local area. One service user told of how she enjoyed the flower arranging which a member of staff had done. Another service user was seen to be enjoying a hand massage. The inspector spoke to four relatives who told the inspector that they visit at any time they choose to. The home enable relatives to come in at mealtimes and for a small charge they can have a meal at the home. One relative came in at lunchtime and was offered a cup of tea straight away. Menus are changed on a weekly basis, and details of those days’ meals are usually displayed on a notice board. Menu cards are also provided. The
Nicholson House J54_S34679_Nicholson House_v228395_190705_Stage 4.doc Version 1.40 Page 13 inspector noted that for service users with severe memory loss the staff brought out both choices of meals and enabled the service user to decide which meal they preferred. Each service user is offered three full meals a day, with choices being available the food was hot, and attractively presented with time given between courses to ensure everyone was able to eat at their own pace. Staff were observed assisting service users to cut up their food and help with feeding was offered where needed. Nicholson House J54_S34679_Nicholson House_v228395_190705_Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Adult protection training and procedures are available and it is clear that residents are being protected from abuse. They are able to voice concerns without fear of repercussion. EVIDENCE: The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of service users money and financial affairs. The manager and all staff have had Protection Of Vulnerable Adults (POVA) training. The staff on duty displayed a good understanding of the vulnerable adults procedure and two residents spoken to said they ‘felt safe at the home’. Two relatives spoken to said they were confident that their relative would be protected within Nicholson House. Nicholson House J54_S34679_Nicholson House_v228395_190705_Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 20 & 24 & 26 Residents are provided with a safe, warm and comfortable environment that is homely and welcoming. EVIDENCE: Part of the environment was seen during this inspection and the home was found to be clean, safe and well maintained. Decorating continues and the decorators were working in the visitors room. The home has two intermediate care beds and there has been some movement as rooms have become available. This has resulted in the intermediate care beds been close to their own lounge and at one end of the home which is an improvement. There has been new carpeting and furniture to many of the communal areas and this has made a significant improvement to the homeliness. The home did not smell at all and the domestic staff have been sampling new products and restructuring their workload to address the cleaning shortfalls. They have achieved this.
Nicholson House J54_S34679_Nicholson House_v228395_190705_Stage 4.doc Version 1.40 Page 16 Two service users were seen in their rooms and both have had the opportunity to personalise their rooms. All rooms are lockable. There is a garden which has seating and paved areas which provides a pleasant space. This is secure so people with memory problems can wander in and out if they choose to and their mobility enables them to. The managers have developed a programme of routine maintenance and renewal for the home. Nicholson House J54_S34679_Nicholson House_v228395_190705_Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 30 The deployment and number of staff is sufficient to meet the needs of the current service users. Staff are trained and competent to do their jobs. EVIDENCE: The inspector looked the staff rota and this indicated that the home are providing sufficient numbers of staff to meet the needs of the current service users. There has been some changes within the staff group and from discussions with staff this has improved the morale and working relationship between staff. New rotas are currently been developed to provide more staff at key times and respond to the needs of the service. The staff role at Nicholson has also been re-assessed and now staff at the home are residential care workers. This is going to give them more responsibility and the managers and staff are working together to provide training and development to enable them to take on the new tasks. Four service users and three relatives commented on the staff and said ‘they are marvellous’ ‘whatever you want if they have it or can get it they will give it to you’ one relative said ‘his face lights up whenever any of the staff come into his room’ Staff confirmed that they have received all of the mandatory training and many other specialist courses. Nicholson House J54_S34679_Nicholson House_v228395_190705_Stage 4.doc Version 1.40 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 & 32 & 33 & 36 & 37 Service users live in a home that is well managed and provides leadership and guidance to staff to ensure the quality of care provided to service users is consistent and of a good standard, however the registered provider is not carrying out regulation 26 visits in accordance with the regulation. EVIDENCE: The manager currently has another manager working with her at the home to develop and improve the service. They are currently working as a team and this partnership working has made significant improvements in the service. The manager is very knowledgeable about the residents at the home and continually looks at ways of ensuring that the home is run in the best interests of the residents. The managers have developed an action plan which covers all areas of life in the home and development work that is in progress. All service
Nicholson House J54_S34679_Nicholson House_v228395_190705_Stage 4.doc Version 1.40 Page 19 users, staff and relatives knew the manager and all commented on how approachable and supportive she is. One resident said that ‘if she is not happy with anything she will see the manager who is very nice and she sorts out any problems for me’. The staff confirmed to the inspector that formal supervision occurs on a regular basis and informal supervision is always available. Regular staff meetings take place. The regulation 26 visits are not occurring on a monthly basis as required by this regulation. This is an outstanding requirement from previous inspections and action must be taken to ensure that this requirement is met. Nicholson House J54_S34679_Nicholson House_v228395_190705_Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 2 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 4
COMPLAINTS AND PROTECTION 3 3 x x x 3 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 Standard No 16 17 18 Score x x 3 3 2 4 x x 3 2 x Nicholson House J54_S34679_Nicholson House_v228395_190705_Stage 4.doc Version 1.40 Page 21 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 12, 13 Requirement The registered person must ensure that the assessment and admission process for emergency admissions ensure that staff have sufficient information to meet their needs. The registered person must ensure that all service users have access to information held about them and they are aware of their right to access this. The registered person must ensure that the home has adequate equipment to ensure that service users weight is monitored. The registered person must ensure that medication is given as prescribed. The registered person must take robust action to ensure that regualtion 26 visits are carried out and copies of the reports forwarded to the registered manager and CSCI. The registered person must ensure that all records are maintained to the same standard. Records must be stored in accordance with data protection legislation at all times. Timescale for action September 30th 2005 2. OP7 14 30th August 2005 3. OP8 12, 13 31st October 2005 14th August 2005 01st August 2004 OVERDUE 4. 5. OP9 OP32 13, 18 26 6. OP37 15,17 31st October 2005 Nicholson House J54_S34679_Nicholson House_v228395_190705_Stage 4.doc Version 1.40 Page 22 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. Refer to Standard OP13 OP28 OP31 Good Practice Recommendations The registered person should develop residents access to community activities/ involvement. 50 of care staff should hold an NVQ level 2 or equivalent in care by 2005. The manager should hold an NVQ level 4 or equivalent in Management & Care by 2005. Nicholson House J54_S34679_Nicholson House_v228395_190705_Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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