Inspection on 05/02/07 for Nicholson House

This inspection was carried out on 5th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Nicholson House 11/03/09

Nicholson House 07/03/06

Nicholson House 19/07/05

Nicholson House 07/12/04

Nicholson House 24/06/04

Nicholson House 03/03/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Nicholson House 97 Mirfield Grove Sutton Way Kingston upon Hull East Yorkshire HU9 4QR Lead Inspector Angela Sizer Unannounced Inspection 5th February 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 DS0000034679.V329563.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. DS0000034679.V329563.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nicholson House Address 97 Mirfield Grove Sutton Way Kingston upon Hull East Yorkshire HU9 4QR 01482 782266 01482 708883 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) Kingston upon Hull City Council Mrs Carole Parker Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30) of places DS0000034679.V329563.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th March 2006 Brief Description of the Service: Nicholson House is a care home offering accommodation and personal care to 29 persons who are subject to a wide range of primary conditions and are experiencing difficulties associated with the aging process. The accommodation is purpose built over two floors that are joined by a passenger lift. The home is used for multiple functions such as long term and respite care, intermediate care and day care. The residents’ rooms are all single and there is a good range of communal facilities available for long-term residential residents. The home is situated in a residential area in the East of Hull and is near to some local facilities. There is reasonable access to local shops and public transport is available nearby. The home has two outside patio areas and a small garden with good car parking facilities. The Local Authority own and run the home with some assistance from the Primary Care Trust. All new residents are given a service user guide explaining what the home will provide. The weekly fees range between £77.42 and £672.00, this information was provided by the registered provider during the inspection visit. Additional charges are made for hairdressing, toiletries, chiropody, papers and magazines. The home has reduced its number from 30 to 29 by changing the use of a bedroom to an office. An application to vary the registration must be submitted retrospectively in order to comply with the regulations. DS0000034679.V329563.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit was part of the key inspection process and took place over one day and took a total of 10 hours. Prior to the visit surveys were posted out to; 25 residents and 20 were returned, 21 to relatives and 13 were returned, 32 were sent to staff members and 8 were returned, of the 16 sent to health and social care professionals 3 were returned and 1 was sent to a care manager and this was not returned. The registered provider returned the pre-inspection questionnaire and this gave some details about the service including staffing, residents’ needs, policies and procedures and training. From this information the decision was made about which staff and resident files would be looked at. The previous requirements were discussed with the shift leader on duty and the majority have now been met. Some of the environmental and care practice issues that relate to the intermediate and day care residents have not yet been addressed by higher management in the Local Authority and this reflects upon the overall rating of the home. During the visit several of the residents, two staff members and one relative were spoken to this was to find out what it was like for people who live here. A tour of the building was undertaken, some of the records looked at included the medication, complaints, quality assurance procedures, 3 resident files, 3 staff files and other paperwork relating to the maintenance of the home and the care of the residents. A discussion with the shift leader occurred regarding diverse needs and in particular how the residents are currently supported to follow their religion of choice and practise their faith. Training courses have being undertaken to ensure that all residents are treated equally and not excluded because of a diverse need. The registered manager was on leave on the day of the inspection, but a shift leader was present throughout the inspection and was told how the inspection had gone at the end of the day. What the service does well: DS0000034679.V329563.R01.S.doc Version 5.2 Page 6 Nicholson House continues to offer a good standard of care. It 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. Residents’ comments indicate that they think a lot of the staff, “the staff are smashing”, “I talk to my key worker when she is on duty”. One relative who was spoken to during the visit confirmed that staff are, “always helpful and polite”. Twenty surveys were returned from residents and some of the comments about the staff included, “can’t fault them at all”, “staff are super” “I know who to complain to” “all staff are lovely and helpful”. Residents’ privacy and dignity is maintained within the home. The home is welcoming and has a relaxed and homely atmosphere. Residents said they are very happy with their bedrooms and can bring in their own possessions, making it feel more like home. The home is exceptionally clean and the staff work hard to make sure the building is odour free. Some comments from residents included; “beautiful and decorated very well, my bedroom is always clean” “my bedroom is lovely”, “spotless, bedroom is beautiful, cleaners are wonderful”. The home is well managed. In addition to the registered manager 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 staff are always looking for ways to make the service a better one for the people who live there. The home works well in partnership with other agencies particularly health staff. A community nurse who was visiting the home confirmed that the staff are; “staff are very good, they listen to advice and take direction”. New and existing staff are given basic training when they start at the home, and then move onto more in-depth work based learning. This ensures residents are cared for by staff that understand their care needs. The menu is nutritious, wholesome and choice is offered, some comments from residents included; “fantastic especially the desserts”, “excellent cook” “meals are very good”, “very good food”. The home has a good complaints procedure and from speaking to residents and relatives they are confident in the management when dealing with any issues. As stated in previous inspection reports a variety of training courses including dementia care mapping, Stroke awareness, Epilepsy, Parkinson’s are DS0000034679.V329563.R01.S.doc Version 5.2 Page 7 accessible to the staff group ensuring that their skills and knowledge are kept up to date. 30 out of the 38 care staff have now achieved NVQ 2 or 3. What has improved since the last inspection? What they could do better: The home offers support to two residents who in addition to memory impairment also have a learning disability, no application to vary the registration has been made nor does the statement of purpose reflect how these diverse needs would be met. The intermediate care residents do not always have planned admissions and therefore limited information comes with them to the home, this could lead to their health and safety being compromised. The structure, teamwork, facilities and stimulating activities for residents receiving intermediate or short-term care should be improved, in order to ensure that the intermediate residents receive the same quality of service and accommodation that the long term residents receive. DS0000034679.V329563.R01.S.doc Version 5.2 Page 8 An action plan must be produced to ensure that the specialist services receive an improved level of input through increased staffing levels, integrated teamwork and designated or specialist staff. If care staff were involved in the assessment process for the intermediate care residents, the home would be able to offer a complete rehabilitation programme. Risk assessments have been updated since the last inspection, these are not specific about the risk, what action is require and when nor are they individual. The medication procedure is clear, but the recording is not always accurate. Although the local authority offers a wide range of both mandatory and more specialised training to it’s staff group, the training records show that this has either not been undertaken or is not up to date and therefore the health and safety of the residents may be at risk. 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. DS0000034679.V329563.R01.S.doc Version 5.2 Page 9 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 DS0000034679.V329563.R01.S.doc Version 5.2 Page 10 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): 2,3,4,5 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s statement of purpose does not reflect the range of needs residents’ may have and the lack of knowledge and training in relation to learning disabilities could prevent needs from being met. Not all residents are assessed prior to or following admission, the intermediate care facility lacks the range of facilities necessary for active rehabilitation and the care staff work in parallel to the health authority staff. This lack of facilities and multi-disciplinary teamwork will not assist residents in maximising their independence. EVIDENCE: DS0000034679.V329563.R01.S.doc Version 5.2 Page 11 During the inspection visit three of the resident’s files were looked at and there was evidence confirming that a contract/statement of terms and conditions is issued and that this covers all the required areas including the room to be occupied, overall care and services offered, fees payable, any additional costs and the terms and conditions of occupancy including the period of notice. Therefore residents are fully informed of what they will receive for their money. Evidence was seen confirming that the permanent and respite residents all have a community care assessment undertaken prior to or within a few days of admission. The home continues to work with the resident and develops a daily living assessment which includes all aspects of daily life within the home such as basic personal details, religion, cultural needs, ethnicity, language used, emergency contacts, personal hygiene, personal care, continence, mobility, medication and mental health. The assessment process for the two dedicated Intermediate Care beds are different as the Health Authority staff assess these residents prior to them coming to live at Nicholson House. Staff spoken to confirmed that sometimes intermediate care residents arrive at very short notice and they may only have a name with no other details. The nursing and other specialist workers (physiotherapists and occupational therapists) do liaise with the care staff, but this is to give direction as to the intervention they have decided is appropriate and they develop the care plan. Senior members of the care staff being involved in the assessment process could assist the integration of these two processes to ensure that the residents’ needs are fully met. From speaking to staff members it was evident that they had a good understanding of the general needs of the residents and some had undertaken training in relation to memory impairment, diabetes and mental health. Some comments made by residents included; “the staff are smashing”, “I talk to my key worker when she is on duty”. One relative who was spoken to during the visit confirmed that staff are, “always helpful and polite”. Twenty surveys were returned from residents and some of the comments about the staff included, “can’t fault them at all”, “staff are super” “I know who to complain to” “all staff are lovely and helpful”. During the inspection visit it was noted that three residents also have learning disabilities in addition to age related problems. The home is not registered to take people who have a learning disability and will need to apply for this category retrospectively. The statement of purpose will also need to reflect how the home intends to meet these needs including staff training in relation to learning disabilities. From speaking to staff members it was evident that they had little knowledge about learning disabilities nor had they undertaken any relevant training. Discussion with the shift leader confirmed that the requirement and recommendation made in relation to intermediate care during the previous DS0000034679.V329563.R01.S.doc Version 5.2 Page 12 inspection visit on 7.3.06 had not been addressed. Residents staying in the Intermediate Care beds have access to a lounge on the first floor, but they do not have separate bathing facilities from the rest of the home. There was a rehabilitation kitchen on the ground floor, but this has been disused for some time. Physiotherapists and an occupational therapist visit the home regularly and carry out their therapeutic practices within the residents’ rooms, or use the facilities (such as staircases) that are available within the home. The shift leader said that there is no dedicated staff team within the home for the Intermediate Care residents as it was not viable to split the team for two beds. This can cause issues for the other residents, especially if the time of an admission into Intermediate Care is not discussed with the home and the individual arrives on mealtimes or at night. The majority of the residents in Nicholson House have dementia and any disturbances to their routine can cause them distress and upset. The provider should look at the impact that the two Intermediate Care beds have on the rest of the residents and consider if these beds could become permanent. Interviews with staff confirmed that they are only asked to provide basic physical care for residents and there is no evidence of plans for their active involvement in the rehabilitative process, which is done by nurses and other medical ancillaries working in the community. There was no evidence of multi disciplinary teamwork or case review on this unit. This will not enable the rehabilitation of residents’ users to be maximised. As stated in the last inspection report this combination of factors indicates that the best use of resources is not made on the intermediate care unit in order to assist service users to return home. DS0000034679.V329563.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 good. This judgement has been made using available evidence including a visit to this service. The care plans cover a variety of areas, but require further development in order to give clear direction to staff about what tasks need to be undertaken and when, also including those receiving intermediate care. The medication recording is not always accurate and therefore the residents’ safety may be compromised. Privacy and dignity is promoted and residents confirmed that they are treated with respect. EVIDENCE: DS0000034679.V329563.R01.S.doc Version 5.2 Page 14 During the inspection three of the residents’ files were looked at and each file contained a photograph of the resident, personal information and details of any specific need such as dietary, diabetic or other health or social care needs. From speaking to the shift leader and from looking at written evidence it would appear that the care plans have been improved since the last inspection. The files are now segregated into sections and are much easier to read and find information. All files contained a referral and admission checklist and this identifies needs, medication, physical, emotional etc. The shift leader explained that from the community care assessment a daily living plan is developed for each person and although this covers a lot of areas, some were more in-depth and prescriptive than others. Also they do not give clear direction to staff about what action or assistance is required and when. The home operates a key worker system and from speaking to several residents it was clear who their worker was and what support they would offer. Some comments made by residents included; “I know who my key worker is and when she is on duty we have a chat”, “the staff are smashing, they make us laugh”. There was evidence in place confirming that regular reviews are undertaken, the residents if they are able to are involved in this process and have a chance to give their views. There are risk assessments in place covering both environmental and individual risk, they are not specific or in depth enough to give clear direction to staff about how to manage the risk. One risk assessment in relation to the bedroom door of a resident being locked whilst on bed rest had been agreed with the family, but not in a multi-agency setting nor had the Fire Department being involved in the decision making. It would appear from speaking to the shift leader that the resident in question has made some improvement and is no longer on ‘bed rest’, therefore it would seem that the risk assessment requires updating and a further review involving all agencies is required. A telephone call was received on 13/02/07 confirming that a best interest review had been arranged and that all relevant stakeholders had been invited. During the inspection visit a Community Nurse was spoken to about the care offered in the home and it was confirmed that staff always listen and act upon advice given by the nursing team. “Staff are very good, the listen to advice and take direction. The home is very clean, staff are always helpful and there is always someone around if needed. Residents who have had pressure sores have received excellent care and have come on well”. Evidence was seen confirming that the residents receive regular healthcare checks for optical, chiropody, dental, nutritional screening is undertaken at the point of admission and residents’ are weighed on a monthly basis. Charts for bowel movement and an assessment re self-medication have been developed, none of the current residents are self-medicating. From speaking to the shift leader it was identified that 6 members of staff have undertaken training in relation to podiatry needs and offer residents assistance with toe cutting and filing. It DS0000034679.V329563.R01.S.doc Version 5.2 Page 15 was also confirmed that the Chiropodist attends on a six weekly basis for those residents who require this support. The home has a medication room, which is kept locked at all times. There is a new medication policy and procedure in place. A discussion with three shift leaders occurred and it explained how the new system had been implemented. Upon inspection of the medication administration records (MAR) the recording was of a good standard with no gaps on the MAR sheets, but it was difficult to ascertain how many tablets had been administered in relation to as and when required medication. The home must develop a system that will clearly show when the medication was given and how many, the Pharmacist should be contacted for further guidance in this area. The amount of new stock received is recorded, but this is not added to the existing stock of medication so therefore it was extremely difficult to carry out an audit. From three records checked none tallied with what medication stock was in the building. There is a controlled drugs cabinet and a controlled drugs register, two staff always signs when administering the controlled medication. There is a refrigerator in the medication room and the temperature is recorded on a regular basis. The shift leaders administer the medication, but not all of them have attended the new accredited course run by the Local Authority. The home does undertake a risk assessment with each resident with regard to self-administration; currently none of the permanent residents are able to self-medicate due to their level of memory impairment or it is their choice not to. Residents’ privacy and dignity is maintained within the home and this was confirmed by speaking to some of the residents, a relative and a community nurse. Some comments included; “the staff knock before they come into my room and they talk to me when they are helping me”, “I have observed the staff assist residents and this is always done in a polite and friendly way”, “I have nothing but praise for the staff they do an excellent job”. One resident confirmed that staff always calls him by the name he prefers. During the visit residents were observed to be individual in their appearance and included in a care plan was to offer a choice of clothing to a resident, as this was important to them. A relative also commented that they were able to “visit any time” and that staff are welcoming. During the visit a community nurse and physiotherapist visited the home and it was observed that they were able to undertake treatment with residents in private. DS0000034679.V329563.R01.S.doc Version 5.2 Page 16 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. A range of recreational activities is provided in the home and resident’s preferences are accommodated. Daily choice for residents is enabled and contact with friends, local community is encouraged. The menu offered is varied and nutritious. EVIDENCE: During the inspection visit several of the residents were spoken to, those who were able to verbally communicate stated that the care they received was of a good standard. Some comments included; “everything is smashing”, “the staff are lovely and if I need anything I just have to ask them”, “the food is very good, they have a very good cook who knows what I like”. Staff were observed interacting with residents and this was carried out in a courteous and DS0000034679.V329563.R01.S.doc Version 5.2 Page 17 professional manner. Some residents who have communication difficulties appeared relaxed and content in their surroundings. Also twenty surveys were received from residents and some of the comments made included; “the girls are very good”, “they talk to me all the time and we have a laugh”, “sometimes I have to wait a few minutes until the girl finds someone else”. From speaking to the shift leader it was confirmed that the religious or cultural needs of residents are catered for. Four to five residents attend church on a regular basis, the shift leader explained, “some of the residents who can go to Church are accompanied by staff and the vicar also comes to see the less able residents once a month”. Regular activities occur including relaxation, bingo, games and sing-a-longs with the staff and outside entertainers. The permanent residents who endure memory impairment are offered activities, but these tend to be individual and for short time periods. Some comments received from residents in the surveys included; “we do lots of things like hangman, throwing rings, prize bingo, cookery sessions, singers, videos”, “Entertainment is especially wonderful”. Visitors are welcomed at any reasonable time and this was confirmed by speaking to residents and a relative. Some comments included; “I can visit my mother at any time, the staff always welcome me and offer me a drink or a meal, I had my Christmas meal here it was very nice”. There are small meeting rooms available to use or residents can receive visitors in the privacy of their own room. Comments were received from visiting healthcare professionals stating that they can see their patient in private and that the staff respect this. The home operates a six-week rotating menu and this is written in large print on a white board. Lunch was observed and consisted of beef stew or lamb cutlets with carrots, mashed potato and cabbage. There was a choice including rice pudding, sugar free jelly with ice cream or fresh fruit. It was very well presented and plentiful. All of the residents spoken to confirmed that the food was of a good standard. One resident said, “The food is very good”. Some residents also completed a survey prior to the inspection visit taking place and comments included; “fantastic especially the desserts”, “excellent cook”, “meals are very good”, “very good food”. One of the cooks was spoken to confirming that themed menus are occasionally offered and these included Indian, Chinese, Spanish and American dishes and she stated that this was to offer a variety of different tastes to the residents. This is in the early stages of development, but once fully implemented along with a picture menu would enhance the menu and take into account the diverse needs of different cultures. DS0000034679.V329563.R01.S.doc Version 5.2 Page 18 Staff were observed in assisting some residents during mealtimes, this was carried out in a sensitive manner. DS0000034679.V329563.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure, which meets the needs of residents who feel their views are listened to. A vulnerable adults procedure and policy is available and staff are formally supervised and trained in order to protect residents from abuse. EVIDENCE: The home has a complaint policy and procedure. There have been several complaints since the last inspection and from speaking to some of the residents and a relative, it was clear that this is made available to them. One resident stated, “if I have any problems I go straight to the manager, she has always sorted it out”. A relative commented, “we were told about how we could complain when we looked around”. From speaking to residents it was clear that they were confident that if they had the need to complain that this would be listened to and taken seriously. There was a folder containing several complaints, the investigation was detailed and so was the outcome. Complainants are asked if they were satisfied with the way the complaint was dealt with. A niggles book has been set up since the previous visit detailing DS0000034679.V329563.R01.S.doc Version 5.2 Page 20 minor issues and how these were dealt with. Compliments and cards are also kept and this forms part of the quality assurance system. A complaint that was received by the CSCI, but passed onto the home to investigate was discussed. This involved a resident being locked in their room for their own safety, the home did call a review to discuss all of the relatives concerns and a plan of action that was agreed by all who attended was put in place, but unfortunately this did not involve all professionals involved in the commissioning of care or the Fire Department. A telephone call was received on 13.02.07 from Nicholson House confirming that a best interest review had been arranged and that both Social Services Care Management and the Fire Department would be represented. The home has a multi-agency policy and procedure for the prevention of abuse, staff have a good understanding of this and training is mandatory. Two staff members were spoken to and they confirmed their knowledge about what the Protection of Vulnerable Adults procedure entailed, all staff have undertaken the training. Staff were able to talk about different types of abuse, signs and symptoms and what they would need to do about it. As detailed earlier in the report the home has a risk management system in place, but the risk assessments require amendment in order to become more individual and specific to the person concerned. DS0000034679.V329563.R01.S.doc Version 5.2 Page 21 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): 19,20,22,24,25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall the homes environment does meet the needs of the long term residents, some areas in particular the intermediate care rooms do not support the rehabilitation process fully. The home provides a safe, comfortable and clean environment for residents, which is pleasant and homely. EVIDENCE: A tour of the building was undertaken confirming that high standards of cleanliness are maintained. Overall the standard of the environment is good and the home is welcoming and warm. The location and layout of the home is DS0000034679.V329563.R01.S.doc Version 5.2 Page 22 not always suitable for it’s stated purpose in particular for the intermediate care residents who do not have access to a range of rehabilitation aids or programmes, therefore the recovery or rehabilitation period can be hindered. The intermediate care resident’s rooms are suitable in meeting their basic needs and all have a wash hand basin, there are no en-suite toilet or shower/bath facilities that would enhance the rehabilitation programme. There is a communal lounge dedicated to the intermediate care beds, but no rehabilitation kitchen to use. There is a toilet; shower and bathroom that is located near to the intermediate care beds. The lighting for the majority of the home was domestic in style and appearance, apart from the downstairs toilets and these were old and industrial. The toilets on the ground floor were also very old and ‘institutional’ in appearance. All of the toilets and bathrooms were clearly marked with both picture and written notices in place. The home does have a maintenance plan in place and identifies work to be carried out on a priority basis. There is a large outside patio area with seating to the rear of the building and a smaller patio and garden area to the side. The grounds were tidy, safe and accessible to all residents. CCTV is only used in the main foyer and car park area and does not intrude on the daily lives of the residents. The home provides a range of aids and adaptations that would aid independence to the permanent residents including; assisted baths, assisted shower room that has disabled access, ceiling track hoist, mobile hoists and other individual aids such as slings. There were grab rails fitted to toilet and bathroom areas, also in the corridors. All of the equipment that is used to move and assist residents was serviced and records confirmed that these were up to date. The passenger lift is serviced on a monthly basis. The home has a range of commodes and some of these although clean, were very old and stood out from the rest of the furniture in the residents’ bedrooms. Individuals’ bedrooms were homely, comfortable and contained a good standard of furniture. All rooms were carpeted or had a non-slip floor covering in place. The home has a central heating system in place and during the visit the environment was warm and welcoming. Residents cannot control the temperature as this is done centrally and therefore residents’ choice is limited to what temperature they would prefer in their own bedroom. Although all of the water outlets have regulators fitted that should ensure that the hot water distributes at a safe temperature, one bath in Zone 6 was found to be distributing at 55 degrees centigrade. The shift leader gave instruction for the bathroom to be locked and an out of order sign was erected immediately. The council resources section was also contacted and it was confirmed that a plumbing contractor would be at the home within 24 hours. DS0000034679.V329563.R01.S.doc Version 5.2 Page 23 A telephone call was received from the home on 6/02/07 confirming that the regulator device had been serviced and the water was distributing at near to 43 degrees. This situation was dealt with in a professional and efficient manner, the residents’ health and safety was maintained throughout. There was no offensive odours detected and the domestic team should be complimented about the excellent level of cleanliness throughout the home. The home has two laundry rooms, one of the ground floor and one on the first floor. There are good infection control procedures in place, all staff have received infection control training. In the entrance area there is alcohol gel for all visitors to use prior to entering the home. Several of the residents were spoken to confirming that they had everything they needed in their individual rooms, some comments included, “the home is very clean”, “it never has a smell”, “I had my room decorated and a new floor put in and I really like it”. Surveys returned from relatives indicated that the home was very clean and hygienic. Surveys from residents also commented about the environment, “beautiful and decorated very well, bedroom always clean”, “my bedroom is lovely”, “my room is lovely and I had a Christmas tree, I have beautiful dolls and a TV and a radio”, “spotless, bedroom beautiful, cleaners are wonderful”. DS0000034679.V329563.R01.S.doc Version 5.2 Page 24 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. The home is staffed to provide a good level of basic care for a group of persons with problems associated with aging requiring long term care. However this staffing level and the training staff receive must be critically examined in order to ensure that all the needs of persons of multiple categories and high dependency levels can be met in the variety of forms of care that are on offer at the home. Issues related to this matter are commented on in all areas of this report directly related to residents care. The home’s recruitment and selection procedure does protect the residents. Although the local authority offers a wide range of both mandatory and more specialised training to it’s staff group, the training records show that this has not been undertaken on a regular basis and therefore the health and safety of the residents may be at risk. EVIDENCE: DS0000034679.V329563.R01.S.doc Version 5.2 Page 25 Whist the staffing level is appropriate if the home-contained only resident’s with long-term care needs. It does not support the variety of designations including intermediate care needs. Evidence is presented in previous sections of this report on this issue, which indicates a shortfall in care needs of the short stay group of residents. The service provider needs to critically examine the staffing level to ensure that all the needs of residents can be met. From speaking to several staff members, relatives and residents it was clear that for most of the time the staffing levels are sufficient, but there are occasions when as residents stated, “Sometimes they are very busy and I have to wait a while”, “sometimes the staff are busy helping others so I do not always get what I need there and then”. Some comments from staff members included, “usually we have enough staff on duty during the day, but sometimes it can be stretched when one or more residents require at least 2 staff to assist”. Some of the surveys completed by residents and relatives confirmed that staff are not always around when needed. There was written evidence confirming that 78.9 of staff including agency staff used have now achieved NVQ level 2, which exceeds the minimum required amount of 50 , it also ensures that residents receive support from a well-trained, knowledgeable and qualified staff group. During the inspection visit three staff files were looked at confirming that the recruitment procedure is adhered to, all files contained evidence that a current Criminal Records Bureau check had been obtained. The majority of the personnel records are held at Brunswick House, the Local Authority’s head quarters and this agreement has been made with CSCI. From speaking to the staff members it was clear that they had a good understanding of the long-term residents’ needs and could describe what care tasks were undertaken. It proved more difficult for them to describe the needs of the residents with learning disabilities or who were receiving intermediate care. They also confirmed that they did not receive any training in relation to these more specialised areas and this could have an affect upon the actual care given to residents. It was clear that the ethos of the home is to offer a high standard of care in a sensitive and supportive way that would maintain the residents’ dignity, independence and choice. The home has a training plan and keeps records on individual staff files. All of the mandatory training is offered to the staff including moving and handling, fire safety, first aid, health and safety, the protection of vulnerable adults and infection control, but unfortunately not all staff have undertaken the training as regular as it should be. The local authority has an induction and foundation training package that meets the specification of the Skills for Care targets. A discussion occurred with the shift leader about three residents who in addition to memory impairment also have a learning disability. The shift leader explained that the three residents had lived there for a number of years and DS0000034679.V329563.R01.S.doc Version 5.2 Page 26 the community mental health team and psychiatrist on a regular basis gave them advice. Although this is positive in attempting to meet individual’s needs, there was a lack of planning and discussion about whether this would be an appropriate placement. None of the staff at Nicholson House have undertaken training in relation to learning disabilities. As mentioned earlier in the report the registered person would need to apply to vary the home’s registration in order to be able to accommodate people with learning disabilities. Two staff members were spoken to about their role and responsibilities, all were able to describe what their role was and how they support the residents. The staff demonstrate a good knowledge regarding the care needs of residents. Some comments included; “I treat people with respect and help keep their dignity”, “I always knock on the door before going into a bedroom”. One staff member said, “mandatory training is done quickly within 3 months of starting work”, “I have achieved NVQ level 2 and other training including diabetes, stroke awareness, difference and diversity”, “I feel that the training is excellent and opportunities are there”. Staff spoken to were able to describe methods of good practice and had a clear understanding of the needs of the long term residents, they stated that they do not receive any training in relation to intermediate care or rehabilitation techniques and feel that staffing levels are insufficient when the home is at full capacity with the intermediate care residents who require two or more staff to assist with personal care. DS0000034679.V329563.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): 31,32,33,35,36,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home is carried out with leadership and appropriate guidance; ensuring residents receive a quality of care and a resident centred ethos is promoted within the home. Resident’s financial affairs are safeguarded by the homes policy. Overall the health, safety and welfare of residents and staff are promoted and protected, the individual and generic risk assessments require further development to ensure staff are fully informed about any risk to residents. EVIDENCE: DS0000034679.V329563.R01.S.doc Version 5.2 Page 28 Since the last inspection the manager has achieved NVQ level 4 in both care and management. There are clear lines of accountability within the home and from speaking to staff it was evident that the manager is open and approachable in her manner. Some comments included, “the manager is firm, but fair”, “I can go to Carol with any queries or issues and these are dealt with quickly”. The home has a quality assurance system and surveys are given to residents, relatives and staff. Currently other people including other professionals (GP’s, social workers, district nurses) are not included in the process and therefore this limits the information that the home receives in relation to the overall care and support offered. The information is collated twice yearly and an annual report is produced giving the results, this was shared with the residents, but a copy was not forwarded to the CSCI. Evidence was seen that regular residents’ and staff meetings are held. Compliments are also recorded and these are considerable in numbers. All of the surveys that were returned to the CSCI before the inspection visit were all extremely positive about the home, stating that a very high standard of care was offered. The home has also achieved Parts 1 & 2 of the Local Authority Quality Development Scheme. Residents’ money and financial interests are safeguarded and written transactions are maintained. It was confirmed by speaking to staff and from looking at written evidence that regular supervision is offered. One staff member said, “I receive supervision on a regular basis and can go to my line manager at any point if there is a problem”, “I love it here and wouldn’t change my job for anything”. During the visit it was confirmed from speaking to the shift leaders and staff and from looking at written evidence that the home offers a range of support to people with diverse needs. The home is registered for people over the age of 65 with their primary need being old age. The majority of staff have undertaken training in relation to equality and diversity training as this is mandatory training offered by the Local Authority. One staff member said, “I have been on the equality and diversity training and here at Nicholson House we try to accept people for who they are and treat them with respect”. The shift leader stated that currently there are no residents who have a different culture, religious beliefs are fully supported and in conversation with several residents this was confirmed. The home offers varied meals and themed food days are held, these include Indian, Chinese and American, there was written evidence to confirm this. Residents were able to recall the various menus and talked fondly about the different food they had tried. Mental Capacity Act training has also been arranged for staff to ensure that they fully understand the new legislation that comes into force from April 2007. The DS0000034679.V329563.R01.S.doc Version 5.2 Page 29 staff spoken to could explain how this may affect the residents they support, one said “everyone should be listened to and get the support they need”. Overall the health and safety of the residents is ensured by having all of the appropriate maintenance certificates in place, regular checks on these take place and evidence was seen confirming this. Staff undertake all health and safety courses within the first 6 months of employment ensuring that the staff are knowledgeable and have the necessary skills to deal with emergencies. All accidents and incidents are reported and recorded appropriately; regulation 37 notices are forwarded to the Commission for Social Care Inspection. Unannounced monthly visits are undertaken by the Local Authority to ensure that the standard of care is maintained and copies of the reports are kept in the home. As mentioned earlier in the report although all of the water outlets have regulators fitted that should ensure that the hot water distributes at a safe temperature, one bath in Zone 6 was found to be distributing at 55 degrees centigrade. The shift leader gave instruction for the bathroom to be locked and an out of order sign was erected immediately. The council resources section was also contacted and it was confirmed that a plumbing contractor would be at the home within 24 hours. A telephone call was received from the home on 6/02/07 confirming that the regulator device had been serviced and the water was distributing at near to 43 degrees. This situation was dealt with in a professional and efficient manner, the residents’ health and safety was maintained throughout. The fire risk assessment has been updated since the last inspection. All staff receive annual fire safety training and the fire alarm and equipment are checked and maintained. The generic and individual risk assessments have been reviewed, and although there are risk assessments in place for almost every eventuality these require further development. This is to ensure that staff are given clear information about what the risk is, how it can be managed and what intervention they would need to take, in other words they need to be specific, give direction about who does what and when. The home has reduced its number from 30 to 29 by changing the use of a bedroom to an office. An application to vary the registration must be submitted retrospectively in order to comply with the regulations. DS0000034679.V329563.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 X 3 2 2 3 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 X 2 X 3 2 4 STAFFING Standard No Score 27 2 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 3 2 DS0000034679.V329563.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 Standard OP1 Regulation 4,5 Sch 1 Requirement The registered person must provide information in the statement of purpose/service user guide regarding how the needs’ of residents who have a learning disability will be met. An application must be submitted to request this variation to registration retrospectively. The care staff must become involved in the assessment and care planning process for intermediate care residents. The registered person must be able to demonstrate that the diverse needs of residents’ can be met, in particular those with learning disabilities. Staff must individually and collectively have the skills and experience to deliver the care, which the home offers to provide. The service provider must develop multi-disciplinary teamwork and short-term review of residents on the intermediate care unit. DS0000034679.V329563.R01.S.doc Timescale for action 05/06/07 2 OP2 14 05/06/07 3 OP4 12,13,16, 17,18,23 05/06/07 4 OP6 14 05/06/07 Version 5.2 Page 32 5 OP6 23 Where residents are admitted only for intermediate care, dedicated accommodation must be provided, together with specialised facilities, equipment and staff, to deliver short-term intensive rehabilitation and enable residents to return home. Care plans must be developed for all residents including the intermediate care unit. Risk assessments require further development and must be personal to the individual, also giving clear direction to staff. The registered person must seek advice and guidance from the pharmacist with regard to the stock control system. If a resident’s door is to be locked, there must be written evidence that this was a multidisciplinary agreement. In particular evidence from the Fire Department that this is acceptable to them. Several of the commodes require replacement to maintain the good quality of furnishings in the home. The central heating system must enable residents to be able to individually control the temperature within their own bedroom. The home must ensure that water is distributed as close to 43 degrees centigrade as possible and a record kept. The registered person will need to critically review the staffing levels to ensure that at all times suitably qualified competent and experienced persons are working in the home in such numbers as DS0000034679.V329563.R01.S.doc 05/10/07 6 OP7 15 05/06/07 7 OP7 12,13 05/06/07 8 OP9 13 05/06/07 9 OP18 12,13,16, 17 05/06/07 10 OP22 23 05/06/07 11 OP25 23 05/10/07 12 OP25 23 07/02/07 13 OP27 18 05/06/07 Version 5.2 Page 33 are appropriate for the health and welfare of the residents paying particular attention to the intermediate care beds. 14 OP30 17,18 Mandatory training must be kept up to date including first aid, infection control, protection of vulnerable adults, health and safety and moving and handling. Training must be undertaken in relation to learning disabilities and meet the specification of the Learning Disability Assessment Framework. The quality assurance system must include consultation with others involved in the care of residents including GP’s, District Nurses, other health and social care workers and a copy of the annual report produced must be forwarded to the CSCI. See standard 30. All staff must undertake and keep up to date training in relation to maintaining the health and safety of the residents including; first aid, infection control, protection of vulnerable adults and moving and handling with records kept confirming this. An application to vary the registration must be submitted with regard to the home reducing its registration to 29 from 30 places. 05/06/07 15 OP30 17,18 05/06/07 16 OP33 17,24 05/06/07 17 OP38 12,13,17, 18 05/06/07 18 OP38 39 05/06/07 DS0000034679.V329563.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 OP6 Good Practice Recommendations The provider should look at the impact that the two ICT beds have on the rest of the residents and consider if these beds could become permanent. Specific care staff should be designated to or specialise in the work of the intermediate care unit. The lighting in the downstairs’ toilets should be domestic in style. The registered person should consider creating en-suite facilities in the intermediate care residents’ rooms to promote and assist with re-integration. The registered person should give consideration to the development of communal space/rehabilitation kitchen for the intermediate care residents. 2 3 4 OP6 OP20 OP21 5 OP22 DS0000034679.V329563.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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. Extracts may not be used or reproduced without the express permission of CSCI DS0000034679.V329563.R01.S.doc Version 5.2 Page 36 - 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. 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