Inspection on 13/06/06 for Northlands House Nursing Home

This inspection was carried out on 13th June 2006.

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

Northlands House Nursing Home 21/07/08

Northlands House Nursing Home 31/08/07

Northlands House Nursing Home 07/12/05

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Northlands House Nursing Home 6 Westrow Road Southampton Hampshire SO15 2LY Lead Inspector Jan Everitt Unannounced Inspection 13th June 2006 08:30 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 Northlands House Nursing Home DS0000064233.V289393.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. Northlands House Nursing Home DS0000064233.V289393.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Northlands House Nursing Home Address 6 Westrow Road Southampton Hampshire SO15 2LY 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) 02380 717600 02380 717601 WILLDEBB@BUP.COM www.bupa.co.uk BUPA Care Homes (CFCHomes) Limited Mrs Moira Baxter Care Home 101 Category(ies) of Old age, not falling within any other category registration, with number (101), Physical disability over 65 years of age of places (101) Northlands House Nursing Home DS0000064233.V289393.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th December 2005 Brief Description of the Service: Northlands House Nursing Home is a purpose built nursing home that was registered and opened in July 2005. The Home is owned and run by BUPA and is part of a joint initiative with Southampton City Council, who own the land the building is on. As a consequence of this joint working, Southampton City Council have a remit to be able to accommodate 70 of the 101 beds registered for elderly people who have been assessed as needing nursing care, who are physically disabled and who are residents within the Southampton city boundaries. The home is not occupied by the full complement of residents for which it is registered and the organisation has phased admission criteria for twelve people to be admitted per month. At the time of the inspection 65 service users were in residence. The home is on three floors and all rooms are single occupancy with en-suite shower room facilities. The interior and fixtures and fittings have been completed to a high specification with lifting aid and adjustable beds available throughout the home. The new building is on the site of the old Northlands House, which at one time was a local authority home and one, which many of the Southampton residents remember. The house is situated in a quiet residential area, close to the city centre of Southampton. Northlands House Nursing Home DS0000064233.V289393.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit to Northlands House Nursing Home, which was unannounced, took place over a two day period on the 13th and 14th June 2006 and was attended by two inspectors. The registered manager assisted the inspectors throughout the two day process. The visit to Northlands House formed part of the process of the inspection of the service to include all the key standards for the year 2006/7. The focus of this visit was to support the information gathered prior to the visit and to monitor how the home is evolving as a growing service, having been opened for just one year and not yet fully complemented with the 101 service users that are registered to be accommodate. The judgements made in this report were made from information gathered prior to the visit, pre-inspection information submitted to the commission by the proprietor, information from the previous report, the service history and correspondence and records of a management meeting that took place in March with the CSCI following a succession of complaints, one resulting in an adult protection investigation by social services. Contact sheets appertaining to the service were also taken into consideration. A number of comment survey cards were sent to relatives prior to the visit of which 7 were returned. They were generally very positive about the care and services but they also identified issues that were discussed with the manager. 15 service users’ comment cards were also received prior to the visit and these were taken into consideration when formulating the judgements and the report. 1 visiting social worker returned a comment survey card and commented that home had improved since opening. The over-riding issue highlighted from the survey was the perception of lack of staff and the time it took staff to respond to the service users call bells. Further evidence was gathered at the two-day site visit. The inspector toured the building and spoke with a number of the residents and a number of staff and visitors. The visiting GP who attends the home spoke with the inspectors on both days and he was complimentary about the care they give but commented that he was initially unprepared for the high level of dependency of the residents transferred from hospitals and likened the home to a community hospital without the resources. The inspector viewed a sample of records, including personnel files but found it difficult to observe practices as most of them were taking place in separate rooms behind closed doors, and a number of service user chose to stay in their rooms all of the time. Northlands House Nursing Home DS0000064233.V289393.R01.S.doc Version 5.2 Page 6 The atmosphere in the home was relaxed but very busy and the call alarm bells were going off constantly. Staff were observed to be working in pairs and were allocated to the same floor for a length of time to ensure continuity of care. What the service does well: What has improved since the last inspection? The home was commissioned one year ago and being a new service has undergone some problems with recruitment of appropriate staff, training and gelling as a team. These teething problems are now being resolved. More staff have been recruited and staff training is high on the agenda for the home and from observations at the time of this visit it would appear that staff are now working as a team and there is less need for agency staff to be employed. The care planning system is now more established and is detailed in content. All service users are risk assessed for nutritional status, tissue viability, dependency and any other problems identified during the admission assessment. The home has now employed three activities organisers who have coordinated a varied programme of activities to meet most service users preferences. Service users were observed to be enjoying the activities taking place and the comments received were, in general, positive. The programme for formal supervision is developing, although staff spoken with did not demonstrate a full understanding of appraisal and supervision and the concepts behind why this takes place. The inspector observed that the service users’ clothes ready to leave the laundry were now presentable and the outcomes for the service user more acceptable than the observations from the previous visit. Northlands House Nursing Home DS0000064233.V289393.R01.S.doc Version 5.2 Page 7 The organisation of the kitchen area and the serving of the meals were less chaotic than the previous inspection visit and plans are in place to improve the serving area in the dining room. The manager reports that there is much improvement in the menu and the choices available and service users comments received were ‘very good’, chef tries hard to please us’. 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 Northlands House Nursing Home DS0000064233.V289393.R01.S.doc Version 5.2 Page 8 contacting your local CSCI office. Northlands House Nursing Home DS0000064233.V289393.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 Northlands House Nursing Home DS0000064233.V289393.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 & 3. Standard 6 is not applicable to this service. Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to this service, viewing documentation and communicating with service users and relatives. Not all service users have a terms and condition of residency at the point of admission to the home. Service users have their social and health needs assessed before being admitted to the home to ensure the home can meet these needs. EVIDENCE: The home has a block contract with social services for 76 beds. The manager does not see the contract and is not aware of how the fees are broken down for each service users who is funded. A sample of service users personal files was viewed. Contracts with the home and Social Services were evidenced along with assessment of needs but the service users are not given the terms and conditions of residency if they are funded. It was discussed with the manager that all service users should have a copy of the terms and conditions. Northlands House Nursing Home DS0000064233.V289393.R01.S.doc Version 5.2 Page 11 This was supported by five out of ten service users comments on their survey questionnaires that they had not seen any information about their terms and conditions prior to admission to the home and little information given, just shown photographs, and one service user commented that they did not understand what a contract was. One of the five service users whose file was viewed was privately funded and this file contained a signed terms and conditions of residency but did not have a breakdown of fees or the room to be occupied. A sample of preadmission assessments was evidenced and the assessment tool was considered to be comprehensive in content and covered all the activities of daily living. The manager and/or her deputy and/or senior nurse will undertake the pre admission assessments in whatever setting the referral has come from, which is generally via the local hospitals. The manager explained that the home would receive referrals from two sources, those being referred who are being funded by social services and those who will privately fund their own care. All nursing aspects of care are assessed and funded by the Primary Care Trust. The manager further explained that if the pre admission assessment for those being funded by social services, is not undertaken within three days from the referral, the home incurs cost penalties for every day after the third day for each service user referred. The manager reported that this puts she and her deputy under pressure to fulfil the contractual agreements, as the block purchasing of beds by social services has not yet reached full occupancy. During the early months of 2006 it was noted via regulation 37 notices to the CSCI that the death rate was particularly high for the home, being that the home was not full at that time. This was discussed on several occasions with the manager and again discussed as part of a management meeting with the manager and operational manager. The outcome of this was that the home was expected to admit very sick people to vacate hospital beds and the manager felt powerless to refuse to admit these service users, as the need for hospital beds was high. The consequence of this is, that the home has now a very high dependency of service users with complex needs. This situation has subsequently been discussed at meetings with the home management and social services and there is an agreement that the management or whoever assesses the service user makes the decision whether that person’s needs can be met with all the contributing factors taken into account. The home is already experiencing shortage of appropriate equipment and availability of medical resources and professionals allied to health. Northlands House Nursing Home DS0000064233.V289393.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service, viewing documentation and communicating with staff and service users. Care planning system has improved since the last inspection and the information is comprehensive. The care planning system is also moving towards a more person centred approach. Service users’ health care needs are not being fully met. This is not the fault of failings of the home and is dependant on resources available from the PCT. Service users are protected by the policies and procedures for managing medication and staff are maintaining safe practices within their professional guidelines. Service users’ privacy and dignity is respected at all times. EVIDENCE: The care planning system has developed since the last inspection. Through the new pre-admission assessment, service users’ needs are clearly identified and transferred to an individual care plan. In addition the home is moving Northlands House Nursing Home DS0000064233.V289393.R01.S.doc Version 5.2 Page 13 towards a more person centred approach to care planning by documenting residents life history and finding out the things they wish to be involved in. Care plans are accessible for staff and are stored in a lockable filing cabinet at the nurses’ station on each floor. The care planning file is divided into sections. Seven care planning files were viewed. All files contained comprehensive information. Although most care plans were detailed to a satisfactory standard, one service user, whose care management assessment and pre-admission assessment had detailed special dietary and support requirements related to cultural and religious beliefs, had not had the information transferred to his care plan. The inspectors were informed that the care plan had not been completed as he had only been admitted a couple of weeks previously. However, these identified needs could be fundamental to his health and welfare and needed to be addressed as soon as he was admitted to the home. The home must ensure that details around residents’ cultural and religious needs are identified on admission to the home and care plans drawn up urgently to support the resident’s specific needs. The care plans are reviewed monthly and, if appropriate, with the service users’ involvement. Seven survey comment cards received by the CSCI from relatives confirmed that they are kept informed of important matters affecting the service user. However, one comment was that the family had to continually ask for information. A survey card received from a placing care manager comment that there was minimal information in care plans. The inspectors could find no evidence of these findings and concluded that this was further evidence that the system had improved since the last inspection. The home has the services of two GPs who visit Monday to Friday. At the time of this visit the GP who visits the home about 3 days a week, described his experience of the home and praised the work of the staff, under difficult circumstances. The other GP who visits usually sees the newly admitted service users and undertakes a full medical clerking-in of that person. The GP spoken with stated that he or his practice did not realise the level of dependency was going to be so high. Initially a GP was going to be assigned to the home. However, the person who was appointed left before the home was opened and it is now covered by two GPs. The GP stated that the home is like a community hospital without the resources. He has made requests for wheelchairs for residents with high dependency but has been refused by PCT – The PCT feel enough resources have gone into the home. There is poor provision for referral to professionals allied to health. The GP gave an example of one lady who is very disabled and who has a very irritating skin condition and the GP is unable to access a dermatologist for an opinion and diagnosis for this lady, whose conditions causes her discomfort and who is unable to respond in any way to the obvious Northlands House Nursing Home DS0000064233.V289393.R01.S.doc Version 5.2 Page 14 skin irritation this condition is causing her. He went on to say that a high number of residents are on PEG feeds and there is a real need for speech therapy for swallow assessments and dietary advice but the therapists will not undertake domiciliary visits to the home so the GP has to refer them back to hospital to be seen, which is totally unrealistic given the physical disability and medical condition of these residents and their vulnerability to hospital acquired infections. The GP reported that many of the relatives are verbally requesting that their loved ones are not admitted to the hospital if there is a medical crisis and wish them to stay at the home. This occurred when the inspectors were at the home and a family told the doctor they would prefer their mother to stay at the home as they realised she was in no fit state in undergo surgery if it was necessary but did not want her stuck in a hospital ward vulnerable to other infections and not being cared for appropriately by people who did not have time to care for her as the home did. The GP reported that he spends quite a lot of time speaking with relatives and whilst the visit was taking place it was observed that the nursing staff were requesting the GP to speak to one or another relative. A relative returned a comment to say that he has to continually ask what the doctor has reported about his mother. The perception of the relatives is that there is a doctor attending the home every day and therefore residents are seen regularly and the provision for care equates to that in a hospital setting, which is not the case. The GP reported that he has lots of concerns with regard to the level of dependency and the lack of resources in the home. He said that the care is very good in the home, but the building design hinders the care. He said it is difficult for staff to respond quickly to service users’ requests due to the geographical layout of the home. The nursing station is inadequate to work at and there is a total lack of privacy and ability to keep information confidential. From speaking to the GP and from evidence gathered at the inspection the level of residents being admitted who are high dependency is a cause for concern not only due to the lack of resources in terms of specialist equipment but also the lack of health professional input, such as consultants and speech & language therapists into the home to meet the high level of need. In addition, the geographical layout does pose difficulties for staff to respond quickly to residents needs. Observation throughout the two days indicated that staff are working under pressure, bleepers were going off all the time and staff were trying to respond as quickly as they can. Staff spoken with said that they are surprised by the level of dependency but feel they are getting the training and support to meet peoples’ needs. The district nurse attached to the GP surgery will attend the home if requested to give advice or opinion on clinical issues. The chiropodist visits the home regularly, for which there is an extra charge. However, there is little provision for a visiting dentist and a relative commented that her father’s teeth continually fall out and she has requested something be done but it seems to fall on ‘deaf ears’. Northlands House Nursing Home DS0000064233.V289393.R01.S.doc Version 5.2 Page 15 The medication policy and procedures were viewed and the inspector observed that the nurse undertaking the morning medicine round took the trolley around the home with her and administered the medicines as per stated procedure. The home uses the monitored dose system and this is delivered to the home in blister packs colour coded for each prescribed time of the day. The nurse who coordinates the ordering, receipt and storage of medicines, reported that the home had changed pharmacist and was now receiving a better service. The home has a policy on the destruction of unwanted medicines and has a contract with a waste disposal company. The inspector observed that the medicine trolleys, one on each floor, were locked securely away when not in use. The treatment rooms are very small and the trolleys are locked in another located cupboard. The inspector viewed the cupboards and controlled drugs cupboard. The inspector checked a sample of stock against the balance in the controlled drugs register and they tallied. It was observed that in general, considering the size of the home, the medicine stocks for PRN medicines (as needed) were low and the cupboards and trolleys were neat and clean. The drugs fridge in the treatment room was locked and temperatures were recorded daily and were noted to be within safe parameters for storage. The inspector also observed the good practice of recording on packaging the dates that eye drops and medicines are opened to ensure their shelf life is adhered to. Service users spoken with reported that they receive their medication at appropriate times and support given if it is needed. Registered nurses only administer medication. The inspector viewed the MAR sheets and these were found to be recorded appropriately with no gaps observed. The deputy manager audits the medication record sheets monthly. One service user was choosing to selfmedicate and this had been risk assessed and she was storing her medicines within a locked environment in her room. All bedrooms are single occupancy with large en-suite shower facilities. There is a lockable storage facility in all rooms. The inspectors observed that staff were treating service users with dignity and respecting their wishes and privacy. A service user spoken with reported that she does like to stay in her room and likes to go to bed at a particular time. Her preferred bedtime activity was documented in her care plan and she reported that she usually goes to bed at the time she wishes but just sometimes it can be later if there is a staff shortage. The manager reported that there is always a full complement of staff on duty particularly at night and that they cannot always assist service users to bed at the exact time they wish but do their best to do so. Staff were observed knocking on doors before entering rooms. Northlands House Nursing Home DS0000064233.V289393.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service, viewing documentation and communicating with staff and service users. The activities and routines of daily living are varied and give choices to service users to participate in the life of the home to suit their own expectations, preferences and capacities. The home is welcoming and receives a high number of visitors from the community throughout each day and service users are able to maintain contact with families and the local community. Service users are provided with choices of a wholesome well balanced diet that suits their individual assessed needs, in pleasant surroundings of their choice. EVIDENCE: The home now employs three activities organisers and one is on duty every day except a Saturday. At the time of this visit three organisers were on duty, one was playing a word game with a group of people, whilst the other was playing a board game with a smaller group, the third was watering the plants that the service users had been supported in planting on raised beds to create a sensory garden. The inspector observed that one activities organiser came Northlands House Nursing Home DS0000064233.V289393.R01.S.doc Version 5.2 Page 17 into the lounge to invite service users to join in activities and he was warmly greeted by the service users who were obviously keen to participate in the events of the afternoon. The activities programme was displayed on the notice board in the hallway and this demonstrated that there were activities available everyday except Saturdays. The programme was varied and would accommodate most people’s preferences. Four of the fifteen service user survey comment cards received by CSCI commented that they always participate in the activities, four said usually and one said sometimes. One other service user said ‘not really suited to my eye sight, ‘do not always go as I like my own company’. One service user reported that the programme looks good but ‘no go’ at weekends. The programme on display did not support this. The newly recruited activities organiser was spoken with, she reported that she is very interested in gaining more knowledge on cognitive pathways to communication and believes that the recording of a thorough service user’s social history is the basis on which to build communication channels with service users who have poor cognitive abilities. The visitor’s book evidenced that many visitors come to the home throughout the day. The inspectors observed that many relatives come to the home from early morning and the inspectors were able to speak to a number of them. The manager reports that many of the visitors take meals at the home with their relatives especially Sunday lunch and are welcome and if requested a separate table will be set up in one of the small lounges to allow the family privacy. All service users have a phone line in their room and one lady was observed to have a special phone for those partially sighted. Service users do go out with their relatives and one service user goes into the community independently. The manager reports that service users are able to bring to the home personal belongings and any special furniture if it adheres to fire regulations. The rooms are pleasantly furnished but some service user have chosen to bring some favourite pieces from their home to personalise their rooms. The rooms visited by the inspectors had been personalised with photographs and pictures. There was evidence of service users choices being respected and their preferences for getting up and going to bed were documented in the care plans. The service users spoken with reported that generally they do as they please when they please but of course this is not always possible if there is not the staff available. Service users are able to manage their own finances for as long as they able. Relatives usually take over the management of these once they are unable to do so. The inspectors witnessed that the staff were heard to give service users choices as to their menus and also if they wished to join in activities. Northlands House Nursing Home DS0000064233.V289393.R01.S.doc Version 5.2 Page 18 The inspectors toured the kitchen area, which was clean and well organised. The chef provided evidence of his auditing and checking of equipment and temperatures for food as stated in Environmental Health guidance provided to care homes called the safer food, better business guidance by the Food Standards agency. The previous report for the home made comment that it had been identified that the kitchen was too small for the provision of the large volume of food prepared each day. The home has now employed a new chef and it has been identified that the kitchen area is large enough but the serving areas in each of the dining rooms must be redesigned to provide more heating facilities and a washing up machine to save the time it takes the kitchen assistant to pack the crockery and take it back to the kitchen for washing. The heating cupboards are being extended in size also. A sample of four weeks menus were submitted with the pre inspection documentation and this together with observation of the food served at the time of the visit, would suggest that the home provides a varied and nutritious diet. The inspector observed that nutritional assessments are now undertaken on all admissions. Special diets are provided for those identified as needing them. One gentleman was identified as needing special dietary requirements and eats Halal food only and does not eat pork – in the homes assessment it states dietary requirements does not eat pork – normal diet – likes spicy food, the chef reported that this service user does receive a Halal diet and was knowledgeable about this diet, which evidenced that resident’s religious and cultural needs are respected. The inspectors observed support was being given to those service users who needed assistance with their feeding. However, speaking to the service users and the analysis of the comment cards received by the CSCI from service users, it would appear there are mixed opinions about the quality and presentation of the meals. Comments such as ‘a bit dry’, ‘chef tries hard but sometimes the food is nearly cold and like cardboard’ were received, conversely talking to service users at the time of the visit there was generally a high degree of satisfaction with the food and comments such as ‘excellent food’, ‘we are given lots of choice’. Comments from visitors also refute the negative comments and they report that the food is excellent and the manager reports that the home provides a high quantity of meals for families especially at weekends. From observation at the time of the visit there were nutritious meals being served with fresh vegetables and fruit available every day. Afternoon tea is served every day with a cake made by the chef. The chef reported that there is food and snacks available at all times of the day and night and he leaves a plate of sandwiches for service users who wish to take a late supper. Service users are able to discuss any issues about the food at the service user’s monthly meetings or discuss their discontent with the manager. Northlands House Nursing Home DS0000064233.V289393.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 116 &18 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service, viewing documentation and communicating with staff and service users. Service users and relatives are confident that their complaints are listened to and acted on. Service users are protected from abuse and the adult protection policy and procedure that has been followed by the home. EVIDENCE: The home has an organisation complaints policy and is part of the statement of purpose and the information given to service users and/or relatives on admission or before admission. The complaints log was viewed. This log is audited monthly and outcomes documented. The log revealed that three complaints had been recorded one being an adult protection issues and was handed over to Social Services adult protection team for investigation. The other two complaints, two of which came to the CSCI initially and was passed to the manager and have been investigated by the manager and the operational manager and in the main have been resolved. The inspector spoke to two visitors whilst at the home. They had been one of the complainants some weeks previously and had written to the CSCI with issues about the care of their friend. This had subsequently been dealt with by the manager, to the complainant’s satisfaction and he had written to the CSCI to say that the issues had been resolved and that he was happy with the Northlands House Nursing Home DS0000064233.V289393.R01.S.doc Version 5.2 Page 20 outcome. He reported to me at the time of the visit that in general he was pleased with the care his friend was receiving but there remained elements of his care that he criticised. I advised that he should speak to the manager/deputy manager, at the time the issues arise. The CSCI held a management meeting in March to discuss the content of the complaints and issues that had been raised to them and the management of the home. The emerging themes around issues of communication, staffing, care practices and families perceptions and expectations for their relative being placed at Northlands, was thought to be the main reasons for the complaints along with the inappropriateness of some residents being transferred to the home from hospital in a very poor state of health. The results of the comment survey returns from service users and relatives indicated that six out of the seven completed were aware of the complaints procedure and had indeed make complaints to the home. Nine out of the fifteen service users survey comment cards received reported they knew how to make complaints and to whom, with a comment like ‘would make it to someone in authority’. Others said they had no complaints. When service users were asked who they would speak to if they were not happy, ten of the fifteen reported they ‘ were happy and people were courteous and very nice’. Others said ‘staff member’ or ‘someone in authority and others said ‘don’t know who is who’. The overall analysis of this survey would suggest that in general both service users and relatives/representatives are aware of the complaints procedure and would speak to someone in authority. The home has the adult protection policy, which guides the procedure should there be allegations of abuse. One complaint has been investigated by Social Services Adult Protection Team and has been resolved in as much as the home has answered satisfactorily to the investigations made by Social Services and strategy meetings have been attended in the past months by the management of the home, the family and CSCI. The CSCI have received a regulation 37 notice of theft of money in the home. This also has been referred to and investigated by the police and no conclusion has been drawn. The manager has written to every member of staff to alert them that this has happened and to be vigilant whilst in the home. No further occurrences have taken place since this incident. The training matrix did not identify that staff receive specific training on the adult protection procedure and how to identify and report abuse. The policy is identified as part of the induction of new staff and is included in the NVQ level 2 & 3 training but a recommendation will be made that all staff receive this training. Northlands House Nursing Home DS0000064233.V289393.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 & 26 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service, a tour of the home and communicating with service users and relatives and staff. However the grounds that surround the home are in need of maintenance as they are unkept and unattractive for service users to sit in or look out on. Service users live in a safe and well-maintained environment. Service users have special equipment to maximise independence, however, there is not sufficient appropriate equipment to meet the needs of the current service users in residence. The home is clean and hygienic. Northlands House Nursing Home DS0000064233.V289393.R01.S.doc Version 5.2 Page 22 EVIDENCE: The inspectors toured the home. The home is newly built and was commissioned just a year ago. The home continues not to accommodate the full complement of 101 residents to date but the manager reported that she anticipates the top floor being opened for the first few admissions within the preceding few weeks. The geographical design of the building, which is on three floors with all individual rooms with en-suite shower rooms, lends itself to comfortable living but is not conducive to nursing high dependency service users with complex nursing needs. It would appear that the layout of the building is such that it also puts staff under pressure to rush around to respond to bells on their allocated floor. This also gives the perception of lack of staff as many of the service users need two carers at one time to provide any care and this leaves the remaining floor area deserted for much of the time, which may well be an indicator that more staff is required to be on duty. The home is clean and tidy and well maintained but unfortunately the grassed areas of the garden are in desperate need of cutting and the grass is very high and would present a risk to service users should they wish to wander into the gardens with walking aids. Besides the fact that it looks unsightly for people to look out on or even sit in the garden and definitely spoils the appearance of the home as it is approached. The manager reports that there is a dispute about who should be cutting the grass and she has instructed the maintenance man to cut it. A requirement will be made from these findings. A separate cleaning and housekeeping staff are employed to undertake the cleaning and laundry work. A recently employed full-time maintenance man is on site to undertaken the routine day-to-day maintenance. The laundry was visited and is fit for purpose. The inspector was pleased to observed that the personal clothes hanging up ready for distribution were in a less creased condition than the previous visit and that service users clothes did appear neat and clean. The survey comment cards did not identified dissatisfaction with the laundry service except one service user who listed missing clothes. The service users spoken with and the comment cards received all commented how clean and fresh the home was. The inspector observed that the home has appropriate cleaning agents that are contained in a locked environment on the cleaning trolleys when they are not in use. It was identified during this visit whilst speaking with staff and the GP that there was a lack of appropriate equipment in the home to cover the dependency of the service users. The GP reported to the inspectors that there is no availability of individual wheelchairs and the PCT commented when the home requested a wheelchair, that they had had their quota. There is a lack of occupational therapy input for the assessment of equipment and again there are not the resources to access this. The home has all profile beds with pressure relieving mattress in place. The manager reports that sometimes Northlands House Nursing Home DS0000064233.V289393.R01.S.doc Version 5.2 Page 23 these are not sufficient and she has to order mattresses for high risk service users at huge costs to meet the service users needs and very occasionally she can beg to borrow a mattress from the PCT equipment store, who profess not to supply to nursing homes, only if they are freeing up a bed in hospital. It would appear that funding of specialist equipment is not adequately resourced and the home is powerless to do anything about this under the present contractual agreement. Staff also spoke of the lack of resources – especially in terms of hoists and wheelchairs for residents so they can get out of bed. The home is adequately equipped with environmental adaptations such as bathrooms, lifts etc. The home has an infection control policy and a policy for waste disposal. Ten members of staff have undertaken the distance learning infection control training course. Hand washing facilities are available throughout the home and in every bedroom. Plastic aprons are worn for personal care and a different coloured apron for serving food. At the time of this visit the home did not have blue aprons and therefore white aprons were being worn for all purposes. The inspector observed that soiled linen is placed in alginate bags and placed on a disinfection wash in the machines. The inspector also observed that a bed cover and linen was placed on the floor of a bedroom whilst the bed was being remade. Staff must be made aware that this is contrary to infection control policy. Northlands House Nursing Home DS0000064233.V289393.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to this service, viewing documentation and communicating with staff and service users. The numbers and skill mix of staff employed at the home is sufficient in numbers to meet the needs of the service users in residence at the time of the visit, however the staffing levels must be reviewed frequently to take into account the dependency levels and skills of staff. Service users are protected by the home’s recruitment procedures. Staff are receive training to enable them to do their job and meet the needs of the service users. EVIDENCE: The staffing rotas were viewed. They are well organised and easy to identify the number of trained staff and carers on duty day and night. The staffing rotas identify a consistent number of staff on duty throughout the day and night. The staffing levels on duty were initially decided by using staffing guidance issued by the health authority, when they were the regulatory body for nursing homes. These levels of staff do not take into account the geographical layout of the home, the dependency and complex physical and nursing needs of the clients and the general environment. The consequence of this is that staff are under pressure to meet the needs of the residents who Northlands House Nursing Home DS0000064233.V289393.R01.S.doc Version 5.2 Page 25 occupy single rooms and who usually need two carers at any one time. Relatives have the perception of lack of staff because their expectations are that of a hospital environment. The over-riding opinion that came out of the service user’s and relative’s survey comment cares and also from the complaints received, was to identify that there are not enough staff on duty at any one time and clients have to wait a long while for bells to be responded to. This was discussed with the manager, who reported that the staffing numbers at the time of this visit were well over the recommended numbers. However, in light of the top floor being opened imminently, the geographical layout of the home and the existing dependency level, the inspector will be recommend that a higher staffing level be applied and one that needs to be reviewed regularly against the needs of the service users being admitted. This was borne out when talking to staff and asking them if they thought staffing levels were sufficient. One carer commented that they would be better for staff if there was sufficient equipment to allow them to be more efficient in their jobs, as hoists have to be shared from floor to floor. Other staff also spoke of the lack of resources – especially in terms of hoists and wheelchairs for residents so they can get out of bed. This was discussed with the manager who reported that this had already been identified and that new hoists and other equipment was on order and would be delivered imminently. The manager reported that over the past six months the home had successfully recruited a number of staff and the staff were beginning to bond as a team and this was evident when observing how they interacted and communicated with one another. The home’s need for using agency staff is growing less by each week and at the time of the visit no agency staff were being used as the home. The home employs a multicultural work force and from observation and conversation with the staff there are no apparent barriers with communication. The manager reported that the home is accommodating and meeting the needs of three service users from other cultural backgrounds. One of the service users has lost the ability to speak English and has reverted back to his mother tongue. Fortunately one of the nurses is able to communicate with him in his own language. Nine staff are identified on the training matrix as having achieved NVQ level 2 or 3. The manager reported that this care staff have the opportunity of this training but undertake the Skill for Care Council foundation training before undertaking NVQ. The recruitment process is robust. A sample of 5 personnel files were viewed there was evidence that the home had seen all the relevant information as stated on Schedule 2 of the Care Home Regulations. Each file had a photograph of the employee and a front checklist of the documents contained Northlands House Nursing Home DS0000064233.V289393.R01.S.doc Version 5.2 Page 26 in the file or those that had been seen, which were ticked and signed to say they had been produced and seen. Staff spoken to report that they had gone through a recruitment process and an induction period. The personnel files viewed also contained a copy of terms and conditions of employment that had been signed by the worker and a job description. Staff training files were viewed at the time of the site visit. Staff training includes: Fire training Manual handling COSSH Health & Safety Basic Food hygiene Tissue viability Loss & bereavement Male catheterization Bladder and bowel management Alzheimer’s Course Hand washing NVQ2 & 3 Medication training and assessments A training matrix was submitted to the CSCI with the pre-inspection documentation and also seen at the time of this visit. The matrix has all staff names on and details the course attended and the next date the course is due for a refresher or renewal. 97 members of staff were on the training matrix. Staff when spoken with stated that the training was good – most had just been on a course about Parkinson’s disease as they have a resident with this condition and two of the staff were requesting follow up training. Staff spoken with stated that the death of service users was quite difficult to manage and would find further training and counselling support, useful. It was acknowledged by the GP that staff have had no access to a counselling service to help them cope with the high incidence of deaths in the home since opening. A review of the loss and bereavement course would be helpful in identifying staff needs and requirements. The inspector discussed with the manager the need for ‘end of life care’ training for the staff in view of the high dependency of the service users and their diagnoses. Northlands House Nursing Home DS0000064233.V289393.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service, viewing documentation and communicating with staff and service users. The home is managed by a person who it fit to be in charge of good character and is able to fulfil the responsibilities of her actions and decisions. The home has an organisational quality assurance system in place. A process for the supervision of staff is in place, however, staff need to receive information and training in basic understanding of the concepts of appraisal and supervision. The health, welfare and safety of service users and staff are promoted and protected by the policies and procedures of the home. Northlands House Nursing Home DS0000064233.V289393.R01.S.doc Version 5.2 Page 28 EVIDENCE: The registered manager has a number of years experience within the NHS and this is her first post as a home manager. She has completed her Registered Managers Award recently. The manager has a deputy manager in post at the present time, who she reports, is an excellent clinician. However, it has been identified by the manager and the operational manager over the preceding months, that the registered manager needs more management support. The operational manager has left her post and the line manager within the organisation has a large area to cover and the organisation has plans to put in a layer of management between the operational manager and the home’s management. The lines of accountability within the management structure has yet to be decided, but it was of concern to the CSCI inspectors that the manager of such a large home whose full complement will be 101 beds, does not have the day-to-day management support as well as a head of care to provide clinical leadership. Staff spoken to report that the manager is approachable and is always around the home should they need to speak to her. Carers have a monthly meeting and a senior carer chairs this and it is within this forum that any issues can be discussed and the manager approached if necessary. Trained nurses report that the carers support them fully and there are clear lines of accountability within the home. The inspector observed that the manager demonstrated good communication skills and relationships with her service users, staff and relatives as we toured the home. Visitors spoken to report that they felt quite confident in approaching the manager to discuss any issues. The organisation has a quality assurance system in place and personnel from head office regularly undertake audits. On the day of the site visit the newly appointed quality auditor was visiting the home as part of her induction to the job. The manager undertakes certain monthly returns to the head office such as analyses of the accidents/incidents & complaints. The deputy manager undertakes the audits of the care plans and the MAR sheets regularly. The home has undertaken one service user/relative satisfaction survey at the end of 2005 and from this, areas that were identified as needing improvement were put into an action plan. Service users meetings are held monthly and recorded. The maintenance man audits all the systems within the home monthly and showed the inspectors the records of all the checks undertaken, which demonstrated that fire alarm system, equipment, water temperatures and other systems are monitored at appropriate intervals. Corporate policies and procedures are in place and available in the manager’s office. The home does look after and collect personal allowances for a number of the service users. The inspector spoke to the administrator and viewed the Northlands House Nursing Home DS0000064233.V289393.R01.S.doc Version 5.2 Page 29 system. The monies go into one account called Personal Accounts Northlands. This account is interest bearing and allocates monthly interest to each of the service users accounts. The service users receive a monthly statement identifying the balance of their monies with the accrued interest added. The inspector viewed a sample of statements, which identified all in and out going monies. The inspector viewed the receipts received for the outgoing monies and copies of receipts for any monies received by the home from relatives/representatives. The administrator audits these accounts monthly. The inspector considered the system to be open and transparent and benefited the service users for whom the account was opened. A supervision process has been introduced to the home. Evidence of staff supervision meetings was seen. Supervisions are held on a one to one basis bimonthly, and on a group basis monthly. The manager reported that staff supervision takes place in the work place on a day-to-day basis, although not formally. A supervision tool has been devised which covers all areas of practice. This tool is used for both the one to one and when supervisions are practised based. There is a separate record for supervised shifts for both RGN’s and care assistants. Not all registered general nurses (RGN) have been on a training course for carrying out supervision and appraisals and this will be necessary to gain an understanding of the process to enable the supervision system for such a large number of staff, to be effective. Staff spoken with appeared confused about what constituted supervision and were unclear about when their next supervision was. The manager did not understand why there would be such confusion as the dates and times are given in advance. The possibility for some of the confusion may lie in some of the staff spoken with by the inspector were new. Guidance on how supervision should be carried out is clear. However, all staff need to have an understanding of what supervision and appraisal means in terms of it being a two way meeting for discussion between the staff member and the supervisor in protected work time. Risk assessments for the building and the environment are in place. The systems and equipment remain at present, under guarantee and will be serviced on the anniversary of commissioning. The inspector viewed the accident book. All incidents and accidents are reported monthly to head office. The manager analyses these reports to identify any emerging themes. It was observed and discussed with the manager reasons why some of the accidents/incidents had not be report on a regulation 37 and returned to the CSCI office. All mandatory health and safety training to include fire, manual handling, COSSH, and basic food hygiene could be demonstrated on the training matrix for all staff and the dates of updates. Ten staff have undertaken the infection control distance learning course. The fire logbook was viewed and Northlands House Nursing Home DS0000064233.V289393.R01.S.doc Version 5.2 Page 30 demonstrated that all the system’s checks are undertaken at appropriate intervals. Northlands House Nursing Home DS0000064233.V289393.R01.S.doc Version 5.2 Page 31 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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 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 3 X X 2 X X X 3 STAFFING Standard No Score 27 2 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Northlands House Nursing Home DS0000064233.V289393.R01.S.doc Version 5.2 Page 32 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 OP2 Regulation Reg 5(1)(b) Requirement You are required to ensure that every service user admitted to the home is issued with a terms and conditions of residency to include the room that is to be occupied and the amount and breakdown of fees. The registered manager must implement a system where there will be an improvement for chronic disease management and transitional care provision and to facilitate core medical service within the nursing home. Closer ties must be achieved with the primary care team and other professionals allied to health to ensure residents receive equitable clinical services and build links between the home and the NHS. Staff must receive training in the adult protection procedure and have an understanding of what constitutes abuse and how that is reported. The grounds that surround the home must be made tidy, attractive and safe for service DS0000064233.V289393.R01.S.doc Timescale for action 31/08/06 2. OP8 Reg 12(1)(a) 30/09/06 2. OP18 Reg 13(6) 30/09/06 3. OP19 Reg 23(2)(o) 31/07/06 Northlands House Nursing Home Version 5.2 Page 33 4. OP22 Reg 23(2)(n) users to access them if they wish. The registered manager must ensure that the home is supplied with appropriate equipment, which has been assessed as being needed to meet the needs of the service users in residence and to enable staff to undertake their jobs in a safe unhurried manner. The registered manager must ensure that there are sufficient numbers of staff on duty over the twenty-four hour period to ensure that service users needs are met in a timely fashion. Staffing rotas must be reviewed on a regular basis to correlate with the dependency of the service users in residence. 30/09/06 5. OP27 Reg 18(10(a) 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations It is recommended that care plans for meeting religious and cultural needs be formulated promptly after admission to the home to ensure that service users religious and cultural rituals can be fulfilled. It is strongly recommended that as part of the induction to the home staff is given information and training into the concept and value of supervision and appraisal. 2. OP36 Northlands House Nursing Home DS0000064233.V289393.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Northlands House Nursing Home DS0000064233.V289393.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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