Inspection on 16/01/07 for Nynehead Court

This inspection was carried out on 16th January 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Nynehead Court 27/01/06

Nynehead Court 07/06/05

Nynehead Court 02/03/05

Nynehead Court 31/08/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Nynehead Court Nynehead Wellington Somerset TA21 0BW Lead Inspector Kathy McCluskey Unannounced Inspection 09:00 16 & 17 January 2007 th th 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 Nynehead Court DS0000055508.V325169.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. Nynehead Court DS0000055508.V325169.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nynehead Court Address Nynehead Wellington Somerset TA21 0BW 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) 01823 662481 01823 665293 nyneheadcare@aol.com www.tssg.co.uk Nynehead Care Ltd Mrs Diana Maud Hathaway Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Nynehead Court DS0000055508.V325169.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Room 22 must be used for mobile service users only. Assessment of service users for Room 25B must include consideration of the use of the chair lift to the room. 27th January 2006 Date of last inspection Brief Description of the Service: Nynehead Court is a Grade II, 17th Century Manor House set in thirteen acres of parkland with a 13th century church adjacent. The home is in the village of Nynehead and there are many links with the community. Nynehead Court has been owned by Nynehead Care Limited since 22nd January 2004. The home is registered with the Commission for Social care Inspection to provide personal care for up to 35 people over the age of 65 years. The home is not registered to provide Nursing Care. Conditions of registration are identified above. The current fee range is between £555 and £1,000 per week. Additional charges are met by service users for hairdressing, papers, holidays and private telephones. A selection of newspapers are provided by the home free of charge. The registered manager is Mrs Diana Hathaway. All rooms have en-suite toilets and private telephone points. The majority of the rooms considerably exceed minimum space standards. The home and grounds are maintained to a very high standard. There is an emphasis on maintaining independence and individuality. The home has Somerset Social Service Quality rating. There is an emphasis on enabling service users to remain independent and enjoy individual life styles. Nynehead Court DS0000055508.V325169.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are; - excellent, good, adequate and poor. This unannounced key inspection was conducted over 2 days (10.5hrs) by CSCI regulation inspector Kathy McCluskey. The registered manager Diana Hathaway was available for the duration of the inspection. The inspector was able to meet with the majority of service users, two relatives, six staff and a visiting healthcare professional. As part of this key inspection, the commission sent comment cards to service users, relatives and G.P’s. Comments received have been included throughout the report. The inspector was given unrestricted access to all areas of the home. A selection of records were examined relating to service users, staff and health and safety. This was a very positive inspection. The inspector would like to thank service users, relatives, staff and the registered manager for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: Nynehead Court provides a gracious style of living for service users. The environment and grounds of the home are maintained to a very high standard. Service users benefit from very spacious ‘bed-sitting’ rooms’ which they are able to personalise. Nynehead Court DS0000055508.V325169.R01.S.doc Version 5.2 Page 6 Without exception, all service users spoken with were very positive about the home, gardens and their bedrooms. Some additional comments made in the commission’s comment cards included; ‘gracious living with great comfort in a countryside setting’, ‘this is a wonderful home, you will never find a better one’ The home is well managed by a very experienced manager who promotes an open an inclusive style of management. Service users stated that they could always talk to the manager and that ‘she will always listen and act on what you say’. Staff were very positive about the manager and the support they received. Staff stated that ‘Diana will always arrange training for you’, ‘she is very supportive’, ‘I wouldn’t want to work anywhere else’, ‘she will do anything for the residents and staff’. Relatives spoken with were also very positive about the manager. Relatives confirmed that they were always kept very well informed. Staff ensure that service users are treated with respect and that their wishes and preferences are respected. Although the home’s care planning systems needed some improvement, service users were very positive about the care they received and confirmed that their needs were fully met. Staff commented on the kindness of staff. Six members of the care team were spoken with at this inspection and all appeared to have a very good understanding of the needs and preferences of service users. Detailed information was available relating to the individual’s contact with healthcare professionals. The manager informed the inspector that they had excellent support from healthcare professionals. The commission sent comment cards to all G.P’s. At the time of this report seven completed comment cards had been returned. Responses to questions were positive and all indicated that the home communicated well with them and that staff demonstrated a clear understanding of the care needs of service users. Additional comments included; ‘the standard of care is very good at Nynehead Court and there is good communication with carers’, ‘the care at Nynehead Court is excellent’. Very positive comments were also received from a district nurse who was spoken with at the inspection. Nynehead Court DS0000055508.V325169.R01.S.doc Version 5.2 Page 7 Some comments received from service users were; ‘this is a wonderful home, you will never find a better one’, ‘I cannot fault it and I am very happy’ The two relatives spoken with during the inspection indicated that they were very satisfied with the care and informed the inspector that they were always kept informed of important matters relating to their relative. Seven relatives completed questionnaires for the commission. All stated that they were kept informed of important matters and were consulted about their relatives care. Other comments from relatives included; ‘I would recommend Nynehead Court, it is a wonderful establishment’, ‘I don’t think I could find a better home for my relative and the team looking after her are brilliant’. The home ensures that prospective service users are appropriately assessed and that they are provided with the information they need to enable them to make an informed choice about moving to the home. Service users benefit from a very varied and interesting programme of activities which include holidays and regular trips out. Staff ensure that mealtimes are a pleasurable experience for service users. A wholesome and varied menu is available. The home ensures that sufficient staff are on duty to meet the needs of service users. The home’s staff recruitment procedures are robust and reduce the risk of harm or abuse to service users. Staff confirmed that they were appropriately trained though records to demonstrate this need some improvements. The home takes appropriate steps to ensure the health and safety of service users, staff and visitors. What has improved since the last inspection? What they could do better: Nynehead Court DS0000055508.V325169.R01.S.doc Version 5.2 Page 8 Service users confirmed that the home was able to meet their needs and they were very satisfied with the care they received. Care staff also demonstrated a good understanding of the needs of service users. The inspector did note that care plans were not always fully reflective of current needs, nor had they been reviewed at least monthly. Although staff confirmed that they had received appropriate training and very good support, this was not always reflected in the records maintained by the home. The home needs to ensure that staff receive an appropriate formalised induction programme when they commence employment. The home has a quality assurance programme though this has not been implemented for the last two years. It has been recommended that this is implemented to seek the views of service users and other stakeholders. 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. Nynehead Court DS0000055508.V325169.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 Nynehead Court DS0000055508.V325169.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): 1, 2, 3, 4 and 5. Standard 6 is not applicable as the home is not registered to provide intermediate care. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home ensures that prospective service users have the information they need to enable them to make an informed decision about moving to the home. Prospective service users and their representatives are encouraged to visit the home and service users are fully assessed by the home. The home takes appropriate steps to ensure that the needs and aspiration of service users are met. EVIDENCE: The home has produced a statement of purpose and service user guide. These documents provide service users and prospective service users with Nynehead Court DS0000055508.V325169.R01.S.doc Version 5.2 Page 11 information about the home and services offered. Copies are also available in the reception area of the home. Fees and additional charges are identified on page 5 of this report. As part of this key inspection, the commission sent questionnaires to a number of service users. At the time of this report, nine completed questionnaires had been returned. Eight service users confirmed that they had received enough information about the home to enable them to make an informed choice about moving there. Service users spoken with during the inspection informed the inspector that they were able to make an informed choice about moving to Nynehead Court. Visits to the home are encouraged. The registered manager stated that service users are offered a trial period so they can be sure that they are happy about living at the home and are satisfied with the services offered. This also enables to the home to ensure that assessed needs can be met. The inspector was able to meet with two relatives. Both indicated that they were ‘more than happy’ with the manner in which their relatives moved to the home was managed. As appropriate, relatives are encouraged and supported to be fully involved in their relatives move to the home. Relatives spoken with were very positive about the support they received. The inspector was able to see evidence that prospective service users are fully assessed prior to a placement being offered. This is to ensure that the home can fully meet the assessed needs and aspirations of prospective service users. Service users are issued with a contract/statement of terms and conditions once they are satisfied that they wish to remain at Nynehead Court. Through discussion with service users, staff, relatives and the registered manager, it was apparent that the home is currently meeting the needs of service users living at the home. The home has an appropriate number of aids and adaptations and receives excellent support from specialised visiting healthcare professionals. Nynehead Court DS0000055508.V325169.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. Staff ensure that the health and care needs of service users are met though care plans could be improved. The home has excellent links with healthcare professionals. The home’s procedures for the management and administration of service users medications are generally good. Staff ensure that service users are treated with respect and that their privacy is maintained. Service users are able to spend their final days in the comfort of their own rooms with their family around them. EVIDENCE: Nynehead Court DS0000055508.V325169.R01.S.doc Version 5.2 Page 13 The inspector examined two care plans in detail and sampled two further care plans. Care plans contained information relating to the preferences of service users and appropriate contact details. The inspector noted that care plans were not always fully reflective of the individual’s assessed needs. Details were discussed with the registered manager at the time of the inspection. There was no care plan for one service user who was experiencing some mental health problems and a care plan relating to one service user who required assistance with personal care had not been updated to reflect that moving and handling needs had changed. The inspector discussed the need to ensure that assessed needs are clearly identified and that there are clear instructions for staff on how needs should be met. It has again been recommended that the home ensures that care plans are reviewed at least monthly. The home needs to ensure that service users are given the opportunity to be fully involved in the care planning process. Care plans seen had not been signed by service users. Whilst it is acknowledged that the home was able to show the inspector a care plan which had been signed by a service user, this was not apparent for the other care plans seen. Although care plans require some improvement, service users informed the inspector that staff were ‘very aware’ of their needs and of ‘how we like things done’. Six members of the care team were spoken with at this inspection and all appeared to have a very good understanding of the needs and preferences of service users. Detailed information was available relating to the individual’s contact with healthcare professionals. The manager informed the inspector that they had excellent support from healthcare professionals. On the first day of the inspection, many service users were seen by a visiting optician. Service users confirmed that they received assistance from staff to attend appointments outside of the home. The home does not charge service users for staff time to attend appointments. The commission sent comment cards to all G.P’s. At the time of this report seven completed comment cards had been returned. Responses to questions were positive and all indicated that the home communicated well with them and that staff demonstrated a clear understanding of the care needs of service users. Additional comments included; ‘the standard of care is very good at Nynehead Court and there is good communication with carers’, ‘the care at Nynehead Court is excellent’. Nynehead Court DS0000055508.V325169.R01.S.doc Version 5.2 Page 14 The inspector was able to meet with a district nurse who was visiting the home. The district nurse was very positive about the home and the care service users received. She also stated that the home communicated well with her and followed health care plans appropriately. The home monitors service users weights on a monthly basis. All service users spoken with were very happy with the care they received. All nine service users who completed the commission’s questionnaires stated that they received the care and support they needed. Some comments received from service users were; ‘this is a wonderful home, you will never find a better one’, ‘I cannot fault it and I am very happy’ The two relatives spoken with during the inspection indicated that they were very satisfied with the care and informed the inspector that they were always kept informed of important matters relating to their relative. Seven relatives completed questionnaires for the commission. All stated that they were kept informed of important matters and were consulted about their relatives care. Other comments from relatives included; ‘I would recommend Nynehead Court, it is a wonderful establishment’, ‘I don’t think I could find a better home for my relative and the team looking after her are brilliant’. Service users spoken with commented on the kindness of staff. All service users stated that they were treated with respect and that their privacy was respected. The inspector was able to observe staff interactions with service users. Staff were noted to be very professional and communicated with service users in a kind and respectful manner. Service users were addressed in their preferred name and any offer of assistance from staff with personal care matters, was conducted in a very discreet manner. The inspector examined the home’s procedures for the management and administration of medication. The home uses the monitored dosage system (MDS) with pre-printed medication administration records (MAR). Medicines were found to be appropriately stored. MAR charts, on the whole, were very well maintained. There were no gaps in signing for medicines and photographs of service users were in place to aid identification. The home does need to ensure that where variable doses are prescribed, the amount administered is recorded. The home has a fridge to store medicines as appropriate. To ensure the safe storage of these medicines, minimum, maximum and current temperatures must be recorded on a daily basis. Acceptable ranges are between 2 and 8C. Nynehead Court DS0000055508.V325169.R01.S.doc Version 5.2 Page 15 The home maintains appropriate records relating to medicines received into the home and for medicines returned to the pharmacy. On the advice of the home’s dispensing pharmacist, the home is currently disposing of used fentanyl patches within their clinical waste system. Following discussion with the commission’s pharmacist inspector, a good practise recommendation has been raised that used fentanyl patches are appropriately stored and returned to the pharmacist as per controlled drugs procedures. Providing assessed needs can continue to be met, Nynehead Court provides service users with a ‘home for life’ so that service users can spend their final days in the comfort of their own rooms. The home provides support to relatives and is also able to offer them accommodation and meals to enable families to stay with their relative. A number of care staff have recently completed a palliative care course. The home needs to ensure that the preferences of service users following death are clearly detailed in the individual’s plan of care. This information was not available in the care plans examined. Nynehead Court DS0000055508.V325169.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 and 15 The Quality in this outcome area is Excellent This judgement has been made using available evidence including a visit to this service. Nynehead Court ensures that service users have access to a wide range of activities both within and outside of the home. Routines within the home are dictated by service users and the home ensures that the preferences of service users are respected. Visitors are made very welcome at the home and relatives are able to stay at the home. Service users are offered a wholesome and varied diet and staff ensure that mealtimes are a pleasurable experience for service users. EVIDENCE: During this inspection, the inspector noted that the atmosphere at the home was very relaxed and welcoming. It was very apparent that routines within the home were dictated by service users. Nynehead Court DS0000055508.V325169.R01.S.doc Version 5.2 Page 17 Service users spoken with informed the inspector that they choose how and where to spend their day. The home provides a very varied programme of activities for service users and each month the home produces a written programme which is made available to service users. Some examples of activities planned for January include; trips out for morning coffee, bridge, arts and crafts, sing-a-longs, church services within the home, trips to the Brewhouse Theatre, gentle exercise, visiting library, poetry, trip to see the pantomime Aladdin and arm chair travel. This is just a selection of activities available. Last year three holidays were arranged for service users in Cornwall and the Isle of Wight. Service users were keen to share their experience with the inspector. Service users spoken with were very positive about the range of activities available to them. This was also indicated in the commission’s questionnaires completed by service users. Service users and staff informed the inspector that the home has purchased a golf buggy to enable service users to enjoy trips around the home’s beautiful gardens. The home also has a wheelchair accessible minibus. In line with the preferences of service users, visitors can visit at any reasonable time. Two relatives were spoken with during the inspection and both stated that they were always made to feel very welcome. One relative was currently staying at the home as they lived a long distance away. The relative had nothing but praise for the care her relative received and how welcome she was made to feel. All meals at the home are freshly prepared by the home’s chef. The chef sources local fresh produce. Fresh meat, vegetables and fruit are delivered several times a week. Fresh fish is purchased from the local fishmonger. The home ensures that the preferences/likes/dislikes of service users are recorded and service users are encouraged to report and record any comments or requests regarding meals. A book is maintained in the dining room. Daily menus are displayed outside of the dining room. Service users informed the inspector that choices were available and that ‘staff know what we like’. Service users were very positive about the meals offered stating, ‘there is always plenty to eat’ and ‘you can have snacks whenever you like’. A main hot meal is offered for lunch and dinner. Various choices are available for breakfast including a cooked breakfast. Homemade cakes are offered with afternoon tea and milky drinks are available during the evening with further snacks on request. Nynehead Court DS0000055508.V325169.R01.S.doc Version 5.2 Page 18 The inspector was able to see lunch being served in the dining room on both days of the inspection. The dining room is furnished and decorated to a high standard and seating is comfortable. Tables were attractively laid and a selection of condiments were available on each table. Service users were served with drinks of their choice. Some chose fruit juices, others wine and beer. Vegetables and potatoes were placed in serving dishes on each table. The atmosphere during lunch was very relaxed and staff were noted to be ‘unobtrusive’ thus allowing the service users to enjoy their lunchtime experience. Nynehead Court DS0000055508.V325169.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, 17 and 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 appropriate systems in place to enable service users and others to raise concerns. The home takes appropriate steps to reduce the risk of harm or abuse to service users. EVIDENCE: The home has produced a complaints procedure. A copy is available in the reception area of the home. The complaints procedure is also available in the home’s service user guide. The registered manager advised the inspector that no complaints had been received by the home since the last inspection. No complaints have been received by the commission. Seven relatives, nine service users and seven GP’s completed comment cards for the commission. All confirmed that they were aware of how to make a complaint though had not had cause to do so. Nynehead Court DS0000055508.V325169.R01.S.doc Version 5.2 Page 20 Service users and staff spoken with during the inspection informed the inspector that they would not hesitate in raising concerns if they had any. Staff were able to inform the inspector of action they would take should they suspect any form of abuse. This included contacting external agencies. The home follows procedures which reduce the risk of harm or abuse to service users. This includes robust staff recruitment procedures. The registered manager confirmed that all service users are registered to vote. Nynehead Court DS0000055508.V325169.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, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. Service users benefit from ‘gracious’ living in a home which is furnished and decorated to a very high standard. Bedrooms are very spacious and service users are encouraged to personalise their private ‘bedsitting’ rooms. The home takes appropriate steps to reduce the risk of the spread of infection. The standard of cleanliness is high. EVIDENCE: Nynehead Court DS0000055508.V325169.R01.S.doc Version 5.2 Page 22 Nynehead Court is a Grade II listed 17th century manor house situated in the heart of the village of Nynehead. Nynehead is a few miles from the town of Wellington and approximately 7 miles from Taunton. Nynehead Court is situated in 13 acres of very well maintained parkland. There are formal gardens containing a walled arboretum, a formal Italianate garden and one of the largest ice houses in the country. The home benefits from panoramic views of the surrounding countryside. The gardens, which are also open to the public, are maintained by three full time gardeners. Nynehead Court, whilst maintaining period features, has been suitably adapted to meet the needs of service users. Grab rails, ramps and a call bell system are available throughout the home. Bedrooms are situated over three floors with a shaft lift providing access to the first and second floor. Three stair lifts are also in situ. The home is decorated and furnished to a very high standard. Whilst the home promotes a homely feel, service users benefit from a ‘gracious’ style of living. A selection of bedrooms and communal areas were seen at this inspection. Many service users were seen relaxing in the drawing room where a log fire was burning in a well guarded hearth. A selection of newspapers, which had been provided by the home, were available. The atmosphere was very relaxed. Staff were able to sit with service users and were heard discussing the morning newspapers. Staff were noted to be very professional and warm in their approach. During the morning communion was held for service users in the drawing room. The library, which was not seen at this inspection, provides another very comfortable area for service users. A smaller lounge is also available on the ground floor. This is known as the ‘blue room’. This room has a television. The dining room is conveniently situated off the main reception area of the home. All bedrooms exceed the national minimum standards for size. All are fitted with en-suite toilet facilities and some are fitted with bathing/shower facilities. It was very apparent that service users are encouraged to personalise their private space. In the majority of bedrooms seen, service users had chosen to bring items of their own furniture and paintings. As bedrooms are large, service users have been able to create comfortable seating areas. Without exception, all service users spoken with were very positive about the home, gardens and their bedrooms. Nynehead Court DS0000055508.V325169.R01.S.doc Version 5.2 Page 23 Some additional comments made in the commission’s comment cards included; ‘gracious living with great comfort in a countryside setting’, ‘this is a wonderful home, you will never find a better one’ Communal toilets are conveniently situated around the home. Assisted bathing facilities are available. Appropriate hand washing facilities are available. Staff confirmed that they always had access to a good supply of protective clothing (gloves etc). The home is centrally heated and was warm and comfortable during this inspection. The standard of cleanliness was noted to be high. Nynehead Court DS0000055508.V325169.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 and 30 Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. The home ensures that sufficient staff are on duty to meet the needs of service users. The home’s staff recruitment procedures are robust and reduce the risk of harm or abuse to service users. Staff confirmed that they were appropriately trained though records to demonstrate this need some improvements. EVIDENCE: The registered manager informed the inspector that the home currently had a full complement of staff with no staff vacancies. Care staff provide 24 hour cover as follows; Mornings – 5 care staff Afternoons – 4 care staff Evenings – 3 care staff Nights – 2 waking care staff Nynehead Court DS0000055508.V325169.R01.S.doc Version 5.2 Page 25 The registered manager currently resides within the grounds of the home during the week and informed the inspector that she is on call during the night. The registered manager works week days and is in addition to the care staff on duty. The home also employs kitchen staff, laundry, domestics, maintenance and an administrator. As previously mentioned in this report, three full time gardeners are also employed. Appropriately trained care staff have allocated time for activities within the home. Six care staff, including two night staff were spoken with during the inspection. All felt that there were sufficient staff on duty to meet the needs of service users. Staff also confirmed that, where a service user was poorly or in their final stages of life, additional staff would always be arranged by the registered manager. Examples were provided. Seven relatives completed comment cards for the commission and all confirmed they felt that there were sufficient staff on duty. Comments included; ‘I don’t think I could find a better home for my relative and the team looking after her are brilliant’, ‘My relative is very happy and I think the staff and care is excellent’. Seven GP’s completed comment cards and all stated that there was always a senior member of staff to confer with. Service users spoken with during the inspection were very positive about the staff. Comments included; ‘the staff are very kind’, ‘I am always treated with respect and they know what I like’, ‘the staff are wonderful and if I ring my bell they come straight away’, ‘nothing is too much trouble’ The registered manager provided the inspector with information which indicated that, at present, 40 of care staff had achieved an NVQ level 2 in care or above. This falls below the national minimum standards of 50 , though the registered manager stated that further training was planned. The home follows robust staff recruitment procedures. Two staff files were examined and all contained required information. There was also evidence that staff did not commence employment without the home first obtaining a criminal records and vulnerable adults check. As required at the last inspection, photographs of employees are maintained in their recruitment files. On commencing employment, staff undertake a period of induction. This was found not to have been completed in one staff file examined. The induction sheet was also noted to be very basic and did not concentrate on aspects of Nynehead Court DS0000055508.V325169.R01.S.doc Version 5.2 Page 26 care. This was discussed with the registered manager at the time who confirmed that staff had a more detailed induction book though this was not currently being completed. It has been required that the home ensures that a staff training programme which meets with Skills for Care recommendations, is put in place and fully completed by staff. The registered manager and staff spoken with confirmed that they had received mandatory training though this was difficult for the inspector to ascertain on examination of records. It has been recommended that the registered manager creates a staff training matrix which would easily identify staff’s achievements and training needs (refer to standard 38). Nynehead Court DS0000055508.V325169.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, 34, 35, 36, 37 and 38. Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. The home is managed by an experienced manager who promotes an open and inclusive style of management. Service users, staff and relatives feel supported and their views are encouraged. The home could improve its quality assurance systems. The home takes appropriate steps to ensure the health and safety of service users, staff and visitors to the home. EVIDENCE: Nynehead Court DS0000055508.V325169.R01.S.doc Version 5.2 Page 28 The registered manager is Diana Hathaway. She has over 35 years experience in care and 15 years experience in a management capacity. Diana has an NVQ level 5 in management and has managed Nynehead Court for 3 years. Through observation, discussion with service users, staff and relatives, it was very apparent to the inspector that the registered manager promotes an open and inclusive style of management. Service users stated that they could always talk to the manager and that ‘she will always listen and act on what you say’. Staff were very positive about the manager and the support they received. Staff stated that ‘Diana will always arrange training for you’, ‘she is very supportive’, ‘I wouldn’t want to work anywhere else’, ‘she will do anything for the residents and staff’. Relatives spoken with were also very positive about the manager. Relatives confirmed that they were always kept very well informed. Service users and relatives are invited to attend a meeting every two weeks with the manager and one of the directors. The manager advised that minutes are not taken. Senior staff meetings are held every 6 weeks. The registered manager confirmed that the home has not sent out quality questionnaires to service users or other stakeholders for the last two years. A recommendation has been raised. The director of the company visits the home at least weekly. Monthly reports are completed and are made available to the commission. Where requested, the home manages small amounts of monies on behalf of service users. A selection of records relating to transactions and balances were checked at this inspection. Records were found to be well maintained with receipts available. Two signatures are obtained for all transactions. Balances checked were found to be correct. The inspector recommended that the manager considers a system for auditing monies on a regular basis. Staff spoken with confirmed that they received an annual appraisal but were unable to confirm that they received formal supervision. Staff did state that they could ‘always approach the manager’ and that ‘she will always arrange any training we need’. It has been required that a formal system is introduced to ensure that staff are appropriately supervised. All records seen at this inspection were found to be appropriately stored in accordance with the Data Protection Act 1998. Nynehead Court DS0000055508.V325169.R01.S.doc Version 5.2 Page 29 The home takes appropriate steps to ensure the health and safety of service users, staff and visitors to the home. This was ascertained through examination of records and a tour of the premises. FIRE SAFETY – Annual servicing was conducted by an external contractor on the homes fire detection and alarm systems, emergency lighting and fire fighting equipment on 19/12/06. The home conducts weekly checks on the fire alarm systems and monthly checks on emergency lighting. Fire drills are conducted every 3 months. This was last carried out on 14/12/06. ELECTRICAL SAFETY – The home has an up to date electrical hardwiring certificate dated July 2004 and valid for 5 years. Portable appliances are checked annually. This was last conducted on 22/02/07. EQUIPMENT SERVICING – The home’s two mobile hoists, three assisted baths and shaft lift were serviced on 14/08/06 and are due again in February 2007. The registered manager was unable to locate servicing records relating to the home’s two stair lifts. It was agreed that these would be forwarded to the commission. HOT WATER/SURFACES - Hot water outlets are fitted with thermostats to reduce the risk of scalding. It has been recommended that the home conducts monthly temperature checks on hot water outlets to ensure that temperatures do not exceed the Health & Safety Executive recommended upper limits. Radiators are fitted with a guard to reduce the risk of injury to service users. A hot towel rail was noted in one bathroom which could pose a risk to service users. It has been required that the home completes a risk assessment and takes action as appropriate. To also reduce the risk of injury to service users, upstairs windows are restricted and free standing wardrobes are secured to the wall. ACCIDENTS – The home maintains records relating to all accidents. The accident book in use conforms with the Data Protection Act 1998. It has been recommended that the registered manager introduces a system for analysing accidents on a regular basis as some traits were noted by the inspector. The registered manager provided the inspector with information which indicated that a total of 20 staff have received training in first aid. A suitably Nynehead Court DS0000055508.V325169.R01.S.doc Version 5.2 Page 30 trained first aider is on duty at all times. The registered manager ensures that the appointed first aider for each shift, is identified on the staff duty rota. As previously mentioned in this report, although the registered manager and staff confirmed that they had received mandatory training, this was difficult to ascertain from the records available. It has been recommended that a staff training matrix is devised which will clearly identify training achievements and training required. Nynehead Court DS0000055508.V325169.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 3 3 3 3 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 4 4 3 3 4 4 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 3 2 3 2 Nynehead Court DS0000055508.V325169.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement The registered person must ensure that service user care plans are fully reflective of individuals assessed needs and contain clear instructions for staff. Particular attention must be given to psychological/mental health needs. To ensure the safe storage of medicines requiring refrigeration, the registered person must ensure that the minimum, maximum and current temperatures of the fridge are recorded daily. The registered person must ensure that staff employed receive an appropriate induction programme relevant to the work they are to perform. The registered person must ensure that staff are appropriately supervised. Formal supervision should take place at least six times a year. To reduce risk of injury to service users, the registered person must complete a risk assessment for the identified hot DS0000055508.V325169.R01.S.doc Timescale for action 30/03/07 2. OP9 13(2) 14/02/07 3. OP30 18(1)(c) 30/03/07 4. OP36 18(2) 30/07/07 5. OP38 13(4) 14/02/07 Nynehead Court Version 5.2 Page 33 towel rail and take action as appropriate. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP7 OP9 OP9 OP33 OP38 Good Practice Recommendations The registered person should ensure that care plans are reviewed at least monthly. The registered person should ensure that where a service user is prescribed a variable dose of medication, the amount administered is recorded. In line with current good practise, the registered person should ensure that used fentanyl patches are returned to the pharmacy with records maintained. The registered person should implement its’ quality assurance programme to ensure that the views of service users and other stakeholders can be measured. To ensure that staff receive up to date mandatory training, the registered person should consider devising a training matrix. Nynehead Court DS0000055508.V325169.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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