Inspection on 07/06/05 for Nynehead Court

This inspection was carried out on 7th June 2005.

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

Nynehead Court 16/01/07

Nynehead Court 27/01/06

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 OBW Lead Inspector Shelagh Laver Unannounced 7 June 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Nynehead Court D53 - D02 S55508 Nynehead V231578 070605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Nynehead Court Address Nynehead Wellington Somerset TA21 OBW 01823 662481 01823 665293 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Nynehead Care Ltd Mrs Diana Maud Hathaway Personal Care Home Only 35 Category(ies) of Old Age (35) registration, with number of places Nynehead Court D53 - D02 S55508 Nynehead V231578 070605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Room 22 must be used for mobile service users only. 2. Assessment of service users for Room 25B must include consideration of the use of the chair lift to the room. Date of last inspection 2 March 2005 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 provides residential care for 35 people over the age of 65 years. 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. Nynehead Court D53 - D02 S55508 Nynehead V231578 070605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on one day over seven hours and was conducted by two inspectors. A tour of the premises took place where a selection of bedrooms and all communal areas were seen. Ten service users were spoken with individually. The registered manager was on duty and was able to assist the inspector. Records relating to care, staff and health and safety were examined. What the service does well: What has improved since the last inspection? At the last inspection requirements were made with regard to recruitment records. There is a now a formal system for applying for POVA and CRB checks for staff. Nynehead Court D53 - D02 S55508 Nynehead V231578 070605 Stage 4.doc Version 1.30 Page 6 At the last inspection there was a requirement to continue to review the implementation of the care planning documentation. Staff have spent time improving the range and quantity of information recorded. The manager now tests emergency lighting monthly. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Nynehead Court D53 - D02 S55508 Nynehead V231578 070605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Nynehead Court D53 - D02 S55508 Nynehead V231578 070605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4, and 5. The manager assesses the needs of prospective service users prior to making a decision about admission. There must be detailed documentation showing how the manager has determined that the home is able to meet the service users needs. Appropriate information, which will assist in making a decision about admission, must be obtained from other health and social services professionals. EVIDENCE: The home has produced a Statement of Purpose and Service user guide which is made available to service users, prospective service users and their representatives. The home’s current fee range is between £500.00 and £1000.00 and is dependant upon the room to be occupied. Nynehead Court D53 - D02 S55508 Nynehead V231578 070605 Stage 4.doc Version 1.30 Page 9 Extra charges are met by the service user for personal toiletries, hairdressing, chiropody, clothing and newspapers. The records of a three service users recently admitted were examined. The records of the pre-assessment undertaken by the manager were informally recorded. All service users whether or not they are privately funded can be assessed for the need for nursing care. It is important that this assessment is undertaken when appropriate. One service user had been recommended for nursing care but no formal assessment had been undertaken. Nynehead Court D53 - D02 S55508 Nynehead V231578 070605 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 The home takes appropriate action to ensure the health care needs of service users are met. Care practice in the home promotes service users dignity and protects their privacy. The home’s procedure for the management and administration of medication was found to be generally sound but attention to maintain detailed and accurate recording on the MAR charts is needed. The care plans do not always reflect the care provided for service users or address needs described in the daily records. EVIDENCE: Individual care plans are maintained for service users. Three were examined. There was insufficient assessment of psychological needs of service users and in one case there was no evidence in the care plan of the excellent programme of care being provided. Nynehead Court D53 - D02 S55508 Nynehead V231578 070605 Stage 4.doc Version 1.30 Page 11 Care plans are compiled from assessments completed following admission. These included personal care needs, moving and handling and nutrition. Whilst some assessments were up to date and detailed the manager needs to ensure that any equipment used by the service user is appropriately recorded. All service users have access to appropriate health care professionals and the manager ensures that the health care needs of service users are met. The manager seeks the input and advice of other health care professionals as required. There were examples of links with community nurses and mental health teams, medical consultants and general practitioners. The home uses the Monitored Dosage System (MDS) with pre-printed MAR charts. Medicines were seen to be appropriately stored. The home’s procedure for the management and administration of medication is basically sound but there were several gaps in the MAR sheet recording. Some changes had been made to prescriptions without appropriate signatures. Appropriately trained staff administers medicines but there is a need for regular auditing of administration records to maintain good practice in all staff. Nynehead Court D53 - D02 S55508 Nynehead V231578 070605 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15. Service users are able to chose a varied lifestyle patterns in the home. The home provides a wholesome and varied menu which takes into account the needs and preferences of service users. Arrangements for service users to maintain contact with family and friends are good. The home provides activities and entertainments to enrich the service users lives. EVIDENCE: Service users described the different ways they are able to spend the day. Breakfast is served in the service users rooms if required. A cooked breakfast is available if required. Some people enjoyed regular outings with families. There are regular trips organised by the home. Recent visits described were lunch on the canal and to places of interest such as the Willow and Wetlands visitors centre. A small group of service users have been on a seaside holiday with the manager and staff from the home. In addition to the programme of activities organised in the home staff are employed to undertake individual activities with service users. Nynehead Court D53 - D02 S55508 Nynehead V231578 070605 Stage 4.doc Version 1.30 Page 13 Throughout the day the inspectors observed staff interactions with service users. Staff spoke to service users with respect and kindness. All service users spoken with confirmed staff were kind and helpful. The manager and current chef have devised a menu, which is wholesome and varied and takes in to account the needs and preferences of service users. Service users confirmed that there was a choice of food and the addition of a selection of sweets was welcome. The manager is committed to ensuring that relatives are supported and kept well informed. Visitors are made welcome at any reasonable time in accordance with the wishes of the service user. The inspectors spoke with two visitors who were satisfied with the care received by their relatives. One commented on the efforts taken by the home to meet the service users needs. Service users were smartly dressed and have the regular services of a hairdresser. Nynehead Court D53 - D02 S55508 Nynehead V231578 070605 Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17, 18 The complaints procedure in this home is good with evidence that the views of service users/visitors are listened to and acted upon. Policies and procedures are in place to protect service users from abuse. EVIDENCE: The home has a complaints procedure, which is clearly displayed, in the home. Copies are also found in the Statement of Purpose and Service User Guide. No formal complaints have been made since the last inspection. Nynehead Court D53 - D02 S55508 Nynehead V231578 070605 Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25, 26. Service users live in a comfortable, safe and clean environment and are able to personalise their own bedrooms. The home’s environment is able to meet the assessed needs of service users. The home provides specialist equipment to ensure the needs of service users are met. EVIDENCE: The home is a listed country house that has been adapted to meet service users needs. All areas, including the extensive and beautiful gardens, are available to service users. All communal areas and a selection of bedrooms were seen at this inspection. Bedrooms were pleasant and comfortable and it was evident that service users were encouraged to personalise their rooms. Some bedrooms contained items of furniture belonging to the service user. Specialist beds and pressure Nynehead Court D53 - D02 S55508 Nynehead V231578 070605 Stage 4.doc Version 1.30 Page 16 relieving equipment were seen to be in place where there was an assessed need. Bedrooms are decorated when they become vacant. Most rooms have pleasant views across the gardens or countryside. Some rooms considerably exceed the minimum standards in size and facilities. Service users informed the inspectors that they liked their rooms. Some enjoy spending a great deal of time in them and have a range of entertainment equipment and space to pursue interests. The home has a large and small sitting room. There are also other quiet spaces in which to sit. There is a large well-appointed dining room. The decoration and refurbishment of the home is on-going reflecting the considerable investment of the current owner. There is a full time maintenance person and gardening staff. The standard of cleanliness was very good. Sufficient domestic staff are employed to care for the home to a high standard. Nynehead Court D53 - D02 S55508 Nynehead V231578 070605 Stage 4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30. The home ensures that there are sufficient staff on duty to meet the service users needs. The home’s recruitment practices are robust and designed to protect the service users when completed. Staff have access to a range of mandatory and developmental training opportunities. EVIDENCE: On the day of inspection there were five care staff on duty. Also on duty were the chef, housekeeper and two domestic staff and a laundry lady. There is a full-time maintenance man and two gardeners. The duty rota showed permanent staff working in numbers to meet the needs of service users. Staff spoken to confirmed they had received manual handling up-dates and fire training. Infection control and medication training had been provided for some staff. Written records of training were seen. Some staff had attended a Dementia Care conference. It is recommended that all care staff receive some training in dementia care. Two recruitment files were observed. Both contained evidence of a thorough recruitment process. However, references must be received in the home before staff commence employment. Nynehead Court D53 - D02 S55508 Nynehead V231578 070605 Stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36, 37, 38. The home is effectively managed by the registered manager who promotes a clear and inclusive style of management that, ensures the needs and well being of service users takes priority. The home has systems in place for ensuring the health, safety and welfare of service users and staff. EVIDENCE: The registered manager is Diana Hathaway who is an experienced manager. Staff confirmed that six weekly meetings are held with senior care staff. Minutes of meetings were observed. Staff stated that they could go to the manager and senior care staff at anytime. The manager is very much a ‘hands on’ manager who has a very clear understanding of the needs of service users living at the home. It is a Nynehead Court D53 - D02 S55508 Nynehead V231578 070605 Stage 4.doc Version 1.30 Page 19 particular strength that she is able to undertake a range of roles. It was evident that the manager is active in ensuring relatives and carers receive the support and information they need. A deputy manager has recently been appointed and is receiving on-going training and support. Staff spoken with were very positive regarding the support and input they received from the manager. At the time of this inspection the home was taking appropriate steps to ensure the health and safety of service users, staff and visitors to the home. The following records were examined: FIRE – Records indicated that appropriate checks were being carried out on the home’s fire detection and fire fighting equipment. Regular training is conducted for all staff. SERVICING – Servicing contracts were seen for the home’s hoists. Bedrails are in use for those service users with an assessed need. Regular checks are made by the home to ensure they remain safe. A number were checked by inspectors and no problems were identified. ACCIDENTS – The home maintains appropriate records relating to accidents at the home. The manager analyses these on a monthly basis to identify any traits. Action is then taken as appropriate. HOT WATER/SURFACES – All radiators are of a low surface temperature type which reduce the risk of injury to service users. Bath hot water outlets are thermostatically controlled to reduce the risk of scalding. Monthly checks are made to ensure that the temperature does not exceed the HSE recommended limit of 44C. Those checked at this inspection were found to be within the acceptable limits. Nynehead Court D53 - D02 S55508 Nynehead V231578 070605 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 1 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 4 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 x x x x 3 Nynehead Court D53 - D02 S55508 Nynehead V231578 070605 Stage 4.doc Version 1.30 Page 21 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 OP3 Regulation 14 (1) (a) (b) (c) 12 (1) Requirement The assessment of service users must be formally recorded and should follow the guidance given in Standard 3.3. If the home wishes to admit any service users in the future with a primary diagnosis of dementia an application to vary the registration of the home must be made to CSCI. A training plan to provide all staff with the skills to support service users with dementia must be submitted. The care plans must set out in detail the actions which need to be taken by care staff with particular regard to psychological and emotional needs of service uers. Two references must be received by the home for all staff prior to to commencement of employment. A system of audit and supervision of medication administration must be implemented to ensure MAR records are completed with consistent accuracy. Timescale for action 1/08/05 2. OP4 1/09/05 3. OP4 18(1) 1/9/05 4. OP7 15 1/09/05 5. OP29 19 31/07/05 6. OP9 13(2) !/09/05 Nynehead Court D53 - D02 S55508 Nynehead V231578 070605 Stage 4.doc Version 1.30 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Nynehead Court D53 - D02 S55508 Nynehead V231578 070605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL 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 Nynehead Court D53 - D02 S55508 Nynehead V231578 070605 Stage 4.doc Version 1.30 Page 24 - 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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