Inspection on 14/02/08 for Overbury House Nursing & Residential Home

This inspection was carried out on 14th February 2008.

CSCI found this care home to be providing an Good service.

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

Overbury House Nursing &... 15/07/09

Overbury House Nursing &... 05/03/07

Overbury House Nursing &... 27/07/06

Overbury House Nursing &... 26/10/05

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

CARE HOMES FOR OLDER PEOPLE Overbury House Nursing & Residential Home Staitheway Road Wroxham Norwich Norfolk NR12 8TH Lead Inspector Mrs Ginette Amis Unannounced Inspection 14th February 2008 10:30 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 Overbury House Nursing & Residential Home DS0000065678.V359990.R02.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. Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Overbury House Nursing & Residential Home Address Staitheway Road Wroxham Norwich Norfolk NR12 8TH 01603 782985 01603 783425 admin@overburyhouse.healthcarehomes.co.uk 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) Healthcare Homes Limited Eileen Louise Ward Care Home 61 Category(ies) of Dementia (61) registration, with number of places Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th March 2007 Brief Description of the Service: Overbury House provides nursing and residential care for elderly people who have been diagnosed with dementia. The home changed ownership in August 2005 and is now owned by Healthcare Homes Limited. The home is a large detached building of traditional design with a number of modern extensions that have been added over the years. Further work was completed in April 2007 adding more bedrooms to the existing building increasing the overall occupancy to a maximum of 61 persons. The residents’ accommodation is located on the ground and first floors. The home informed CSCI of its charges in February 2008 and charges from £390 to £650 per week for care provision. Residents are expected to pay extra for hairdressing, chiropody and toiletries. Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This unannounced inspection took place on Thursday 14th February 2008 between the hours of 10:30 and 18:00. The registered manager of the care home was available throughout the day to assist with the provision of information. The regional manager of Healthcare Homes who operate the service was also on hand. Five members of staff were spoken with in the course of the inspection. Three relatives who were visiting the home were spoken with along with the residents they had come to see. Another resident was also conversed with individually. A forth relative was spoken with on the telephone. All of the above people were courteous and helpful in informing the content of this report. In addition, 2 residents, 8 members of staff and 12 relatives completed CSCI surveys about the care home. Although some concerns were raised by the survey, the majority of responses were positive about this service What the service does well: What has improved since the last inspection? There have been a number of changes to the care home and in its practices following the Inspection of March 2007. Building works had been completed and a new wing opened in the summer of 2007. This provided an additional 11 rooms on the ground floor, all with en suite facilities, finished to a high standard, suitable for the needs of older Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 6 people and comfortably furnished. In addition, a spacious sitting and dining area had been created with doors opening onto an enclosed and attractively designed patio area where residents would be able to sit in good weather. Other bedrooms in the main house had been redecorated and new carpets fitted in them as well as in the front lounge area. A new sensory garden had been designed and would be completed by early Spring. This area was already attractive and interesting with many features designed to stimulate memories. The requirements made in 2007 to improve the way in which medication was managed and administered had been acted upon and in April 2007 a CSCI pharmacy inspection had confirmed that standards in this area were now good. While the inspection of March 2007 acknowledged there had been improvements to the way in which residents’ needs were assessed and their care planned, additional improvements were required. These too had been acted upon and each resident’s needs had been reviewed and care plans completed to a satisfactory standard. In addition, in collaboration with residents and their relatives, social histories had been compiled as a means of ensuring the provision of more meaningful activities. Residents and staff meetings were being held at regular intervals and relatives were being encouraged to take part as much as possible in the life of the care home. There had been a number of social events including a bonfire party with fireworks in November 2007 that was greatly enjoyed by residents and staff alike. Further training had been made available to members of the staff team. There had been some improvement to staffing levels. As one member of the staff group put it “everyone had pulled together and worked hard” and it was evident felt some measure of achievement on realising the improved reputation of the care home. During 2007 some concerns had been raised with the adult protection unit, but in all cases the care home had been found to have acted correctly. What they could do better: There were a small number of rooms that continued to be used for double occupancy. We have discussed with the management how continued use of these rooms might cause some problems for people with dementia and have asked them to think about these issues. There had been some concerns raised over the competence of some members of staff coming from overseas regarding their ability to understand and communicate well in English. The manager agreed that in future any staff for which English was not their first language should be supported to gain better understanding of the terms and ways of usage of the language. Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 7 There remained a need to continually monitor the numbers of staff required to effectively meet the needs of so dependent a group of people as were resident at Overbury House. 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. Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 8 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 Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 9 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 and 3. Quality in this outcome area is good. Ample information was made available to anyone considering making Overbury House his or her home or who was concerned to find an appropriate home for a relative or friend. The needs of people wishing to move there were carefully assessed to ensure they could be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An information pack had been produced describing the services available at Overbury House. The pack included a copy of the Statement of Purpose, a Resident’s Guide to the care home, copies of the Terms and Conditions of Residence and the Complaints procedure along with an edition of the care home’s own news letter “Home News”. The manager described the process by which prospective residents came to be admitted, relating that most people were referred by the Julian or Helesdon Hospital or came to Overbury House as a result of a Social Service’s referral. Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 10 The manager or her deputy visited people in their own homes or in hospital to assess what their needs were and ensure these could be met by the care home. Prospective residents and their families were always encouraged to visit the care home prior to coming to live there and a six-week trial period followed admission. The assessment of a person’s needs would be strengthened and further refined once they had arrived at the home. Any new resident coming from out of the area would be registered with a local GP. We examined the files of 6 residents, including people who had lived at the care home for several years and one person who had been there for less than a month. All of these files contained evidence that people’s needs had been comprehensively assessed. Detailed information had been gathered relating to health and personal care needs, including an assessment of dependency, risks, safety, mobility, minimal moving and handling, pressure area care, nutritional needs, social and emotional needs and those aspects of life that contributed to well being or otherwise. Information gathered in these files was found to be detailed and fully informative. Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 11 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 and 10 Quality in this outcome area is good. Improvements noted at the previous inspection had been built upon and care plans further developed to help ensure that residents’ needs were comprehensively taken account of and met. The improvement to the way medication was managed had been sustained, safeguarding its safe storage and administration. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The 6 files already inspected to assess the admission procedures were further examined to gather information about care planning. At the previous inspection outcomes were considered adequate. It was noted that care plans had significantly improved, but that further development was still needed. At this unannounced inspection, we found that care plans had been regularly reviewed. Each was produced in a format that explained the nature of the resident’s need, the expected outcome or how it was intended the need should be met and instructions to carers outlining the actions they must take in order to ensure the desired outcome was achieved. This information was detailed Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 12 and clear. For example, where a resident had been assessed as having difficulties in maintaining continence, it was noted how this might lead to their becoming distressed and embarrassed and that staff must take particular steps to ensure this undesirable outcome was avoided. How encouragement and support should be offered to aid residents’ in maximising their independence was explained and members of staff were provided with clear guidance as to how this might be achieved. Some residents were assessed as being subject to variable moods. Care plans contained sufficient information for staff to be able to interpret changes in demeanour and respond accordingly so as to lessen any possibility of that person becoming increasingly unhappy. Members of staff related how their training had better equipped them to react appropriately whenever any person living at the care home became agitated. An incident when one resident took offence at another had been quickly and properly dealt with. A member of the staff team was able to demonstrate how she understood the disposition of a resident who was known to occasionally be aggressive and described how guidance was available to staff in relation to behaviours that could be difficult to deal with. Where a resident had developed a pressure area a proper plan of care had been initiated and progress in healing was being monitored ensuing treatment could be evaluated. The manager had appointed 3 members of the staff team as “Dignity Champions” to monitor how other team members approached residents and to ensure that privacy and dignity were always respected. During the inspection we noted how members of staff swiftly responded when a resident embarked on actions that undermined their dignity and took care for example to see that a person did not indiscriminately remove items of clothing or expose themselves in areas of the care home designated for communal use. All members of the staff team had completed training in the care of people with dementia. During the inspection, observations were made of how members of staff behaved towards residents. The impression gained was of a kindly understanding attitude among members of staff. In the Annual Quality Assurance Assessment (AQAA) the manager had outlined how findings resulting from research undertaken at the Stirling and Bradford Universities had been incorporated into methods of care delivery with a view to producing a therapeutic environment. Guidance was contained in the Care Management Policies Folder located in the staff duty room. The manager related how Aromatherapy had been introduced as a means of improving residents’ feelings of well-being. She related how this had proved particularly useful in the case of a resident who was in the latter stages of their life. An accredited Aromatherapist who regularly attended the care home made additional visits to treat this person, using massage and essential oils to Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 13 instil calm and a peaceful atmosphere. This therapist was engaged in a research programme designed to evaluate the benefits of Aromatherapy to people suffering from dementia. In the AQAA the manager further stated that the aim was for Overbury House to be able to supply the accredited Gold Standard For End of Life Care and she expected to attend a training course in preparation for doing so. She had already completed training in the application of the Mental Capacity Act 2005 and in the process of reviewing care plans had sought to ensure the provisions of the Act were abided by. Other members of the staff team would also soon be able to access this training. Residents’ files contained evidence that any risks they might encounter had been carefully considered and set out guidance for safeguarding people. Some residents had bedrails in place. Where this was so, an explanation had been given and the agreement of the resident or a relative had been recorded. Each care plan contained a missing persons guidance sheet that detailed action to be followed in any case when a resident could not be found. The noted recent incident when a resident left the care home and was found in a nearby boat yard was discussed with the manager who explained how relatives of another resident had inadvertently allowed this resident to leave the care home when they did, having mistaken her to be a visitor. Coded locks were now fitted to all main exits from the care home and visitors advised to check out with staff before leaving. The number of incidents when residents had sustained injuries as a result of falls was also discussed with the manager. Residents were not restricted from moving around the care home, (as it was noted had been the case in the past prior to the present owners and manager taking charge), and while every effort was made to ensure safety it would be unreasonable to try to prevent people from walking around the care home and gardens. During the inspection residents were observed moving around the corridors and from one communal area to another. Members of staff were also present in all these areas. When accidents had occurred, the proper reporting procedures had been followed. Two former residents had been discharged to hospital because their mental health had deteriorated in ways that meant the care home could no longer offer them the support they needed. It was noted from their files how some residents had moved a number of times between care homes before finally coming to live at Overbury House. The manager commented that whenever a resident’s needs became too great to be managed there, it was invariably the case they needed hospital care. Some residents had difficulty communicating verbally, though throughout the day were observed interacting with staff who, through their personal Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 14 knowledge, ability to read body language and mood and general intuitiveness appeared to readily understand what was being asked of them. Following pharmacy inspections made in January and March 2007 when a number of failings were identified, the CSCI Pharmacy Inspection of April 2007 noted significant improvements to the way in which medicines were managed and administered. The care home had developed a Best Practice Folder containing the policies and procedures it now insisted were adhered to. Trained nursing staff or carers who had undergone training specific to the administration of medication were the only staff authorised to deal with medication. A monitored doseage system had been introduced and the majority of medication was now being delivered in that way. Where medication was prescribed on an “as required” (PRN) basis, this was found to be clearly labelled with guidance in place over its use. All medication was found to be appropriately stored, including controlled drugs and medication requiring refrigeration. The medication fridge temperature chart was checked and this had been regularly completed and was accurate on the day of the inspection. During the inspection, the nurse in charge was accompanied on the midday medication round. Medication was carefully and systematically administered, with careful checks made in each case to ensure the person in question received the correct medication. Liquid medication was delivered in individual amounts drawn up by medication syringe for accuracy. Careful assessments were made prior to any PRN medication being administered, for example when pain relief was the issue. Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 15 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 and 15 Quality in this outcome area is good. Steps had been taken to find out more about the past lives of residents so as to make meaningful recreational pastimes available to them. A particularly pleasant garden had been developed with a view to stimulating memories as well as being a source of pleasure. Residents were well fed and special needs catered for with assistance offered in a tactful manner. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We found that each resident had an additional new file entitled “This is Your Life”. This had been constructed with the help of the resident and their relatives where possible and gave a synopsis of their life history with additional information about such things as where they lived and went to school, their working and family life as well as detailing preferred interests and past times. Gathering this information had provided an “activity” in itself but on its completion could be used by staff helping them ensure residents had opportunities where possible to engage in doing things they enjoyed. The manager had, since the previous inspection, taken steps to ensure relatives were included in the life of the care home, inviting them to attend functions Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 16 and meetings, take part in the review of care plans and for those who wished, keeping in touch by e-mail. Since the previous inspection a new Activities Co-ordinator had been appointed. During the course of the inspection, a musician came to the home in the afternoon to entertain residents with his playing. Musical entertainment, sing a long, art therapy and the celebration of national holidays with parties were all regular features. Some residents were involved with local community groups. Visitors were observed to come and go through the day and 3 who were spoken with all voiced positive opinions of the care home saying they found it a relaxed and friendly place. The manager of the care home had a small dog that regularly came to work with her and though remaining mostly in the manager’s office it was evident some residents liked to see a pet. There was also a resident cat and once a month the ‘PAT The Dog’ service came into the home. Some residents had used pictures of pets as markers on their bedroom doors to help them identify which room was their own. Since the previous inspection a sensory garden had been designed and was nearing completion. This garden was attractive and full of imaginative focal points. One corner had been devoted to seaside memories, complete with beach hut. In another area an ornamental bus stop was located. A third area featured a small replica bandstand. All had integral seating so that residents could make use of them whilst perhaps being reminded of how similar objects had been part of past lives. There were various ornamental creatures amidst the flowerbeds and wind chimes in the trees. The grounds were boarded by mature trees, were well kept, with numerous spring flowers starting to appear. During the inspection we observed meals being served. The manager had indicated in the AQAA how 5 meals were offered each day as this was found to be more supportive of residents with poor or impaired appetite. There were 3 main dining areas although some residents preferred to take their meals in their own room. People who required very little support used one of these rooms. This was a bright comfortable room with doors that opened onto the patio outside. Tables were nicely set with cloths and napkins and there were pots of spring bulbs as decorations. (Residents had planted the bulbs as an activity.) Residents had lunch there in a leisurely manner, socialising with one another and with staff. Food was nicely presented and appeared of good quality and quantity. In another room, residents were receiving one to one assistance as required. This area too was well appointed and clean and the food was nicely served. The cotton aprons and tablecloths in evidence at the previous inspection were still available. Residents appeared to enjoy their meals and said they were satisfied. Menus were displayed in picture format so that anyone who needed prompting could understand what choices were being offered. The third dining area was located in the new wing of the care home and formed an open plan extension to the sitting area. Here some residents Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 17 had their food liquidised to assist their swallowing. Assistance where needed was again offered on a personal basis. One resident had assistance from a visiting relative who commented that, in her experience the quality of the meals was always good, adding “And I come here 3 or 4 times a week.” Some relatives returning surveys to CSCI expressed different views about the food, in particular the view that at teatime there were only sandwiches on offer. This was not the opinion of those residents spoken with or visitors there during the inspection. At teatime, baked potatoes, pork pie and sandwiches were all available. A member of staff also commented that any special wishes could usually be accommodated. The manager said a new head chef had just been appointed and that the appointee had expressed the intention of getting to know all the residents and their preferences or particular dietary needs before commencing to prepare new menus for the care home. Those care plans examined during this inspection contained evidence of residents’ dietary needs being assessed and monitored. Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 18 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 and 18 Quality in this outcome area is good. Residents were protected by the care home’s policies and procedures and by the training given staff to help them recognise signs of abuse. Residents and their relatives had access to the complaints procedure and felt confident any concern would be quickly and effectively dealt with by the management team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The provider and manager had put in place clear policies and procedures to ensure residents were safe and protected from any potential harm. The complaints procedure was included in the resident’s Welcome Pack (Service User Guide) and displayed in the care home’s main foyer. Relatives spoken with during the inspection said they would have no hesitation in approaching the manager, deputy or area manager had they any concern they wished to discuss. The complaints procedure document bore a photograph of the manager and of the area manager in case anyone had any doubt over who they were. Of the 12 relatives who responded to the CSCI survey none expressed doubt over the effectiveness of the complaints procedure. Since the previous inspection 2 issues concerning the safety of residents were referred to the Adult Protection Unit for investigation but neither was found to contain any evidence that the care home had acted inappropriately or failed to act as necessary in any way. Records of such incidents had been carefully recorded with witness statements taken. Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 19 All members of the staff team had received training to protect vulnerable adults from abuse and as necessary, this training was renewed over time. Members of staff spoken with had a good understanding of the whistle blowing procedure. All staff, residents and relatives spoken with described the manager and area manager as approachable people who would be prepared to listen and act to right any kind of concern. Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 20 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, 23, 25 and 26 Quality in this outcome area is good. Considerable investment had been made in the premises, not only to increase the number of available rooms but also to significantly improve the environmental standards. Residents benefited from the improved comfort and cleanliness of their surroundings. The continued use of double rooms was not however acceptable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We made a tour of the premises at the start of this inspection and a number of areas were revisited in the course of the day. As found at the previous inspection a comfortable, open sitting area had been created at the front of the main building and this remained a favourite area for residents to walk through, or to sit with visiting relatives. Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 21 The new wing had opened in the summer of 2007. This area was particularly well appointed, each of the 11 bedrooms having en suite facilities, being individually decorated and carpeted and containing many examples of small ways in which residents had made this space their own. The communal areas were spacious, clean and nicely furnished with doors opening onto an enclosed courtyard where residents would be able to sit in good weather. A majority of residents were to be found using this sitting area, as this was where activities were held. The care home was found to be generally clean and tidy, a number of bedrooms had been refurbished and re-carpeted. The standard of decoration and furnishings was good. Two vacant rooms were in the process of being redecorated. Residents and relatives spoken with said they liked their accommodation and found it comfortable. At the previous inspection a requirement was made for bad odours to be eliminated from one particular bedroom. On first inspection it was noted how unpleasant odours were still evident in this room. Although a new carpet had been fitted in the intervening months this already bore marks of where it had been soiled. The odour was explicable in that cleaning staff were working their way around the home and had not yet reached that part of the building. Some time later on the same day the smell had been eliminated. Throughout the day there were instances when parts of the care home had a slightly unpleasant odour and this was undoubtedly caused by the behaviour of some residents. No requirements or recommendations were made on this occasion, as it was evident from discussion with the manager and observations of the day’s activity in the care home how the need to manage this potential problem was well understood. The manager had produced a Best Practice for Infection Control folder to assist and guide staff in their duties. Members of staff were trained in how to control the potential for spread of infection and throughout the day were observed making good use of the available protective clothing and equipment. Domestic assistants were also in evidence during much of the day and the policy of promptly attending to problems as and when they arose was appreciated. One relative commented how this practice was an improvement on how things had once been prior to the care home being taken over by Healthcare Homes, another saying “Since the change of ownership, I feel the home has become a cleaner, happier place”. Bathrooms were particularly attractive and considerable effort, (by use of decorative features, plants and pictures), had been put into offsetting the potentially clinical effect of having necessary equipment to hand. All bathroom and toilet doors had been colour coded yellow to assist residents in identifying their whereabouts. Throughout the care home, residents had been encouraged to mount a picture of their choice on the door to their own room to assist them with its identification. Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 22 We noted the continued use of some larger rooms for double occupancy and discussed this with the management team about how this might create some difficulties, e.g. where people suffer from dementia so cannot easily exercise choice and equally may fail to respect one another’s belongings. A recommendation was made to consider phasing out the use of these rooms. Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 23 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 good. Residents were protected by the sound recruitment policies and procedures of the care home and by good standards of training and supervision given the staff team. There were sufficient staff on duty, but with reference to the high dependency of residents the adequacy of staff numbers should be continually monitored. The manager should be mindful that residents might find it hard to communicate with people who do not have a good grasp of the English language and make sure any staff employed form overseas can speak and understand English well enough. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this inspection the care home was not full to capacity with only 54 people in residence. There were sufficient numbers of staff on duty throughout the day to care for the needs of residents. There were 10 members of the care team including 1 nurse and 1 senior carer on shift during the morning. 1 nurse covered the afternoon and evening shifts and 1 senior carer plus 9 care assistants and at night one nurse and 4 carers were on duty. In addition, the manager or her deputy took charge and either one was on call during the night. There were cleaning staff, a cook and kitchen assistants on duty throughout the day. The care home also had an administrator to deal with Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 24 such matters as residents’ contracts, collection of fees and general correspondence. A gardener and handyman were also employed by the care home and responsible for the new garden and redecoration of the premises. The regional manager was present on the day of the inspection and had come to the care home on a scheduled visit to support the manager, not simply to attend the inspection. In the AQAA the manager described how staff numbers had increased since the last inspection with the introduction of a twilight shift to assist with preparing residents for bed. There was no time during the day of this inspection when it became apparent there might be insufficient staff available to meet resident’s needs. However, some members of the staff team responding by survey, together with some relatives said they felt there were times when more staff might be needed. Three of those members of staff spoken with during the course of the inspection were asked about this and they did not feel there were times when a greater number of staff were needed. However, given the acute needs of many residents, and high dependency levels, this was discussed with the manager and it was agreed staffing levels should remain subject to constant review, to ensure sufficient flexibility to meet needs at all times, particularly should resident numbers or needs increase. A recommendation has been made. There remained a number of staff who worked long shifts and this was questioned at the previous inspection. From discussion it was established that for the persons concerned this represented their preferred way of working. Recruitment practices were discussed with the manager and, as was found at the previous inspection and had been detailed in the AQAA, these remained robust. The files of 3 members of the staff team were examined, one recent recruit, one person who had been employed for over a year and another longstanding member of the team. Each file contained evidence to support the view that residents were protected by sound recruitment practices. The care home employed a training officer and had created a training room on the upper floor of the premises. Staff training needs had been assessed and plans drawn up to ensure all members of the team had appropriate training made available to them. All the care team had completed training to protect vulnerable adults from abuse and in the care of people with dementia. Additional training had been accessed from the Alzheimer’s Society to help staff care for residents diagnosed with this form of dementia. All mandatory training had been completed and where necessary refresher courses had been booked. A refresher fire training course was booked for the 25th of the month. Two members of the staff team were undergoing training to become manual handling trainers for the care home. There were 13 out of 19 members of care staff had attained NVQ Level 2 accreditation or above. The organisation responsible for Overbury House was about to gain an Investors in People Award. Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 25 Some of the relatives and members of staff who returned surveys to CSCI commented that there were times when it was difficult to understand what was said by members of the care staff team for whom English was not their first language. Some relatives raised concerns that members of staff from abroad might not be understood by residents or, might not fully understand what residents said to them. This concern was discussed with the manager who agreed there had in the past been members of staff who had some problems with English language but that they were no longer employed there. Other members of the team from abroad were, she felt, competent in English. None of the staff spoken with during the inspection had any problems with English. It was however agreed that the employment of staff from overseas could present difficulties of this kind and as a result a recommendation was made for training in use of English to be automatically made available to any person employed from overseas in order to establish that their competence in both written and spoken English was sufficiently good for them to understand and be understood by residents and other members of the team. A recommendation was made. The manager and area manager were both in agreement over this and for that reason this was not issued as a requirement. Members of the staff team were spoken with during the course of the inspection and also interviewed separately. All agreed that standards at the care home were good and those who had been employed there for some time felt they had raised significantly since the care home was taken over by its present owners and manager. The manager in particular was described as very approachable with good leadership skills. Regular staff meetings had been introduced and with minutes taken. One recent meeting had addressed concerns caused by staff ringing in sick at the “last minute” and members of staff also felt this was a potential problem as it necessitated use of agency workers who might not know the home or its’ residents so well. All the staff spoken with felt they had good training made available to them and that they were well supervised and supported. Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 26 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 and 38 Quality in this outcome area is good. The manager who was now registered with CSCI was competent and had exhibited good leadership skills. She had commendably achieved significant improvement in standards at the care home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the previous inspection the appointed manager had been registered with CSCI. As was found at that inspection of April 2007, it was evident that her appointment had resulted in considerable changes being brought about at Overbury House and that these were all changes for the better. The manager was well qualified, holding a Degree and Diplomas in Nursing and Business and had achieved the Registered Manager’s Award. The organisation’s Regional Manager supported her in her role. Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 27 The atmosphere and ethos of the care home had become more sympathetic to the needs of residents who were now more relaxed and happier as a result. One member of the team commented on how everyone had “Pulled together as a unit and worked very hard” saying leadership and training had been good and that it had become “a pleasure to work in a home with a lovely atmosphere “ where “residents are relaxed and relatives enjoy coming into the home”. The problems surrounding the administration of medication had been overcome and the pharmacy inspection of April 2007 had found outcomes were good. Nursing staff spoken with during this inspection felt that poor practices had been “Swept away”, that some staff who had been “less than conscientious had left” and that individuals now took pride in their work and were happy to be part of a successful team as opposed to one that had been down rated (in previous inspection reports). The care home had regularly returned Regulation 26 reports to CSCI in 2007. As was found at the inspection of 2007, the care home had begun to develop its quality auditing with surveys of residents. By redesigning the way questions would be put to them, it was hoped future surveys would be more meaningful. Surveys of the views of staff and relatives continued. During 2007 relatives had been asked to attend meetings to review care planning and contribute to formulating the resident’s life history document, but also to give feedback on how the care home was changing and developing. Regular residents’ and relatives’ meetings were being held as a means of gathering information and a Friends of Overbury House Committee formed. The new garden had been completed with the input of ideas from residents and their relatives as had the designated arts and crafts area. The organisation had analysed its surveys and hoped to build on its findings. As was found at the previous inspection members of staff were regularly supervised. Those members of staff who were spoken with during the inspection confirmed this. No concerns over health and safety were noted during the inspection. Risk assessment of the entire premises had been conducted in 2007. Good information was available to staff on how to control risks along with COSHH information sheets and the Best Practice Infection Control audit. PAT testing had been completed in Feb 08. The lift was serviced in Jan 08. Hoists were serviced in May 2007. A full fire risk assessment was completed in April 07 and fire detection and fighting equipment and emergency lighting serviced in July 07. Emergency call system serviced July 07. Members of staff received regular training in how to act in the event of fire and equipment was regularly tested. Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 28 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 Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 29 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 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 2 X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 X X 3 Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 30 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. Standard Regulation Requirement Timescale for action 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 OP27 Good Practice Recommendations The manager should consider regularly monitoring the adequacy of the number of staff on duty to ensure sufficient care staff are available to meet the needs of residents at all times When ever staff are employed for whom English is not their first language, the provider should consider providing support in the use of English is made available if this is required to help them communicate effectively with other staff and residents. The registered person could consider the continued use of those rooms that provide double occupancy and how their use may impinge upon good care practice for people with dementia. 2 OP30 3 OP23 Overbury House Nursing & Residential Home DS0000065678.V359990.R02.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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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