Inspection on 17/10/06 for Patcham Nursing Home

This inspection was carried out on 17th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Patcham Nursing Home 10/01/06

Patcham Nursing Home 17/08/05

Patcham Nursing Home 23/11/04

Patcham Nursing Home 15/06/04

Similar services:

Old Hastings House

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

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

CARE HOMES FOR OLDER PEOPLE Patcham Nursing Home Eastwick Barn Eastwick Close Brighton East Sussex BN1 8SF Lead Inspector Elizabeth Dudley Key Unannounced Inspection 17th October 2006 10:00 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 Patcham Nursing Home DS0000014022.V313734.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. Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Patcham Nursing Home Address Eastwick Barn Eastwick Close Brighton East Sussex BN1 8SF 01273-501358 01273-542028 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) Eastwick Barn Ltd Sheila Kidd Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability (30), Terminally ill (4) of places Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service can provide up to thirty (30) nursing places, thirty (30) social care places. The maximum number of service users to be accommodated is 30. Up to thirty (30) service users with physical disabilities and four (4) service users who are terminally ill may be accommodated. 10th January 2006 Date of last inspection Brief Description of the Service: Patcham Nursing Home is situated in a pleasant residential area on the outskirts of Brighton, close to a bus service and all main routes to the city centre. It provides nursing care for thirty service users over 65 within the categories of elderly care, physically disabled and terminally ill. Care is provided in exceptionally well-maintained and comfortable surroundings with access to a well-maintained and interesting garden. A high standard of catering is provided. The home was extended from a converted barn and has exposed beams in some areas. Accommodation is provided in either single or double rooms, most of which have views of down land or the garden. There are two lounge areas, one large and one relatively small, both of which give access to the gardens. Garden access is also available from some ground floor rooms. Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection took place on the 17th October 2006 over a period of eight and a half hours and was facilitated by Mr & Mrs C Dauncey, Registered Providers and Mrs S Kidd, home manager. During the visit to the home, nine residents, ten members of staff and two visitors were spoken with. A tour of the home was undertaken and records, which included care plans, medication records, and personnel files, catering information and health and safety documentation were examined. Prior to the visit to the home questionnaires were sent to ten residents, ten relatives/visitors and three general practitioners and one other health care professional. At the time of writing this report all ten residents and six visitors have responded by returning the questionnaires. Following the visit, telephone calls were made to two relatives or representatives of residents to gain their views on the service provided by the home, and the CSCI was further contacted by three relatives or representatives of residents. All comments received, both written and verbal were very positive. Some of the views given by residents and representatives are as follows: ‘Sometimes I have had to ask the manager about certain things, nothing major, but things that had been done differently and she always gives me a proper explanation and there was always a good reason. Mother is always well looked after here’. ‘All the staff are absolutely super, the food is good, plain cooking just like school meals’. ‘The food is very good and very imaginative, the staff are lovely, very kind’. ‘I am so glad I found this place, it’s as near to home as a care home can be’. ‘They have given me plants in pots outside my window and put bird feeders there, that is my own piece of the garden’. ‘A wonderful place, they look after her so well, full marks to all the staff’. What the service does well: Patcham Nursing Home provides an excellent standard of care and quality of life for the residents that are living in the home. The home is very clean and comfortable with a well-maintained, thoughtfully planned garden, with residents being provided with pots of plants outside their windows and bird feeders. Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 Page 6 A good range of activities is in place with residents being seen to be producing a high standard of painting and craftwork under the guidance of the activities organiser. Records are kept of all activities and resident participation and it was seen that a variety of activities is on offer and there is also recognition that some residents prefer to read, or have one-to–one time with the activities co-ordinator. The standard of catering is high, with most meals consisting of homemade food, including homemade soup, cakes and desserts. Staff turnover is low with a high level of staff (63 ) having attained their National Vocational Qualification level 2 in care, and trained nurses being given opportunities for further training and updating of their clinical knowledge. What has improved since the last inspection? 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. Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 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 the following standard(s): 1,2,3,4 and 5. Quality in this outcome area is excellent. Sufficient information is provided to enable prospective residents to decide whether the home can meet their needs. Thorough preadmission assessments are undertaken which ensure that the staff are well informed of the needs of the prospective resident, and to confirm that the home has the ability to meet these assessed needs. EVIDENCE: The home has a ‘Statement of Purpose’ and a ‘Service User Guide’, which meet this standard. However, the provider has decided to review both of these documents and to produce them in shorter, more ‘user friendly’ versions, adapting them to the needs of the older person, whilst maintaining the current information. The ‘Statement of Terms and Conditions’ is in line with the National Minimum Standards and associated regulations, and all residents have a copy of both this and the service user guide following their admission to the home. The provider is aware of the need to provide the statement of terms and conditions with notification of the fees to be paid, to the resident prior to their admission, Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 Page 9 as detailed in amended Regulation 5. However, in the case of those funded either totally or partially by local authorities this will be constrained by the time delay of the receipt of the fee details provided by these authorities. There was evidence of thorough preadmission assessments being undertaken by the manager, and these form the basis of the care plans. The manager takes the statement of purpose and service user guide with her when she assesses a resident in order that they receive full information about the home. At present the resident is informed verbally of whether the home can meet their needs and offer them a place, this must be followed by written confirmation. Prospective residents and their representatives may visit the home to look around and meet staff and residents and are admitted on a four-week trial period, prior to deciding whether they wish to live at Patcham Nursing home. Staff receive sufficient training to enable them to meet the needs of the residents within the home and 63 of the care staff have their National Vocational Qualification level 2 in care. Registered nurses receive regular updating and training, this taking place both in-house and externally. Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 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 the following standard(s): 7,8,9,10 and 11 Quality in this outcome area is excellent, this is based on the available evidence including a visit to this service. Care planning is of a good standard enabling residents to receive individualised care relevant to their needs. There is evidence of the involvement of residents or their representatives in the formation of the care plans. The standard of medication administration safeguards the residents and there was evidence of maintenance of privacy and dignity of the residents. EVIDENCE: Care plans reflect the physical, social and psychological needs of the residents, with evidence of monthly updating and formation in conjunction with the resident or their representative wherever possible. All care plans are detailed and formed for ease of use, with a daily record which reflects the activity around the resident. Social care plans are kept separately and these also reflect what activities the resident has taken part in and their past and present interests and capabilities. Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 Page 11 There was evidence of consultation with other health and social care professionals, including General Practitioners, the Continence Advisory Nurse and Wound Care Specialist Nurse, with input also being sought from the nurses in the Nursing Home Support Team. A physiotherapist from the Nursing Home Support team attends the home as required, and there is an option to obtain treatment from a physiotherapist contracted on a private basis. Opticians and chiropodists visit the home. Residents are able to maintain the services of their own General Practitioner if this is within the area covered by the surgery. Residents spoken with said ‘They get the doctor as soon as I ask or if they feel I need to see one’, ‘The staff keep a good eye on me and if they are worried they get the doctor straight away’. The home has a variety of equipment required for the nursing needs of the elderly person. These include full body hoists, variable level baths, variable height beds, which include both electric and standard hospital beds, and pressure relieving mattresses and cushions. There are no residents with pressure damage within the home at present, but there was evidence of the Wound Care Specialist nurse’s involvement with any residents in the past who have incurred this. There was evidence of a nutritional tool (the Malnutrition Universal Screening Tool – MUST) being used to monitor the nutritional standard of residents, with regular weighing of residents being undertaken. Advice regarding nutrition of the elderly has been gained from external sources including the Nursing Home Support Team. There was evidence of involvement of the community psychiatric nurses and social work input to two residents within the home. All risk assessments and consent for bedrails were in place. All residents appeared well cared for and well nourished, with appropriate nursing care interventions taking place. The standard of administration of medication was good, all medication charts had been signed by the administering member of staff, and all medications were within their expiry date. Controlled drugs had been recorded and stored appropriately. The clinic room was clean with evidence of both clinic room temperatures and drug fridge temps having been recorded. The manager must monitor the amount of supplement foods coming into the home, as some of these are not always needed. Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 Page 12 A registered nurse was seen explaining to a resident that the doctor had prescribed new medication for him, she was explaining some of the side effects and what the staff would do if these occurred, asking the resident to let her know if he experienced any of these. She also explained to him how often the medication would be given. She later said that although she knew that the resident might not remember this information, she would explain this as often as required. All residents receive nursing and medical interventions within their own rooms and staff were seen to be respecting the residents’ privacy, both on entering rooms, and in their interaction with them. All residents have their own telephone. The home is registered for the care of the terminally ill resident and staff have attended courses on the care of the dying resident. Until recently staff were taking part in specialist courses, including the Liverpool Care Pathway and Gold Standards Framework, which details the care to be given to the terminally ill resident. This is to be resumed in the near future. Some residents were seen to be nursed in bed and appeared comfortable with all nursing intervention documented. Testimonials reflecting positive comments regarding care of the dying resident have been seen. Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is excellent, this is based on the available evidence including a visit to this service. Residents are able to enjoy good quality of life according to their abilities, and are treated as individuals with their likes and dislikes recorded and addressed. The standard of catering is high which encourages residents to enjoy their meals and attain an optimal nutritional intake. EVIDENCE: Residents spoken with said that they had flexibility in their activities of daily living, being able to choose the time that they retire at night and rise in the morning, what time they go to the lounge or whether they wish to stay in their room. They stated that the chef visits them every day to tell them what is on the menu and to offer them choice of meals for both supper and lunch and that they can vary what they have for breakfast. All residents said that they could choose what they wished to wear that day and where to see their visitors. One resident said ‘Staff give us as much help as possible to allow us to lead as normal a life as possible’. One gentleman was seen to be walking in the garden alone and said he does this several times a day and enjoys the fact that ‘The home gives me the freedom to be able to do what I want without having to worry about the mundane tasks of life’. Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 Page 14 The home now employs an activities co-ordinator who comes in at varying times throughout the week. A variety of activities were seen to be taking place, with residents producing embroidery, painting, photograph albums, baking and making small articles. One gentleman stated that ‘I don’t like the painting or embroidery. but she (the activities organiser) involves me in other things as much as possible’, another resident stated that ‘I cannot do activities as my hands no longer work but she (the activities person) comes in and talks to me quite often’ whilst another said ‘I don’t want to be involved with anything like that and this is respected by the staff’. A group of around eight residents were seen to be involved in various craftwork on this day and an album is kept of photographs showing various work they have produced and examples of the cooking and decorating of food that they have done. The garden also had various stones painted by residents. There was evidence in the activities records of one-to-one time being spent with residents. It is recommended that a formal activities programme is produced which will show all residents what is available. Some outings take place but these tend to be on a one-to-one basis rather than formally organised by the home. One resident attends church on a weekly basis with a taxi being arranged to take her to the church where her daughter meets her, and ministers of religion also visit the home. Discussions were held with the manager relating to the availability of reduced or free transport for residents in nursing and residential care. Two residents attend day centres two or three times a week. There is an open visiting policy with residents being able to see visitors in the communal area or in their own rooms. One visitor stated that the home ‘always makes me welcome and the manager addresses any minor concerns I may have and tells me the reasons for various actions being taken i.e. my mothers bed turned around, they also inform me if they have to call the doctor out’. Residents are encouraged to manage their own finances if able, and the manager has contacted advocates for resident when required. Solicitors and financial advisors can be contacted and residents see these in private. There was evidence that residents can bring personal possessions into their rooms. Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 Page 15 The kitchen was clean, and there was evidence of the chef keeping records as required by the Environmental Health Authority. The home has again received its ‘Clean Food Award’. There is a varied menu offered with a cooked option at most supper meals, homemade soup is offered at lunchtime and all cakes and desserts are home made. There was evidence of fresh fruit and vegetables with some residents been given a fruit bowl in their rooms if they request this. There were adequate amounts of other foods, fresh, dried and frozen within the home. The meal offered on the day of the site visit was: Parsnip and Ginger soup or grapefruit, either kedgeree or omelette, hash browns and leaf spinach and braised grated carrot, with apple crumble and custard or ice cream for dessert. Residents spoken with described the food as ‘the food is good and we always get a choice’, ‘there is always plenty to eat, its freshly cooked and there is a good choice’, ‘very good food’, ‘food is quite good, a bit like school dinners, plain home cooking’, ‘I love the food, the choice is good and its well cooked, they give you a lot to eat and I’ve expanded somewhat’. ‘You can have a cup of tea whenever you want one, they always bring a tray of tea for visitors without being asked, and if you get hungry they offer you a snack even in the night - not that we need it but they always offer when they come in’. There was evidence that all food, including the liquidised meals, was well presented. Residents can take their meals either in the lounge/dining room at the main tables or on over chair tables, or in their own room. Staff were seen to be maintaining resident’s dignity when offering help with meals. Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 and 18 Quality in this outcome area is excellent, this is based on the available evidence including a visit to this service. The management within the home addresses all concerns in a transparent and open manner, whilst ensuring that all staff have the appropriate training in the management of complaints and the protection of the people within their care. All staff were able to show that they were aware of their role in the protection of the residents. EVIDENCE: There have been no complaints received either by the home or the CSCI during the past twelve months. Any minor concerns are dealt with immediately and a visitor to the home confirmed this, as did various residents. All residents spoken with were aware of the complaints procedure and all questionnaires sent out to relatives confirmed that they were aware of this procedure but had never needed to make a complaint. Residents identified that they would have no hesitation in speaking with either the manager or the provider if they had any concerns about matters in the home. Residents are able to participate in the civic process by the use of postal votes. There have been no incidents requiring adult protection reporting within the home and staff questioned were able to show that they were well informed Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 Page 17 regarding their role in the protection of those in their care and were aware of the reporting procedures and whom to inform if this should occur. The home is a subscriber to the ‘Prevention of Adult Abuse Society’ and has training videos, which are shown to staff at varying intervals as well as more formalised training by an outside agency being provided. All staff receive adult protection training during their induction process. Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 and 26 Quality in this outcome area is excellent, this is based on the available evidence including a visit to this service. Patcham Nursing home provides a pleasant, well-maintained clean environment for residents. There is evidence that improvements take place to maintain the existing high standards, thus ensuring that residents have as comfortable a home as possible. EVIDENCE: Building work is in progress to add an extension to the property, which will allow the two existing double rooms to be converted into four ensuite bedrooms, all of which will measure approximately 14.5 sq metres. The ensuite bathrooms will consist of a washbasin and wc. Two additional wc.s are being added to the home along with an assisted shower room. There will be no addition to the number of residents accommodated in the home. It was noted during the site visit that this is being accomplished without evidence of any obvious disruption to residents, no impact on the cleanliness Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 Page 19 of the home and little noise incurred. The manager states that she has checked with residents that they are not being disturbed. None of the residents spoken with during this visit mentioned the building work taking place. The only evidence that building work is in progress is in temporarily moving the main access to the home to being through the back door. Discussions were held with the manager and provider regarding the importance of keeping this exit corridor clear in case it is required to be used in the event of fire, although there are other fire exits available. Other improvements to the home have taken place in the last six months: Eight bedrooms have been completely redecorated as has the entrance hallway, new carpets have been provided to seven rooms, two new full body hoists have been purchased and recently commissioned for use, one new sluice machine has been purchased, a computer network system put in place and two rooms have had new furniture. Automatic fire door closures have been provided on all doors including the residents’ personal accommodation. The kitchen has undergone a deep clean with a new grille fitted to the extractor unit. The lounge has also been redecorated with a new carpet fitted and a new wide screen television having been purchased. Two-way radios have recently been purchased for key members of staff on duty in the home, to enable them to respond to any emergencies or urgent queries, the provider states that he now intends to purchase more of these based on the success of this system. The garden is exceptionally well maintained and planned to look attractive all year. All residents whose rooms open out onto the garden have pots of plants which they can see, and if they wish, maintain, put outside their doors or windows. Residents refer to these as ‘my garden’, and there are many bird feeding devices in full view of residents windows. Individual seats and benches have been placed around the garden. All residents are able to access the garden. The home has a lounge/dining room, which looks out onto the garden, and a small lounge where relatives can spend quiet time. Both lounges are well used. All residents’ rooms have a lockable facility and lockable doors, keys being given within the auspices of a risk assessment. All rooms have a call bell facility. The home has assisted bathrooms with variable position baths and a new assisted shower room is being added. All rooms have ensuite facilities consisting of a washbasin and wc. Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 Page 20 There was evidence that water temperatures to resident outlets have been monitored and recorded on a regular basis, all temperatures falling within recommended parameters. There was evidence of window restrictors, in good order, on all upper rooms within the home. The size of the rooms in the home fall within the requirements of the National Minimum Standards. The home has been assessed by a Qualified Occupational Therapist and recommendations made put in place. There are grab rails, manual-handling equipment, walking aids and wheelchairs within the home. All areas of the home are very clean, even though building work is ongoing. There are good laundry systems in place and laundry is undertaken to a good standard. Red bags are used for soiled items and all machines can provide a sluice wash facility. There is a comprehensive range of infection control policies and these have been reviewed on a regular basis. Staff spoken with identified that they had infection control training and that there were sufficient supplies of protective gloves and aprons available. Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good, this is based on the available evidence including a visit to this service. There is a sufficient number of care and ancillary staff to meet the assessed needs of the residents over a twenty-four hour period. The standard of staff training is high and is of sufficient quality to ensure that residents receive care relevant to their needs, however written evidence of training is not always available. Some areas of staff recruitment procedures do not comply with the requirements of regulation, and could lead to residents being compromised. EVIDENCE: The duty roster showed that there are sufficient staff on duty over a twentyfour hour period to meet the assessed needs of the residents. Registered nurses lead each shift and are supported by a sufficient number of care staff. Domestic assistants, a laundry assistant and a chef and kitchen assistant provide the general services to the home. The home employs an administrator and an activities co-ordinator. The manager is on duty five days a week and is supernumerary to the other nursing staff. Staff spoken with said that the staff turnover is low and that they are rarely short of staff with agency brought in when the manager is aware that there will be a shortfall. The home runs its own nurse bank and uses agency staff that Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 Page 22 are familiar with the home. Staff said that they often cover for each other for unexpected sickness etc. A total of 63 of the care assistants have now achieved the National Vocational Qualification level 2 or 3 in care, with further care assistants undertaking study for this course. Staff receive the mandatory health and safety training at nationally recommended intervals and also attend training in matters relating to the care of the older person. This has included catheter care, infection control, nutrition, Parkinson’s disease, diabetes and dementia training. Registered nurses also attend updating training, both in house and externally, including updating their knowledge in the use of syringe drivers. Six members of staff have recently undertaken First Aid training. Domestic and catering staff have received COSHH (Control of substances hazardous to health) and some have received moving and handling training. A further course of this is planned for next month to ensure that all staff have attained this. The chef and relief cooks have their food hygiene training, but the kitchen assistants have not yet received this. It is recommended that care staff not dealing with food preparation undertake the food handlers training. Induction training is given to all staff on commencement of employment but no written records are in place. Staff however verified that they had undertaken this and worked shadowing an experienced carer, and had their mandatory training during their induction period. A total of six personnel files were examined belonging to staff employed over a minimum of four months to twelve years. The majority of personnel files had all documentation as required by the regulations, however one member of staff had been employed and is working without a current Criminal Records Bureau check but has a recent protection of Vulnerable Adults First check and one member of catering staff did not have an enhanced Criminal Records Bureau check. The manager and provider have now put measures in place to ensure that the home meets the regulations in this matter. The provider must be able to assure himself that adequate protection of residents is in place when the decision not to use the enhanced Criminal Records Bureau checks are made. Discussions were held with the provider and manager relating to these issues. Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37 and 38 Quality in this outcome area is good, this is based on the available evidence including a visit to this service. Management systems within the home ensure the safety and well being of residents and staff. Regular formal supervision of staff would enhance the protection and care of residents. EVIDENCE: The manager, Mrs Sheila Kidd, is a first level registered nurse with many years experience in both the acute and chronic health care sectors, including care of the older person. She has attained her Registered Managers Award and has been registered with the CSCI. She has been working at Patcham Nursing Home for three years and held the post of registered manager for two and a half years. Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 Page 24 The ethos in the home is good, staff turnover is very low and staff stated that they enjoyed working at the home and would be happy to allow one of their relatives to be cared for in the home. Ten residents were spoken with and all made very positive comments about the home and the care that they receive. Comments received were ‘I am very happy with the care, the staff are kind and the food is good’, ‘The staff are wonderful, always bright and cheerful and always make time to talk to us’, ‘The staff are very considerate and always listen to us and do what we ask, they answer the bells promptly, both day and night, and the night staff are a delight’. ‘Always shown very thoughtful behaviour both by managers and staff, very satisfied’, ‘Very nice home, it’s the nearest to home you can get, I am glad I found this place’. ‘The staff are absolutely super’. A questionnaire returned from a relative stated ‘All nursing staff are so helpful and caring as are the rest of them, this home deserves top marks’. Quality monitoring takes the form of questionnaires to residents and to relatives, the provider undertakes regulation 26 visits and during the course of these visits has in-depth discussions with residents. Views from residents and relatives influence change within the home. It is recommended that the viewpoints of health and social care professionals are elicited in order to give a balanced view of issues within the home. An annual development plan is in place and action has been taken to address any issues raised at the last inspection. Requirements made at the last inspection have been addressed within the required timescales. All staff are made aware of the results of the homes inspection reports and a copy is made available to residents and visitors to the home. Staff meetings have taken place three times over the past year. All policies and procedures have been reviewed recently and the manager and provider stated that they are in the process of updating some policies to ensure they reflect current practice within the home. The home does not act as appointee for any resident but holds a bank account for two residents. There was evidence of robust financial procedures in dealing with this resident’s personal allowance. Two residents are under a guardianship order, with the manager having the authority from the relevant bodies to deal with their monies. All financial records were in place including the Public Liability insurances. Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 Page 25 Formal staff supervision has not been taking place over the past few months and this must be commenced. Residents meetings do not take place at present, but the manager talks to all residents on a daily basis. It is recommended that combined relatives and residents meetings are commenced. All records are kept in a secure environment. Certificates relating to the servicing of utilities and equipment were in place and in date. A new fire risk assessment is in the process of being formed and the provider will send a copy of this to the fire officer and the CSCI. The provider was aware of the implications of the new fire orders and discussion was held around these. It is recommended that the staff room door and kitchen are kept locked when no one is using these rooms, and that the corridor to the back door is kept clear. All staff have received mandatory training with six members of staff having attained the first aid certificate. Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 Page 26 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 4 4 4 4 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 4 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 3 18 4 4 4 4 4 3 3 4 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 4 3 3 2 3 3 Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 Page 27 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 OP29 Regulation Reg 19 Schedule 2 Requirement That all staff are in possession of a current Criminal Records Bureau check prior to working unsupervised. That the provider assures that Criminal Records Bureau checks are of a sufficient grade to ensure that service users are protected. Timescale for action 10/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP12 OP30 Good Practice Recommendations That the activities programme is displayed where all service users can view it. That written evidence of subjects covered in the induction course is produced. That the induction course reflects the curriculum in the recognised core standards for care staff. That all care staff handling food undertake the appropriate course. That formal staff supervision is in place with written DS0000014022.V313734.R01.S.doc Version 5.2 Page 28 3 OP36 Patcham Nursing Home 4 OP38 evidence to support this. That the kitchen and staff room are kept locked when not in use, and that the exit to the back door is kept clear. Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Patcham Nursing Home DS0000014022.V313734.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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