Inspection on 15/11/06 for Priory Paddocks Nursing Home

This inspection was carried out on 15th November 2006.

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

The inspector 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

Priory Paddocks Nursing Home 05/12/05

Priory Paddocks Nursing Home 26/09/05

Priory Paddocks Nursing Home 10/03/05

Priory Paddocks Nursing Home 01/09/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Priory Paddocks Nursing Home Priory Lane Darsham Saxmundham Suffolk IP17 3QD Lead Inspector Jill Clarke Key Unannounced Inspection 15th November 2006 10:50 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 DS0000024475.V320057.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. DS0000024475.V320057.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Priory Paddocks Nursing Home Address Priory Lane Darsham Saxmundham Suffolk IP17 3QD 01728 668244 01728 668306 priory.paddocks@virgin.net 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) Mr Andrew Burgess Miss Marian Lloyd Miss Marian Lloyd Mr Andrew Burgess Care Home 37 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (37) of places DS0000024475.V320057.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th December 2005 Brief Description of the Service: Priory Paddocks, previously an Edwardian country house, was converted into a nursing home in 1987 by its present owners, who jointly manage the home. It is situated in the village of Darsham, near the A12 and the local railway station. Village amenities include a public house, a garage and a shop. The home is located next to a farm, which can cause problems with flies at times, and is set in two acres of landscaped gardens with a summerhouse and ample parking. During the summer months, residents can take advantage of the patio areas overlooking the gardens. Residents can access all areas of the home and gardens via a stairwell, ramps and a passenger lift. The accommodation consists of twenty-three single bedrooms (twelve with ensuite facilities), seven shared bedrooms (three with en-suite facilities) and assisted bathrooms and toilets. Communal space includes two lounges and a dining room. A separate staff training facility also offers overnight stay for relatives if required. The home has been decorated throughout in keeping with its original style. The two lounges and dining room evidenced many period features. Pets are welcome at the home, which holds two ‘Cinnamon National Pet Friendly Awards’, and chickens roam the car park. The home has its own twelve-seated mini bus, with a battery-operated tailgate, which enables easy access for wheel chair users. The bus is regularly used to take residents on trips and outings. The home is co-owned and jointly managed by two Registered Nurses, Miss Marian Lloyd and Mr Andrew Burgess. Fees which range from £462 - £663.68, depending on the room selected, is fully inclusive of everything (including toiletries, newspapers, hairdressers, chiropody, alcoholic drinks) apart from private medical expenses and clothing. DS0000024475.V320057.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, undertaken over nearly 8 hours, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to, and during the inspection. Commission for Social Care Inspection (CSCI) feedback cards were sent to the home in September. This gave an opportunity for relatives, visitors and staff to give feedback on how they thought the service was run. A good response was received with 26 residents, 22 joint relative/visitor and 26 staff surveys returned, comments from which have been included in this report. Residents, staff and management were helpful and cooperated fully throughout the inspection. Time was spent with 2 residents in private, to hear their views on the level of service provided. General discussions were also held whilst walking around the home and meeting residents, and visiting relatives. A tour of the building, took in all the communal rooms and a sample of 5 bedrooms, bathroom, kitchen, laundry and medication room. Records viewed, included care plans, staff recruitment, supervision and training records, servicing invoices, Menus and medication records. Previous visits to the home identified that people living at Priory Paddocks prefer to be known as residents, this report respects their wishes. What the service does well: Priory Paddocks provides residents with a comfortable, homely environment, within a rural location. The home is committed to providing a good level of training, and both residents and relatives describe the staff as being approachable. Time spent with residents, and feedback given through surveys showed that they like the staff and felt that their physical and nursing needs were being met by the home. One resident said that ‘I am very happy here. nowhere is perfect but the staff are caring, fun to be with and make it friendly and comfortable’. Another resident who said they ‘always’ enjoyed the food including the meat, which they described as ‘excellent’. Relatives and visitors are made to feel welcome. Comments made by relatives (CSCI surveys) included ‘I’m very impressed by staff and owners attitude to DS0000024475.V320057.R01.S.doc Version 5.2 Page 6 residents and the excellent level of care’, and ‘Priory Paddocks is an excellent care home’ and that they were ‘pleased with the treatment and support given’ to their next-of-kin. 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. The summary of this inspection report can be made available in other formats on request. DS0000024475.V320057.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 DS0000024475.V320057.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Home does not undertake intermediate care therefore standard 6 was not assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People wishing to move into the home, will be given information on the level of care provided, and can expect their needs to be fully assessed. This supports the prospective resident in identifying if the home is suitable, and ensures the home only admits residents whose care needs they can meet. EVIDENCE: Residents completing the CSCI questionnaires ‘have your stay about….’, were asked if they had received a contract giving information on fees payable. Nineteen out of the 26 confirmed they had. The remaining 7 had either said ‘no’, as they had received a contract from Social Services, or were unsure if they had, as their family dealt with their finances. Records seen showed that residents had either been given a contract by the home, unless they were social care funded as they supply their own contract. There was also correspondence sent annually, giving information on fee increases. This DS0000024475.V320057.R01.S.doc Version 5.2 Page 9 reflected conversations during the inspection with residents and family, confirming that they were aware of costs, and what was included in the fees. A new resident’s care was tracked, which showed that staff had visited them before their admission and carried out their own pre-assessment. The owners confirmed that this was normal practice for all prospective residents; to support them in identifying if they can offer the level of care the person is looking for. Information gained during the visit covers nursing, physical, social and mental health needs, is used to form the basis of the residents care plan. At the time of the inspection the home was updating their Statement of Purpose, and Service Users guide. Once this has been undertaken a copy will be sent to the CSCI. This led to discussions that whilst updating the Service Users guide, they should review the format used, to ensure it meets the range of current service users sensory and mental health needs. Feedback given both verbally during the inspection, and through surveys showed that relatives and residents felt they had generally received enough information. A relative commented that when their next-of-kin moved into the home that ‘information was readily forthcoming for all concerned at that time’. Where able, the owners encourage prospective residents and/or their representative to visit the home to meet the other residents and staff, as part of their decision making to ensure the home is what they are looking for. One resident wrote that ‘a member of my family visited Priory Paddocks, plus other homes in the area, and decided that it was the best suited for my needs’. Time spent with a new resident confirmed that they felt the home was able to meet their physical needs, and they were settling in. Of the residents completing CSCI surveys, 11 had confirmed that they ‘always’ received the care and support they required, and the remaining 15 said that they ‘usually’ did. Twenty out of the 22 relatives CSCI feedback questionnaires said that they were satisfied with the overall care provided, with 1 relative describing Priory Paddocks as an ‘excellent care home’. Discussions with staff showed that they had a good insight into residents care needs. To support residents with dementia the owner had taken positive action to arrange for staff to undertake the Alzheimer’s training course ‘Yesterday, Today and Tomorrow. The course requires staff attending 8, 2 hour sessions delivered over 14 months which was completed by 26 staff. At the end of the course staff were required to take an exam. The owner said that feedback from staff was positive with 1 commenting that they “now feel closer with people with dementia”. DS0000024475.V320057.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can expect staff to monitor their nursing care, based on their individual needs, and take appropriate action to support their changing physical and mental health. The principles of respect, dignity and privacy are put into practice. Residents cannot be assured that staff are always following safe systems for the transporting, and recording of medication being given out. EVIDENCE: Two residents care was tracked during the inspection which involved spending time with the resident to gain feedback on the level of support given, looking at their care records, and discussing with staff their understanding of the person’s need. Both residents had their own care/nursing plans, which were kept in their bedroom, and accessible for them to read if they wished. Records showed that the management had used the information they had obtained during the pre-assessment visit, along with information from social care assessments and hospital transfer letters to form the basis of the residents plan of care. DS0000024475.V320057.R01.S.doc Version 5.2 Page 11 Time spent going through a resident’s care plan with them, identified that the information given in the manual handling assessment, which required the use of a hoist, was not always happening. The resident was concerned that staff might hurt their backs when they tried to lift them. This was fed back to the owner, who said that at times the resident may be able to transfer, without the use of a hoist. However this was not reflected in the manual handling assessment. The care plan, kept in the bedroom, contained a ‘life history’, which was detailed and informative, especially when initiating topics of conversations. The resident confirmed that they liked the staff, and that their physical care needs were being monitored by staff and appropriate action taken in consulting with external health professionals when needed. This included monitoring their skin, to ensure no pressure sores developed, and their nutritional intake. Time spent with the second resident who was new to the home and whose care was being tracked, described staff as being “very good, and very, very kind”. Information held, showed that their care plan was being developed as staff got to know them. Good practice was seen with a detailed guidance for staff on how the resident liked to be position at night, to ensure their comfort and safety. Information contained within the care plan, reflected the level of support the resident said they required/needed. The resident confirmed that they had been fully involved in the development of their care plan. This was further evidenced by the wording used, for example (resident’s name) ‘likes to watch TV’. Staff write daily in the care notes kept in the residents bedroom, and at the ‘nursing station’, where a second file is held for each resident. These files gave detailed information on nursing care needs and visits from Health Professionals. Whilst both sets of care records contain a daily record of events, which reflect the task and medical intervention, they did not include information on the resident’s social well-being. For example ‘care as routine’, had been entered in 1 residents care plan 2 days running. Neither these nor the daily records held by staff reflected how the resident was adjusting to moving into the home, or how they were spending their day. Care plans also held a social diary, which covered activities they had attended in the home (see Daily Life and Social Activities section of this report). As the home provides nursing care, Priory Paddocks has qualified nurses on duty each shift. Both registered providers are also qualified nurses, and residents stated that Miss Lloyd takes a regular ‘hands on’ role to monitor staff practice. In addition to this nursing support, residents have access to a General Practitioner and hospital visits when necessary. The home benefits from having their own transport, which gives residents greater flexibility when attending hospital appointments. A relative said that their next-of-kin ‘has always received prompt and efficient medical help when they have needed it’, another said ‘I trust the medical staff to look after (resident’s name) well – DS0000024475.V320057.R01.S.doc Version 5.2 Page 12 they have done so far’. Comments made also reflected information given in the resident’s surveys. During the inspection residents were asked if staff undertaking personal care, undertook this sensitively, ensuring their dignity and privacy was maintained. Residents spoken with replied “Yes”. However, further discussion identified that sometimes staff spoke to each other, rather than the resident about work issues, especially staffing levels. Also some overseas staff spoke to each other in their own language, which can make the resident feel excluded, and could further confuse residents with dementia. Good practice was seen with the use of door indicators, alerting people not to enter the room as personal care was being undertaken. Medication is supplied to the home in original pharmacist containers. Residents’ individual Medication Administration Records (MAR) gave information on the name, time and dosage of the medication to be given. Staff sign the MAR sheet to confirm that medication has been given to the resident. Generally the standard of recording in the MAR charts were good, except for the 14/11/06, where at least 13 of the residents’ morning medication had not been signed as given. An audit check of 2 resident’s medication identified that the tablets had been given out, but the Nurse had not signed the MAR sheet to confirm this. This raised concerns that staff were not always checking the medication against the resident’s MAR sheet at the time of dispensing to ensure the dosage is correct. This was fed back, and the home will look into why the medication had not been signed that morning. The home has a lockable medication trolley, which is used to securely take medication around the home, and in-line with safe practice, dispense medication straight from its original container to the resident. However, it was noted that there were tags with resident’s names inside the trolley. The inspector was informed that these were used when medication is dispensed into open medication pots, placed on a tray and taken to the resident. This led to discussions as being unsafe practice, as previous concerns made by the Commission that medication should not be transported around the home on trays, or without the MAR chart, as this could potentially lead to medication getting lost, or given to the wrong person. The home has systems in place for recording all medication coming in and out of the home, and the safe disposal of medication no longer required. Controlled drugs were held securely, with restricted key access to trained Nurses only. Sample checks of 2 residents controlled medication against the home’s records were correct. The home’s medication policies and procedures required updating to reflect current practice, such as the disposal of medication. Time spent with a resident confirmed that they received their medication as required, and staff had never missed giving them their medication. DS0000024475.V320057.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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff liaise with residents to ensure they are offered a choice of home cooked meals, which meets their preferences. Residents are able to choose if they want to take part in organised social activities and are supported to keep in contact with family and friends. EVIDENCE: Discussions with relatives, and feedback from CSCI surveys confirmed that they were made to feel welcomed whenever they visited. As previously mentioned in reports, the staff run jointly with relatives and residents a ‘Friends of’ committee, who organise, free of charge a range of activities. The residents notice board held minutes of meetings, and social activities planned for November: 3 Crossword 7 Fireworks 10 Bingo 12 Remembrance Sunday 13 Crossword 17 Bingo 24 Holy Communion 27 Bingo 29 Christmas shopping DS0000024475.V320057.R01.S.doc Version 5.2 Page 14 Minutes of social care committee meetings, showed that external outings were arranged during May, June and July. Relatives asked as part of the CSCI survey if they felt that the home organised enough suitable activities, 15 out of the 22 said ‘Yes’, 3 had ticked ‘No’ and 4 were left blank, but comments had been written in. One relative raised concerns over their next-of-kin, who has dementia, whose television is sometimes left on, with no evidence of monitoring the programme’s content, to see if I is what the resident would like, or feel comfortable to watch. Other relatives comments included ‘more stimulation would benefit those who sit in the lounge for dementia residents’, and ‘amount of activities varied’. This reflected feedback given in the residents CSCI surveys, with 10 saying there was always activities they could take part in, 4 saying ‘usually’, 2 ‘sometimes’ and 4 ‘never’. Three residents had not completed this section, instead they had written comments. One resident said ‘there are – but I choose not to take part’, which evidenced that residents are given a choice if they want to take part or not. Other comments made included ‘because they do not comply with my interests’, ‘more outings would be nice when weather permitting’ and used to go out’’. A member of staff had also written that ‘social care could be more’ and that there should be ‘more outings’. Further comments made by residents included that they ‘enjoy quizzes and crosswords – perhaps need more in the afternoons, after lunch’ as they felt sometimes it felt like ‘ a long afternoon’. And ‘a few more outings would be nice when weather permitting’. Care plans held a ‘Social Diary’, and for 1 resident showed that they had enjoyed a special Halloween and Fireworks Tea. The owners were disappointed that not everyone felt that the home provided enough suitable social interaction, as staff are very committed to offering a range of activities. This led to discussions on how residents fill their days, looking at what meaningful activities they could join in with. This should involve looking at 1 to 1, or as a group activity, taking into account their physical and mental health needs, to supplement the positive work already being undertaken by staff. Feedback from residents on the meals provided was good, with the majority of responses falling equally within the ‘always’ and ‘usually’ categories. One resident had written that they had ‘no complaints at all – the meat is excellent’. Out of the 3 residents who had said that they ‘sometimes’ like the meals, 1 had also added ‘but the Chef prepares me special meals’. Good interaction was observed between the Chef and a resident, who they were visiting in their bedroom to find out what they would like for tea. The DS0000024475.V320057.R01.S.doc Version 5.2 Page 15 conversation showed that the resident got on well with the member of staff, who had insight into the resident’s dietary likes and dislikes. Time spent with the Chef, confirmed that if residents did not like the choices given at meal times, or required a special diet they would always accommodate by offering alternatives, and specialist diets. This was also reflected in a relative’s comment card who said that if they asked for a special meal for their next-of kin, ‘it was always provided’, and that they always ‘enjoyed the meals supplied’. Another relative also commented on the ‘good, fresh cooked meals’ provided at the home. One relative said that they would like to see the home use organic foods, rather than a supermarkets ‘value’ brand, and ‘also more fruit’. A resident also asked it was possible to have ‘better quality soft drinks?’. Time spent with the Chef identified that fresh fruit is not offered around as standard; however, a fresh fruit salad is offered on Sundays, or on request. Store cupboards did contain value brand tinned fruit, which is used for desserts such as crumbles. The Chef confirmed that all the vegetables used are fresh, with frozen vegetables only used as a “back up”. The home does not produce a menu in advance; instead it is “chosen day-byday”. Records showed that the home offered a balanced meal with choices such as Turkey & Mushroom Pie, Liver Casserole, Pasta and Roast Pork. The tea-time menu on the day of the inspection was Sausage rolls, sandwiches, home made soup and cake. A resident asked what they were offered for breakfast replied “Cornflakes or Porridge, Weetabix and prunes”. They said that they were also offered a “cooked breakfast now and then”. Good practice was seen with the home putting a hot drinks machine in the lounge, for visitors and residents to help themselves. Residents were seen to be offered hot and cold drinks throughout the inspection. The ‘all inclusive ‘ fees paid by residents also includes ‘naughty but nice treats’, meals taken during outings, beer, sherry and other alcoholic drinks on request. DS0000024475.V320057.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected from abuse, and can expect any concerns they have to be listened to, and acted on in an appropriate manner. EVIDENCE: Fourteen out of the 21 relatives surveyed, said that they were aware of the home’s complaint policy displayed in the entrance area, and contained within the Statement of Purpose/Service Users Guide. One relative also wrote ‘the owners/staff are always approachable and discuss any concern I have’. The home’s policy gives information on who to complain too, and timescales that the complaint will be actioned in. The policy needs to be updated/amended to reflect that the CSCI is not a complaints agency. However, if the person making a compliant is not satisfied in the way the home had dealt with their complaint, they can contact the CSCI to seek further advice. Currently the complaints policy informs people that they may ‘wish to issue a concern anonymously to the NCSC who will investigate’. The home also needs to check their wording to reflect CSCI and not NCSC is used throughout the document. Residents spoken with said if they had any concerns they felt comfortable to raise them with the owners, or a member of staff. This reflected feedback given in the CSCI surveys with comments including ‘I can speak to the owners or staff at any time’, and ‘the level of care and standards are excellent – I haven’t needed to complain’. All but 1 of the staff asked (CSCI surveys) said DS0000024475.V320057.R01.S.doc Version 5.2 Page 17 that they were aware of the homes complaint policy; therefore know what action they should take. Staff were also asked if they had received training in the home’s abuse policy, and again 25 out of the 26 staff said that they had. During the inspection 2 members of staff were asked what action they would take if a resident informed them, that that a member of staff had shouted at them. They answered correctly, saying that they would report the concern straightaway, as it was unacceptable practice. Discussions with the owners and training coordinator, confirmed that staff receive training in abuse awareness as part of their induction training. Although a copy of the staff training records supplied by the home, did not clearly identify abuse training as a separate heading to insure staff receive refresher training. The owners also stated that staff are also made aware of the different types of abuse through their dementia training. Previous discussions with the owners confirmed that they were aware of Suffolk local protocols in the reporting and investigation of abuse, and have a copy of the Vulnerable Adult Protection Committee’s – Inert-agency Policy Operational procedures and staff guidance (June 2004). DS0000024475.V320057.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, and 24. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service can expect to live in a clean, safe, homely and comfortable environment. The kitchen and laundry are showing signs of wear and tear, however this will be addressed through the forthcoming refurbishment. EVIDENCE: The home has an on-going maintenance programme to modernise and maintain the home internally and externally. At the time of the unannounced inspection, painting was going on in the corridors and a resident’s bedroom. As part of the home’s refurbishment programme a new training centre which also provides a staff room, and sleeping facilities for relatives if required, has been built within the grounds of the home. During the tour of the home, the kitchen and dishwasher was showing signs of wear and tear. However this will be addressed during the next stage of the refurbishment with the extension of the kitchen, which will include a new dishwasher. The owners confirmed that DS0000024475.V320057.R01.S.doc Version 5.2 Page 19 this is due to start in January 2007. The kitchen was found to be clean, which reflected the findings of the Environmental Health Officer’s (EHO) routine visit in July 2006. The ‘food safety risk assessment was not seen in the kitchen, however discussions with the EHO following the visit, confirmed that the home has recently received training and will be producing their action plan, which will be looked at during a future inspection. The tour of the building took in the lounges and dining room. Prior to the inspection 2 relatives raised concerns over the ‘strong smell of cigarettes’ in the dining room, which they described as ‘unpleasant’. This reflected the inspector’s findings during the afternoon. Discussions with the owners showed that they were trying to support a resident who smokes, to be able to also join in with the rest of the home, and not shut themselves away in their bedroom. The home was aware of the sensitive issues of trying to accommodate everyone’s rights. Although the smoking area is in an alcove off the dining room, the extractor fan was not sufficient to keep the atmosphere clear from smoke. The owner said that they are looking into addressing the situation by fitting glass doors to close off the alcove, but still enable the resident using the smoking room to see what is going on, and not feel shut away. The area has already been supplied with it’s own television, and furnished comfortably. Time spent with residents in their bedrooms, showed that they had personalised their rooms, and it met their needs. However, 1 resident due to their physical disability could not operate the homes call bell system. Discussions with the resident, relatives and their family confirmed that the owners were seeking advice and would be fitting a call system, that can be activated by the resident taking into account their needs. Staff were aware of the situation, and regularly checking to see if the resident needed any assistance. Five out of the 26 staff completing the CSCI survey, raised concerns that they felt the home did not have enough mobility aids. Comments written to evidence why they felt this way included 3 staff saying that there were not enough hoists/bath slings and handling belts. However, where 1 member of staff had commented that there were not enough handling belts, they then went on to say ‘problem solved, we’ve just received more’. This was fed back to the owners, who were surprised that staff felt this way, as the home has 5 hoists, and each resident using a hoist regularly, has their own sling. … Two staff also raised concerns over the ‘constant equipment failure – washing machine, lift and inadequate laundry facilities’, which were ‘always breaking down and in need of repair’. They went on to say that a new kitchen and laundry had been promised over a year ago (as mentioned earlier this should be started in January 2007 as part of the next phase of planned works). Comments made were fed back to the owners, who said the situation with the laundry equipment breaking down had been rectified. Records showed that the lift had been serviced regularly, and staff had needed to call the DS0000024475.V320057.R01.S.doc Version 5.2 Page 20 contractors out again only 2 days after it was serviced as it broke down. The owners also confirmed that the situation had now been rectified. The lounges, with its period features including a fireplace, and views out on to the landscaped gardens, were domestically furnished. Residents confirmed that they felt the home had a ‘homely’, comfortable atmosphere, and they could access all part of the home and gardens using the passenger lift, stair lift, stairs or ramps. The sample of 4 bedrooms visited were found to be clean and fresh, which reflected the feedback given by a majority of the residents who said the home was ‘always kept fresh and clean’. Positive comments included ‘Yes – they keep it clean, they hoover everyday’, ‘always of a high standard’ and the ‘proprietors work very hard to ensure this is the case’. From the 8 residents who stated that they ‘usually’ found the home was kept clean and fresh, comments included the smoky atmosphere, and that ‘occasionally cleaning is not up to standard’. Discussions with the owners and housekeeping staff confirmed that they had had a supervisor vacancy, which has been filled, but their start date delayed due to injury. The staff said they had worked to try where possible, to cover the hours. They felt they worked well as a team and were looking forward to the new person starting. Housekeeping staff complete a monthly ‘spring clean check list’, used to record bedrooms have been given a “top to bottom” clean each month. Staff said their daily routine included cleaning all residents wash hand basins, emptying bins, vacuuming and mopping en-suite floors. Staff asked if they had difficulties keeping any bedrooms clean and fresh, identified 2 bedrooms, which they always focused on, due to the individual residents continence problems. They discussed the action taken to support the residents in maintaining a clean, fresh environment. This included replacing the flooring for one resident with carpet tiles, which can be easily cleaned and renewed if they become soiled. Liquid soap, paper towels, disposable gloves and aprons were seen throughout the home, for use by staff, as part of the homes infection control procedures. The home is located close to a farm, which at times can lead to problems with flies, which reflected 1 resident’s plea ‘get the fly’s sorted – they craze me!’. This was fed back to the owners, who felt unfortunately it was part of living next to a farm. No flies were seen during the visit, however, previous visits during the summer evidenced that there was flies around, and the home was constantly working to deal with the situation, whilst enabling residents to have windows and French doors open to enjoy the fresh air. DS0000024475.V320057.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service can expect to be cared for by sufficient skilled staff to support their physical needs. However, it cannot be assured that staff are always following the correct manual handling procedures. EVIDENCE: Staffing levels as given in the home’s Statement of Purpose Staffing levels are: • • • • During the morning - 2 Registered Nurses and 7 care Assistants During the afternoon – 1 Registered Nurse and 4 care Assistants During the evening - 1 Registered Nurse and 5 care Assistants Overnight (10 pm to 7am) 1 Registered Nurse and 3 care Assistants To support the CSCI in taking a view if the current staffing levels meet the current residents needs, all those completing surveys were asked their views. The outcome to the surveys identified that 91 of the relatives, and 62 of the staff felt that there was sufficient staff on duty to meet residents needs. From comments by staff, 7 felt that there was a ‘shortage of night staff’. Rotas for the period of 29 Oct – 11 Nov, showed that on 5 nights there had been 3 instead of 4 staff on duty. The owners confirmed that on some nights they had been working 1 member of staff down, due to 2 staff leaving without giving notice they had been left a lot of hours to cover, whilst they recruited. However, they did not feel it left the nights short of cover. This was due to the DS0000024475.V320057.R01.S.doc Version 5.2 Page 22 home in their view, having more than the required staff on duty, which staff had got use to, so when it was reduced they felt that they were short staffed. The owner said they did not use agency staff, as they prefer the consistency of using staff who know the residents well. When the home is unable to cover a night shift, they make arrangements for a day worker to come in earlier to help with the busy period when residents are waking up. Time spent talking to residents confirmed that their call bells were answered within a short period, however staff’s comments made to residents, indicated that they felt there was not enough staff on duty. Future rotas showed that only 2 shifts, currently were down by 1 member of staff. Residents asked if staff were available when they needed them? – 6 had replied ‘always’, 17 ‘always’, and 2 ‘sometimes’. One resident had not replied, however their relative had written on their behalf said that residents in the sitting room, unable to use a call bell were regularly checked. They also made a suggestion that ‘staggered tea-time for staff may help’. One relative having overheard a resident saying that sometimes their tea was ‘cold’, was worried as they could not be there at meal times, if there was enough staff to help residents eat their food before it cooled down. During the inspection calls bells were answered promptly, and staff were busy supporting residents with their personal care, which including assisting them with their drinks. The home currently has 14 out of their 25 Care Assistants, qualified to National Vocational Qualification (NVQ) level 2 or above. With 5 staff currently undertaking this training the home will achieve having 76 of their staff trained to this level. The home benefits from having a training coordinator who overseas all the care staffs induction, and is themselves a qualified NVQ assessor. Time spent talking to the owner and training coordinator evidenced their commitment to providing a good level of training to staff, and using the new training centre to its full potential. All staff completing the CSCI surveys felt that the home had a good training and development programme, which was also confirmed during discussions with staff. This has included being credited to undertake overseas nurses ‘adaptation’ training, to support them in obtaining their registration number to be able to practice as nurses in this country. Concerns were raised prior to the inspection by a relative who said they had witnessed staff undertaking ‘drag lifts’ (underarm lifts) instead of using the hoist, or other mobility aids. One member of staff had commented in their survey that they felt that they were not ‘encouraged enough to abide by manual handling policy at times’ they felt the emphasis (sometimes) was ‘more to get the job done on time – rather than safely’. Discussions with a resident also identified that staff were lifting them, instead of using a hoist. Discussions with the owners confirmed that they had problems with staff using the banned underarm lift, and records showed that this had been discussed during team meetings. Minutes of the Nurse Managers meeting (12/10/06) referred to ‘stamping out the drag lift’. The management were looking to further address DS0000024475.V320057.R01.S.doc Version 5.2 Page 23 the situation, by cautioning a member of staff if they were seen to use the lift for a third time. The inspector identified that action must be taken before this, in case a resident or member of staff hurt themselves. Training records showed that trained nursing staff was updating their professional knowledge by attending training sessions such as ‘Wound care’. To confirm that the home was following safe recruitment procedures a sample of 3 staffs files were looked at. These showed that a full employment history had not been obtained for 1 member of staff, and that another member of staff had started employment without the home being in receipt of a second written reference. The owners showed records evidencing that the home had been contacting the referee both verbally and in writing – but had not received a reference. Records provided by the home showed that they had obtained paperwork to validate the person’s identity and undertaken Criminal Record Bureau checks. DS0000024475.V320057.R01.S.doc Version 5.2 Page 24 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, 33, 35, 36, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can expect a well managed home, where staff are committed to providing a good level of care within a safe environment. EVIDENCE: The owners, who are both trained nurses, jointly manage the home. Mr Burgess takes the lead in the administration side, and Miss Lloyd taking a more hands on role monitoring care and staff practice. Staff who were asked in the CSCI surveys if they felt the home was well run? - 24 out of 26 had answered ‘yes’. One member of staff said that ‘they have enormous respect for both proprietors who both work very hard to give the residents and staff what they need’. They went on to say that they liked working at the home, which they felt was like ‘one big family’. The friendly atmosphere of the home was also reflected during discussions with residents and comments made on surveys DS0000024475.V320057.R01.S.doc Version 5.2 Page 25 which included, ‘a good relationship has been developed with several members of staff, who are friendly and supportive to my mother’. Discussions with staff confirmed that they were aware of the organisational management of the home. The majority of the staff completing CSCI surveys confirmed that they received regular supervision, with only 2 saying they did not. However, 1 of the staff had commented that supervision used to be ‘regular’ however it was now intermittent’. This reflected information given by the management that there had been a slight ‘hic up’ with the supervision system when changing supervisors, which had left to some staff not receiving formal supervision, but this had now been addressed and they were “catching up”. The home keeps an overall record of staff being supervised and when. The records showed that staff had received regular supervision up to February 2006, then the next entries covered October and November. Good practice was seen, as part of the home’s quality monitoring systems, with the owners undertaking an audit of comments taken from staff’s supervision during January/February 2006, which they had then written a response, and if applicable an action plan. Some of the concerns raised during this period, reflected the concerns raised in the CSCI staff surveys, which they completed during October. This included ‘more hoist slings needed’, and ‘Night staff are frustrated when the washing machine and tumble dryers are not working properly’. The owners, who undertook a quality assurance feedback 2 years ago, said that the CSCI surveys, arrived at the same time they were looking to undertake this years quality review. As they did not want the residents and relatives to be overburden with questionnaires, they have decided to send theirs out next year. As previously, once completed they will analyse the results and display them for everyone to read. They felt that the CSCI own surveys and key inspection, also formed part of their quality monitoring subsystem, in identifying how well there are doing, and any areas that require further development. Discussions with both owners, demonstrated their commitment in working with the CSCI, and on-going review of the level of service they provide, to ensure it is maintained at a good standard. Generally the standard of record keeping was good, however shortfalls were identified if the completing MAR charts. Staff had used correction fluid in 1 care plan looked where best practice would be to cross out and initial any mistakes, in case they are later required for legal purposes. The home has safe systems in place for the recording and safekeeping of residents’ monies. A check of 2 residents’ money held, against the home’s record were correct. DS0000024475.V320057.R01.S.doc Version 5.2 Page 26 Training records showed a list of formal staff training undertaken since January 2006, and the name of the people attending them. This included manual handling, Food Care and Fire training. Records showed that hoists and lift are being regularly serviced. DS0000024475.V320057.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 3 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 2 DS0000024475.V320057.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Not applicable STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13 (4) (5) Requirement It must be clearly identified when a hoist must be used. Where it is identified that a resident may not always require a hoist for moving and handling this must be clearly documented in their manual handling assessment, and staff given clear instructions on what assistance to give, including mobility aids. The home must ensure staff follow a safe system of transporting medication around the home, and completing residents’ Medication Administration Records correctly, at the time medication is dispensed to the resident. The home must continue monitoring, and take appropriate action to ensure that staff are using correct, safe, manual handling procedures, using the correct mobility aids. Timescale for action 15/11/06 2. OP9 13 (2) 17 15/11/06 3. OP38 13 (5) 15/11/06 DS0000024475.V320057.R01.S.doc Version 5.2 Page 29 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 OP1 Good Practice Recommendations The home should look at different formats that they can produce their ‘service User Guide’ in, taking into account residents individual communication needs. The home should monitor staff practice to ensure medication is being checked against residents MAR charts prior to the medication being dispensed. The home should monitor staff’s professionalism to ensure that staff only speak in a language that residents will understand, and concerns over staffing levels are directed to the office, not the resident. The home should further develop their social interaction looking at how each resident spends their day, and what can be included to make it more meaningful. This should include consulting with residents, or if unable their families to ensure their preferences are clearly recorded, especially if they like the radio or television to be left on in their room, what programmes they like to watch/listen to. The home should look at how they can meet the resident who wish to smoke needs, whilst ensuring non-smokers are not affected by the smoke. The home should consult further with staff to identify if they still feel that the home has not sufficient hoist slings, and if required take appropriate action. The home should consult with further with night staff to identify their concerns when working with 3 persons, to ensure that they are able to meet all residents needs, and act upon any findings. 2. OP9 3. OP10 4. OP12 5. OP20 6. OP22 7. OP27 DS0000024475.V320057.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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. Extracts may not be used or reproduced without the express permission of CSCI DS0000024475.V320057.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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