CARE HOMES FOR OLDER PEOPLE
Quinton House Nursing Home Lower Quinton Stratford On Avon Warwickshire CV37 8RY Lead Inspector
Jackie Howe Unannounced Inspection 01 December 2005 09:45 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 Quinton House Nursing Home DS0000004407.V268063.R01.S.doc Version 5.0 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. Quinton House Nursing Home DS0000004407.V268063.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Quinton House Nursing Home Address Lower Quinton Stratford On Avon Warwickshire CV37 8RY 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) 01789 720247 01789 720245 Quinton House Limited Ms Kathleen Januszka Care Home 35 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (35) of places Quinton House Nursing Home DS0000004407.V268063.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Ms Kathleen Januszka to undertake management training equivalent to NVQ level 4 by April 2005. Residents with dementia will not be accommodated in the annex. Date of last inspection 12th July 2005 Brief Description of the Service: Quinton House is situated in the village of Lower Quinton a short drive away from Stratford on Avon. The home is registered to provide nursing care to 35 elderly residents, with three of these places registered for care of those with dementia. Accommodation is provided in two main care areas. The main House, which accommodates up to 26 residents and a smaller annex, which is adjacent to the main building and accommodates up to 8 residents. The main house has accommodation on three floors with access via a passenger lift or stairs. The annex is a single storey building. The majority of resident accommodation is provided in shared accommodation. The current provider Quinton House Ltd has owned the home since 1995. Gardens to the front and side of the main building are well maintained with access possible for all of the homes residents including those who may require a wheelchair. Quinton House Nursing Home DS0000004407.V268063.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the second of the inspection year 2005/06, and took place over a period of six and a half hours. The inspection included talking with the matron, observing staff practices and accessing records, which included staff files, and reading care plans, and time spent around the home meeting service users, staff and relatives. During the inspection a number of service users were spoken to over lunch, as well as two service users on a one to one basis, five staff members and two relatives. What the service does well: What has improved since the last inspection?
Work has started on the covered passageway, which will connect the annex to the main home. This is now due to be completed by February 2006. The wording in the care plans is less judgemental and is more sympathetic to the needs of vulnerable people, especially those with confusion. A comprehensive training plan has been drawn up for 2005/06 aiming towards achieving three days paid training for all staff. A few staff have achieved three training sessions, but this needs to be provided for all staff.
Quinton House Nursing Home DS0000004407.V268063.R01.S.doc Version 5.0 Page 6 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. Quinton House Nursing Home DS0000004407.V268063.R01.S.doc Version 5.0 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 Quinton House Nursing Home DS0000004407.V268063.R01.S.doc Version 5.0 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): These standards were not assessed at this inspection. EVIDENCE: Whilst these standards were not assessed, relatives spoken to said that they had chosen Quinton House after visiting several homes in the area. They felt that they had the information available to make an informed choice, and were happy with the facilities provided. Quinton House Nursing Home DS0000004407.V268063.R01.S.doc Version 5.0 Page 9 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 Care plans are improving, some elements are full and informative, however further development is needed to provide the staff with the necessary information to meet individual service users’ needs. Service users are treated with respect through good communication and health needs are assessed. Service users are protected by the home’s policies, procedures and practices in dealing with medicines. EVIDENCE: Care plans read showed a good understanding of the care required to meet the needs of individuals. The language used was sensitive, and care needs documented, are based on the assessment undertaken. Risk assessments related to nutritional needs, tissue viability and risk of falls are detailed and informative to staff. More training is required to ensure that staff are aware of how positive risk taking especially for those people with dementia, can be documented.
Quinton House Nursing Home DS0000004407.V268063.R01.S.doc Version 5.0 Page 10 Service users health care needs are fully assessed and met by the home’s staff. Evidence was seen of good recording and that access to health care professionals and services is available. Service users and relatives spoke highly of the staff and the care they receive. ‘Staff couldn’t be nicer, more like a family.’ Medication policies and procedures and systems for administering, storing, disposing and recording of medications are sound. At present there are no service users wishing to self - administer medication, but it would be advisable for the home to initiate a self- administration risk assessment to be in place should this situation change. All of the remaining standards were met, and the home’s staff should be commended for their sound practices. Quinton House Nursing Home DS0000004407.V268063.R01.S.doc Version 5.0 Page 11 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): These standards were not assessed in detail at this inspection. EVIDENCE: Whilst these standards were not assessed at this inspection, service users spoke about activities and outings they had attended. A Christmas fete was planned for two days time and there was a buzz of anticipation. Music was playing in the home, festive decorations were present in all areas, and service users were making use of books and magazines and watching the television. Lunchtime service was observed, and the meal was seen to be well presented and enjoyed by all. Service users spoke highly of the quality of the food and the choice available. There were a number of service users being assisted by staff and this was seen to be done in a sensitive way, and at an appropriate pace. Quinton House Nursing Home DS0000004407.V268063.R01.S.doc Version 5.0 Page 12 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): These standards were not assessed at this inspection. EVIDENCE: Service users and relatives during conversations with the inspector said that they knew how to access the complaints procedure and who to go to should they have any concerns. Quinton House Nursing Home DS0000004407.V268063.R01.S.doc Version 5.0 Page 13 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): These standards were not assessed at this inspection. EVIDENCE: Whilst these standards were not assessed in detail, the home was seen to be well maintained and comfortable. There was evidence of specialist equipment being used and this was well maintained. The home was seen to be clean and without unpleasant aromas. Quinton House Nursing Home DS0000004407.V268063.R01.S.doc Version 5.0 Page 14 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): 29. Gaps in recruitment practice may lead to residents being exposed to people who are not suitable to work with vulnerable people. EVIDENCE: The home’s policy on abuse is given to all new starters, along with their responsibilities within the code of conduct. There was little evidence of protection of vulnerable adult (POVA) training having taken place this year. Recruitment files were accessed in the absence of the owner who is responsible for recruitment, and no evidence was available to show interviews having taken place. Some CRB checks were dated after the recorded start date, and there was no evidence of a ‘Pova first’ check. There are a number of staff recruited from overseas via an agency, which takes responsibility for criminal records checks prior to their arrival in England. The home provides sufficient numbers of staff and the skills mix is generally good, but some areas of staff training and development remain below recommended standards and have the potential to effect the standards of care and safety to service users. Quinton House Nursing Home DS0000004407.V268063.R01.S.doc Version 5.0 Page 15 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): 33, 35, 38 The management of the care home provides clear and comprehensive guidance to inform staff of how to provide care in the home. Service users should be more involved in quality audits and their opinions and views used to develop the running and direction of the home. An organised management system of policies and procedures, which protects the interests of service users, is in place. All staff have not received training which is supportive of a safe environment. EVIDENCE: A ‘residents meeting’ takes place twice yearly, minutes are taken of this meeting and copies sent to everyone. There is evidence of a reviewing process in regard to quality assurance and health and safety taking place, with the owner undertaking quality checks and
Quinton House Nursing Home DS0000004407.V268063.R01.S.doc Version 5.0 Page 16 questionnaires being sent to staff. A health and safety policy review undertaken in August 2005 identifies areas for improvement within the home, and the manager regularly audits drug administration processes. Staff in the home could be more proactive in their approach in seeking the views of service users and visitors by reintroducing a programme of surveys and / or questionnaires. Results should be made known to people living in the home along with action being taken. One resident told me she had come up with what she thought was a bright idea, but was told it was not possible but not why. Comments books and evidence of feedback from service users and relatives is kept in the office and not visible to all, subsequently there are very few entries. Some comments received included: ‘It’s a pleasure to visit. There is a very friendly bunch here, always helpful and very kind.’ ‘ Mum remarked on the lovely atmosphere, the hospitality and kindness of the staff.’ The policy on personal funds and pocket money was seen and as with other policies had been signed by staff. The administrator works three days per week, but unfortunately was not there on the day of the inspection, so not all records were seen. Personal monies and the recording systems were accessible and sample records and funds were checked. Generally systems are good and monies are not pooled. One envelope checked was incorrect. Generally Health and safety systems within the home are good and well monitored with regular review dates. One concern was that a member of the domestic staff, had not received COSHH or health and safety training, and was working with chemicals such as bleach. Her trolley was also seen to be left unattended for periods of time, which could put vulnerable people especially those with dementia at risk. Quinton House Nursing Home DS0000004407.V268063.R01.S.doc Version 5.0 Page 17 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 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x 2 x x 2 Quinton House Nursing Home DS0000004407.V268063.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? 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 19 Requirement The registered manager must ensure that a CRB/POVA check is undertaken on all staff prior to their employment in the home. The registered manager must ensure safe working practices, by implementing a training programme for all staff in regard to COSHH and Health and Safety. Timescale for action 01/01/06 2 OP38 13 01/02/06 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 Refer to Standard OP33 Good Practice Recommendations The registered manager should develop ways that service users’ comments about life in the home are sought and then published and made accessible to others. This information should then by used to set aims and objectives for the home and as part of a self-audit tool. Quinton House Nursing Home DS0000004407.V268063.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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