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Inspection on 12/07/05 for Quinton House Nursing Home

Also see our care home review for Quinton House Nursing Home for more information

This inspection was carried out on 12th July 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home meets the needs of the service users accommodated. The home is well-maintained and pleasant and set in extensive and accessible grounds. All service users spoken to felt their needs are being met and expressed their satisfaction living in the home. A team of staff who are kind and caring deliver the care.

What has improved since the last inspection?

The lounge has been redecorated since the last inspection, service users are pleased with the new look. The manager is undertaking NVQ level 4 in managing care, which is required as a condition of her registration. Improvements are being made to the laundry floors to improve infection control. Many of the service users bedrooms are having bedroom furniture replaced with coordinated furniture. Planning permission has been obtained to join the annex with the main house in the near future, which will improve the accommodation for service users, as they will no longer have to go outside to get to the annex.

What the care home could do better:

The home should ensure that all needs can be met in a non judgemental way, including managing behaviour that challenges staff. Staff need clear directionand guidelines about how to manage these sorts of situations, to ensure that all parties remain safe. There is a need to increase the numbers of toilets that can be used by people who need assistance with a hoist, on the ground floor, as the current number of toilets is inadequate to meet service users` needs. There should be an opportunity to address this in the proposed building work (see above). The activities co-ordinator`s time has been cut by half (from 4 to 2 hours per week) since the last inspection. This must be reviewed to ensure service users are satisfied with the amount and variety of activities in the home. In terms of developing best practice, the home would benefit from some staff being trained in dementia care mapping, (this is a tool which staff can be trained to use, which is designed to assess the quality of care from the perspective of the person with dementia). All staff (including nursing staff) should be paid to attend a minimum of three days training per year.

CARE HOMES FOR OLDER PEOPLE Quinton House Nursing Home Lower Quinton Stratford On Avon Warwickshire CV37 8RY Lead Inspector Tracy Regan Unannounced 12 July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Quinton House Nursing Home E53 s4407 Quinton House NH v236941 120705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Quinton House Nursing Home Address Lower Quinton Stratford On Avon Warwickshire CV37 8RY 01789 720247 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Quinton House Limited Ms Kathleen Januszka Care home with nursing 35 Category(ies) of OP Old Age (35) registration, with number DE (E) Dementia - over 65 (3) of places Quinton House Nursing Home E53 s4407 Quinton House NH v236941 120705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Ms Kathleen Januszka to undertake management training equivalent to NVQ level 4 by April 2005. Date imposed 07/01/04. 2. Ms Kathleen Januszka to undertake comprehensive dementia training to ensure clear understanding of the condition within 6 months. Date imposed 07/01/04. 3. I agree that if the registration of Quinton House Nursing Home is increased from 34 to 35, we will not admit any resident with dementia to the annex. Date imposed 20/01/04. Date of last inspection 2 March 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 E53 s4407 Quinton House NH v236941 120705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection of the home took place over one day (seven hours). It was the first of the homes two statutory inspections for the year 2005/2006. A partial tour of the premises took place. Four service users records were examined. 12 service users, five staff and five relatives were spoken to. What the service does well: What has improved since the last inspection? What they could do better: The home should ensure that all needs can be met in a non judgemental way, including managing behaviour that challenges staff. Staff need clear direction Quinton House Nursing Home E53 s4407 Quinton House NH v236941 120705 Stage 4.doc Version 1.40 Page 6 and guidelines about how to manage these sorts of situations, to ensure that all parties remain safe. There is a need to increase the numbers of toilets that can be used by people who need assistance with a hoist, on the ground floor, as the current number of toilets is inadequate to meet service users’ needs. There should be an opportunity to address this in the proposed building work (see above). The activities co-ordinator’s time has been cut by half (from 4 to 2 hours per week) since the last inspection. This must be reviewed to ensure service users are satisfied with the amount and variety of activities in the home. In terms of developing best practice, the home would benefit from some staff being trained in dementia care mapping, (this is a tool which staff can be trained to use, which is designed to assess the quality of care from the perspective of the person with dementia). All staff (including nursing staff) should be paid to attend a minimum of three days training per year. 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 E53 s4407 Quinton House NH v236941 120705 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Quinton House Nursing Home E53 s4407 Quinton House NH v236941 120705 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,4 Service users are provided with sufficient information on which to base a decision to move into the home. Needs are appropriately assessed prior to admission. EVIDENCE: Adequate admission procedures and documentation are in place. The most recently admitted service user’s needs are were assessed prior to admission to ensure the home could meet their needs. Some of the service users files have useful life histories giving an insight to the individuals past, which helps inform the care provided is appropriate to their needs and preferences and is person centred. Some relatives said they had helped their relative make a positive choice to be admitted to Quinton House because of the home’s good reputation, caring staff and clean and pleasant environment. Some had managed to visit the home before admission. Quinton House Nursing Home E53 s4407 Quinton House NH v236941 120705 Stage 4.doc Version 1.40 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 standard(s) 7,10 The home is mostly meeting service users needs. The home should ensure that all needs can be met in a non judgemental way, including managing behaviour that challenges staff. Staff need clear direction and guidelines about how to manage these sorts of situations, to ensure that all parties remain safe. EVIDENCE: Service users plans generally set out in detail the service users needs and the actions to be taken by staff to ensure these were met. Risk assessments are in place with particular attention made to the risk of falls. All service users care plans are reviewed monthly by nursing staff. Evidence of service users / relative involvement was noted, some service users or their relatives have signed care plans. There are regular daily entries made to evidence the care given. One of the service users had been described as “being difficult” and “throwing a tantrum” when they had presented with some behaviour that had challenged the staff, this is unhelpful and judgemental language. There was evidence that one of the service users slaps staff on occasions, the manager was able to give Quinton House Nursing Home E53 s4407 Quinton House NH v236941 120705 Stage 4.doc Version 1.40 Page 10 indications about recognition of the signs in this situation, but clear guidelines were not seen on the individuals care plan. There are good links with other professionals such as the Macmillan Nurses and Clinical Advisory team staff. Service users and relatives spoken to all stated that the staff treat them with dignity and respect. A common comment heard was that staff are very kind and caring. One relative said “I’d give the staff 10 out of 10”. Quinton House Nursing Home E53 s4407 Quinton House NH v236941 120705 Stage 4.doc Version 1.40 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 standard(s) 12,13,14,15 The home needs to keep the amount of activities on offer under review, to ensure service users are satisfied with the amount and variety on offer. Service users are able to exercise choice in their routines in the home. EVIDENCE: The activities co-ordinator has attended reminiscence training. She works two hours on Fridays and does activities with approximately eight people. Other activities include a pianist monthly, hairdressing twice weekly, “Pat the dog”, manicure and aromatherapy, occasional trips out (boat trip planned for eight service users to Evesham in the near future), videos and crafts. The number of hours the activities co-ordinator has reduced as it was four hours each week at the last inspection. Some service users said they would like to have more frequent activities on offer. Service users can receive their visitors at any time and can see them in private or in the communal areas, there were a good number of visitors seen on the day of inspection, those spoken to expressed satisfaction with visiting arrangements. Service users chose what activities they join in with and chose times for getting up and going to bed etc: Quinton House Nursing Home E53 s4407 Quinton House NH v236941 120705 Stage 4.doc Version 1.40 Page 12 All service users spoken to, felt the food is wholesome and attractively presented with a good variety in the menu. Alternatives to the main meal would be offered if requested. There is good variety of fresh fruit and vegetables each day. Quinton House Nursing Home E53 s4407 Quinton House NH v236941 120705 Stage 4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 There is an adequate complaints procedure in place and service users feel their views are listened to even though there have been no complaints raised. EVIDENCE: There have been no complaints recorded since the last inspection. Service users and relatives said they are aware who to complain to if they have any concerns. Those spoken to confirmed they have not had any complaints to make. The Commission has not received any complaints about the home in the past year. Staff have been trained in the recognition and reporting of abuse by the manager and deputy manager. Staff have signed to confirm they have read and understood the policies and procedures relating to vulnerable adults. Quinton House Nursing Home E53 s4407 Quinton House NH v236941 120705 Stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,26 The home is attractive and homely. There is a need to increase the numbers of hoist accessible toilets on the ground floor, as the current number of toilets is inadequate to meet service users needs. EVIDENCE: Service users spoken and relatives to all felt the home is an attractive environment, which is generally comfortable and homely. The home was clean and appeared hygienic on the day of the inspection, no issues were raised about malodours. The main lounge has been redecorated since the last inspection, with some of the service users helping to chose the materials for redecoration. Service users expressed their satisfaction with the newly decorated room, making it a pleasant and relaxing room to be in. There are very extensive grounds, which the service users have access to, the gardens have been made pleasant with garden furniture for the service users to enjoy. Several of the service users and relatives felt there were not enough hoist accessible toilets. There is one hoist accessible toilet on the ground floor and the majority of the service users require hoisting, this means that there is a Quinton House Nursing Home E53 s4407 Quinton House NH v236941 120705 Stage 4.doc Version 1.40 Page 15 queue for the toilets and service users sometimes have to wait to go to the toilet, particularly before mealtimes. Many of the service users bedrooms are having bedroom furniture replaced with coordinated furniture, as part of the planned programme of renewal. The raised floor in the laundry has been painted to ensure improved infection control and the main floor is covered with fitted vinyl. The annex and main house are due to be joined in the near future, which will improve the accommodation for service users, as they will no longer have to go outside to access the annex. When this work is undertaken it may provide opportunity to extend the availability of toileting facilities. Quinton House Nursing Home E53 s4407 Quinton House NH v236941 120705 Stage 4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,30 Service users needs are met by sufficient staff, who have appropriate skills. In terms of developing best practice, the home would benefit from some staff being trained in dementia care mapping. EVIDENCE: The staff have all attended one day certificated dementia care training. The staff receive in excess of three training days per year, however they are not always paid for their time to attend training (i.e. qualified nurses). Staffing levels were adequate to meet the needs service users on the day of inspection. Service users said there are enough staff on duty usually, there are six care staff in the mornings, five in the afternoons and evenings, plus two qualified nursing staff between 8am and 5pm and one between 5pm and 8pm. Overnight there are two carers and one nurse on duty with an extra carer between 6am to 8am. There are some issues about the amount of time taken to assist service users to the toilet, but this is due to accessible toilets rather than staffing levels. Quinton House Nursing Home E53 s4407 Quinton House NH v236941 120705 Stage 4.doc Version 1.40 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 The home is run by a management team, who demonstrate commitment to the service user group. The matron is working towards meeting her condition of registration regarding management qualifications. EVIDENCE: The manager/matron is undertaking NVQ level 4 in management, which is a condition of her registration. She hopes to have completed this by the end September 2005. She has undertaken a four-day dementia care training course with the Alzheimer’s Disease Society and intends to undertake a further certificated course in dementia following the completion of her NVQ. The deputy manager is currently undertaking a distance-learning, certificated, person centred dementia care course through a local university. The owner holds meetings with relatives periodically and relatives expressed their satisfaction with the level of involvement and communication, about their relatives, with the home. Quinton House Nursing Home E53 s4407 Quinton House NH v236941 120705 Stage 4.doc Version 1.40 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 2 x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x x x x Quinton House Nursing Home E53 s4407 Quinton House NH v236941 120705 Stage 4.doc Version 1.40 Page 19 NO 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 7 & 38 Regulation Regulation s 13 & 15 of the care homes regualtion s Requirement The registered person must ensure that detailed care plan and risk assessment/risk management plans are drwan up relating to needs identified and in particular behaviour which challenges staff. Complete within one week by 19 July 2005 and send confirmaiton to the commission of action taken. The registered person must consider ways in which the hoist accessible toilet facilities, on the ground floor of the home, can be extended in order to meet the needs of the service users. A plan is to be provided to the commission within two months to show how this will be addressed. Timescale for action 19 July 2005 2. 21 23 30 September 2005 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 30 Good Practice Recommendations Arrange for some staff to be trained in dementia care E53 s4407 Quinton House NH v236941 120705 Stage 4.doc Version 1.40 Page 20 Quinton House Nursing Home 2. 3. 30 12 mapping. All staff (including qualified staff) should receive a minimum of three paid training days per year (i.e. payemnt for their time to attend training). Keep the activities under review to ensure that service users are happy with the amount and variety of activities on offer. Quinton House Nursing Home E53 s4407 Quinton House NH v236941 120705 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection 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 © 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 Quinton House Nursing Home E53 s4407 Quinton House NH v236941 120705 Stage 4.doc Version 1.40 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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