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Inspection on 11/12/05 for Rectory House Nursing Home

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

This inspection was carried out on 11th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 service is very welcoming to relatives and they are encouraged to visit residents at any time of the day. The residents spoken with liked their rooms and the way they are decorated. Residents made very positive comments about the staff saying they were kind caring and committed. A full and robust assessment of residents needs is now carried out before residents come to live in the home and used to ensure that the Rectory House is going to be a suitable place for them to live.Staff know their responsibility for reporting possible abuse.

What has improved since the last inspection?

The home has employed a general manager and the Commission is looking forward to receiving her application to become the Registered Manager. All radiators are now covered and all hot water outlets are now regulated to protect residents from the possibility of scalding themselves.

What the care home could do better:

The majority of the requirements made at this inspection have previously been raised as areas for improvement at Rectory House nursing home. There are concern`s at the level of documentation and recording in the home. The danger of not maintaining accurate records is always that people may not provide safe and consistent care and that changes in needs cannot be tracked. The home has started the process of supervision, however this needs to be more proactive to assist staff to improve the quality of care and provide safety for the residents.

CARE HOMES FOR OLDER PEOPLE Rectory House Nursing Home West Street Sompting West Sussex BN15 0DA Lead Inspector Mrs J Farrell Unannounced Inspection 11th December 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rectory House Nursing Home DS0000052037.V271859.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. Rectory House Nursing Home DS0000052037.V271859.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Rectory House Nursing Home Address West Street Sompting West Sussex BN15 0DA 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) 01206 828290 Rectory House (Sompting) Limited Post Vacant Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Rectory House Nursing Home DS0000052037.V271859.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Forty Eight service users in total may be accommodated. Five service users aged between sixty to sixty five may be accommodated. One service user aged between fifty and sixty five years may be accommodated. 11th July 2005 Date of last inspection Brief Description of the Service: Rectory House is a care establishment registered to provide nursing care for forty-eight service users. Rectory House is a detached property arranged on three floors and situated within Sompting village within easy travelling distance of Lancing and Worthing town centres with their shops and other amenities. The accommodation includes two lounge/dining room areas, one on the ground and another on the first floor. There is also a conservatory, which is separate from the main building but is part of the communal area. There are thirty-eight single and five double rooms. Rectory House Nursing Home DS0000052037.V271859.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Sunday 11th December 2005. This is the second statutory inspection of this year. The purpose of this inspection was to assess compliance with the requirements of the last inspection and to generally monitor care practices. At present there are 34 residents living at the home. Two inspectors were involved in the inspection. Mrs Farrell who was the lead Inspector, Mrs Peel who was the second Inspector. Both Inspectors spent four and half hours touring the home, talking to residents and staff and examining records. Residents and staff members were spoken with, to gain a sense of what it was like to live in Rectory House Nursing Home. During the inspection the inspector spoke to ten residents and four members of staff. Two members of staff were interviewed formally. The inspector undertook a tour of the premises and looked at nine care plans. Various record books, policies and procedures were also examined. The residents have different levels of communication ability and therefore it was difficult to ascertain all their views on how their needs are met. The reader is advised to read the inspection report of the announced inspection carried out in July 2005 to gain a fuller picture of this home. What the service does well: The service is very welcoming to relatives and they are encouraged to visit residents at any time of the day. The residents spoken with liked their rooms and the way they are decorated. Residents made very positive comments about the staff saying they were kind caring and committed. A full and robust assessment of residents needs is now carried out before residents come to live in the home and used to ensure that the Rectory House is going to be a suitable place for them to live. Staff know their responsibility for reporting possible abuse. Rectory House Nursing Home DS0000052037.V271859.R01.S.doc Version 5.0 Page 6 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. Rectory House Nursing Home DS0000052037.V271859.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 Rectory House Nursing Home DS0000052037.V271859.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): 3,5 There are systems in place to ensure residents and their representatives’ make an informed choice about the home. No resident moves into the home without having had a thorough assessment of their needs discussed with them. EVIDENCE: Four pre admission assessment documents were looked at and they clearly showed that the admission procedure was thorough and well recorded. This procedure ensures that new residents needs are now properly assessed and planned for. Trial visits are offered and a new resident confirmed she had been offered this but had decided she did not need this, as she knew the home. The staff interviewed did comment that due to the complex nature of the residents now being admitted that they would like to have more training in bereavement, nutritional needs and tissue viability. Rectory House Nursing Home DS0000052037.V271859.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): 7,8,11 Progress has been made on improving arrangements to ensure that health care needs of the residents are identified and met. The documentation in place does not fully reflect the high level of care provided. Residents wishes regarding the end stages of life are not being discussed or recorded and this could mean that a resident might not have the care they want to receive. EVIDENCE: Risk assessments are currently adequate, but it was noted that though these risks are recorded well there were examples where no action had taken place to improve the outcome for the resident. It was difficult to audit the monitoring of these risks had taken place, as documentation was not complete. It is required that where risks are identified, they are followed through with an assessment of the controls in place to minimise those risks. This is particularly important in respect of the residents who have high nutritional needs and are at high risk of pressure damaged. The care plans for five residents were viewed in depth and there was evidence that improvements had been made since the last inspection. The system of Rectory House Nursing Home DS0000052037.V271859.R01.S.doc Version 5.0 Page 10 care planning now provides some of the support plans to guide staff in the delivery of identified care needs. However there was little evidence to suggest that residents have been consulted in developing or reviewing their care plans. It was noted that the positive outcomes observed for residents at this time are still dependent upon staff knowledge and memory, rather than full and detailed recording systems. Care plans identify some goals for individual residents, which are then monitored as part of the ongoing review process. At this time, the goals are basic and it is hoped that as this system develops, peoples’ experiences and aspirations will progress. The inspector observed staff members entering resident’s bedrooms, knocking on the door and waiting for permission before entering. Staff members said that there was strict guidance about respecting resident’s privacy. However it was noted that there are some bedroom doors with no locks on them. This could lead to resident’s dignity and privacy not being respected. Most staff have had practical training on what to do after the death of a resident and there are clear policies to guide staff on what to do. The inspector was impressed with the staff knowledge and their sensitive approach to this difficult subject. However it was noted that there was little in the care plans to evidence that a discussion had taken place with the residents or their relatives to ensure that the resident’s wishes might be met. Rectory House Nursing Home DS0000052037.V271859.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): 12 Routines in the home could be more flexible. Opportunities are offered for residents to be involved in activities and for contact with family, friends and the local community EVIDENCE: From observations and discussion with the residents it is evident that the Rectory House is substantially routine driven as a home, particularly in relation to meal times and the provision of personal care. Residents stated that they get up and go to bed when staff request them to do so because they feel staff are ‘always so busy’ ‘I do as I am told’ ‘ I know it helps them if I go to bed early’. A programme of activities is provided and staff are encouraged to share their skills, interests and hobbies with residents through this programme. Activities were mentioned and enjoyed by residents. Residents also mentioned that they could go out to church if they wished. Staff spoke enthusiastically about wanting to spend their time with residents to provide meaningful activities inside and outside of the home. Rectory House Nursing Home DS0000052037.V271859.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): 16,17,18 Complaints are not being forwarded to the management from care staff. Therefore residents and relatives are not confident that their concerns are being listened to, or taken seriously. There has been progress on training staff on the correct way to respond to any suspicion or allegation of abuse and this will safeguard the residents. The residents right to participate in the political process is upheld. EVIDENCE: Residents are encouraged to vote and postal votes are provided. The Inspector was pleased to note that training has now been provided to most staff on the important area of how to identify possible abuse and what to do about it. Staff members told the inspector that they had received training in recognising the different forms of abuse. Staff know their responsibility for reporting possible abuse. During the inspection the inspectors became aware of two residents who said they had raised concerns to care staff about issues but had received no action. The general manager advised the Inspector that she had not been informed of these concerns. Rectory House Nursing Home DS0000052037.V271859.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): 19,23,26 The environment is subject to ongoing improvement. The room residents are admitted to need to be large enough to meet the assessed care. The home is clean and hygienic. EVIDENCE: Rectory House Nursing Home DS0000052037.V271859.R01.S.doc Version 5.0 Page 14 The location and layout of the establishment is suitable for its’ stated purpose. A record of all maintenance is maintained and the inspector was assured that there has been a programme of renewal of the fabric and decoration of the premises as from October 2004. Currently the organisation is awaiting planning permission in order to proceed with an extension to the premises to increase communal space and improve other facilities. Service users rooms are comfortably appointed and in accordance with standard 24.2. Service users are able to bring into the establishment with them some of their own furniture and other possessions, which was much in evidence. A number of adjustable beds are provided and arrangements to provide more were in hand. The doors to service users accommodation are not fitted with locks. Residents rooms have been made comfortable with their own belongings and residents who spoke with the inspectors were happy not to have a lock on their bedroom door, one resident said she was happy with the arrangements for respecting her privacy and dignity. The National Minimum Standards state that (24.5) Doors to service user’s private accommodation are fitted with locks suited to service user’s capabilities and accessible to staff in emergencies. The National Minimum Standards also state (24.6) Service users are provided with keys unless their risk assessment suggests otherwise. Aids and equipment are in use in the home to aid independence and support staff with good moving and handling. The premises were clean and tidy on the day of the inspection. It was noted and brought to the general manager’s attention that the boiler room on the top floor was open and residents could access this room if they wished. It was also brought to the attention of the general manager that in several rooms on the top floor there is no hot water. Staff informed the inspector that they had to bring hot water from the lower floors to wash residents. The maintenance man informed the inspector that this problem would be rectified in the very near future. It was noted that one bathroom has a bath and a toilet but still no hand basin. Other issue were fed back to the general manager and the inspector is confident that they will be addressed as a matter of urgency. The Inspectors were concerned to find a resident, who required all care being cared for in a room which staff had difficulty in gaining access to both sides of the bed. Rectory House Nursing Home DS0000052037.V271859.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 The deployment of staff may not be sufficient to meet the needs of the residents. EVIDENCE: All residents and relatives spoken to say that staff at the home were kind, caring and committed but were always too busy and could spend little time with them. Residents spoken with felt staff were often very busy and one resident stated that she did not ask for help because of this, others also gave examples of when they felt their needs had not been met. These comments included that staff were always to busy to talk, they just come in and look at you and leave, they just do what they have to do and go. Residents also talked about the time it took to answer the bell, one resident commented that it had taken thirty minutes to answer the bell. This resident was encouraged to discuss the problem with the general manager. The regional manager informed the inspector that there is a full time activity co-ordinator. Staff interviewed also made comments regarding the staffing levels and felt at times there was a problem and they could not always deliver the high standard of care the home required. However they were very encouraged by the new general manager who was employing new staff. They felt that as the levels of staff increased, the use of agency staff would diminish. Rectory House Nursing Home DS0000052037.V271859.R01.S.doc Version 5.0 Page 16 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): 32,36,38 The homes management are approachable and staff feel they are supported. The outstanding issues regarding lack of supervision of staff could lead to poor practice and potentially put the resident at risk. EVIDENCE: The home has employed a general manager and the Commission is looking forward to receiving her application to become the Registered Manager. Staff were very positive about the working environment and made very positive statement about the new general manager. They felt confident in her abilities to move the home forward. They were very enthusiastic about her new ideas and the way she approached the problems the care staff were experiencing. They talked about meeting’s they had with the manager, which Rectory House Nursing Home DS0000052037.V271859.R01.S.doc Version 5.0 Page 17 they felt benefited the resident. However they did feel that they should have a comprehensive hand over at the start of a shift as they described problems where they ‘had missed things’. All staff interviewed were unable to confirm that they had received any formal supervision in the last six months. Staff also were unable to confirm that they had received all mandatory training this included first aid and infection control. The staff on duty demonstrated that they were aware of their responsibilities under Health & Safety. A maintenance person is employed to undertake a variety of checks and audits and to keep the home in a good state of repair. The establishment has a comprehensive health and safety policy and the organisation’s property department, including the responsibility for the servicing and repairs of equipment and installations, oversees much of this. Rectory House Nursing Home DS0000052037.V271859.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 3 3 x x x 2 x x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 3 x x x 1 x 2 Rectory House Nursing Home DS0000052037.V271859.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement To ensure all care plans cover all aspects of health, personal and social care needs of the service user and reflect actual current practice. That care plans include all aspects of Standard 7, 11,12,13. The level of risk must be clearly identified on all risk assessment. This is an outstanding requirement from 01/06/05 OP13 OP12 2 15 To ensure all care plans cover all aspects of health, personal and social care needs of the service user and reflect actual current practice. That care plans include all aspects of Standard 7, 11,12,13. The level of risk must be clearly identified on all risk assessment. This is an outstanding requirement from 01/06/05 That the home reviewes the staffing level and the way they are deployed in the home in such a way as to ensure that at all times suitable qualified and experienced care and domestic staff are working in sufficient numbers to ensure the health and welfare of service users. Timescale for action 1 15 01/02/06 01/02/06 3 18(1)(a) OP27 01/02/06 Rectory House Nursing Home DS0000052037.V271859.R01.S.doc Version 5.0 Page 20 4 18(2)& 13(a)(c ) OP38 OP30 That all staff receives induction, supervision and training relevant to their roles and responsibilities. A care manager must be appointed and registered with the CSCI. 01/02/06 5 8 OP31 01/02/06 6 13(4) (c) OP38 The registered person shall ensure that all staff have suitable training in first aid. 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 2 Refer to Standard OP4 OP8 Good Practice Recommendations Staff feel they would benefit from Bereavment training It is recommended that nutritional screening be undertaken on admission and then on a periodc basis, a record maintained of nutrition, including weight gain and loss and appropriate action taken. That service users assessed as requiring nursing care be provided with an adjustable bed. Equipment necessary for the promotion of tissue viability and prevention of pressure sore, that is provided by the organisation, is duly provided to the service users. Staff feel they would benefit from more tissue viability training. That residents who require all care are not admitted to rooms where there is not enough room on either side of the bed, to enable access for care staff and any equipment needed. Fit locks of a suitable type to all bedroom doors and doors. A handbasin needs to be provided in an upstairs bathroom. 3 4 5 6 OP8 OP8 OP8 OP23 7 8 OP24 OP26 Rectory House Nursing Home DS0000052037.V271859.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY 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 Rectory House Nursing Home DS0000052037.V271859.R01.S.doc Version 5.0 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. 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