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Inspection on 16/08/07 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 16th August 2007.

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

One of the people living in the home and the person visiting them agreed that the home "couldn`t be bettered." They said that they had looked at a number of homes before deciding on this one. People`s files contain brief biographical information about them, thus helping staff to have a fuller picture of them and their past lives and interests. Staff are caring and some have developed positive relationships and a good rapport with the people living in the home. A variety of activities are offered to people living in the home both in small groups and on an individual basis. The people living in the home said that they particularly enjoyed the trips out to places such as the airport and garden centre. More equipment is on order to increase the variety of in-house activities. An area of the newly built extension has been earmarked as an activity area where group sessions can be held. It is planned that as people become more severely affected by their medical conditions they will benefit from the multisensory room also being added. Most of the people living at the home spoke positively about the staff, especially staff that had been there some time. They were described as being, "lovely," " beyond reproach," and as, " Good tempered, helpful and caring."

What has improved since the last inspection?

Building work is currently being undertaken that will improve the amount of communal space available for the people living in the home. Once completed this and the new bedrooms being added will enhance the environment.

What the care home could do better:

There is currently insufficient communal space, but this is being addressed, and an extension had been erected. Building work was continuing at the time of the visit to the home to get it ready for use. Lack of communal space and cramped conditions in the space available, means there are times when people`s privacy and dignity are being compromised. Care plans could be a more useful document for care staff if they were in a more accessible format and location. They could then be referred to, particularly by staff unfamiliar with the person they were providing care for, thus reducing the likelihood of unsatisfactory care being given. Improvements to the recording and resolution of complaints, requested at the last inspection, had not been made. The home should work at raising the awareness of staff and the people using the service as to how to register and respond to any concerns or complaints raised. The recording of issues raised and action taken also needs to be improved. People living in the home found it frustrating that some staff did not have sufficient English to understand then properly. Staff have received mandatory training such as fire safety, basic food hygiene and safeguarding vulnerable people. However several were not up to date with their moving and handling training. By extending staff training to nonmandatory subjects such as the specific conditions experienced by people living in the home such as dementia, mental health problems etc., staff`s understanding, and hence the quality of care, could be improved. More staff should be trained to NVQ level 2 or above. Currently 40% of staff have achieved this. The National Minimum Standards recommend that this should be at least 50%Although mechanisms are in place for consulting the people who live there about the running of the home. People did not feel that things were changed as a result of their views. Where fire doors were being held open, most were being done so with devices that would close automatically if the fire alarm sounded. However some were held open with items such as wedges or a suitcase that would keep them open if there was a fire. This would put the person in the room at risk. The use of such door props must stop.

CARE HOMES FOR OLDER PEOPLE Rectory House Nursing Home West Street Sompting West Sussex BN15 0DA Lead Inspector Wendy Thomas Unannounced Inspection 16th August 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rectory House Nursing Home DS0000052037.V348788.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. Rectory House Nursing Home DS0000052037.V348788.R01.S.doc Version 5.2 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) 01903 750026 01903 751923 rectory@caringhomes.org 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.V348788.R01.S.doc Version 5.2 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. 10th May 2006 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 in 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. Building work is currently underway to increase the number of bedrooms and communal space. There are thirty-eight single and five double rooms. There is a large garden to the front, side and rear of the house. Car parking is available at the front. The fees are currently £680 to £750 per week. The new rooms are intended for people with a higher level of dependency and will therefore command a higher fee. The building is not yet completed and the planning for the provision of care and, therefore, the fees have not yet been finalised. Rectory House Nursing Home DS0000052037.V348788.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is a report on a key inspection of Rectory house Nursing Home. The inspection looks at all the key standards plus any others particularly pertinent to the home. This information is gathered from a variety of sources including a visit to the home, information provided by the manager in the annual quality assurance assessment (AQAA), which the home is required by law to provide to the Commission for Social Care, notifications from the home and correspondence. and a visit to the home. During the visit to the home, between 10.15 and 18.15, on Thursday 16 August 2007, the inspector spoke with a number of the people living in the home, several staff and a visitor to the home. Care records were sampled, as were staff and training records and other recording relevant to the standards being inspected, a tour of the communal areas of the home was undertaken, and some individual bedrooms were also seen. Although registered to take 48 people, at the time of the inspection visit there were 32 people living at the home. This was in part due to several rooms being out of action as they were being refurbished. There was also extensive building work being done with an extension being added to the home. What the service does well: One of the people living in the home and the person visiting them agreed that the home “couldn’t be bettered.” They said that they had looked at a number of homes before deciding on this one. People’s files contain brief biographical information about them, thus helping staff to have a fuller picture of them and their past lives and interests. Staff are caring and some have developed positive relationships and a good rapport with the people living in the home. A variety of activities are offered to people living in the home both in small groups and on an individual basis. The people living in the home said that they particularly enjoyed the trips out to places such as the airport and garden centre. More equipment is on order to increase the variety of in-house activities. An area of the newly built extension has been earmarked as an activity area where group sessions can be held. It is planned that as people become more severely affected by their medical conditions they will benefit from the multisensory room also being added. Rectory House Nursing Home DS0000052037.V348788.R01.S.doc Version 5.2 Page 6 Most of the people living at the home spoke positively about the staff, especially staff that had been there some time. They were described as being, “lovely,” “ beyond reproach,” and as, “ Good tempered, helpful and caring.” What has improved since the last inspection? What they could do better: There is currently insufficient communal space, but this is being addressed, and an extension had been erected. Building work was continuing at the time of the visit to the home to get it ready for use. Lack of communal space and cramped conditions in the space available, means there are times when people’s privacy and dignity are being compromised. Care plans could be a more useful document for care staff if they were in a more accessible format and location. They could then be referred to, particularly by staff unfamiliar with the person they were providing care for, thus reducing the likelihood of unsatisfactory care being given. Improvements to the recording and resolution of complaints, requested at the last inspection, had not been made. The home should work at raising the awareness of staff and the people using the service as to how to register and respond to any concerns or complaints raised. The recording of issues raised and action taken also needs to be improved. People living in the home found it frustrating that some staff did not have sufficient English to understand then properly. Staff have received mandatory training such as fire safety, basic food hygiene and safeguarding vulnerable people. However several were not up to date with their moving and handling training. By extending staff training to nonmandatory subjects such as the specific conditions experienced by people living in the home such as dementia, mental health problems etc., staff’s understanding, and hence the quality of care, could be improved. More staff should be trained to NVQ level 2 or above. Currently 40 of staff have achieved this. The National Minimum Standards recommend that this should be at least 50 Rectory House Nursing Home DS0000052037.V348788.R01.S.doc Version 5.2 Page 7 Although mechanisms are in place for consulting the people who live there about the running of the home. People did not feel that things were changed as a result of their views. Where fire doors were being held open, most were being done so with devices that would close automatically if the fire alarm sounded. However some were held open with items such as wedges or a suitcase that would keep them open if there was a fire. This would put the person in the room at risk. The use of such door props must stop. 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. Rectory House Nursing Home DS0000052037.V348788.R01.S.doc Version 5.2 Page 8 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.V348788.R01.S.doc Version 5.2 Page 9 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, 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prior to moving in people benefit from having an assessment of their needs to make sure that the home is able to support them. The people living in the home would further benefit if the information they had about the home was up to date. EVIDENCE: One of the people who live in the home and someone visiting them explained that they had looked at a number of homes before deciding on Rectory House Nursing Home. They were very pleased with their choice and said that it was better than the others they had looked at. Although they could not remember the specifics of the information they had been given about the home at that time, they recalled that the home had provided them with written information, which they found satisfactory. Rectory House Nursing Home DS0000052037.V348788.R01.S.doc Version 5.2 Page 10 Copies of the home’s statement of purpose and service user’s guide were seen in several of the bedrooms visited. These were out of date. Including details of the registered manager who had left over two years ago. The administrator reported that these documents were being updated. A summary of the complaints process was included. Files sampled showed that people had had an assessment of their needs prior to moving to the home. There was sufficient information for the home to be able to ascertain whether they could meet the person’s needs. The manager in the annual quality assurance assessment (AQAA) sent to the Commission for Social Care Inspection stated that wherever possible people were invited to the home for a meal or social activity before deciding if they wanted to move in, and that the home was planning to introduce an assessment of people’s social and emotional needs. Those people asked, were happy with the way in which they moved to the home. The people who moved into the home the day before the visit did not have care plans in place. One of the nurses said that some of the information the home had been given was contradictory and they were getting to know the person better before completing the care plan. The administrator reported that the home did take people for intermediate care and that in the past some people had successfully returned to their own home. There were no people receiving intermediate care at the time of the visit to the home. Rectory House Nursing Home DS0000052037.V348788.R01.S.doc Version 5.2 Page 11 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 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living in the home benefit from care plans that outline how staff are to meet their physical needs. More detail is required in relation to mental health needs. Better sharing of information in the care plans would promote more effective care for those living at Rectory House Nursing Home. EVIDENCE: Care plans were sampled and were found to contain information for staff on supporting the person with such matters as; washing and dressing, continence, activities, use of bed rails, eating and drinking and skin viability. There were also assessments relating to manual handling and risk of pressure ulcers. Risk assessments in relation to falls were also documented. One of the care plans sampled was for a person with significant mental health issues. Care plans relating to this were lacking. Although nursing staff said Rectory House Nursing Home DS0000052037.V348788.R01.S.doc Version 5.2 Page 12 that the approach used had been agreed with the person’s community psychiatric nurse, psychiatrist and GP, there was no documentation of this. There were notes to show that the GP had been consulted when their physical health had deteriorated as a consequence of their mental state and that the GP was satisfied with the care being given by the home. Biography sheets were seen in people’s files giving information about the person’s past life, their occupation family etc. These give a more holistic picture of the person and the manager in the AQAA says that this is something the home plans to develop further using a passport style document. Care plans for bathing or showering gave little detail of how the person liked to be supported, their particular preferences or routine. Some care staff found the medical terms in care plans and other people’s handwriting made them difficult to understand. The usefulness of care plans and improving the level of detail was discussed with the clinical team leaders. Staff said that people’s weight was being monitored and any fluctuations that caused concern could be referred to the person’s GP. Records of weight were seen in people’s files and they confirmed that they were weighed. Staff said that food charts are kept where there are concerns about a person’s weight. Due to the receipt of information from health and social care professionals about the home’s management of pressure ulcers we looked at this area of care. One of the people living in the home said that they when they moved to Rectory House they had pressure ulcers, but that these had now healed. Nursing staff spoken with reported that no one currently had pressure ulcers. Records were seen that showed that someone who had had pressure ulcers had had them attended to, and it was reported that these were now better. Staff training records showed that staff had not been trained in pressure area care. Further training should be provided if people in the home develop or are at risk of developing pressure ulcers. All those staff asked, said that unless they were unwell people were actively encouraged to get up. At the time of the visit to the home some people were in bed, but those the inspector met were not well enough to get up. Care staff reported that where there was a risk of pressure ulcers developing people were turned every two to three hours and this was recorded. All those asked said that they had plenty to drink and staff confirmed that where there were concerns about the amounts people were eating or drinking, then recording charts were kept. The people living at the home, who were asked, said that they were happy with the infection control processes and that staff used gloves and wore aprons when attending to their personal care. Rectory House Nursing Home DS0000052037.V348788.R01.S.doc Version 5.2 Page 13 The storage arrangements for medication were seen and found to be satisfactory. The medication recording sheets for the people living on the ground floor were examined. The records included a signature sheet so that the person administering the medication could be identified, and photographs of each person to make sure medication was administered to the correct person. The completion of the medication recording was largely satisfactory. There were gaps in one person’s recording, which the clinical team leaders said they would investigate. A number of the records said that medication should be administered “as directed”. The clinical team leaders agreed to liaise with the doctors prescribing to ensure that the frequency and dose of medication was clearly recorded on the recording sheets provided by the pharmacy. Lively and friendly banter was observed between some staff and the people living in the home. This demonstrated the positive and affectionate way that staff and the people who use the service viewed each other. Staff, however, need to be careful that their knowledge and concern for people does not compromise their dignity and privacy. For example due for their concern for a person, a member of staff commented to another member of staff about an aspect of the persons care which was inappropriate in a room full of people. The manager, in the AQAA, outlines plans to develop the care people receive at the very end of life. A new wing with improved facilities for this area of care is being built and the manager says that there are plans to implement the Liverpool Care Pathway, a programme, including staff training, concerned with promoting best practice in supporting people at the end of life. Rectory House Nursing Home DS0000052037.V348788.R01.S.doc Version 5.2 Page 14 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): 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. The people living in the home enjoy entertainment and activities in the home as well as trips out in the local area. Although visitors are welcome in the home, support could be improved to support friendships between people in the home. The food is varied and nutritious but further consultation between the chef and the people living in the home could lead to greater satisfaction with the food. EVIDENCE: The people living at Rectory House Nursing Home said that they were happy with the activities programme. Several said that they had particularly enjoyed the trips out to places such as the airport, garden centre, parks and gardens. One of the people who uses the service, when asked what other in-house activities they would like, pointed out that there wasn’t the space to do them in the cramped first floor lounge/dining room. The current building project includes a large new lounge and an activities area, and staff explained that there would be facilities for a greater number and variety of activities. The Rectory House Nursing Home DS0000052037.V348788.R01.S.doc Version 5.2 Page 15 activities coordinator described some of the equipment already ordered to help with this. Through talking with the people living in the home she was now planning trips suggested by them. Several people mentioned that they were looking forward to going bowling soon. One person described how much they had enjoyed having support to go out for a pub meal with a friend from the home to celebrate their birthday. As well as group activities the activities coordinator spends time one-to-one with individuals. This can involve nail care, reading and discussing the newspapers, chatting about their families etc. Some of the people who had been moved from their rooms in order for them to be refurbished were spoken with. Although accepting that this was necessary, they were not happy about the manner in which this had been done and were keen to get back to their rooms and have their familiar things around them again. They had not been asked if they wanted to be involved in the choice of the new décor for the rooms. A number of people living in the home, and staff, were asked about the food. All confirmed that it was always served at a desirable temperature. The people in the home recognised that it would be difficult to provide food that was satisfactory to everyone’s likes and dislikes all the time, however the overall response could be summed up by the comment of one of those asked, “it’s adequate.” Although one person said that it was, “good.” The chef had been working in the home for two months and had devised a four-week menu plan offering balanced nutritious meals. The chef had had a discussion with one of the people living there about their likes and dislikes and their medical needs regarding the food they ate, as they had requested to see him. People make their choice for the next day’s meals on an individual menu sheet. This included breakfast. This means that people weren’t committed to having the same breakfast every day, but could vary their choices. One person said that their favourite meal was their cooked breakfast. Many of the people living in the home choose to eat their meals in their own rooms. The inspector joined those who were eating in the first floor lounge/dining room. Some were sat round tables, some in armchairs. Three were receiving support from members of staff to eat their meals. Not all staff were observed to be interacting with the people they were supporting. Rectory House Nursing Home DS0000052037.V348788.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 adequate. This judgement has been made using available evidence including a visit to this service. The people living at Rectory House Nursing Home are safeguarded from abuse by having all staff trained in this area. A complaints procedure was in place, but a lack of awareness of it and confidence that using it would lead to improvements meant that the people living in the home were not raising the concerns they might have. EVIDENCE: The previous inspection had judged this outcome group (standards 16 to 18) to be adequate, as details of complaints were not being recorded properly. The complaints log was seen during this visit to the home. The clarification requested at the last inspection had not been provided. The administrator thought that the manager had improved the recording of complaints, however this could not be found. Given that a number of people living in the home voiced concerns about standards in the home (mainly in relation to staffing levels, staff competency and catering matters), the manager should be more proactive in seeking the views of those living there, recording these and any investigations and outcomes. Rectory House Nursing Home DS0000052037.V348788.R01.S.doc Version 5.2 Page 17 Those people living at the home who were asked about raising concerns and complaints thought that if they did so, a reason would be given for how things were, rather than there being a desire for change that would lead to action. Although a summary of the complaints procedure was included in the service user’s guide seen in some bedrooms, those people asked, were not clear about the process. The need to promote the complaints procedure with the people living in the home was discussed, as was the need to raise awareness amongst the staff at all levels so that concerns raised by the people living there and their representatives are recorded along with their outcomes. The manager had also identified this in the AQAA and said that she planned to make improvements in this area. Staff reported that they had training in safeguarding vulnerable people, and this training was updated annually. Training records showed that all staff including ancillary staff had received this training, although not necessarily within the last twelve months. Although it was thought that the home had a copy of the locally agreed policy between the agencies in West Sussex responsible for investigating allegations of abuse, staff were not able to locate it at the time of the visit to the home. A copy should be available so that should a situation arise staff can follow the correct protocol. Rectory House Nursing Home DS0000052037.V348788.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 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is not enough communal space, however once the improvements currently being made to the building are completed, the people living in the home will benefit from sufficient space to socialise and carry out activities and pursue their interests. EVIDENCE: There is currently insufficient communal space for the number of people living in the home. The first floor lounge/dining room is well used. During the morning a number of people were in there, some watching television and others sat around a table chatting. At lunchtime several people ate their lunch sat in the armchairs and others sat around the tables. When one person requested to be sat more comfortably in their armchair it was necessary to bring a hoist into the room. There was insufficient room to manoeuvre this Rectory House Nursing Home DS0000052037.V348788.R01.S.doc Version 5.2 Page 19 and one person who was sitting in a wheelchair at a table was moved out of the way, whilst part way through their pudding, and had to wait until the hoist had been removed again before continuing with their meal. It was not possible to maintain the dignity of the person in the hoist throughout the process. The issue of lack of communal space was being addressed at the time of the visit to the home. Building work was being undertaken to add a new lounge, an activity area, a multisensory room and a number of bedrooms. The new bedrooms have patio doors so that people will be able to access the courtyard garden if they wish. However, although they have patio doors, the rooms do not have opening windows to allow natural ventilation if it was too cold or windy to have the doors open. It was reported that the rooms would have air conditioning, but the lack of opening windows denied the occupants the choice of having natural fresh air instead of the air conditioning. At the time of the visit some of these rooms were occupied. The air conditioning was not working so it was hot and stuffy. A person in one of these rooms explained that the previous day they had been so hot they had become unwell. Most of the people who used the first floor lounge did not choose to venture downstairs where there is another dining room. This is pleasantly decorated but rarely used. There was little movement between floors. Hence people who might have enjoyed each other’s company did not get to spend time together. It was noted that paintwork in the home’s corridors looked worn and in some places was damaged. It was reported that once the building of the new wing had been completed the rest of the building would be redecorated. The home has one bathroom, which has an assisted bath. Many of the bedrooms have their own en suite shower which some of those who live in the home use. The bathroom had no natural light and the bath was not clean. It was reported that this was because the cleaners had not got there yet. However when asked, staff said that the bath was cleaned after each use. When one of the people who lives at the home and uses the bath, was asked, they said that it was always clean. Apart from the bathroom, the home was clean at the time of the visit. The hot water supply to the top floor continues to be a problem. The administrator reported that attempts have been made to remedy this and that these are ongoing. Several people mentioned that they made use of the garden, with one saying that they liked sitting out in the “beautiful garden.” The garden is at the front of the home separated from the road by a high wall. A large gazebo had been erected and furniture provided so that people could sit out. Rectory House Nursing Home DS0000052037.V348788.R01.S.doc Version 5.2 Page 20 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. Providing staff with training about the medical conditions the people they care for experience and how these relate to their specific care needs could further enhance the quality of the care provided to the people living at the home. EVIDENCE: Opinions about the staff varied and comments included, “they are beyond reproach,” “they are good tempered, helpful and caring,” “they are lovely,” and “everyone is very kind.” “Staff are friendly,” “they are not officious.” “They’re good staff here they are.” “They’re good girls.” People liked to have staff they had got to know and did not like it when there were a lot of different staff. Several people expressed frustration that some of the foreign staff did not have sufficiently good English and described being given something other than what they had asked for. A good rapport between the people who use the service and some of the staff was observed, which included good-natured teasing by both parties. There was evidence of positive relationships built up over time. Other staff were observed to keep a greater emotional distance from the people they were working with, and, for some, language presented a barrier, which made such personal interactions difficult. Rectory House Nursing Home DS0000052037.V348788.R01.S.doc Version 5.2 Page 21 The people living in the home accepted that the routines of the home dictated the pattern of the day. One thought that the staff did very well, “against all the odds” and that, “staff are working flat out.” Another said that, “They work ever so hard” and that. “They keep on getting more residents in but not more staff.” Because of this the people living there accepted that they might have to wait a while for breakfast or for someone to come and help them when they rang their call bell. Although several of the people who use the service said that staff were always in a hurry and that there were not enough staff, staff also described sometimes having time to accompany people on trips arranged by the activities coordinator or to take people out of the home to the local shops or for a walk. Staff time was mainly focused on meeting people’s personal care and physical needs. Some care and nursing staff did not see the meeting of social and recreational needs as being part of their role. Care staff training focused on mandatory training such as moving and handling, basic food hygiene, health and safety and safeguarding people from abuse. Staff said that they had not had training specifically on working with frail elderly people, or in the areas of dementia or other conditions the people living in the home might have. Nursing staff said that through their nurse training and previous experience, they had had training in relation to the particular needs of the people they were caring for. Training records showed that eight of the twenty care staff had achieved NVQ level 2. That is 40 . The National Minimum Standards recommend that there should be a minimum of 50 trained to this level. The regional manger has pointed out that until recently when several staff left, the number with NVQ 2 had been 48 . In the AQAA the manager stated that there were plans to offer NVQ training to all staff once they had completed their initial induction and foundation training. Staff training records indicated that not all staff (five care staff) had received moving and handling training within the past year. Staff must have this training. The people living in the home and the staff are being put at risk of injury if staff are not supporting them properly when they are moved. Some staff said that they were receiving regular (monthly) supervision sessions. Others said that they did not. The recruitment records of three recently appointed staff were seen. One member of staff had started work without written references being provided, however it was explained that whilst the written confirmation was awaited, the manager had spoken to the referees by telephone. There was no record of this or details of what had been discussed. The person was working constantly supervised as their Criminal Records Bureau check had not yet been received by the home. It was reported that a POVA first check had been done but there was no evidence verifying this. The administrator reported that this was held at the organisations headquarters. Rectory House Nursing Home DS0000052037.V348788.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living in the home benefit from being a part of an organisation that seeks their views and incorporates them in their business planning. Despite this they do not feel actively involved or that they have influence over how the home is run. By not adhering to fire safety guidelines the people living in the home could be put at risk in the event of fire. EVIDENCE: The manager has been in post for approximately two years and has submitted an application to be the registered manager. She was not present at the time of the visit to the home, being involved in business elsewhere in the organisation. Rectory House Nursing Home DS0000052037.V348788.R01.S.doc Version 5.2 Page 23 Most staff expressed their satisfaction with the manager saying that she was approachable and that staff meetings were held where they could discuss the running of the home. Some of the people living in the home voiced concerns that staff were not well supported by the manager. They, themselves, did not have a direct relationship with the manager, for example one person said that they had seen her about three times in the last few months. The manager, in the AQAA, stated that meetings for the people living in the home and their relatives take place monthly. People living in the home confirmed that residents meetings are held to consult them about the home. However they did not feel that their opinions had much effect on what actually happened in the home and accepted the reasons they were given as to why things were the way they were. Staff confirmed that staff meetings are held monthly and that the notes from these are available to staff in the staff room. The administrator described the quality assurance process. As part of an organisation having ninety residential services there are established annual quality assurance routines to follow. These included three-monthly questionnaires for the people living in the home and staff. The information from these is collated by the organisation’s head quarters and feeds into the home’s business plan. There are three-monthly reviews of the business plan and monthly internal audits. Although the home does not control the money of any of the people living there, they do hold money for people to spend on personal items. Records are kept of the amounts held and the expenditure. These were sampled and the amounts held tallied with the recorded amounts. Entries in the records showed what the money had been spend on. Certificates confirming servicing and maintenance of plant and equipment such as gas appliances, fire alarm and hoists were sampled and found to be satisfactory. The bedroom doors in the new wing had automatic door closures connected to the fire detection and alarm system, which ensured that fire doors were closed when the alarm sounds. In the older part of the house people could choose to keep their bedroom doors open by having a door closure fitted that was activated by the sound of the fire alarms. One bedroom door was observed to be propped open with a suitcase. This puts the person, who was in the room at the time and confined to bed, at risk, as their door would not automatically close in the event of fire. This is unacceptable and a devise as approved by the fire authority must be used if the door is to be left open. An office door was also wedged open. Rectory House Nursing Home DS0000052037.V348788.R01.S.doc Version 5.2 Page 24 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 3 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 2 X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Rectory House Nursing Home DS0000052037.V348788.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP16 Regulation 22 Requirement Complaints received by the home must be recorded along with the details and outcomes of any investigation. The complainants must be informed of the outcome. Fire doors are can only be held open by devises approved by the fire authority. Their advice must be sought and followed regarding the holding open of fire doors. All care and nursing staff must have up to date training in relation to moving and handling the people in their care. Timescale for action 08/11/07 2. OP38 23 (4) 13/09/07 3. OP30 18 (1) (c) 08/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000052037.V348788.R01.S.doc Version 5.2 Page 26 Rectory House Nursing Home Standard Rectory House Nursing Home DS0000052037.V348788.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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. 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