Inspection on 24/01/06 for Regents View Nursing Home

This inspection was carried out on 24th January 2006.

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

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

Other inspections for this house

Regents View Nursing Home 25/11/08

Regents View Nursing Home 30/11/06

Regents View Nursing Home 12/07/05

Regents View Nursing Home 24/02/05

Regents View Nursing Home 30/06/04

Regents View Nursing Home 19/02/04

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

CARE HOMES FOR OLDER PEOPLE Regents View Nursing Home Francis Way Hetton Le Hole Houghton Le Spring Tyne & Wear DH5 9EQ Lead Inspector Sam Doku Unannounced Inspection 18:20 24 & 31 January 2006 th st 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 Regents View Nursing Home DS0000018204.V273783.R01.S.doc Version 5.1 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. Regents View Nursing Home DS0000018204.V273783.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Regents View Nursing Home Address Francis Way Hetton Le Hole Houghton Le Spring Tyne & Wear DH5 9EQ 0191 526 6776 0191 526 6882 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) www.fshc.co.uk Tamaris Healthcare (England) Ltd (wholly owned subsidiary of Four Seasons Health Care Limited) Mrs Caralyn Janice Bowman Care Home 50 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (50), Mental disorder, excluding learning of places disability or dementia (5) Regents View Nursing Home DS0000018204.V273783.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th July 2005 Brief Description of the Service: Regents View is a purpose built home in 1995 to provide both nursing and personal care places for 50 older people who have mental health care needs. It stands in grounds that are shared with another care home belonging to the same company. The home is located in a village, in a rural area, among a residential estate and there are local facilities close to the home including shops, post office, bank and public houses. The city centre of Sunderland and the town centre of Houghton-le-Spring is within a short direct bus route from the home. The home itself is constructed in a traditional style of brick and tile and has two floors with passenger lift access to the first floor. The access is level from the ground floor entrance. The car park is located to the front of the building. Bathrooms and communal WCs have handrails and appropriate lifting equipment for disabled service users. The internal space is generous and there are a variety of lounges and dining areas. Audio and television facilities are provided in these lounges. The grounds are well kept and there is a protected safe area to the rear of the home, in the form of a small sensory garden with a bird stand, enabling service users to meander in relative safety, weather conditions permitting. Regents View Nursing Home DS0000018204.V273783.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection involved one inspector and was carried out on 24 January at 18:20 in the evening to observe the evening care arrangement including the arrangements for serving super and preparing service users for bed. A second visit was done on the 31 January and a final visit was conducted three weeks later to check on some of the observations made on the first day. These three visits all contributed to the inspection report and the observations made in the report are results of the three inspection visits. The views of service users service users were sought. Observations of staff practices and procedures, examination of documents and records and discussions with staff and management, also contributed to the inspection findings. The atmosphere and environment within the Home was friendly, relaxed and comfortable throughout the time of the inspection. A number of service users and a relative were spoken with. All were very complimentary about the Home and the staff. Service users appeared cared for and comfortable with the staff. The standards relating to Complaints and Protection and staffing were not examined on this occasion. These were examined at the last inspection and assessed as being met. The home continues to maintain these standards. Readers wishing to read about these standards should refer to the last inspection report of 12 July 2005. What the service does well: The arrangement of fire instructions and training is good. The nominated fire warden has provided regular fire instructions to all staff. A record is maintained of all fire testing and drill indicating the names of staff who were present. The home continues to provide good staffing ratio to meet the needs of the service users. The company has provided the necessary training for the staff to equip them for their job. Care staff confirmed that they receive regular supervision from the nurses and found this use. Good assessment procedures remain in place, which clearly identify individual service user’s needs and plans are formulated on how best those needs can be met within the home. Regents View Nursing Home DS0000018204.V273783.R01.S.doc Version 5.1 Page 6 The home has good systems in place for dealing with the service users finances. Receipts are available for all the purchases made on behalf of the service users. What has improved since the last inspection? What they could do better: On the first day of the inspection it was noticed that the arrangement for serving supper was of concern for the inspector. The process did not provide choice of drinks for the service users. Service users were also not actively offered biscuits or cakes for their supper most went without. A separate unannounced visit was made to the home four weeks later on 19 February at 7.00 p.m. It was pleasing to note that the management and staff team had taken appropriate action to address the issue. On this visit the staff were noted to be sitting with service users and offering assistance, and were engaged in offering choice of supper and drinks. On the first day of the inspection, the dignity of a number of service users was compromised by not being provided with dressing gowns. A large number of service users were ready and in their nightdresses or pyjamas but apart from two people, the rest did not have dressing gowns which compromised their dignity. But again in the subsequent unannounced visit to the home on 19 February at 7.0 pm there was encouraging indications that the management and staff team had taken appropriate action to address the issue. During this visit the service users who were wearing nightdress or pyjamas had dressing gowns on thus promoting and their dignity. The plastic teacups used for the service users were badly stained and scratched. The cups were also institutional in their outlook and consideration should be given to replacing these. A number of staff who were spoken with agreed that these are old and need to be replaced with more modern cups. The some of the fridges and freezers require attention. Some of the fridge shelves are damaged and beginning to corrode. Also one of the freezer doors need to be repaired to ensure that it is operating well. Regents View Nursing Home DS0000018204.V273783.R01.S.doc Version 5.1 Page 7 The company should be consulting with the staff to hear their concerns. There was low moral amongst the care staff. Staff felt that their efforts are not being recognised by the company. Also that the long twelve-hour shift adds to the already stressful working environment. 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. Regents View Nursing Home DS0000018204.V273783.R01.S.doc Version 5.1 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 Regents View Nursing Home DS0000018204.V273783.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 5. The home has a service user guide, which provides information to prospective service users about the service. The information includes details about contracts and also about the home’s policy on pre-admission visits to the home, including the arrangements for pre-admission visits. EVIDENCE: The service user guide provides good information to prospective service users and their families, which enables individuals or families to make decisions about Regent View. This was discussed with one visiting relative who confirmed that he and the rest of the families found the information pack very useful. The manager confirmed that all service users have been issued with contract between Tamaris Healthcare (England) Ltd and the service users. It is the home’s policy to regard the first six weeks of residency as a trial period. This is stated in the statement of terms and conditions and in the Service User Guide. All prospective service users are invited to visit the home to meet with other service users and staff. This arrangement is stated in the Service User Guide, copies of which are available to all service users. Two service users and a Regents View Nursing Home DS0000018204.V273783.R01.S.doc Version 5.1 Page 10 visiting relative commented positively on the pre-admission arrangements for them to visit the home. However, because of the mental frailty of the service users, the manager stated that it has not always been appropriate for prospective service users to personally visit the home before their admission. The manager stated that such visits are often done by relatives. This was confirmed by one visiting relative who described the numerous visits he made to the home before deciding on his relative coming to live in the home. He stated that the arrangements were helpful in enabling his relative to settle into the home, and also gave him the reassurance that he had made the right decision for his relative. Regents View Nursing Home DS0000018204.V273783.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 10, 11. The individual care plans set out the health, social and personal care needs of each service user and plans are formulated to meet those care needs. This has ensured that the care needs of the individuals are met. The service users are treated with respect and dignity by the staff, but on the day of the inspection practices were observed which compromised these. EVIDENCE: Three service users were identified and their care plans were selected for examination. The files were found to provide details of their nursing and personal care needs. The plans also set out how those needs are to be met by the staff. Risk assessments have been carried out for those service users for whom it is thought necessary. These included prevention to fall, nutrition, pressure sore risk assessment and moving and handling risk assessments. This promoted the service users safety and wellbeing within the care environment. The files that were examined contained details of visits by GPs, consultant psychiatrist, chiropody treatment, opticians, dentists and other healthcare professionals. In discussions with one relative, he confirmed that his relative’s Regents View Nursing Home DS0000018204.V273783.R01.S.doc Version 5.1 Page 12 healthcare needs are met within the home and feel that the staff take active role in promoting this. Two service users were spoken with specifically about their healthcare needs. They both confirmed that their healthcare needs are adequately met in the home and that the arrangements for their care are good. They confirmed that staff would always make appointments for them to see their GPs and other professionals if needed. This promoted good health for the service users. One staff member was spoken with about the issues surrounding death. She described the general policy on caring for the dying. She described the care routines and the general support given to the family and the wishes of the service user at such times. The staff member demonstrated good understanding of the care needs of service users at such times. She confirmed that all staff have the same approach to caring for the dying and that this is closely supervised by the nursing staff and appropriate support given where necessary. This provides reassurance to families that their loved one would be properly care for when a service user is approaching death. Regents View Nursing Home DS0000018204.V273783.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15. Aspects of the social and cultural norms were compromised by the lack of sensitivity to the dignity of the service users. Menus examined showed service users receive nutritious meal meals but practices on the day of the inspection compromised this. EVIDENCE: On the night of the first visit to the home, practices were observed which compromised the cultural norms of the service users. Only two of the large number of service users in their night cloths had dressing gowns over their pyjamas or night dresses. There was clear lack of observation on the part of the staff, which compromised the dignity of the service users. However, a visit to the home at a later date indicated these issues had been addressed and suitable arrangements are in place to promote the dignity and welfare of the service users. The four weeks rotating menus provided evidence of varied and nutritious meals, including alternatives for the service to choose from. Nutritional assessments have been carried out for those service users who require their diet intake to be monitored to ensure they receive adequate diet. However, the manner in which supper was served to the service users on the Regents View Nursing Home DS0000018204.V273783.R01.S.doc Version 5.1 Page 14 first day of the inspection raised some concerns with the inspector regarding the amount and choice offered. The entire process of serving supper and assisting service users with their drinks took a total of fifteen minutes. However, on the second unannounced visit four weeks later it was noted that suitable arrangements had been put in place to address these. The cups used to serve the service users are in need of replacement. The cups are plastic and institutional in their outlook. A number of staff considered the cups to be too old and institutional looking and needing to be replaced. A replacement would enhance the quality of the service and the dignity of the service users. Regents View Nursing Home DS0000018204.V273783.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed on this occasion. EVIDENCE: The standards relating to this part of the section had not been assessed on this occasion. These standards were examined at the last announced inspection of the 12 July 2005. All the standards were met and at this inspection it was observed that the standards have been maintained and remain satisfactory. Readers wishing to read about these standards should refer to the last inspection report of 12 July 2005. Regents View Nursing Home DS0000018204.V273783.R01.S.doc Version 5.1 Page 16 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 service users life in safe, clean well maintained environment that meets their individual needs and promotes their safety and well-being. EVIDENCE: Regent View is a home designed to accommodate older people, some of whom may have mobility and mental health problems. The corridors are wide and allow easier access for people with wheelchairs or other walking aids. All rooms are single occupancy with en-suite facility. Individual rooms have good ventilation and natural lighting. These ensured comfortable surroundings for the service users. Window restrictors have been fixed to all windows and all radiators have suitable covering. Checks of hot water at randomly selected bathing outlets confirmed that hot water did not exceed 43°c. thus protecting the service from accidental injuries. Regents View Nursing Home DS0000018204.V273783.R01.S.doc Version 5.1 Page 17 The home has written policies and procedures relating to safe handling of hazardous materials for staff to follow. The manager indicated that staff have had training in health and safety, infection control and food hygiene. At the time of the inspection the home was noted to be clean and free from offensive odour. However, the state of some of the kitchen equipment requires attention. The service users cups were dirty and in discussions with staff some of them described the cups as institutional and needing to be replaced. These are badly scratched and tea stained. The groves round the bottom of the cups were grained with stains. This presents very institutional and compromised the dignity of the service users. Suitable cleaning materials must be made available to the domestic staff to allow these plastic cups to be cleaned properly. The two tea trolleys were dirty and badly stained. The assembled joints of the trolleys were dirty and present a potential source for food contamination. This compromises the health and welfare of the service users. The shelves in one of the fridges have lost the plastic covering in parts and are beginning to corrode. This could be a source of contamination, which could be harmful to the service users. There is a small freezer behind where the trolleys are stored. This freezer has the lid hinges broken and therefore the freezer was not properly closed. This could compromise the integrity or safety of the food items stored in that freezer. The laundry machines have facilities for sluicing and washing foul linen at very high temperature to avoid the spread of infection, thus ensuring the welfare of the service users. Regents View Nursing Home DS0000018204.V273783.R01.S.doc Version 5.1 Page 18 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): These standards were not assessed on this occasion. EVIDENCE: The standards relating to this part of the section had not been assessed on this occasion. These standards were examined at the last announced inspection of the 12 July 2005. All the standards were met and at this inspection it was observed that the standards have been maintained and remain satisfactory. Readers wishing to read about these standards should refer to the last inspection report of 12 July 2005. Regents View Nursing Home DS0000018204.V273783.R01.S.doc Version 5.1 Page 19 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): 31,33, 35, 36, 37, 38. The manager provides good leadership and direction for the staff. This ensured that the service is run for the benefit of the service users thus promoting and safeguarding their rights and wellbeing. However, staff expressed concerns about the lack of support received from the company, leading to low moral amongst the staff team. EVIDENCE: The manager is a Registered Mental Nurse and is currently and has NVQ Level 4 in management. She has long experience of working nursing homes and with older people with mental health problems. Staff indicated that the manager runs the service for the benefit of the service users and has positive relations with them. The personal allowance records were examined and these were found to be in order and appropriately accounted for. Receipts are available for all transactions that have been made on behalf of service users. This ensured Regents View Nursing Home DS0000018204.V273783.R01.S.doc Version 5.1 Page 20 that service users are protected from any form of financial abuse. Relatives have been consulted on the methods of holding monies for the service users using a single bank account for that purpose. Relatives have the option of managing such monies for their relatives or agree for the home to manage this using a single bank account in the name of the home. The manager confirmed that most relatives have agreed for service users monies to be placed in a ‘pooled’ account. The staff confirmed that they receive appropriate on-the-job supervision from the trained staff and that support and advice is always available to them when needed. This ensured that the service users receive appropriate care that is suitable to their needs. However, a number of staff expressed concerns about the low staff moral. Staff indicated that the company that owns the home shows little or no interest in their welfare. Staff cited, for example, the rotas not taking account of the high stress levels in working with such client group. They said the twelve-hour shift is causing them a lot of stress in such an already high stress work environment. A number of staff indicated that the company does not value them and are seriously considering alternative employment. The staff acknowledged the good support they receive from the senior staff in the home but feels that the registered manager’s hands are tied and that it is the company do not seem to be interested in their welfare. The company must address these issue as a matter urgency as there could be negative impacts for the service users. The company’s Health and Safety policies remain in place and these were made available for inspection. These cover policy areas such as fire prevention and Care of Substances Hazardous to Health (COSHH). The training provided for the staff ensures that the staff maintained safe working practices, which safeguard the safety and wellbeing of the service users. Servicing records were examined and it was noted that all portable appliances have been tested. A record is maintained of regular water temperature tests in the home. There is evidence of regular servicing of fire equipment, gas and electrical appliances being carried out by the contracted companies. All the servicing records that were examined were up to date. These included lift servicing, servicing of hoists, water treatment, electrical installation and gas servicing. Up to date servicing and maintenance of these services and equipments ensure a safe environment for the service users and the staff who work there. Regents View Nursing Home DS0000018204.V273783.R01.S.doc Version 5.1 Page 21 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 3 X X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X 3 X X 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 3 2 Regents View Nursing Home DS0000018204.V273783.R01.S.doc Version 5.1 Page 22 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 2 Standard OP10 OP15 Regulation 12(4)(a) 16(2)(1) Requirement Timescale for action 25/01/06 3 OP33 12(5)(a) 4 OP38 13(3) The service users dignity must be preserved at all times. The manager must continue to 25/01/06 ensure that the arrangements for serving supper benefit the service users and offer choice to them. The provider must take action to 01/05/06 address the concerns raised by staff and issues affecting the low staff moral in the home. The provider must take suitable 01/05/06 action to address the state of the freezer, fridge and the tea trolley to ensure food safety and hygiene. 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 OP10 Good Practice Recommendations It is recommended that the service users tea cups are replaced as these are badly stained, marked and DS0000018204.V273783.R01.S.doc Version 5.1 Page 23 Regents View Nursing Home institutional looking. Regents View Nursing Home DS0000018204.V273783.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT 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. 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