Inspection on 14/07/05 for Resthaven Nursing Home Limited

This inspection was carried out on 14th July 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.

Other inspections for this house

Resthaven Nursing Home Limited 08/05/08

Resthaven Nursing Home Limited 14/05/07

Resthaven Nursing Home Limited 12/06/06

Resthaven Nursing Home Limited 21/12/05

Resthaven Nursing Home Limited 31/01/05

Resthaven Nursing Home Limited 12/08/04

Resthaven Nursing Home Limited 16/03/04

Resthaven Nursing Home Limited 09/12/03

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Resthaven Home of Healing Pitchcombe Nr Stroud Glos GL6 6LS Lead Inspector Janice Patrick Unannounced 14 July 2005 18:00hrs th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Resthaven Home of Healing D51_D03_S16559_Resthaven_V228003_140705_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Resthaven Home of Healing Address Pitchcombe Nr Stroud Glos GL6 6LS 01452 812 682 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) N/A Rest Haven Home of Healing Limited Mrs Jayne Roberts Care Home - Care Home with nursing 32 Category(ies) of OP Old age (32) registration, with number of places Resthaven Home of Healing D51_D03_S16559_Resthaven_V228003_140705_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 31 January 2005 Resthaven Home of Healing D51_D03_S16559_Resthaven_V228003_140705_Stage 4.doc Version 1.30 Page 5 Brief Description of the Service: Resthaven is situated in quiet countryside. The grounds offer wonderful views across the surrounding valley and up to the woods behind. The wildlife around the Home is particularly enjoyed by some. The Home has recently completed a major new build and part refurbishment programme and now benifits from new bedrooms and facilities. The older part of the Home is yet to be refurbished. Resident accommodation is in single bedrooms that all meet the National Minimum Standards and communal space is ample. To the front and side of the building there is car parking and access to the Home for wheelchairs is via a ramp or on the flat, at the side of the Home. The Home has a qualified nurse on duty at all times and is able to offer access to other health care services. Specialised equipment is provided if required. Resthaven Home of Healing D51_D03_S16559_Resthaven_V228003_140705_Stage 4.doc Version 1.30 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this inspection between 6pm and 8.20pm. Residents were spoken to including staff from both day and night teams. A tour was made of the building, which included the kitchen and storage areas. A small selection of care documentation was seen. Duty rosters were also inspected. A new member of staff was spoken to along with her mentor for that day. General staffing numbers were discussed. Residents’ views on the food and their ability to make choices were the main topic of conversation. The security of the Home was particularly looked at. What the service does well: What has improved since the last inspection? What they could do better: Some of the manual handling practice in the Home is putting residents at risk and requires supervision and improvement. Equipment needs to be used correctly and carefully. Resthaven Home of Healing D51_D03_S16559_Resthaven_V228003_140705_Stage 4.doc Version 1.30 Page 7 The poor security in the Home is compromising service user safety. Care planning requires improvement. Systems for communicating the specific preferences of residents and their choices need reviewing. Staffing levels at the beginning of the night shift may require review to ensure residents do not have to fit in with the Homes routine and that all parts of the Home are adequately staffed. The numbers of un-witnessed falls or injuries need to reduce. The Manager needs to ensure that staff deployment is meeting the residents needs and not the staff’ needs. More robust day-to-day supervision of staff is required by senior staff to ensure ‘good practices’ are being adhered to. The Manager needs to be supervising her senior staff more effectively to ensure the Home is running the way she wishes it to be run. 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. Resthaven Home of Healing D51_D03_S16559_Resthaven_V228003_140705_Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Resthaven Home of Healing D51_D03_S16559_Resthaven_V228003_140705_Stage 4.doc Version 1.30 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 standard(s) 1 & 3 There is not as yet available, updated information that informs the public or the regulatory bodies what services the Home offers. Prospective residents and their families therefore are not helped to make an informed decision about their future care at the Home. A more comprehensive assessment format will help residents needs be assessed more thoroughly and allow information required prior to admission, to be pased onto other staff. This will enable the Manager to be sure that the individuals needs can be met. EVIDENCE: An updated Statement of Purpose and Service User Guide was required on completion of the Home’s new build and increase in size. The Manager has informed the Inspector that this has been completed in draft form, but has yet to be agreed upon by the Trustees. The pre-assessment documentation pertaining to a fairly recent admission was read. This was extremely brief with a lot of the individual’s specific needs being identified once they had been admitted. Resthaven Home of Healing D51_D03_S16559_Resthaven_V228003_140705_Stage 4.doc Version 1.30 Page 10 The Home has had several examples in the past of either inappropriate admissions or where the persons needs have just not been able to be met following a trial period. This is either due to a weak pre-admission assessment or in some incidents, possibly due to a lack of truthful information being given to the Manager regarding individual’s needs. The Home is required to demonstrate, through a thorough pre-admission assessment, that the majority of someone’s needs are identified ‘prior’ to their admission. The Inspector was informed that the assessment format had been altered but was not yet in use. Resthaven Home of Healing D51_D03_S16559_Resthaven_V228003_140705_Stage 4.doc Version 1.30 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 standard(s) 7 & 8 The present written care plans are too limited and in places too difficult to read to be able to offer staff adequate guidance on the care required, therefore putting residents at risk of not having their needs either met or understood. Service users health care needs could be met more fully if the care planning, their reviews and the care delivery decisions were shared with a wider updated and diverse skill mix. EVIDENCE: Several care plans were read, including the risk assessments of one particular resident. There was evidence that residents and some relatives had been involved in the process. It was noted that one member of staff writes all the care plans and completes all other care documentation, excluding the daily report. At times however, during the day and at night, other registered nurses are leading the care, but they do not appear to contribute to the care planning. The diverse knowledge within the team does not therefore appear to be being utilised, limiting the care delivery to just one nurse’s knowledge base. Resthaven Home of Healing D51_D03_S16559_Resthaven_V228003_140705_Stage 4.doc Version 1.30 Page 12 In places it is not easy to read what has been written and there is little allocated space for a comprehensive care plan. Following a minor accident involving a resident, a risk assessment had been written to help reduce the risks to the individual whilst enabling continued freedom of choice and independence. This related to the resident choosing to walk/wander outside of the Home. However, the related action to be taken did not encompass how an observation of this person would be carried out, once outside of the building. This was pointed out during this inspection. Care documentation showed that residents were accessing their GP, the Community Nurse and other NHS outlets. Resthaven Home of Healing D51_D03_S16559_Resthaven_V228003_140705_Stage 4.doc Version 1.30 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 standard(s) 12, 13, 14, & 15 Those able to express their particular preferences and choices are predominantly able to achieve them, but on occasions routines are not always suiting the resident and those that cannot speak up may not be getting choice. EVIDENCE: The Inspector spoke with several residents however, one was very able to express what she liked and did not like. She said: ‘I just tell them what I want to do or, if I am not happy about something’. This resident implied that she needed to be quite assertive with some staff and was concerned for those who are not able to be so assertive. According to two residents who both choose to have their tea in their bedrooms, tea was served on the day of this inspection at 4.30pm. This they felt was too early. One resident said it was because the staff like to get people to bed early in the evening. On walking around the building at 7pm many residents were in bed. One lady said she prefers to lie on the bed early. Another who was not so able to follow a conversation was noted to have been in bed a lot earlier than this and was still wide-awake. Resthaven Home of Healing D51_D03_S16559_Resthaven_V228003_140705_Stage 4.doc Version 1.30 Page 14 The Inspector is aware that the Manager has stipulated in the past that teas must not start prior to 5pm. Some residents that require feeding have their tea at 4.30pm. The Inspector has been assured that these residents all have a warm drink and something to eat if they wish with the night staff at about 8.30pm. The next meal is breakfast at 08:00hrs-08:30hrs. Those able to decide for themselves decide what they want to do with their day. Two of the residents said they choose not to sit in one of the lounges, although it is the nearest to them as there is no one to hold a conversation with and one of the residents tends to shout a lot, therefore they stay in their room. The general view of the food was good, although one resident said she continued to get food that she disliked, despite this being written down and she thought displayed in the kitchen. On checking, the list was on the kitchen notice board. One resident described the vegetarian option as limited. One resident was receiving their nutrition via a tube inserted into the abdomen. Resthaven Home of Healing D51_D03_S16559_Resthaven_V228003_140705_Stage 4.doc Version 1.30 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 standard(s) 16 Although the Homes complaint procedure is evident in reception there are historical circumstances within the Home that would suggest that concerns and complaints are not investigated fully. EVIDENCE: The Complaints procedure was on the notice board in the Hall. The Management team has not effectively looked into some concerns that have been raised by staff, which, in some cases have a direct link to the care residents are receiving and care practice. This lack of action is to be discussed with the Manager and Trustees in a future meeting with the CSCI. One resident informed the Inspector that a member of staff had accidentally pushed the hoist into her leg and that this had not been the first time. On trying to raise this as a concern, she said staff had not agreed with her and it was pointless arguing. On reading the care documentation the incident had been recorded as the resident knocking her own leg on the hoist. In view of the points made above the Inspector is not confident that the procedures in place are protecting residents. There is also concern that those residents that are more vulnerable may not find it easy to voice a concern or complain. Resthaven Home of Healing D51_D03_S16559_Resthaven_V228003_140705_Stage 4.doc Version 1.30 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 standard(s) 22, 24 & 26 A clean and ‘ homely’ environment enables residents to live in pleasant surroundings, which is also able to offer appropriate equipment to enhance their lives as needed. EVIDENCE: The environment was clean and free of any odorous smells. Cleaning of the Home remains contracted out to a company. The kitchen was especially tidy, organised and clean. This included food storage areas. A pile of dirty clothes and bed linen were seen sitting on the carpet in the hallway, which should have been in the linen skips provided. Soiled continence pads were being placed in an appropriate waste bag, but which was sitting in the corridor itself. This would not have been pleasant for other residents to see or indeed any visitors. Containers for these bags are located within bathrooms or the sluice area and are out of sight. Resthaven Home of Healing D51_D03_S16559_Resthaven_V228003_140705_Stage 4.doc Version 1.30 Page 17 Several bedrooms were inspected and were seen to be very personalised in some cases. These vary considerably in size, but are a set size that meets with the National Minimum Standards in the new build. One resident felt that the room was not large enough for her needs and precluded her from being able to look out of the window. This resident did require several pieces of specific equipment that had either been provided or that she had brought with her. Resthaven Home of Healing D51_D03_S16559_Resthaven_V228003_140705_Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 30 Despite staffing levels being regularly reviewed and the deployment of staff being altered, the safety of residents and their specific requirements are not always being ensured. Despite staff being initially inducted and trained the lack of ongoing supervision and professional self-development does not ensure that best and safe practice is always maintained. EVIDENCE: Since the completion of the new build and ‘nursing’ corridor the Home’s environment has become fairly widespread. The number of care staff has been increased since completion, but there are times of the day where staff are busy or working together and this leaves other areas unsupervised. In one wing of the Home, care delivery is almost solely carried out by care staff. Although this area is always allocated a NVQ trained carer, this is unacceptable in a nursing home where care needs are high. It is not allowing for adequate supervision of staff as the one qualified nurse on duty, administers medication and is then incorporated in the care numbers else where in the Home. Most of the falls and injuries occurring in the Home are unwitnessed. Resthaven Home of Healing D51_D03_S16559_Resthaven_V228003_140705_Stage 4.doc Version 1.30 Page 19 A new member of staff was spoken to and she confirmed that she had spent the day being supervised by the Registered nurse on duty. Her spoken English was poor, but English lessons had been organised for twice a week at the local college. Another member of staff confirmed that she had completed her induction period and had completed Manual Handling training, Fire and Infection Control training and was due to do First Aid Awareness. The registered nurse responsible for inducting staff informed the Inspector that the training given was not recorded. A subsequent visit to the Home showed new documentation in place and a record being kept. Resthaven Home of Healing D51_D03_S16559_Resthaven_V228003_140705_Stage 4.doc Version 1.30 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 & 38 A lack of staff supervision and home security is not ensuring resident safety. EVIDENCE: A requirement has been made four times now, for all staff to receive adequate supervision. The Manager has confirmed that this is still not taking place. This is of concern, particularly as the Home relies on carer led care in a large proportion of the building. It also allows consistent ‘bad practice’ to go unchecked and unchallenged, such as poor use of footplates on wheelchairs and teas being served earlier than the Manager has stated. The security of the Home on the day of this inspection was of great concern. The Home has suffered several thefts. A protocol was introduced following these stating that main entrances would be locked from 4pm onwards. This Resthaven Home of Healing D51_D03_S16559_Resthaven_V228003_140705_Stage 4.doc Version 1.30 Page 21 notice informing visitors was still on the door but at 8.15pm both front doors were open including the summer room door and conservatory door. Ground floor windows were open extremely wide (it was a hot day). Two residents were sitting in an isolated far end of the ground floor lounge and others were in bed. Staff were a great distance away in the opposite side of the building at this point. Apart from the lack of security it is organisation like this that allows for unwitnessed falls and injuries to occur. Resthaven Home of Healing D51_D03_S16559_Resthaven_V228003_140705_Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 1 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION x x x 3 x x x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x x x x x x 1 x 2 Resthaven Home of Healing D51_D03_S16559_Resthaven_V228003_140705_Stage 4.doc Version 1.30 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 4(2), 5(2) & 6(a) Requirement A copy of the ammended Statement of Purpose must be made available to read by anyone within the Home or visiting the Home and a copy forwarded to the Commission.(Timescale not met 1/12/04) And: Each service user must be issued with an updated Service User Guide. All service users must have a comprehensive assessment of their needs carried out prior to admission, which must be kept within the Home. Care plans must be written in such a way that offers staff clear guidance on how that care is to be delivered. And demonstrate service user/representative involvement. Whilst making provision for service users health and welfare their wishes and feelings must be taken into account. Food must be served at times that are reasonably suited to service users and/or when have been stipulated by the Manager. The Home must be adequately staffed at all times and staff Version 1.30 Timescale for action 31st October 2005 2. 3 14(1) & Schedule 3 (1)(a) 15(1) 31st October 2005 31st October 2005 3. 7 4. 12 12(3) 31st October 2005 31st October 2005 31st October Page 24 5. 15 16(2)(i) 6. 27 18(1) Resthaven Home of Healing D51_D03_S16559_Resthaven_V228003_140705_Stage 4.doc 7. 8. 30 36 17(2) & Schedule 4 (6)(g) 18(2) within the Home must be deployed in a way that enables service users needs to be met safely. Once deployed, staff must adhere to the plan chosen by the senior member of staff. A record of all induction training must be kept. The Home must be able to demonstrate that all staff are receiving adequate supervision, which covers all aspects of practice, philosophy of the Home and which covers career development.(Timescales not met 16/3/04, 30/6/04, 30/9/04 & 31/5/05) The Home must ensure its agreed security proceedures are carried out to maintain service user and staff safety. 2005 31st October 2005 13th December 2005 9. 38 13(6) 31st October 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 7 Good Practice Recommendations It has been strongly recommended before that all registered nurses should be involved in service user care planning. Those with specific knowledge relating to the residents need, should lead/advise on the care that is planned. Supervision sessions for all staff should be recorded, dated and signed by the person giving the supervision and the person receiving it. These sessions should be a minimum of 6 per year for each person. 2. 36 Resthaven Home of Healing D51_D03_S16559_Resthaven_V228003_140705_Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester GL3 4AB 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 Resthaven Home of Healing D51_D03_S16559_Resthaven_V228003_140705_Stage 4.doc Version 1.30 Page 26 - 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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