CARE HOMES FOR OLDER PEOPLE
Retired Nurses National Home Riverside Avenue Bournemouth Dorset BH7 7EE Lead Inspector
Marjorie Richards Unannounced 14 July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Retired Nurses National Home D55 S3976 Retired Nurses National Home V236618 140705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Retired Nurses National Home Address Riverside Avenue Bournemouth Dorset BH7 7EE 01202 396418 01202 302530 anything@rnnh.co.uk Trustees, Retired Nurses National Home Limited 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) Mrs Elaine Brace CRH PC - Care Home Only 52 Category(ies) of OP Old age (52) registration, with number of places Retired Nurses National Home D55 S3976 Retired Nurses National Home V236618 140705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None. Date of last inspection 1st March 2005 Brief Description of the Service: The Retired Nurses National Home is a long established care home located in a purpose built building on the outskirts of Bournemouth. The home enjoys a semi-rural situation, yet is within walking distance of a local superstore (food, clothing, electrical goods, newspapers/magazines etc.) Local buses are available less than half a mile from the home, travelling to Bournemouth, Christchurch and beyond. The home is surrounded by extensive grounds that are easily accessible, attractively laid out and offering plenty of seating areas. Car parking is available for visitors. The home is registered to accommodate up to fifty-two older people. Ramps are available to assist access to the home. Accommodation is arranged on the ground and first floors, with a passenger lift or stairs between floors. All bedrooms are for single occupancy and thirty-five rooms have have ensuite facilities. There are sufficient communal bathrooms and WCs available on each floor. A spacious dining room and two sitting rooms are provided and the home also has its own chapel, a reading room and a hairdressing salon. The home is a registered charity and has recently extended the criteria for permanent admissions to include certain other medical professions, as well as nurses. Trustees have overall responsibility for the functioning of the home, which is managed on their behalf by Mrs. E. Brace. 24-hour personal care is provided, as well as all meals, laundry and domestic services. A range of activities is available, including crafts, a reading group, quizzes and gentle exercise to music. Occasional outings are also arranged.
Retired Nurses National Home D55 S3976 Retired Nurses National Home V236618 140705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over seven hours on the 14th July 2005 and was one of the two anticipated inspections carried out each year. The main purpose of the inspection was to check that the residents living in the home were safe and properly cared for and to check on progress in meeting the four requirements from the previous inspection. A tour of the premises took place and a variety of records and related documentation were examined, including the care records for five residents. Time was spent talking with thirteen residents, as well as the deputy manager, the staff on duty and visitors to the home, in order to get a real feel of what it is like to live at the Retired Nurses National Home. What the service does well:
The Retired Nurses National Home has a thorough admissions procedure. Management staff carry out pre-admission assessments to ensure that only people whose needs can be met are offered places in the home. The home encourages prospective residents and their relatives to visit and assess the facilities and services on offer, before making any decisions about admission. The health needs of residents are well met, with evidence of good support from community health professionals, such as GPs, district nurses, chiropodists etc. There are systems in place to ensure that medication is handled safely. Residents wishing to manage their own medication may do so. Residents are well cared for and treated with courtesy, respect and dignity. The need for privacy is also understood. I can be on my own if I want to be, my privacy is respected. Residents have the opportunity to choose their own lifestyle within the home and their individual preferences and routines are respected. A variety of activities are made available within the home and occasional outings are arranged. Residents can have visitors whenever they like and are able to come and go as they please. They are encouraged to make decisions about how they live their lives. Meals are varied, wholesome and nutritious. Residents commented favourably about the food provided, We have good food here, well cooked and nicely served. Special diets are catered for and residents say they only have to ask and the chef will deal with any special requirements, likes and dislikes etc.
Retired Nurses National Home D55 S3976 Retired Nurses National Home V236618 140705 Stage 4.doc Version 1.40 Page 6 No complaints have been received by the home or the Commission since the last inspection. Residents commented, If I have any concerns, I go straight to the manager and she sorts everything out. I have been here a long time and never had to complain about anything. The home is well maintained, comfortable and safe for the residents living there. Residents enjoy access to a variety of communal areas, including attractive, well-maintained grounds, with a variety of seating available. There is easy access to the home and grounds for wheelchairs and less able residents. Bedrooms are comfortably furnished and individually personalised, with residents able to bring their own furniture and belongings if they wish. Residents confirm, The home is always kept nice and clean. Sufficient staff are employed to meet the current needs of residents. Staff are well motivated and enthusiastic in their work. Residents spoke very favourably about staff in the home, The staff are excellent here, they could not be better. The manager is qualified and experienced in care and management and provides clear leadership throughout the home. Managers and staff have developed good relationships with residents and this results in a relaxed, supportive and caring environment in which residents feel secure and comfortable. The home has quality assurance procedures in place and actively seeks the views of residents, relatives and staff to make sure the home is run in the best possible way. What has improved since the last inspection?
Access to the home, especially for those in wheelchairs, has been greatly improved. One resident commented, You only have to press the button now and the doors open for you. The home has an ongoing programme to provide ensuite facilities in as many bedrooms as possible. Two bedrooms have been redecorated and new carpets have been fitted. Some new garden furniture has been purchased, including a swing seat. Further activities have been introduced, including armchair Pilates. A new pre-admission assessment form has been developed which is very informative and will help to ensure that all relevant information is obtained prior to admission, so that care needs can be met.
Retired Nurses National Home D55 S3976 Retired Nurses National Home V236618 140705 Stage 4.doc Version 1.40 Page 7 What they could do better:
Following the last inspection, four requirements were made. One of these has now been met in full and one has been partly met. However, two requirements have not yet been met. Written information about the Retired Nurses National Home is provided to assist prospective residents in making a decision about admission to the home. This information comes from a variety of sources, but some of these are now in need of amendment to ensure the information is accurate and up-to-date. Details about the admissions procedure would also benefit from updating, to include the opportunities for respite care and a trial period in the home. After a member of the management team has carried out a pre-admission assessment, the home needs to confirm in writing that it is able to meet the prospective residents needs, to give them the necessary reassurance that the home is right for them. The Retired Nurses National Home has a good care planning system in place. However, some residents have only temporary care plans and the full care plan has not yet been put in place. At the last inspection, a requirement was made with regard to regularly reviewing care plans, to ensure they are always up-todate, but this has still not been achieved. The home has a good system for dealing with complaints. However, care must be taken to ensure that all sources of written information about how to make a complaint are kept fully up-to-date. On the day of inspection, a fire door was found to be wedged open. This is a dangerous practice and in the event of a fire, could allow smoke and flames to spread within the home, putting lives at risk. (The manager is currently making arrangements for an alternative means of holding open this door for a resident, so that fire safety will not be compromised.) The way that staff are recruited still needs to be improved. At the last inspection a requirement was made to ensure the necessary staff information was in place. However, one of the staff files examined during this inspection showed that references had not been requested and a Criminal Records Bureau check had not been received, prior to the member of staff starting employment within the home. It is very important that proper checks are carried out in order to protect residents. The Responsible Individual, on behalf of the Trustees, is legally required to visit the home at least once a month and prepare a written report. Such visits should be unannounced and give the opportunity to talk with residents, visitors and those working in the home, as well as inspecting the premises and records etc. and ensuring the standard of care is satisfactory. A copy of the written report should then be supplied to the Commission and the registered manager.
Retired Nurses National Home D55 S3976 Retired Nurses National Home V236618 140705 Stage 4.doc Version 1.40 Page 8 This was a requirement of the previous inspection report but has still not been actioned. 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. Retired Nurses National Home D55 S3976 Retired Nurses National Home V236618 140705 Stage 4.doc Version 1.40 Page 9 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 Retired Nurses National Home D55 S3976 Retired Nurses National Home V236618 140705 Stage 4.doc Version 1.40 Page 10 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, 2, 3 and 5 Standard 6 is not applicable to this home as intermediate care is not provided. Information provided about the Retired Nurses National Home and a thorough admissions procedure allows prospective residents to make informed decisions about admission and ensures that only those whose needs can be met by the home are offered places there. However, some of the information needs updating and the outcome of pre-admission assessments is not confirmed in writing, so prospective residents are not fully assured that their care needs will be met. Prospective residents and their relatives have an opportunity to visit to assess the facilities and suitability of the home, prior to making a decision about admission. EVIDENCE: Information about the Retired Nurses National Home is available for prospective residents to help them decide if the home is right for them. The Service user Guide, or Welcome document is informative and gives a good indication about what a prospective resident can expect from the home.
Retired Nurses National Home D55 S3976 Retired Nurses National Home V236618 140705 Stage 4.doc Version 1.40 Page 11 However, some documents require amendment, (for instance, details about the registration authority) and some information is not included, (for example the qualifications and experience of management and staff etc.) Reference to the value of property covered by the homes insurance policy for residents is different in the brochure to the amount stated in the current residents contract. (It is suggested that rather than reprint the brochure, a loose sheet insert is enclosed containing the up-to-date information.) The Retired Nurses National Home has an e-mail address where further information can be obtained at any time. The homes terms and conditions/contract also need a little updating, to include information such as changes in the admission criteria, (i.e. no longer only nurses, but other medical backgrounds and respite care for residents without a nursing or medical background.) Also, details of the room to be occupied and who is responsible for the payment of fees, (for instance the resident, local authority or relative etc.) The contract states that all complaints must be made, in the first instance, to the homes manager. It should be made clear that a complaint may be referred to the Commission for Social Care Inspection at any stage, should the complainant wish to do so. Individual care records are kept for each resident and five of these were examined. All showed that, prior to moving to the home, care needs had been assessed by the homes manager or deputy manager. A new pre-admission assessment form has recently been developed which is very informative and will help to ensure that all relevant information is obtained prior to admission. Whilst the home clearly gathers all the information needed to decide if they could provide care for a prospective resident, this is not confirmed in writing. Prospective residents are not, therefore, fully assured that their care needs will be met. If an enquiry is received about admission to the Retired Nurses National Home, an invitation is issued to come and visit, look around and ask questions, meet the staff and other residents etc. Prospective residents are welcome to take a short break in the guest accommodation or come in for a day to meet people and sample meals etc, to help get a better feel of the home and what it might be like to live there. It would be helpful if more information was available to prospective residents about the admissions procedure. For example, the deputy manager referred to respite care and giving prospective residents a sixweek trial period, allowing people time to make this very important decision, but there is no mention of these options in the Service User Guide, contract or brochure etc. Retired Nurses National Home D55 S3976 Retired Nurses National Home V236618 140705 Stage 4.doc Version 1.40 Page 12 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, 9 and 10 The Retired Nurses National Home has a detailed care planning system in place, which ensures that staff have the information they need to meet the health, personal and social care needs of residents. However, only temporary care plans are in place for some residents and regular reviews are not being carried out, to reflect changing needs and current objectives. The systems for the administration of medication are good with clear and comprehensive arrangements in place to ensure residents medication needs are met. Residents are treated with respect by staff that are sensitive to their need for privacy and the preservation of dignity. EVIDENCE: All five of the care plans examined follow from the assessments made earlier. They are clearly set out and informative about the personal, social and health care needs of each resident. However, this information is not being regularly reviewed. Reviews should be carried out at least monthly, to ensure care plans are updated to reflect changing needs and current objectives. For the files seen, only one review was carried out between the months of January and
Retired Nurses National Home D55 S3976 Retired Nurses National Home V236618 140705 Stage 4.doc Version 1.40 Page 13 May 2005. The deputy manager advised that a staff ‘handover’ is held at the start of each shift and up-to-date information is shared verbally. However, this must be backed up with written documentation to ensure all staff have access to the same information. Not all care plans for recent admissions have been completed and temporary care plans are still in use. Time must be made available so that care plans can be completed at the earliest opportunity, in order to ensure that staff are fully aware of all care needs and how these are to be met. Residents have been involved in drawing up their care plans. A comprehensive social history is also recorded for all residents and the home is commended for the quality of the information obtained. The health needs of residents are well met, with evidence of good support from community health professionals. The Commissions Pharmacist Inspector, Miss Christine Main, visited the Retired Nurses National Home in April 2005 to inspect the arrangements for the recording, handling, safekeeping, administration and disposal of medicines. Two requirements and two recommendations were made as a result of this visit. These were checked and found to have been met. Residents wishing to do so can manage their own medicines. Staff were observed throughout the inspection to be treating residents with courtesy, patience, kindness and respect. Staff were seen to be knocking at bedroom doors. Staff assistance, when needed, was carried out discreetly and with due regard for the preservation of dignity. The service user’s preferred form of address is recorded on admission. One of the first things they asked me when I came here was how did I wish to be addressed. Discussion with staff and residents indicates that the preferred term of address is being used. Residents have their own single bedrooms, thereby offering an opportunity to be on their own if they wish, or allowing privacy for any visitors or personal care needs. Residents commented, I can spend as much time as I want to in my own room. I can be on my own if I want to be, my privacy is respected. The staff are very good. They are always polite and respectful. Retired Nurses National Home D55 S3976 Retired Nurses National Home V236618 140705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 A range of activities is available to provide variation and interest for residents. Residents are able to maintain contact with their family and friends and there are opportunities to go out if they wish. Residents are helped to make choices so that they retain control over their lives. Good wholesome meals are provided in pleasant surroundings that meet residents’ tastes and special dietary needs. EVIDENCE: Residents have the opportunity to choose their own lifestyle within the home, and their individual preferences and routines are respected. The home offers a range of activities and these are advertised on the notice boards, with additional reminders given by staff where necessary. These include handicraft sessions, a reading group, armchair exercise classes to music and armchair Pilates, arts and crafts and a monthly quiz night with supper and prizes. The mobile library visits monthly. Visits are also made from clothing outlets. Occasional outings are arranged and a volunteer also provides regular transport at cost, for those wishing to go out into the community. Residents commented, “I enjoy the activities. I think the balance is about right.” I would like to see more options available, especially those that
Retired Nurses National Home D55 S3976 Retired Nurses National Home V236618 140705 Stage 4.doc Version 1.40 Page 15 stretch our minds and occupy more of our time. This is particularly important for those who are not able to go out.” “I look on the notice board to see what is available. We can then join in if we want to, but it is not compulsory.” “I really enjoy the quizzes and wish we could have them more often.” The home has its own chapel offering weekly services. Clergy will also visit individual residents on request. Friends and relatives are made welcome at the home and there are no restrictions on visiting, unless at the request of residents themselves. Residents and visitors confirmed that they can visit at any time and are well received. A visitors book is maintained, which confirms the number and range of visitors to the home. Residents are encouraged to be in control of their lives. This is demonstrated in many ways and residents are encouraged to make choices in their daily lives. For example, at lunchtime, vegetables are served in dishes so that residents may decide how much they want and help themselves. Some residents are keen gardeners and have their own small patch of garden to tend. Residents also organise a weekly mobile shop, which tours the home selling sweets, birthday cards, stationery, toiletries etc. A quarterly residents meeting is held, where residents can raise any issues of concern or make suggestions for the better running of the home. Lunch on the day of inspection was shepherds pie, with creamed potatoes, carrots and cabbage. This was followed by homemade bread and butter pudding. Residents said they only had to ask and any personal preferences were well accommodated by the chef. The meal was sampled and found to be very good. Residents may choose where to eat their meals. During warm weather, some residents like to have their morning coffee or afternoon tea served outside in the garden. The lunchtime meal took place in a relaxed, unhurried atmosphere with discreet staff assistance provided wherever necessary. A tray of fresh fruit is taken around the home every day, so that residents may choose from this whatever they wish. Residents commented, We have good food here, well cooked and nicely served. I appreciate the fresh fruit and vegetables we all receive. I am sure it contributes greatly to our continued good health”. On the whole, the food is very good. It is not always easy to please everyone. Retired Nurses National Home D55 S3976 Retired Nurses National Home V236618 140705 Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 A system is in place for dealing with any complaints. This needs slight amendment to ensure up-to-date information is always given. Residents are confident complaints would be listened to and dealt with appropriately. EVIDENCE: The home has a complaints policy and procedure that is displayed on a notice board within the home and included in the range of information provided to residents or their representatives. Some documents need slight amendment to ensure that they are all up-to-date and providing the same information. For instance, the Brochure suggests that complaints may be taken up with a previous Registration Authority. No complaints have been received by the home or the Commission since the last inspection. Residents spoken to say they have no concerns, “ I have been here a long time and never had to complain about anything.” “If I have any concerns, I go straight to the manager and she sorts everything out.” I have no complaints about the home at all. I am very satisfied with everything here. If I wasnt, I would say so and feel confident something would be done about it. Retired Nurses National Home D55 S3976 Retired Nurses National Home V236618 140705 Stage 4.doc Version 1.40 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 24 and 26 Continuous investment in the upkeep of the home results in a well-maintained, comfortable and safe environment for residents, where standards are constantly improving. There is easy access to both indoor and outdoor communal facilities. Bedrooms are comfortably furnished and individually personalised to suit their occupants. The home is clean with no unpleasant smells, making daily life more pleasant for all in the home. EVIDENCE: The Trustees ensure that the Retired Nurses National Home is well maintained, providing a safe environment for all in the home. Each month, a group of Trustees meet with the manager to walk round the home and grounds, identifying any potential risks, e.g. worn items of furniture, leaves on paths, car parking hazards etc. Appropriate steps are then taken to eradicate or minimise any of these risks. A maintenance book is used to record any work needed in the home and three maintenance staff are employed to deal with any requirements.
Retired Nurses National Home D55 S3976 Retired Nurses National Home V236618 140705 Stage 4.doc Version 1.40 Page 18 It was noted that one fire door was wedged open. This is a dangerous practice and in the event of a fire, could allow smoke and flames to spread within the home, putting lives at risk. This was discussed with the Deputy manager who explained the difficulties experienced by this particular resident. Alternative means of holding open the door without compromising fire safety are currently being arranged, so an Immediate Requirement Notice was not issued. The communal space available to service users is well in excess of that prescribed in the National Minimum Standards. This comprises a large and spacious dining room; separate sitting rooms on the ground and first floors, a reading room and a hairdressing salon. On the day of inspection, a number of residents and visitors were enjoying the very attractive grounds surrounding the home. It is possible to achieve solitude if wished, or to sit with a small group, or meet with friends or visitors. A summerhouse and all year round seating is available. New garden furniture, including a swing seat, has just been purchased. Residents commented, We have beautiful gardens here. It is always such a pleasure to look out on them, or sit out when the weather is good. I love watching all of the wildlife that comes into the garden. Bedrooms are comfortably furnished and individually personalised to suit their occupants. Many residents have their own furniture and belongings around them. The home continues to improve standards with the addition of en-suite facilities and thirty-five bedrooms have now been completed. Several residents expressed the view that theirs was, The best room in the house. A tour of the premises demonstrated that the home is maintained to a good standard of hygiene and cleanliness. There are no unpleasant smells, thereby making daily life more pleasurable for residents, staff and visitors. Residents confirmed, The home is always kept nice and clean. Some homes smell dreadfully, but that is never the case here. Suitable facilities and procedures are in place in respect of laundry and the disposal of clinical waste. Retired Nurses National Home D55 S3976 Retired Nurses National Home V236618 140705 Stage 4.doc Version 1.40 Page 19 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 and 29 The home is adequately staffed with an enthusiastic workforce that works positively with residents to ensure their safety and comfort. Practices in relation to recruitment of staff need improvement as residents are potentially placed at risk through a failure to always carry out appropriate checks. EVIDENCE: Examination of the staff rota, discussion with residents, staff and the deputy manager and observation throughout the inspection demonstrated that the home has a sufficient number and skill mix of staff to meet the current needs of residents. During the morning, there are 6 care staff and one senior on duty and in the afternoon there are 5 care staff and one senior care assistant. There are 3 care staff on duty overnight with a senior member of staff on call. In addition there are administrative staff, chefs and kitchen staff, maintenance, domestic and laundry staff as well as a management team working in the home. Staff and residents spoken with felt that staffing levels were satisfactory for the numbers and care needs of the present group of residents. However, they felt they had been stretched in recent months with some of the admissions for short-term respite care. A few residents expressed concern about the perceived detrimental effect this was having on available staff time. For example, It sometimes takes longer for staff to answer call bells, because they are busy elsewhere. The manager is aware of these concerns and the matter will be discussed at the next residents meeting. Staff are well motivated and enthusiastic in their work. Residents spoke favourably about staff, The staff are excellent here, they could not be better.
Retired Nurses National Home D55 S3976 Retired Nurses National Home V236618 140705 Stage 4.doc Version 1.40 Page 20 The staff are all very good, polite and helpful whenever you need them. One of the staff files examined showed that a Protection of Vulnerable Adults (POVA) check had been carried out but the employee started work before the Criminal Records Bureau (CRB) disclosure was received. Not all of the required information was in place, e.g., satisfactory references, prior to the member of staff commencing employment. There was no record to show that satisfactory arrangements for the supervision of the employee by a named experienced person had been put in place until the receipt of a satisfactory CRB disclosure. The deputy manager explained that this member of staff was already known to the home, but it is important that the required information is obtained in relation to all staff, to ensure the protection of residents. Retired Nurses National Home D55 S3976 Retired Nurses National Home V236618 140705 Stage 4.doc Version 1.40 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33 and 35 The registered manager is qualified and experienced in care and management and provides clear leadership throughout the home. However, the registered provider is not carrying out monthly visits to the home (and preparing a written report) in order to ensure the standard of care provided is satisfactory. The home regularly reviews its performance and actively seeks the views of residents, staff and relatives to ensure the home is run in the best interests of residents. Residents are assured of sound management of their financial interests. EVIDENCE: The Retired Nurses National Home is overseen by a group of Trustees who are ultimately responsible for the viability of the home. The Registered Manager, Mrs Brace, was on leave at the time of inspection, leaving the deputy manager in charge. Staff confirm that they are clear about the lines of management and accountability within the home.
Retired Nurses National Home D55 S3976 Retired Nurses National Home V236618 140705 Stage 4.doc Version 1.40 Page 22 Mrs Brace has recently completed her National Vocational Qualification level 4 in care and the Registered Managers Award. Staff speak highly of the management team, Mrs Brace has been so helpful, she has helped me a great deal. The managers listened to what we say. They want our ideas. The staff are made to feel valued, like we are all part of an important team. Working relationships between the deputy manager, staff and residents were directly and indirectly observed throughout the course of the inspection. They were amicable, yet professional, contributing to a positive and relaxed atmosphere, which was beneficial to all in the home. A member of staff said, This is a good place to work. We receive plenty of training and have everything we need to do the job. Regulation 26 of the Care Homes Regulations requires that the Responsible Individual, on the half of the Trustees, should be making unannounced visits to the home at least once a month. After each visit, a written report on the conduct of the home should be prepared and a copy forwarded to the Commission for Social Care Inspection. Monthly reports are still not being received by CSCI. Reports viewed in the home show that in 2005, visits have only taken place in March and May and not monthly, as required. Discussions with service users confirm that they feel they have a voice within the home and are able to promote their ideas, raise concerns, suggest changes etc and feel that their contributions are valued. Much of this is achieved through the quarterly Residents Meetings. The home operates an open door policy, where residents, staff or visitors are able to speak with a member of the management team at any time to discuss any matters of concern. This was confirmed by residents and staff and seen in action during the inspection. Quality Assurance questionnaires are also distributed to residents, relatives and other visitors to the home. The feedback received helps to ensure that the home is run in the best interests of residents. Quarterly staff meetings are also held and staff may express their views during formal supervision sessions. It is planned to commence a quarterly relatives meeting, in order to keep them updated about what is going on in the home and allow them to raise any ideas, issues of concern etc. In order to protect residents, it is the policy of the home not to have any involvement in their personal finances. Therefore, all residents who are unable or do not wish to handle their own affairs, have a relative or other representative to deal with their finances etc. The home never handles residents monies. If necessary, the home pays for services such as chiropody and this amount is then invoiced to residents, relatives or representatives for payment each month. Information about advocacy services is available to residents should they require independent help and advice.
Retired Nurses National Home D55 S3976 Retired Nurses National Home V236618 140705 Stage 4.doc Version 1.40 Page 23 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 2 2 2 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 3 x x x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x 2 3 3 x 3 x x x Retired Nurses National Home D55 S3976 Retired Nurses National Home V236618 140705 Stage 4.doc Version 1.40 Page 24 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 3 Regulation 14(1) Requirement Timescale for action 31/10/05 2. 7 15(1) 15(2) 3. 7 15(2)(b) 4. 19 23(4)(c) (i) The registered persons must confirm in writing to the prospective resident that, having regard to the assessment, the care home is suitable for meeting his/her needs in respect of health and welfare. The registered persons must 31/10/05 ensure that a fully, detailed care plan is in place for every resident. Temporary care plans must be replaced as soon as possible. The registered persons must 31/10/05 ensure that the service users plan is reviewed at least once a month, updated to reflect changing needs and current objectives for health and personal care, and actioned. . (Previous timescale of 30/6/05 not met.) The registered persons must 15/09/05 take adequate precautions against the risk of fire. Fire doors must never be wedged open. If a fire door is to be held open, it must be by appropriate means so that fire precautions are not compromised. The Commission must be informed as
Version 1.40 Retired Nurses National Home D55 S3976 Retired Nurses National Home V236618 140705 Stage 4.doc Page 25 5. 29 19 (Schedule 2) 6. 31 26(2)(3)( 4)(5) soon as this matter has been resolved. The registered persons must 30/09/05 implement a thorough recruitment procedure and demonstrate that the information required by regulation has been obtained and a satisfactory. (Previous timescale of 30/6/05 not met). The registered Responsible 30/09/05 Person must visit the home unannounced at least once a month and prepare a report.The person carrying out the visit shall: 1. Interview, with their consent and in private, such of the service users and their representatives and persons working at the care home as appears necessary in order to form an opinion of the standard of care provided in the care home. 2. Inspect the premises of the care home and its records of any complaints; 3. Prepare a written report on the conduct of the care home. The registered provider shall supply a copy of the report toa) the Commission; b) the registered manager. Previous timescale of 30/6/05 not met. 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 1 Good Practice Recommendations It is strongly recommended that the written information provided about the Retired Nurses National Home is
D55 S3976 Retired Nurses National Home V236618 140705 Stage 4.doc Version 1.40 Page 26 Retired Nurses National Home 2. 3. 2 16 amended and updated as necessary. Reference can be made to National Minimum Standard 1 and Regulation 4, Schedule 1, for guidance in the content of the Service User Guide and Statement of Purpose. It is strongly recommended that the statement of terms and conditions/contract is updated. Reference can be made to National Minimum Standard 2 for guidance. It is strongly recommended that all written sources of the complaints procedure are updated, to ensure they give the same accurate information. Retired Nurses National Home D55 S3976 Retired Nurses National Home V236618 140705 Stage 4.doc Version 1.40 Page 27 Commission for Social Care Inspection Unit 4 New Fields Business Park Stinsford Road Poole Dorset BH17 0NF 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 Retired Nurses National Home D55 S3976 Retired Nurses National Home V236618 140705 Stage 4.doc Version 1.40 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
