Inspection on 22/08/07 for Retired Nurses National Home

This inspection was carried out on 22nd August 2007.

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

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

Other inspections for this house

Retired Nurses National Home 16/09/09

Retired Nurses National Home 31/01/07

Retired Nurses National Home 06/02/06

Retired Nurses National Home 14/07/05

Retired Nurses National Home 01/03/05

Retired Nurses National Home 10/08/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

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 Retired Nurses National Home Riverside Avenue Bournemouth Dorset BH7 7EE Lead Inspector Debra Jones Key Unannounced Inspection 22nd August 2007 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Retired Nurses National Home Address Riverside Avenue Bournemouth Dorset BH7 7EE 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) 01202 396418 01202 302530 rnnhoffice@btconnect.com Trustees, Retired Nurses National Home Limited Mrs Elaine Brace Care Home 52 Category(ies) of Old age, not falling within any other category registration, with number (52) of places Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named person (as known to CSCI) under the age of 65 may be accommodated to receive care. 31st January 2007 Date of last inspection 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 half a mile walking distance of a local superstore (food, clothing, electrical goods, newspapers/magazines etc.) Local buses are also available approximately half a mile from the home, travelling to Bournemouth, Christchurch and beyond. The home stands within extensive attractive grounds offering numerous 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 and stairs between floors. All bedrooms are for single occupancy; thirty-five bedrooms have en-suite facilities. There are sufficient communal bathrooms and WCs available on each floor. There is a spacious dining room and two sitting rooms. The home has its own chapel, reading room and hairdressing salon. The Retired Nurses National Home is a registered charity and has recently extended the criteria for permanent admissions to include some other medical professions, as well as nurses. The home also provides short-term or respite care, including for those who are not from a nursing or allied professional background. Trustees have overall responsibility for the functioning of the home, which is managed on their behalf by Mrs. Elaine Brace. 24-hour personal care is provided, as well as all meals, laundry and domestic services. A range of activities is available to provide stimulation and interest for residents, including crafts, a reading group, quizzes and gentle exercise to music. Occasional outings are arranged. Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 5 All meals are prepared and cooked within the home. Special diets can be catered for. The fees for the home, as confirmed to the Commission for Social Care Inspection (CSCI) at the time of inspection, range from £355 - £455 per week. Additional charges include hairdressing, chiropody, dry cleaning, toiletries and newspapers. A copy of the current inspection report is available on request to the manager. The Office of Fair Trading has published a report highlighting important issues for many older people when choosing a care home, e.g., contracts and information about fees and services. The CSCI has responded to this report and further information can be obtained from the following website: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_ choosing a care home .aspx Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on 22 August July 2007. Debra Jones and Martin Bayne were the inspectors who carried out the visit. Elaine Brace (registered manager) and staff at the home helped the inspectors in their work. The main purpose of the inspection was to check that the residents living in the home were safe and properly cared for and to review progress in meeting the requirement and recommendations made at the previous inspection. The inspectors were made to feel welcome in the home throughout the visit. A tour of the premises took place and a variety of records and related documentation were examined, including care records. Time was spent talking with 9 residents in their bedrooms and in the lounge. Two requirements were made as a result of this visit and one recommendation. None were carried over from the previous report. Some good practice suggestions were discussed at the inspection and these are referred to in the report, intended to encourage improvement in an already highly rated service. The management of the home have a sustained track record of delivering good performance and managing improvement. ‘We listen and care. It is all about the residents. It is their home, we do their bidding’ (the manager). During the course of the visit residents talked about the food, the standard of cleanliness and the high calibre of staff in the home. There were no negative comments about the home. Comments included:‘They do everything they can for us’, (a resident). ‘It is a very good home and a very clean home.’ (another resident) ‘It was so nice at Christmas. We all received a little present and were made to feel very special.’ (another resident) Prior to the inspection the home submitted to the Commission a thoroughly completed annual quality assurance assessment (AQAA). This gave information about the service and it’s performance. This document was also helpful in the planning of the inspection visit. The home also sent out comment cards on behalf of the Commission; seven were returned by residents, 11 by relatives and 2 by GPs. Comments from residents were as follows:‘There is generally a good atmosphere and I should not want to be anywhere else.’ ‘The friendliness and availability of all staff makes this place feel like home. Staff seem to inter relate well, which helps.’ ‘I am satisfied with the care I receive and am quite comfortable.’ Relatives said when asked ‘What do you feel the care home does well?’ Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 7 ‘Pretty well everything.’ ‘Their staff are always helpful and willing to discuss any concerns either mine or those of my mother.’ ‘Maintains friendly atmosphere.’ ‘Care (physical and mental), spotless laundry, excellent food and service, good social programme, hairdressing facility, happy, cheerful atmosphere, excellent medical care.’ ‘The staff are very caring and competent. There is always good staff cover. The environment is pleasant. The home is well organised. They are very flexible.’ ‘Provides a calm and caring environment. Treat people as individuals and with dignity.’ ‘Respects it’s residents. Sensitivity to individual needs. Good food diet.’ ‘The whole organisation from the care manager to the care assistants have all been very caring, friendly and open, and have treated my mother with dignity and respect. They have encouraged her to mix and integrate, but have remained mindful of her preferences.’ ‘Home always very clean and free from smells (urine etc). They are very good at getting my mother to mix with the other residents, meal times etc and they make sure that she doesn’t just sit in her room vegetating.’ ‘The manager and her senior staff are exceptional. They listen carefully to the needs of residents and are proactive in seeking ways to improve their lives. All the staff are friendly and genuinely caring in their attitude to both the residents and relatives. When my father was very ill and subsequently died the home handled this and the aftermath extremely well.’ ‘The best care home in our experience – caring, loving, keeping residents in beautiful, clean comfortable surroundings, with exceptional choice and quality of food. Keeping residents cared for to the utmost of the staffs ability. Endless patience – even with unbearably difficult residents. Every facility – hairdresser / salon and church, craft, garden and keep fit clubs and outings.’ When asked ‘How do you think the care home can improve?’ relatives commented ‘I don’t think they need to. I think they do a wonderful job and I would sincerely hope that these comments are made known. The staff all need praise for a job well done.’ ‘More rooms at ground floor level.’ ‘The staff and the care they provide is excellent and it is hard to think of an area they could improve in. The décor is rather tired but nevertheless homely and it is always clean and tidy.’ ‘By calling the doctor out as soon as there is a need and not waiting.’ ‘Although residents are consulted daily about menu choices, the food could be more imaginative, especially for residents such as my mother who have difficulty swallowing.’ ‘more staff – so as present staff aren’t running around the whole time trying to ‘see’ to everyone. Very hard work! Especially as mum needs two carers every time she needs the hoist.’ In addition relatives commented Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 8 ‘The Retired Nurses National Home staff handle my aunt’s needs and wishes sympathetically and as well as I can visualise that any care home could do.’ ‘This is one of the cleanest homes I have ever visited. It is a delight that it does not smell, which so often is the case with homes……… There is absolutely no doubt in my mind that my mother has made the remarkable progress that she has, as a direct result of the care and commitment of all the staff at this home. I would always be happy to refer this home to any client or family member.’ ‘Fully recommend the Retired Nurses National Home.’ ‘I have been very pleased with the home.’ ‘I looked at several other care homes, all with good to excellent CSCI reports, and I unreservedly commend the RNNH for the excellent service they provide. I am grateful that mum qualified for admission, for is was without doubt my preferred choice.’ ‘The RNNH is an excellent home and I feel very fortunate that my mother is in their care.’ What the service does well: The Retired Nurses National Home provides a homely, relaxed and comfortable environment with a welcoming and friendly atmosphere. The home is well presented and has attractive grounds. The home is kept clean and smells pleasant. A good admissions procedure is in place that ensures that only people whose needs can be met are offered places at the home. Prospective residents and their representatives have the opportunity to visit the home to see if they like it before they move in. A range of community health professionals support the care staff in looking after residents. Residents confirmed that they felt well treated. Residents are encouraged to exercise choice in their daily lives. Activities are on offer at the home that residents can join in with if they choose to. Visitors are always welcome at the home and residents are encouraged to maintain and develop relationships with people in the home, with their families and friends and maintain links with the local community. Meals are varied and a choice is always available. The dining rooms are pleasant and comfortable. The complaints and adult protection procedures reassure residents and their representatives that the well-being and comfort of residents is important to the home and that any concerns raised will be properly investigated and resolved. Sufficient numbers of well trained staff are on duty throughout the day and night to be able to meet the needs of the residents. Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 9 The home is well managed and organised with the care, contentment and safety of residents being central to the way the home is run. What has improved since the last inspection? What they could do better: In their annual quality assurance assessment (AQAA) the home has identified that they intend to as a result of consultation with residents • Introduce seminars from professional bodies on a regular basis. • Refurbish the day room to accommodate a library and a computer, with provide support for interested residents. • Creating a sensory garden for residents to visit and work in. In addition they are • Intending to enlarge their lift to make it more accessible for people who use wheelchairs. • also looking at adding more shower facilities around the home. • considering the provision of suitable activities for residents who do not like leaving their rooms. In the course of the inspection some shortfalls were identified which the home will need to address. The home must confirm in writing the outcome of the pre admission assessment thereby reassuring prospective residents that their needs can be met at the home. Where handwritten changes are made to medication administration records these should be signed and countersigned by competent people to confirm the accuracy of the changes. Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 10 In respect of staff all checks and documentation required by law must be made including a full employment history. Where agency workers are employed by the home the home needs to obtain evidence to demonstrate that these staff have been appropriately employed and trained. In addition to the requirements and recommendation made in this report the following good practice suggestions are made that the home is urged to adopt and act upon. The home is encouraged to • Obtain the clinical triggers available on the CSCI website in respect of continence, dementia, falls and nutrition. • Carry out basic moving and handling assessments for all residents to establish needs. • Obtain the most up to date guidance from the Department of Health e.g. Essential Steps to Safe Clean Care and check that the home’s policy is consistent with the guidance. • Add to their policies how staff in the home are to keep commodes and bottles clean. • Obtain the latest guidance from the Medicines and Healthcare products Regulatory Agency guidance, which contains information on assessing the risk of the use of bed rails etc and carrying out ongoing maintenance and safety checks of such equipment. Also the home is asked to consider amending their statement of purpose to include that they are flexible in respect of age and may accept people in need of their service below the age of 65 and, if amended, send a copy of this updated document to the Commission. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 11 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 Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 12 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4. Standard 6 does not apply to this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A thorough pre admission procedure is in place and assessments are routinely undertaken to ensure that only residents whose needs can be met by the home are offered places there. EVIDENCE: Recently compiled pre admission assessments were seen for two residents. Prior to anyone moving to the home their needs are fully assessed by the manager or deputy manager. Information from the first point of contact onwards is kept and feeds into the assessment. The records indicated that the needs and circumstances of the people had been properly assessed. Prospective residents are given the opportunity to visit the home as are their representatives, and residents can stay on a trial basis. Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 13 The home has a number of independent ‘flatlets’ on site and most new longterm residential care residents come into the service via these or following respite care. Records seen did not demonstrate that all new residents had had confirmation in writing that the home could meet their needs following pre admission assessment. The manager put this down to their routes of entry into the home. Simple systems to build in the written confirmation of meeting needs was discussed. Prior to the visit the home sent comment cards out on behalf of the Commission to find out what people thought about the service. All 7 residents who returned cards said that they had enough information about the home before they moved in to decide if it was the right place for them. Two residents wrote about their experiences of moving to the home. ‘I had injured my back, so did not try other homes, but was glad there was a room available, do not regret coming here.’ ‘I would always say to any enquirer that this place feels like a HOME and not an institution. I was given good time in which to decide and was surprised that I could choose colour of carpeting and paint – as this would be freshly done. The general attitude was helpful and welcoming with no pressures.’ A relative commented ‘my mother has only been a resident for a few months. The staff could not have been more welcoming, informing and helpful.’ Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to provide staff with the information they need to meet the health and personal care needs of residents. The principles of respect, dignity and privacy are put into practice. EVIDENCE: The information contained in pre-admission assessments, and also any assessments supplied by funding authorities, is used to help draw up a detailed plan of care. The home are advised to date any information that relates to residents with the date of it’s receipt at the home e.g. local authority assessments. All residents have a care plan and two care plans were reviewed at this visit. Files were well laid out and plans easy to read; informative about the needs of the resident and of how the home was to meet these needs. It was clear that reviews were being undertaken and plans updated with changes. Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 15 Care plans are based on a range of information e.g. medication history and physical needs as well as a series of relevant assessments e.g. risk assessments. Where residents have significant moving and handling needs occupational therapists are asked to carry out assessments. The home is encouraged to carry out basic moving and handling assessments for all residents to establish needs or if a more specialist assessment is needed. Evidence was seen which showed that residents are involved in drawing up their care plans. A comprehensive social history is also recorded, often by the residents themselves and, where this is not possible, relatives or representatives are encouraged to contribute to provide important background information, social history etc. Daily notes support and evidence the delivery of care to residents. A system is in place to alert staff to significant events or changes in care needs. When asked ‘Do you get the care and support you need?’ Five of the 7 residents who returned comment cards prior to the visit replied ‘always’ and 2 ‘usually,’ commenting ‘I do not often need extra help, but it is available when requested. There does not often seem to be anticipation of personal needs.’ ‘A lot depends on who is on duty – most are very caring.’ ‘Always but I would like to qualify this. I do not normally need extra help at present. But on two occasions that I have had a temporary problem, the immediate help needed wasn’t received – a nurse would have recognised it! However any request or suggestion for help has always (in my 3 years) been acted on in some way. I would prefer this to having an unwelcome decision made for me.’ ‘Staff are very flexible if you change your mind.’ Ten out of the 11 relatives who responded by comment card said that they were ‘always’ informed of important matters in respect of their relative, comments included ‘When x slipped and broke her hip we were informed within minutes. Also the home kept in touch with the hospital during her stay there, and directly x was able to return to the home she was immediately welcomed back.’ ‘Excellent communication.’ ‘Immediately, I am informed and respond, to be at the hospital before mum.’ Five felt the home always met the needs of their relative, and 6 ‘usually’ ‘they do a good best. x’s personal attitude makes her difficult to look after. ‘It is difficult to fully meet the needs of the old but they do very well.’ ‘My mother has only on a couple of occasions had to wait slightly longer than she expected when asking for attention.’ Eight said that the home gave the support or care to their relative that they’d expected or agreed. ‘Royal Nurse National Home care excellent.’ ‘They are very good and very caring.’ ‘Virtually always.’ Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 16 Evidence was available on file and through discussion with management and staff that GPs, district nurses, and chiropodists are available to residents. Specialist services and advice are also accessed when needed e.g. rehabilitation. Four of the 7 residents who returned comment cards said that they ‘always’ received the medical support they needed and 3 that this was the case ‘usually.’ Medication procedures were reviewed. Risk assessments are carried out for those residents who self-administer some or all of their medications. Accountability for medication administered to residents by the home lies with the senior on duty holding the key. All of the staff who give medication have been trained and there was a record of sample signatures. The medication administration records were seen for residents on the ground floor, the procedures for the home being kept at the front of the medication administration records. There were no gaps in the records and a good organised system was in place, colour-coding information to assist staff. The procedure in the home is to give out medication to one person at a time, signing the record before going on to the next person as per recognised good practice. Where hand entries have to be made, staff say that they check that the entries are correct but no second person is formally checking and signing that the entries made were correct. Medication was appropriately and safety stored. Those that require refrigeration are kept in a separate locked, small fridge and maximum and minimum temperatures are recorded to ensure that the medication does not get too hot or too cold. No residents are currently being prescribed controlled drugs although two drugs were being kept in a separate inner lockable container and being recorded as ‘controlled drugs’ with two staff signing a separate register along with the balance of the medication held. All bedrooms at the Retired Nurses National Home are single occupancy, giving residents opportunities for privacy. Residents spoken with said that they were treated very well. Staff were seen to treat residents with courtesy, patience, kindness and respect. Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A range of activities is available for residents to participate in should they choose to. People are generally encouraged to make choices about their life style and to maintain contact with their family and friends. The meals in this home are wholesome and varied and are served in a pleasant environment. EVIDENCE: The Retired Nurses National Home provides organised activities such as art therapy, craft, and reading group. There are also occasional entertainers, a notice in the hallway showed that a violinist from the Bournemouth Symphony Orchestra was due to do a recital at the home during the coming weekend. The home have developed a monthly calendar showing activities. Evaluation forms are used in order to assess whether or not activities are popular. A new large TV has been bought to be used for showing films as part of the new film club, which has proved popular with a surprisingly good attendance. A Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 18 gardening club is being developed as a response to interest shown by residents. The manager said they were ‘encouraging residents to own the garden.’ On the day of the inspection visit the home were having their summer fundraising coffee morning / bazaar, open to residents and non residents. This proved to be a successful event and the home was buzzing with activity when inspectors arrived. Residents spoken to during the visit were asked about how they kept themselves occupied and all seemed satisfied. Most said that they were happy with their own interests and company and none said that they wanted more group activities. Of the 7 residents who returned comment cards 4 said that it was ‘always’ the case that there are activities arranged by the home that they can take part in, 2 said that this was true ‘usually,’ and 1 ‘sometimes.’ Comments included ‘Activities are increasing and widening. Some existing ones were not of interest to me, but this is individual. I am well enough to always be occupied.’ ‘A very good mix of activities and thank goodness no bingo or community singing.’ ‘I am a bit of a loner.’ One resident talked of how her spiritual needs were met. She said that one Tuesday a month a Holy Communion service was held in the home and that each Sunday there was a service in the chapel. One Sunday this was nonconformist and the next Church of England. Visitors are encouraged to visit the home at any time. Residents records and the visitors book demonstrate contact with family and friends as well as visits by professionals. A telephone is always available to residents so they may make or receive calls. Some residents have their own computers and so are able to keep in touch with family and friends via electronic means. Residents’ meetings are held, giving them an opportunity to raise any issues of concern or make suggestions for the better running of the home. Residents are encouraged to pursue their own lifestyles within the home and make individual choices wherever possible. These include choosing when to get up and go to bed, what to wear, what to eat or drink and to generally do as they wish during the day. Relatives commented ‘they encourage rather than force. She has a choice of how to live her life there.’ ‘It certainly seems that way to me. They are respectful of my mothers needs and wishes and help her make the choices she needs to.’ Many bring their own possessions into the home and personalise their bedrooms as was seen when the premises were toured. Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 19 Residents are encouraged to be involved in decisions made about the home such as when areas are being redecorated or when new furnishings or furniture are being purchased. Residents also organise a mobile shop, which tours the home selling sweets, birthday cards, stationery, toiletries etc. Residents usually go to the dining rooms for meals but can have meals in their own rooms if they wish or need. Menus for the week are advertised on the notice board and residents are individually offered meal choices the day before. The manager said there was always scope for people to change their minds on the day. A cooked breakfast is always available in the morning. There is a choice of hot meals at lunchtime and a choice of hot and cold meals in the evening. Morning coffee and afternoon tea are served. All residents were seen to have a jug with water or squash in their rooms and many had a small bowl of fresh fruit. Inspectors joined residents in the main dining room for lunch, which was soup, followed by roast lamb, mint sauce, broccoli, roast parsnips and potatoes. Dessert was tapioca or melon with ginger. Records are kept of what residents eat and these show the range and variety of meals and the alternatives that were made available for those who did not want what was on offer that day. The Chef has a list of residents who require puréed food or have their meat minced. One resident has soya rather than dairy products. In general people said that the food was to their liking with plenty to eat and if anything they were provided with more food than they could eat. Four of the 7 residents who returned comment cards said that they ‘always’ liked the meals at the home, with 2 saying that they liked them ‘usually’ and 1 ‘sometimes.’ Comments about meals were mixed and these were fed back to the home. Positive Comments included: ‘It is impossible to please everyone for every meal.’ ‘If there is something one doesn’t like, the staff always seem to provide an alternative. I think we have good variety, including fruit daily.’ ‘Very good food.’ Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to a complaints procedure. Policies and staff training in abuse protect residents from harm. EVIDENCE: The complaints procedure is displayed on the notice board in the hallway and includes information about who to contact and how long it takes for the home to respond to a complaint. No complaints have been received by the home or by the Commission for Social Care Inspection since the last inspection. The comment cards sent to residents asked the question ‘Do you know who to speak to when you are not happy?’ Of the seven who replied 5 said that this was ‘always the case’ and the other ‘usually.’ ‘One feels free to discuss ‘anything’, from the top down. This is good.’ Six people said that they would know how to make a complaint. One resident spoken with during the visit said ‘people should have nothing to complain about here’. Relatives were also asked if they knew how to make a complaint if they needed to. Nine people said that they knew, comments included Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 21 ‘I have not needed to but would know what to do.’ ‘The need would not arise at this establishment. But if I ever did, I would make sure I knew.’ Relatives were also asked if the service had responded appropriately if they or their relative had raised concerns about their care. Eight said it was ‘always’ the case that the home had responded appropriately and one said ‘usually.’ ‘My mother sometimes does complain – but they always have an adequate response. They keep very good written records of all incidents.’ ‘I have not had cause to raise any concerns.’ The home has an adult protection policy that shows that they are working to the Dorset guidelines, based on the Department of Health ‘No Secrets’ document. There is also staff training in this subject at the home from induction onwards. Prior to any members of staff commencing employment at the home the Protection of Vulnerable Adults list is checked to ensure their suitability. Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in comfortable, safe and well-maintained surroundings where standards are constantly improving. The Retired Nurses National Home is clean and there are no unpleasant odours, ensuring that residents live in a pleasant environment. EVIDENCE: A tour of the premises confirmed that the Retired Nurses National Home is well maintained. The home has a warm and homely atmosphere. It is well decorated throughout. Lounges and dining areas are comfortably furnished. The home is registered for 52 people. On the day of the visit 32 were being accommodated. Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 23 Aids and adaptations are available throughout the home e.g. raised toilet seats - and some residents with particular needs have their own personal equipment to assist with their independence. Most bedrooms have en suite facilities and there are communal bathrooms and toilets around the home. Residents are able to personalise their rooms with furniture and general belongings as they wish and in agreement with the home. New residents are offered a choice of decorations. There is a passenger lift in the home, enabling easy access between the floors. There are emergency alarm bells throughout the home – in each bedroom and in communal areas. The home has suitable machines to launder clothes and bedding at appropriate temperatures. The home has an infection control policy. They are advised to obtain the most up to date guidance from the Department of Health e.g. Essential Steps to Safe Clean Care. Once they have got hold of this they will need to check that their policy is consistent with the guidance. It is also suggested that the home add to their policies how staff in the home are to keep commodes and bottles clean. A number of sluices are available in the home. All areas of the home seen were very clean and residents made comments about how clean the home was kept. Five of the 7 residents that returned comment cards said that the home is ‘always’ fresh and clean, with the other 2 saying that this was the case ‘usually.’ Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient, well-trained care staff are employed and deployed to meet the care needs of residents. EVIDENCE: Clear staffing rosters are in place that show who is on duty, where, when and what jobs they do. A record is also kept showing what was actually worked. There are currently 32 residents living at the home. The present roster shows that there are 5 care staff and a senior carer on duty at all times during the day, with up to 7 care workers and 2 seniors on duty at peak times. At night there are 3 care staff on duty along with a senior care assistant. Care staff are further supported by catering, housekeeping and maintenance staff to keep the home running. The Manager and deputy work in addition to the staff listed above. A GP commented ‘always pleasant and caring attitude from staff.’ A group of staff who were taking a break were spoken with. High staff morale was apparent with staff being proud of the good standards in the home and feeling that they did a good job. The manager praised the staff describing them as ‘wonderful.’ Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 25 Residents were asked are the staff available when you need them? Three who responded said ‘always’ with the other 4 saying ‘usually.’ Asked if staff listen and act on what you say 6 said yes. Relatives were asked to comment on the skills and experience of staff. Comments included ‘So far as I can judge, they are well qualified and motivated.’ ‘Staff always cheerful as well as being efficient.’ Two files were reviewed of staff who have joined the home since the last visit in January 2007. Most documents that should be on file were. Prospective staff complete an application form and are interviewed. The file included proof that the person was not on the Protection of Vulnerable Adults list, held by the Department of Health. Two references had been received. One file did not contain the person’s full employment history. At times the home has to rely on agency workers to keep the home fully staffed. Records were not available to show that the home has the required information about agency workers e.g. in respect of pre employment checks, proof of identity and training. Thirty-three care staff are employed at the home. Twenty-two have a National Vocational Qualification (NVQ) at level 2 in care, representing 66 . Some others have or are studying for their NVQ 3 in care. (The Department of Health target is for 50 of care staff to have an NVQ at level 2 this qualification.) The deputy manger has responsibility for training and is qualified as a ‘Train the Trainer’. The home has recently signed up with a training company who provide a number of in-house training packages, staff work through written modules and then sit a knowledge paper, which is sent back to the training organisation for certification. A system is in place for ensuring that staff receive mandatory training such as manual handling and there was evidence that updates were being given. Staff also receive fire safety training, first aid, infection control, abuse awareness and health and safety. Staff are also encouraged to attend other non-mandatory training. Two senior staff had just gone on a Dysphasia Awareness training and another staff member had been on an activities training day. Copies of the General Social Care Council code of conduct are given to staff. Staff spoken with said that they received good training, that they had just completed infection-control and were about to start abuse awareness training. Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is very well organised and the daily management and running of the home centres round the care and contentment of residents. Excellent management practice, systems in place, and records kept, confirm the health and safety of people in the home. EVIDENCE: The Registered Manager, Mrs Brace is an experienced manager and has completed her National Vocational Qualification level 4 in care and the Registered Managers Award. She keeps herself up to date by doing training courses with staff. Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 27 Mrs Brace is enthusiastic and committed to the care of residents and talked of how she worked with her staff in ‘striving to do a brilliant job.’ The Retired Nurses National Home is overseen by a group of Trustees who are ultimately responsible for the viability of the home. The registered provider carries out monthly visits to the home and prepares a written report in order to ensure the standard of care provided is satisfactory. Reports seen were informative and showed that the person doing the report had spoken with residents and was aware of developments in things happening within the home e.g. discussions about the appointment of an activities coordinator, an ongoing injury to, and recovery of, the chef. There was also evidence to demonstrate that the home was being run in the interests of residents with residents’ meetings being referred to along with their involvement in choosing books and jigsaws for the upstairs lounge. Prior to this inspection the home completed an annual quality assurance assessment (AQAA), which they submitted to the Commission for Social Care Inspection. This identifies how the home have taken into account the views of residents and their supporters in the running of the home and sets out their plans for improvement over the next twelve months. The home sent out and made available comment cards for the Commission as requested before this visit. Comments came back from residents, relatives and a GP. They were all generally positive about home and showed that residents are confident in expressing their views. Resident and general staff meetings take place regularly. A trustee attends both. To get the best out of these meetings they are regularly reviewed for effectiveness for example currently small groups of residents are meeting making it easier for attendees to contribute. Where suggestions are made to improve the quality of life for residents at the home they are acted upon where possible. In order to protect residents, it is the policy of the home not to have any involvement in their personal finances. Therefore, any resident unable or not wishing to handle their own affairs has a relative or other representative to deal with their finances etc. The home does not handle 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. All records were available as requested at the inspection. An up to date insurance certificate was on display along with the home’s registration certificate. There were photographs of residents as required by law on files that were reviewed. Practices at the home are underpinned by a range of policies and procedures which the home confirmed were recently updated. Appropriate notifications about incidents and accidents are made to other bodies. Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 28 Dorset Fire and Rescue visited recently and have confirmed that they are satisfied with the fire risk assessment in respect of Retired Nurses National Home, reviewed in 2007. A resident expressed concern about fire precautions in a comment card. The Manager said that they had recently been discussing how best to involve residents in fire awareness and that later that week they were due to have a session with residents explaining what staff and residents are to do in the event of a fire. This is with a view to ‘empowering residents so that they feel more in control’ (the manager). Staff fire training and fire drills are also carried out at least six monthly for day staff and quarterly for night staff to ensure all are fully aware of what to do should a fire break out. Accident records were looked at. Accident forms seen were generally well completed. Records could have been clearer in some cases about how staff came across accidents, if they had witnessed them or if residents had told them what had happened. Accident records feed into the review process at the home so that where appropriate measures are put in place to minimise further risks to residents and anyone working at the home. In addition equipment is regularly maintained. Information sent to the Commission prior to the inspection confirmed that the home is undertaking appropriate checks of equipment and facilities at appropriate intervals. The home were advised to obtain the latest guidance from the Medicines and Healthcare products Regulatory Agency guidance which contains information on assessing the risk of bed rails and other such equipment and carrying out ongoing maintenance and safety checks. Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 4 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X 3 3 Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP4 Regulation 14 Requirement The registered person must in all cases confirm in writing to the resident that having regard to the assessment the care home is suitable for the purpose of meeting the resident’s needs in respect of his health and welfare. All documentation required by law in respect of recruitment and staff must be in place e.g. a full employment history. This requirement in respect of all documentation applies to all people working in the home i.e. permanent staff, agency staff and volunteers. Timescale for action 01/10/07 2. OP29 19 01/10/07 Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 31 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 OP9 Good Practice Recommendations Where handwritten entries or amendments are made to Medication Administration Records these should be signed and countersigned by competent people to confirm the accuracy of the entry/ amendment. Retired Nurses National Home DS0000003976.V349074.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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