Inspection on 31/01/07 for Retired Nurses National Home

This inspection was carried out on 31st January 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 22/08/07

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 Marjorie Richards Key Unannounced Inspection 31st January 2007 09:45 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.V316991.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.V316991.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 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.V316991.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. 6th February 2006 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.V316991.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 £338 - £435 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.V316991.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 9.75 hours on the 31st January 2007. The main purpose of this inspection was to review all of the key National Minimum Standards, check that the residents living in the home were safe and properly cared for and to look at progress in meeting the two requirements and one recommendation from the previous inspection. On the day of inspection, forty-five residents were accommodated, including eight for respite care. A tour of the premises took place and records and related documentation were examined, including the care records for three residents. In addition, the Commission received twenty-six completed comment cards from residents, ten from relatives, two from care managers, one from a health care professional and four from General Practitioners. All expressed general satisfaction with the care provided. Time was spent observing the interaction between residents and staff, as well as talking with a total of thirteen residents. The daily routine was also observed during the inspection. Discussion took place with Mrs Elaine Brace, the registered manager, the deputy manager and with members of staff on duty. For the purposes of this report, people who live at Retired Nurses National Home are referred to as residents as this is the term generally used within the care home. The Inspector was made to feel very welcome in the home throughout the visit. What the service does well: The Retired Nurses National Home carries out a thorough pre-admission assessment of prospective residents 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 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, subject to risk assessment. Retired Nurses National Home DS0000003976.V316991.R01.S.doc Version 5.2 Page 7 Residents are well cared for and treated with courtesy, respect and dignity. The need for privacy is also understood. 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. In general, residents commented favourably about the food provided. 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. The home is well maintained, comfortable and safe for the residents living there. Residents are able to bring their own furniture and belongings if they wish, to personalise their rooms. Sufficient staff are employed to meet the current needs of residents. Staff are well motivated and enthusiastic in their work. Comments made by residents include: - I was not well recently and the staff were marvellous. The staff are very good, always trying to help me. It is lovely here, we are very well looked after. You cannot fault the staff.” Comments from relatives include: - Staff are cheerful and warm in their manner and remember little personal things that my relative likes. I am more than satisfied with the care my relative is receiving. The staff are kind and always pleasant. I have no complaints. We have been extremely impressed with the excellent care and kindness shown to our relative. She is very happy at the Retired Nurses National Home. Robust employment and recruiting procedures are in place to ensure the protection of residents when employing new staff. Staff are provided with suitable training, so they will have the skills necessary to meet the needs of residents. The registered manager, Mrs Brace, has a good rapport with residents, visitors and members of staff and this was demonstrated throughout the inspection. Comment cards from relatives demonstrate satisfaction with the home. This is an excellent home in my opinion. We visit frequently and are happy with the home. Friendly caring environment. Clean, lovely setting. Good services provided. Very helpful staff. Residents commented, I dont think you could find anywhere better than this. There is always wonderful support and help available should you need it. This place is second to none. This truly is HOME. Retired Nurses National Home DS0000003976.V316991.R01.S.doc Version 5.2 Page 8 The home has no involvement in the finances of residents. Those who are unable or do not wish to undertake this responsibility for themselves, have nominated relatives or other representatives to do this on their behalf. Measures are in place to promote the health and safety of residents, e.g. equipment, such as the lift, assisted baths and hoists are regularly serviced and maintained. Policies and procedures are in place to ensure safe working practices. The home provides staff with fire safety training, holds periodic fire drills and tests or checks fire safety equipment at the required frequencies. What has improved since the last inspection? What they could do better: Care plans are 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. Some residents are not entirely happy with the activities offered within the home. There are very few opportunities for those residents who remain in their rooms due to general frailty. More needs to be done for those who experience difficulty in participating in the current programme. Several residents commented on the difficulties experienced in getting out and about from the home. It is a long way to the bus stop and taxis are very expensive. If you want to go out you have to take a taxi. This is far too expensive, so I dont go out. I am very happy living here. The only problem is one of accessibility. We are very cut off here. It is recommended that possible solutions to transport difficulties be considered, to assist residents to access the wider community if they so wish. Retired Nurses National Home DS0000003976.V316991.R01.S.doc Version 5.2 Page 9 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.V316991.R01.S.doc Version 5.2 Page 10 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.V316991.R01.S.doc Version 5.2 Page 11 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 Standard 6 is not applicable in this care home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the Retired Nurses National Home. Prior to admission, an assessment is carried out to ensure that only those whose needs can be met by the home are offered places there. The home then assures prospective residents in writing that their needs can be met. EVIDENCE: Clear pre-admission assessment information had been recorded for two residents who recently moved into Retired Nurses National Home. Mrs Brace says that she always visits prospective residents or invites them to the home, prior to making a decision as to whether Retired Nurses National Home is suitable to meet their needs. An assessment form has been developed for this purpose. Retired Nurses National Home DS0000003976.V316991.R01.S.doc Version 5.2 Page 12 A letter of confirmation is then written to the prospective resident so that they may feel assured their care needs can be met. Copies of such letters were evidenced on file. The information contained in pre-admission assessments and also any assessments supplied by funding authorities, is then used to help draw up a detailed plan of care. Retired Nurses National Home DS0000003976.V316991.R01.S.doc Version 5.2 Page 13 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 the Retired Nurses National Home. 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, regular reviews are not always being carried out to fully reflect any changing needs. The home has satisfactory procedures in place for managing residents’ medication, to ensure their safety. Residents are treated with respect so that their right to privacy and dignity is promoted at all times. Retired Nurses National Home DS0000003976.V316991.R01.S.doc Version 5.2 Page 14 EVIDENCE: All of the care plans examined are clearly set out and informative about the personal, social and health care needs of each resident. However, this information is not always being regularly reviewed. Reviews should be carried out at least monthly, to ensure care plans are updated to reflect changing needs and current objectives. 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 the development of care plans by providing important background information, social history etc. 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. Care plans show that where care needs change, appropriate professionals have been consulted to carry out further assessments etc. Risk assessments are in place and appropriate steps taken to minimise the identified risks. The home has systems in place for managing medicines. Medicines are stored securely, to ensure the protection of residents. A Monitored Dosage System is in use. Those Medicine Administration Records (MAR) charts examined were well maintained. Residents wishing to do so can manage their own medicines, following a risk assessment. Staff record all medicines received in the home and a system is in place for providing an audit trail, e.g. dating eye drops and creams when starting or recording a carry forward balance on the MAR chart for each medicine. Observation of medicines being given to residents demonstrated safe and careful practice. Staff were seen to knock at bedroom doors and to offer personal care discreetly. Staff interact with residents in a friendly and caring manner and residents appear comfortable and at ease with staff. Staff were seen throughout the inspection to be treating residents with courtesy and kindness, with due regard for dignity and respect. Information recorded on admission includes the resident’s preferred form of address and preferred gender for care etc. A resident said, When I arrived, I was asked how I wished to be addressed and the staff respect my wishes. Discussion with staff and residents indicates that the preferred term of address is being used. Retired Nurses National Home DS0000003976.V316991.R01.S.doc Version 5.2 Page 15 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 spend all my time in my room, that is my choice. In the main, staff fully respect my privacy. Retired Nurses National Home DS0000003976.V316991.R01.S.doc Version 5.2 Page 16 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 the Retired Nurses National Home. A range of activities is available to provide variation and interest for residents. However, some residents have difficulty accessing these and Mrs Brace is currently working to improve the range of activities on offer. Residents are encouraged to maintain contact with their family and friends but some would like more assistance to get out and about if possible. 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. Retired Nurses National Home DS0000003976.V316991.R01.S.doc Version 5.2 Page 17 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 gentle armchair exercise classes to music, armchair Pilates, art therapy and a craft group. The mobile library visits monthly. Occasional outings are arranged and the spring outing is currently being organised. Fundraising events also take place, such as coffee mornings. There were mixed comments from residents about the activities: “I like the quizzes and crafts, but not the exercise classes.” I do not wish to take part in any activities. There is nothing to interest me.” We would like to see more of the room-bound residents encouraged to participate.” I enjoy the outings very much, I wish we could get out more often. The Christmas activities were excellent. I enjoy the outings very much, but could we go to some different places? The evening quiz shows have become rather boring. If you are stuck in your room, there is nothing much to do. “I enjoy most of the activities, but a lot of people are not able to take part.” Mrs Brace is aware that some residents are not completely happy with the activities on offer and is consulting with them to obtain their views. A member of staff will be attending an activities training course shortly and will then assume greater responsibility for coordinating and promoting activities within the home, particularly for those who experience difficulty in participating in the current programme. The home has its own chapel offering regular interdenominational services. Clergy will also visit individual residents on request. Mrs Brace says that visitors are encouraged to visit the home at any time. Members of staff and residents confirm that visiting times at the Retired Nurses National Home are unrestricted. 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 from family and friends. Several residents have their own computers and are able to keep in touch with family and friends through email. Several residents commented on the day and in comment cards about the difficulties experienced in getting out and about from the home. It is a long way to the bus stop and taxis are very expensive. We used to have a minicoach to take us to Boscombe once a week. Marvellous! It has been stopped because it was too expensive. I have considered leaving because there is no transport. If you want to go Retired Nurses National Home DS0000003976.V316991.R01.S.doc Version 5.2 Page 18 out you have to take a taxi. This is far too expensive, so I dont go out. I am very happy living here. The only problem is one of accessibility. We are very cut off here. Residents are encouraged to make choices in their daily lives wherever possible. Residents confirmed that their decisions to spend their time as they pleased, for example spending time in their bedrooms, or going to bed early or late, are respected by staff. Residents are able to bring their own possessions into the home to personalise their bedrooms and this was witnessed in many of the rooms viewed during the inspection. Residents also organise a mobile shop, which tours the home selling sweets, birthday cards, stationery, toiletries etc. Residents’ meetings are held, giving them an opportunity to raise any issues of concern or make suggestions for the better running of the home. The three-course lunch on the day of inspection consisted of leek soup, then sausages and onions in a tomato sauce, with boiled potatoes, carrots and swede. This was followed by homemade apricot crumble or semolina. A range of alternatives is always available, such as omelettes, jacket potatoes with assorted fillings or soups to satisfy individual taste and preference. Residents may choose where in the home they eat their meals. The lunchtime meal was observed in the dining room and took place in a relaxed, unhurried atmosphere with discreet staff assistance provided wherever necessary. Fresh fruit is available to residents every day. Residents provided a wide variety of comments: I enjoy my meals, they are always sufficient for my needs. On the whole, the food is very good and satisfying.” If we dont like what is on the menu, the chef will always provide something else. We should not complain about the food. It is usually wholesome and nourishing. More could be done about delays in serving between courses. Sometimes the cutlery is not very clean. There are too many sandwiches on the menu at suppertime. We have too much bread. I like the sandwiches at suppertime. I dont want a heavy cooked meal at this time of day. I have meals in my bedroom and occasionally when they arrive, they are not very hot. We sometimes have to wait a long time to be served in the dining room, especially between courses. I think the food here is very good indeed. A letter from a resident who had stayed in the home for respite care stated, “The wide variety and quality of food, coupled with very friendly service, would do credit to some reputable restaurants.” Retired Nurses National Home DS0000003976.V316991.R01.S.doc Version 5.2 Page 19 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 the Retired Nurses National Home. A complaints procedure is available which provides information on the procedure to follow for anyone wishing to make complaint. The home has an Adult Protection policy and procedure in place and Adult Protection training is arranged, to ensure a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has a complaints policy and procedure that is displayed on the notice board in the hallway and in the Service Users Guide. 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. A complaints record is maintained, but since the last inspection, no complaints have been received. The Retired Nurses National Home has an Adult Protection policy in place to protect residents from possible abuse. This has been recently updated and makes reference to the Department of Health No Secrets guidance, which is Retired Nurses National Home DS0000003976.V316991.R01.S.doc Version 5.2 Page 20 also now available to staff. Most staff have received Adult Protection training to ensure that they remain vigilant in protecting vulnerable residents from risks of abuse and know how to properly manage any allegation or suspicion of abuse. Training for the remaining staff is booked to take place during February. Retired Nurses National Home DS0000003976.V316991.R01.S.doc Version 5.2 Page 21 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 the Retired Nurses National Home. 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: The Trustees ensure that the Retired Nurses National Home is well maintained, providing a safe environment for all in the home. A maintenance book is used to record any work needed in the home and maintenance staff are employed to deal with any requirements. Prompt attention is paid to any minor defects and repairs whenever necessary. Continuous investment in the upkeep of the home results in a comfortable environment for residents, where standards are constantly improving. Recent Retired Nurses National Home DS0000003976.V316991.R01.S.doc Version 5.2 Page 22 improvements include redecoration of corridors, the continuing upgrading of bedrooms with the addition of ensuite facilities, the widening of some doorways to bedrooms to allow easier access, especially for wheelchairs and upgrading of offices for staff, including Internet access. However, examination of one of the linen stores showed that a few items were in need of replacement. Mrs Brace is currently reviewing linen and towels and will ensure the replacement of any worn items. A tour of the premises demonstrates 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 were, in the main, satisfied with the standard of cleanliness. The following comments were made either on the day of inspection or in comment cards: The cleaning of rooms could be improved, but it depends on the efficiency of the individual (and room clutter of course!) This home and garden is so clean and fresh, it looks as if it is never used. The cleaners are all lovely people and they always look so clean and nice. All of the communal areas are kept spotlessly clean. We have just had the windows cleaned outside too. For a large home to be able to stay fresh and clean is a good recommendation. The standard of cleanliness is very high. The home always looks spic and span. Suitable facilities and procedures are in place in respect of laundry and the disposal of clinical waste. Plans are in hand for improvements to the laundry later this year. Retired Nurses National Home DS0000003976.V316991.R01.S.doc Version 5.2 Page 23 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 the Retired Nurses National Home. The home employs sufficient staff to meet the current needs of residents and to ensure their safety and comfort. The home has exceeded the recommended ratio of 50 NVQ level 2 trained staff, to help ensure residents are in safe hands. Robust employment and recruiting procedures are in place to ensure the protection of residents. Staff are provided with suitable training, so they will have the skills necessary to meet the assessed needs of residents. EVIDENCE: Examination of the staffing roster and observation throughout the inspection demonstrates a sufficient number and skill mix of staff to meet the current needs of residents. Relationships between staff and residents were directly and indirectly observed throughout the course of the inspection. Staff were seen to be responding to Retired Nurses National Home DS0000003976.V316991.R01.S.doc Version 5.2 Page 24 residents appropriately and working to protect their need for privacy and dignity. Staff showed a friendly, relaxed and caring approach when dealing with residents. Most residents commented favourably about staffing during the inspection or in comment cards. I am very happy to be here. I count myself as very fortunate to live in this place. The staff are very good, always trying to help me. There is sometimes a major reliance on agency staff for holidays and sickness, but there is always a member of the regular staff available if necessary. I have always had a good response from staff ” It is lovely here, we are very well looked after. You cannot fault the staff.” The management listen, but this is variable with seniors and care staff. I have every confidence in the staff. They are always very helpful to me. I was not well recently and the staff were marvellous. Comment cards from relatives were very positive: Staff are cheerful and warm in their manner and remember little personal things that my relative likes. I am more than satisfied with the care my relative is receiving. The staff are kind and always pleasant. I have no complaints. The staff are capable and friendly and our relative appreciates them and their care. We have been extremely impressed with the excellent care and kindness shown to our relative. She is very happy at the Retired Nurses National Home. Staff are fantastic at working extra shifts to cover any gaps in staffing. This is a very good, caring home. The home has exceeded the target of 50 trained members of care staff with National Vocational Qualification (NVQ) level 2, to ensure residents at the Retired Nurses National Home are in safe hands. Fifteen members of staff have now attained NVQ level 2 and two more are currently in progress. Three members of staff are currently studying for NVQ level 3. Mrs Brace has five further staff ready to commence NVQ training. The records of two recently employed staff members were examined and found to contain all essential information including an application form, an enhanced Criminal Records Bureau disclosure, evidence of identity and of training. An equal opportunities policy underpins the employment practice of the home. The Retired Nurses National Home has a staff training programme in place. The home uses a mixture of in-house and external training, as well as distance learning to provide a range of topics that will ensure staff have the skills and knowledge necessary to fulfil their roles within the home. On the day of inspection, an external provider was giving refresher training to staff in moving and handling. The home is working to ensure that staff will have completed all mandatory training, e.g., first aid and Adult Protection during spring 2007. Retired Nurses National Home DS0000003976.V316991.R01.S.doc Version 5.2 Page 25 Copies of training certificates will be retained to provide evidence that staff receive a minimum of three paid days training per year. Retired Nurses National Home DS0000003976.V316991.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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the Retired Nurses National Home. Mrs Brace is qualified and experienced in care and management and provides clear leadership throughout the home. 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. The Retired Nurses National Home works to ensure the general health, safety and welfare of residents. The premises and equipment are properly maintained in good condition and subject to ongoing improvements to ensure the comfort and safety of all in the home. Retired Nurses National Home DS0000003976.V316991.R01.S.doc Version 5.2 Page 27 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, is supported by a deputy manager and a team of care and support staff. 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. Mrs Brace is an experienced manager and has completed her National Vocational Qualification level 4 in care and the Registered Managers Award. A member of staff said, We have a good management team here, they are very supportive of staff. Residents commented, A friendly spirit pervades from the top right through. I find Elaine Brace very understanding and helpful on any occasion. If you want something done go straight to the top. Mrs Brace is always very approachable. The Retired Nurses National Home has a calm and welcoming atmosphere, which is beneficial to all in the home. Mrs Brace has a good rapport with residents, visitors and members of staff and this was demonstrated throughout the inspection. Comment cards from relatives demonstrate satisfaction with the home. This is an excellent home in my opinion. This view is shared by other family members and friends. We visit frequently and are happy with the home. We are always made to feel welcome and if we wanted to speak to a ‘senior’ we can always do so. Friendly caring environment. Clean, lovely setting. Good services provided. Very helpful staff. Residents commented, There are occasional frustrations, but this is HOME and I sincerely hope that I shall be able to stay until death. I dont think you could find anywhere better than this. There is always wonderful support and help available should you need it. This place is second to none. This truly is HOME. Discussions with residents show 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 Residents Meetings, which take place every three to six months. The home also operates an open door policy, where residents, staff or visitors are able to speak with a member of the management team or senior staff at any time to discuss any matters of concern. This was confirmed by residents and staff and seen in action during the inspection. Retired Nurses National Home DS0000003976.V316991.R01.S.doc Version 5.2 Page 28 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. The last Quality Assurance questionnaires were sent out approximately a year ago and work is currently in hand preparing new questionnaires for residents, relatives and other visitors. It is hoped to see the results of these at the next inspection. Staff meetings are also held every three to six months and staff may also express their views during formal supervision sessions. 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 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. From touring the premises, looking at records and discussions with staff and residents, it is evident that measures are in place to promote the health and safety of residents, e.g. equipment, such as the lift, assisted baths and hoists are regularly serviced and maintained. A new electrical certificate was issued in March 2006. Staff work in accordance with a collection of written policies and procedures to ensure continuity of approach and safe working practices. The majority of staff have received first aid and moving and handling training and further training is planned. All substances that could be potentially hazardous to health are handled and stored safely. Examination of the fire records shows that appropriate procedures are in place to ensure the safety of residents and staff. Regular maintenance of the fire warning system, emergency lighting and fire fighting equipment is arranged. Routine checks are carried out at appropriate intervals and staff receive fire training and take part in fire drills to ensure they are fully aware of the action to take in the event of a fire. Retired Nurses National Home DS0000003976.V316991.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 X X N/A 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 2 13 2 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 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Retired Nurses National Home DS0000003976.V316991.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 OP7 Regulation 15(2)(b) Requirement The registered person must ensure that care plans are regularly reviewed and updated where necessary. Timescale for action 01/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations It is recommended that residents be consulted to ascertain their wishes regarding social activities. Particular consideration should be given to ways of engaging those residents less able to access the present activities programme. It is recommended that thought be given to possible ways of overcoming transport difficulties and enabling residents to access the wider community if they so wish. 2 OP13 Retired Nurses National Home DS0000003976.V316991.R01.S.doc Version 5.2 Page 31 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. Extracts may not be used or reproduced without the express permission of CSCI Retired Nurses National Home DS0000003976.V316991.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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