CARE HOMES FOR OLDER PEOPLE
Rossendale Nursing Home 96 Woodlands Road Ansdell Lytham St Annes Lancashire FY8 1DA Lead Inspector
Susan Dale Unannounced Inspection 2.00 7 August 2006
th 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 Rossendale Nursing Home DS0000006077.V299247.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. Rossendale Nursing Home DS0000006077.V299247.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Rossendale Nursing Home Address 96 Woodlands Road Ansdell Lytham St Annes Lancashire FY8 1DA 01253 737740 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) Mrs Caroline Taylforth Carol Marline Griffiths Care Home 27 Category(ies) of Dementia (17), Old age, not falling within any registration, with number other category (10) of places Rossendale Nursing Home DS0000006077.V299247.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 27 service users to include: up to 10 service users in the category of OP and up to 17 service users in the category of DE Date of last inspection Brief Description of the Service: The Rossendale Nursing Home is registered with the Commission for Social Care Inspection to provide personal and nursing care for 27 service users of either sex aged 65 years and over. Care is offered to those with physical/medical needs and those with dementia (up to 17 service users). The Rossendale Nursing Home is a detached Victorian property, which retains many of its original features. Three en-suite bedrooms were added to the home in 2004.It is situated in a residential area of Ansdell Lytham St Annes, overlooking Grannies Bay. The home is within easy reach of shops and local amenities. It is situated on a bus route and within five minutes walking distance of Ansdell railway station. Service users are encouraged to retain their links in the community and every effort is given to ensuring that relationships, hobbies and interests are pursued. Relatives, friends and visitors are made welcome at the home at any time. Service users accommodation is provided in nineteen single rooms and four double rooms, nine of which have en-suite facilities. Communal areas are provided in two lounges, a dining room and a conservatory. The conservatory is designated a smoking area. There are attractive gardens to the front and side of the home which are accessible to service users, and there are car parking facilities at the rear of the home. Rossendale Nursing Home DS0000006077.V299247.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced, took place over two days and focused on key standards. The inspector was able to speak to service users and staff and examine various records. Comment cards were provided to service users, relatives/friends and health professionals prior to the inspection. 3 comment cards were returned from relatives/visitors and the results were taken into account as part of the inspection. A tour of the premises took place. What the service does well: What has improved since the last inspection?
A maintenance programme is now in place and some of the furniture in bedrooms has been replaced. The dining room has been decorated. Consideration is being given to a new lift that will cause some disruption but will improve the current very small lift. All staff have an NVQ or Nursing qualification and some Dementia training is to be provided in the near future. The Deputy Matron is now registered with the Commission for Social Care Inspection as manager and the registered provider/owner is concentrating on looking at quality issues and carrying out audits on the existing systems and devised a Business Plan.
Rossendale Nursing Home DS0000006077.V299247.R01.S.doc Version 5.2 Page 6 The recording of medication has been improved with a separate sheet for each service user on which a record is made each time medication is missed and the reason; a photo of each service user is attached to the medication record. All ingestible products such as shampoo are now kept in lockable facilities to ensure the safety and welfare of vulnerable service users. What they could do better: 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. Rossendale Nursing Home DS0000006077.V299247.R01.S.doc Version 5.2 Page 7 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 Rossendale Nursing Home DS0000006077.V299247.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, & 3 Quality in this outcome group was good. Information about the services provided by the home is available. An initial assessment is conducted that ensures an appropriate service is provided. EVIDENCE: The statement of Purpose and Service User Guide has been reviewed and updated; a copy has been provided to each service user and is also available in the entrance hall. There was evidence of an initial assessment that covers all areas to ensure that the services provided are appropriate. There was a reminder that it is important for the assessor to sign and date the record. Service users and relatives are involved in the assessment process as much as possible and the background and history of the service users are obtained and taken into account. A relative commented that he had been present at the admittance of his grandmother and was very satisfied with the process. Rossendale Nursing Home DS0000006077.V299247.R01.S.doc Version 5.2 Page 9 Details about any dietary requirements are taken on admission. The chef confirmed that he soon becomes familiar with individual likes and dislikes and any dietary need, these are recorded and kept within the kitchen area. The home does not provide intermediate care. Rossendale Nursing Home DS0000006077.V299247.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 The quality in this outcome group was good. The physical and health needs of each service user are met appropriately and staff treat service users with respect and understand the importance of privacy. EVIDENCE: Individual care records are kept for each resident with a plan of care setting out in detail the action that needs to be taken by care staff to ensure all aspects of health, personal and social care needs of the residents are met. Significant events had been recorded on appropriate documentation and daily entries made setting out the care given. The documentation seen was user friendly and each care plan is reviewed on an almost daily basis because the majority of service users have high needs and any plan may have to be adapted constantly. There was evidence that a GP had been contacted over the health requirements of a recent admission and detailed notes had been kept. Service users have their choice of own GP and the home has access to other healthcare practitioners including a community psychiatric nurse, audiologist, dietician, optician, chiropodist and physiotherapist. Liaison also takes place with a pharmacist.
Rossendale Nursing Home DS0000006077.V299247.R01.S.doc Version 5.2 Page 11 At the last inspection some improvements were recommended over the recording of medication. These recommendations have been put in place and each service user now has a separate sheet which details any time medication is not provided and the reason; a photograph of the service user is now attached to each medication record. The registered responsible provider of the home confirmed that she carries out an audit of the medication record each month. There was evidence that patient information leaflets are kept which details any contra-indications about the medication; this is considered good practice. A relative commented that the care provided was “Excellent” and that he had nothing but praise for the staff over the care provided. Observation of staff showed that service users are treated with respect and their privacy and dignity was maintained as much as possible. At induction staff are taught the importance of privacy and dignity. Rossendale Nursing Home DS0000006077.V299247.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome group was good. Leisure and recreational activities are provided. Contact with relatives/friends and the local community is encouraged. Meals are varied and nutritionally well balanced. EVIDENCE: Consideration to the high percentage of residents with dementia is taken into account when activities are planned. A physiotherapist attends the home every Monday. Activities include, games, skittles dominoes; outings are undertaken when possible with trips to Fairhaven Lake to feed the ducks and trips to the illuminations. Relatives are able to visit the home and take service users out and one service user is regularly taken to the local public house each day. The home is centrally located with shops, churches and the promenade very close by and there is good links with local transport making it easy for relatives and visitors to pop in to the home. Clergy from various local churches visit the home on a regular basis. Individual choice is recognised with service users able to choose when they wish to go to bed or get up and they are able to wander freely around the home while at the same time strategies are in place to ensure their safety.
Rossendale Nursing Home DS0000006077.V299247.R01.S.doc Version 5.2 Page 13 The chef confirmed that there are no restrictions on the budget with regard to food and nourishing meals with an emphasis on fresh vegetables were seen to be available. A service user spoken to confirmed that he enjoyed the food and said it was “smashing”. Many of the service users require ‘soft’ food and where meals are liquidised they are made to be as attractive as possible. Rossendale Nursing Home DS0000006077.V299247.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome group was good. A suitable complaints procedure is in operation and policies and procedures are in place that ensures service users are protected from abuse. EVIDENCE: There was evidence that complaints had been recorded and investigated appropriately; the registered provider confirmed that minor complaints as well as more formal complaints were recorded and acted upon. No complaints have been received by the Commission for Social Care Inspection. A concern had been raised about service users being got ready for bed in the afternoon but there was no evidence of this on the day of the inspection, which, was unannounced and took place in the afternoon. Staff confirmed that some service users are not happy with close personal care and in order to lessen the distress were got ready for bed when being toileted. The registered provider confirmed that she would monitor the situation. The home has a procedure in place for dealing with allegations of abuse. The manager and staff spoken to had a good understanding of the procedures to be followed in the event of any allegations or suspicion of abuse or neglect. The home’s training addresses issues of physical and or verbal aggression and inappropriate behaviour displayed by Service Users. A whistle blowing policy is in place and staff are made aware of this via training. Rossendale Nursing Home DS0000006077.V299247.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome group was good. The home is clean and safe and a maintenance programme is in operation. EVIDENCE: The home is not purpose built and has a very homely atmosphere with many of the rooms large, spacious and full of character. Some of the rooms have good views overlooking Grannies Bay. A tour of the home took place and all parts of the home were clean, tidy and hygienic. As recommended at the last inspection, a maintenance programme is in operation and the details have been recorded as part of the Business Plan. Some of the furniture has been replaced and the dining room has been decorated. The registered provider is considering the purchase of a new lift that will also affect other parts of the home when it is installed. At the last inspection a recommendation was made that all ingestible products such as shampoo and bubble bath are locked away due to the vulnerability of
Rossendale Nursing Home DS0000006077.V299247.R01.S.doc Version 5.2 Page 16 the service users and the registered provider confirmed that all such products have been locked away. Rossendale Nursing Home DS0000006077.V299247.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome group was poor. Service users are looked after by appropriately trained staff. The recruitment and selection of staff should be improved. EVIDENCE: There were sufficient staff on duty at the time of the inspectors visit and staff and visitors spoken with confirmed that sufficient staff are on duty at all times. The majority of service users have high needs and this is taken into account when planning the rota; one service user did require a staff member with her at all times and this was implemented but has now become unnecessary because she has improved. Agency staff are employed when necessary. A key worker system of staffing is in operation and staff are also divided into two teams that change over once a month. All staff have either a nursing qualification or an NVQ qualification and training is seen as a high priority. The induction training has been improved and is linked to the NVQ programme. The registered manager is an NVQ Assessor and this supports the high numbers of staff achieving an NVQ qualification. All staff now have to study the home’s individual policies and procedures and they are checked on their knowledge and sign a document confirming that they have been provided with the information and understand its content. Specialised training on the subject of Dementia is to be provided to all staff in the near future and staff confirmed that they have been told they will be provided with the training.
Rossendale Nursing Home DS0000006077.V299247.R01.S.doc Version 5.2 Page 18 The documentation relating to the recruitment of staff was examined and as at previous inspections there is a need to tighten up in this area. In order to ensure that suitable staff are employed it is important that a check is undertaken with the Criminal records Bureau as well as with the Protection of Vulnerable Adults (POVA) checklist. Staff have commenced at the home prior to clearance by the Criminal Records Bureau (CRB) although they have been checked by telephone to ensure that they are not on a POVA list. According to the registered provider this is done routinely because of the length of time taken to obtain clearance by CRB and new staff are kept under supervision until clearance is obtained. References had been obtained but the ones seen were not appropriate as they were, ‘To whom it may concern’ or were telephone references that had not been followed up in writing. A recommendation was made that referees are provided with a job description with the reference request and a record should be kept of each stage of the application with a date and signature at each stage. Rossendale Nursing Home DS0000006077.V299247.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome group was good. The health, safety and financial interests of the service users are protected and both service users and staff benefit from the leadership skills of the current management of the home. EVIDENCE: The previous registered manager was also the registered provider/owner and she has now taken a step back and the deputy matron is now registered with the Commission for Social Care Inspection as manager. Both the registered manager and the registered provider are appropriately qualified having completed the Registered Managers’ Award. The staff and service users spoken with said that the management team were helpful and approachable. Routines within the home are devised with the wishes and needs of the service users in mind. None of the residents in the home completely manage their finances, with only two residents able to access and utilise their money. All fees and expenses are paid either by relatives or via a solicitor.
Rossendale Nursing Home DS0000006077.V299247.R01.S.doc Version 5.2 Page 20 Staff confirmed that staff meetings take place once a month as well as one to one individual supervision; records are kept of all meetings. The Deputy Matron is now registered with the Commission for Social Care Inspection as manager and the registered provider/owner is concentrating on looking at quality issues and carrying out audits on the existing systems and devised a Business Plan. Risk assessments are carried out in all areas including the environment and all aspects of care. Policies and procedures are in place with regard to health and safety and regular maintenance of equipment takes place. Regular fire drills take place and fire equipment is regularly serviced. Fire training is covered within induction. All accidents and incidents are recorded appropriately. Rossendale Nursing Home DS0000006077.V299247.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 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 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Rossendale Nursing Home DS0000006077.V299247.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2 Standard OP29 OP29 Regulation 19 19 Requirement Appropriate references must be obtained prior to new staff commencing at the home. Written evidence must be provided showing clearance has been obtained via POVA prior to new staff commencing at the home. Timescale for action 31/08/06 31/08/06 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 OP29 Good Practice Recommendations A job description should be sent with a request for reference and a record should be kept for each stage of recruitment. Rossendale Nursing Home DS0000006077.V299247.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rossendale Nursing Home DS0000006077.V299247.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
