CARE HOMES FOR OLDER PEOPLE
Royal Bay Nursing Home 86 Barrack Lane Aldwick Bognor Regis West Sussex P021 4DG Lead Inspector
Mrs J Farrell Unannounced Inspection 30th January 2006 10:00 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 Royal Bay Nursing Home DS0000024205.V281007.R01.S.doc Version 5.1 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. Royal Bay Nursing Home DS0000024205.V281007.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Royal Bay Nursing Home Address 86 Barrack Lane Aldwick Bognor Regis West Sussex P021 4DG 01243 267755 01243 266123 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) Royal Bay Care Homes Limited Mrs Angela Ward Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35), Physical disability (10), Physical disability of places over 65 years of age (6) Royal Bay Nursing Home DS0000024205.V281007.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. A maximum of 16 service users in the PD & PD (E) category may be accommated. Only service users over the age of 40 years of age in the physical disability (PD) category may be admitted. A total of 35 service users may be accommodated. Date of last inspection 12th August 2005 Brief Description of the Service: The Royal bay Nursing Home is a care home with nursing. It is registered to accommodate up to thirty-five service users in the category of older people, six of whom may have physical disabilities. It is a three storey building located in a residential area of Bognor Regis, West Sussex. Accommodation is provided in Thirty-three single rooms and one double room. There is a lift between the ground and 1st floor. All areas of the home are accessible to wheelchair users. There is a large modern conservatory overlooking the gardens, which are well maintained and surround the premises. The home has private parking to the front of the building. There is also a smaller conservatory and a dining room. Royal Bay Nursing Home DS0000024205.V281007.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over three and a half hours on 30th January 2006. This is the second statutory inspection of this year. The purpose of this inspection was to inspect standards that were not assessed on the announced inspection and to generally monitor care practices. This report must be seen in light of the previous inspection report, which was carried out in September 2005. This is a consistently high achieving home, which responds to any constructive criticism actively and is proactive in improving the services for the residents. The inspection in September 2005 highlighted practices above the minimum standards in 1 area and the inspector scored this area at a 4, which is commendable. The Inspector saw nothing, which would change her mind regarding this good practice. The Inspector would like to thank the management, staff and residents for their hospitality and cooperation throughout the inspection. What the service does well: What has improved since the last inspection?
Royal Bay Nursing Home DS0000024205.V281007.R01.S.doc Version 5.1 Page 6 Since the last inspection all staff have commenced formal supervision, which in time will provide a forum for improvement to the quality of care provided to the residents. A fulltime activities co-ordinator has now been employed to work between three homes. Though staff and residents comment that it is ‘early days as this person has only been in post since last December’. The residents commented that they enjoy the games. Staff have now had training on dementia which they enjoyed and feel they gained from the experience. 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. Royal Bay Nursing Home DS0000024205.V281007.R01.S.doc Version 5.1 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 Royal Bay Nursing Home DS0000024205.V281007.R01.S.doc Version 5.1 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): 2,3,5,6 Prospective service users have the opportunity to see if the home will be able to meet their needs before they accept a permanent placement. They are also protected by a robust contract and benefit from a twenty eight day trial visit. Arrangements are in place to ensure that the health care needs of residents are identified and recorded. EVIDENCE: A new contract was seen and this meets the standards. Residents spoken to were unaware of the contract however they concluded that their relatives or advocates would probably have these. Four pre admission assessment documents were looked at and they clearly showed that the admission procedure was thorough and well recorded. This procedure ensures that new residents needs are properly assessed and planned for. In discussion with the manager and documental evidence no person is admitted to the home without a full assessment. In the event of an emergency the manager still goes to see and produces a written assessment before a potential resident is admitted. This home does not provide intermediate care.
Royal Bay Nursing Home DS0000024205.V281007.R01.S.doc Version 5.1 Page 9 Royal Bay Nursing Home DS0000024205.V281007.R01.S.doc Version 5.1 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): 7,11 Most arrangements are in place to ensure that the health care needs of residents are identified and met. Staff would benefit from more information on how to assist in the care needs of residents at their life’s end. This might benefit the resident and the relatives in the quality of care they receive. EVIDENCE: The care needs of residents are set out in their individual files. The inspector examined three files at random including two new residents. Some residents said they were aware that information is recorded about them and that staff members refer to it in order to meet their varying needs. Other residents were unable to confirm that they were aware of their care plan due to communication problems. The inspector noted that there was limited written evidence to show that residents had been included into the care planning process or at the monthly reviews. Individual files contained relevant information, including risk assessments for moving and handling and special dietary needs. However there was little evidence to show that any discussion regarding what resident would want to happen if they should become very unwell or at life’s end. Most staff have had practical training on what to do after the death of a resident and there are
Royal Bay Nursing Home DS0000024205.V281007.R01.S.doc Version 5.1 Page 11 clear policies to guide staff on what to do. The inspector was impressed with the staff knowledge and their sensitive approach to this difficult subject. The inspector observed staff members entering resident’s bedrooms. They knocked at the door and waited for permission before entering. Staff members said that there was strict guidance about respecting resident’s privacy. Residents said when they use their call bell, staff members respond quickly in a friendly respectful manner. Royal Bay Nursing Home DS0000024205.V281007.R01.S.doc Version 5.1 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, 14 Residents confirmed that they are able to exercise personal choice in their dayto-day life. Residents said that their social needs were met as far as possible taking into account their increased physical frailty. EVIDENCE: Discussion with service users during this Inspection confirmed that service users are encouraged to exercise choice and some control over their lives. A lockable facility is provided in all bedrooms for service users to keep important items in. Service users are encouraged to handle their own financial affairs for as long as they wish or have the ability to do so. Advocacy services are provided if needed. No residents spoken with required any outside advocates. The new activities co-ordinator was spoken with and confirmed that she had been in post since December 05. She works five days a week, thirty hours in total, dividing her time between three homes, spending approximately ten hours a week in each home. At weekend care staff take over the role of leading games, quizzes and music mornings and afternoons. New equipment has been acquired and residents spoken with are much more positive about this issue. Royal Bay Nursing Home DS0000024205.V281007.R01.S.doc Version 5.1 Page 13 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): 18, All staff must have training on the correct way to respond to any suspicion or allegation of abuse and this will safeguard the residents. EVIDENCE: All staff must have training in this important area of how to identify possible abuse and what to do about it. The staff interviewed were knowledgeable about the vulnerability of residents and the systems in place to protect them. Staff spoken with were less confident in describing the importance of the POVA (Protection of Vulnerable Adults) register introduced in July 2004. The registered manager confirmed that not all staff have had training in how to protect vulnerable adults. However she hopes that this will be addressed very shortly. Royal Bay Nursing Home DS0000024205.V281007.R01.S.doc Version 5.1 Page 14 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): 19,21,22,23 Service users benefit from a clean, comfortable and mostly well-maintained home. EVIDENCE: The home was purpose built in reference to the previous regulatory authority standards and is suitable for its stated purpose. The home is on 3 floors, all accessible by a lift. The home has a large garden and patio area, which is accessible to wheelchair users. At the time of the inspection, all communal areas and the six bedrooms seen by the Inspector were found to be clean, tidy and well maintained. All residents spoken with confirmed that the home was always clean and free from odour. Residents commented that they were happy with their rooms and were able to bring with them (within reason) items from home. The staff interviewed stated that they take pride in maintaining a very clean environment and all were very clear regarding the issues of infection control. A Legionella policy is in place, and regular health and safety checks are carried out. Water temperature checks are regularly recorded.
Royal Bay Nursing Home DS0000024205.V281007.R01.S.doc Version 5.1 Page 15 There is a programme of routine maintenance, and these records were produced during the inspection. A small number of areas require attention. This includes the sluice area on the ground floor, which is in need of up grading, particularly in relation to infection control. It was noted that the home is in need of making good a number of rusty bins. It was noted that some resident still do not have locks on their bedroom doors. The manager is reminded that The National Minimum Standards state that (24.5) Doors to service user’s private accommodation are fitted with locks suited to service user’s capabilities and accessible to staff in emergencies. The National Minimum Standards also state (24.6) Service users are provided with keys unless their risk assessment suggests otherwise. Royal Bay Nursing Home DS0000024205.V281007.R01.S.doc Version 5.1 Page 16 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): 28,30 The home has not reached the target of a minimum ratio of 50 achieving an NVQ in care or equivalent by 2005. The home needs to fulfil its requirement to ensure that all new staff receive induction and foundation training to the Skill for Care standards as if this is not done it may effect the quality of care received by the residents. EVIDENCE: Working within the home there are twenty-three care staff and seven trained nurses. At present there are three care staff with NVQ level 3 and 2 with equivalent qualifications, there are also 2 care staff currently undertaking an NVQ level 2 in care. The manager is hopeful that more staff will be undertaking these qualifications, however she is experiencing some problems accessing the training. The manager confirmed that the home is not currently using a Skill for care specification induction programme. This is for the induction or foundation levels. Royal Bay Nursing Home DS0000024205.V281007.R01.S.doc Version 5.1 Page 17 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): 33,34,36,37 Residents’ finances are handled appropriately. The residents and relatives are consulted about the quality of care at the home and are confident their comments are taken into account when bringing about change. Progress is being made with formal supervision of staff and in time this may improve the quality of care the residents receive. EVIDENCE: A sample of records pertaining to residents’ finances and other issues were viewed and found to be satisfactorily maintained. The home undertook an audit last year including outside professionals. This produced an action plan which identified that residents would like to have more activities. This has now been actioned. The process will be ongoing. Staff are monitored during induction. A formal supervision programme has started this was confirmed by staff and records maintained. There was some
Royal Bay Nursing Home DS0000024205.V281007.R01.S.doc Version 5.1 Page 18 evidence to show that it is occurring six times a year. It was also discussed with the manager that staff undertaking supervision should be trained to carry out this task. The manager was reminded that Reg 26 visits should be sent to the Commission monthly. Royal Bay Nursing Home DS0000024205.V281007.R01.S.doc Version 5.1 Page 19 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 3 3 x 4 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 2 3 x 3 3 3 x x x STAFFING Standard No Score 27 x 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 3 x 3 3 x Royal Bay Nursing Home DS0000024205.V281007.R01.S.doc Version 5.1 Page 20 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 OP11OP7 Regulation 15(1) Requirement Timescale for action 01/04/06 2 OP18 13(6) That the resident must be involved in the development and review of their care plan and that aspects of standard 11 should be incorporated and discussed with the resident. All staff must have training on 01/04/06 how to protect vulnerable adults 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 2 Refer to Standard OP28 OP30 Good Practice Recommendations 50 of care staff should acquire an NVQ in care at level 2 or above or equivalent. All new staff should have induction and foundation training which meets the TOPSS specification and this should be achieved within the time framework set out in standard 30. Royal Bay Nursing Home DS0000024205.V281007.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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