CARE HOMES FOR OLDER PEOPLE
Royal Bay Nursing Home 86 Barrack Lane Aldwick Bognor Regis, West Sussex PO21 4DG Lead Inspector
Judith Farrell Announced Tuesday 6 September 2005, 10.00am, V235881
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Royal Bay Nursing Home H60-H11 S24205 Royal Bay V235852 120805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Royal Bay Nursing Home Address 86 Barrack Lane, Aldwick, Bognor Regis, West Sussex, PO21 4DG Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01243 267755 01243 266123 Royal Bay care Homes Limited Mrs Angela Ward CRH 35 Category(ies) of OP-35, PD-10, PD(E)-6 registration, with number of places Royal Bay Nursing Home H60-H11 S24205 Royal Bay V235852 120805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 09/11/04 Brief Description of the Service: The Royal bay Nursing Home is a care home with nursing. It is a three storey building located in aresidential area of Bognor Regis, West Sussex. Accommodation is provided in thirty single rooms and three double rooms. 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 H60-H11 S24205 Royal Bay V235852 120805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place on the 6th September 2005. This is the first statutory inspection of this year. At present there are 33 service users resident at the home. The home has a mix of residential and nursing care service users. The inspection took 9 hours. A tour of the premises took place. Records were examined at random. Residents and staff members were spoken with, to gain a sense of what it was like to live in Royal Bay Nursing Home. Residents spoke highly of both the establishment and the food provided, but did have negative comments regarding the level of activities provided by the home. During the inspection 12 members of staff, 2 relatives and 12 residents were spoken to. No comment cards were received. The residents have different levels of communication ability and therefore it was difficult to ascertain all their views on how their needs are met. However all comments by residents who were able to contribute were mostly very positive. Comments such as ‘it is wonderful here’ ‘the staff will do anything for you’. Relative’s comments included ‘staff are always there to help if I need them’ ‘I feel I am always listened to’ What the service does well: What has improved since the last inspection?
Royal Bay Nursing Home H60-H11 S24205 Royal Bay V235852 120805 Stage 4.doc Version 1.40 Page 6 The Statement of Purpose and Service Users Guide has now been up-dated and provide current and prospective residents with information about the services that Royal Bay Nursing Home purports to provide. New carpet has been provided on the second floor to prevent residents from the possibly of falling. New locks have been provided to the resident’s private accommodation, which means they can lock their doors when leaving the room. However they are unable to lock their doors from the inside should they wish too. There has been significant improvement in the documentation kept in staff files. 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 H60-H11 S24205 Royal Bay V235852 120805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Royal Bay Nursing Home H60-H11 S24205 Royal Bay V235852 120805 Stage 4.doc Version 1.40 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 standard(s) 1,3,4, There are systems in place to ensure residents and their representatives’ make an informed choice about the home. No resident moves into the home without having had a thorough assessment of their needs discussed with them. Residents confirmed that their varying care needs were being met. EVIDENCE: Six residents spoken with in private were able sated they Knew about the Service Users Guide. They said they had visited the home prior to being admitted on a trial short stay. A review of their care needs was discussed with them during the first two weeks of their stay. One resident said he thought his health had considerably improved since entering the home. Residents said they found it particularly helpful to have met with the manager prior to entering the home. A relative said her Mother’s care needs and preferences had been discussed in detail during this initial assessment, which she said made her feel more confident about placing her Mother in the home. The Statement of Purpose states the qualification details of the staff. Royal Bay Nursing Home H60-H11 S24205 Royal Bay V235852 120805 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 Arrangements are in place to ensure that the health care needs of residents are identified and met. The home demonstrated good medication handling practices. EVIDENCE: The care needs of residents are set out in their individual files. The inspector examined five files at random including two new residents. 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. Individual files contained all relevant information, including risk assessments for moving and handling and special dietary needs. From discussion with the residents they gave a clear and concise pen picture of the person. The inspector observed staff members entering resident’s bedrooms. They knocked 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 H60-H11 S24205 Royal Bay V235852 120805 Stage 4.doc Version 1.40 Page 10 One resident said she was lifted using a hoist, which at first she had been fearful of. However because staff members had been thoroughly trained she now felt relaxed and not so anxious. The manager advised that there is a now a very good working relationship with the residents GPs, the district nurse service and specialist nurses. The resident’s can choose which GP they wish to register with, in the locality. Relatives spoken with discussed how their relatives are assisted to attend all hospital outpatients, dentist, eye, and hearing appointments. Medication administration record charts are printed in the pharmacy every four weeks, with the information on the medicines dispensed. The home operates a homely remedy policy. Royal Bay Nursing Home H60-H11 S24205 Royal Bay V235852 120805 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15 Residents will benefit from a more robust programme of fulfilling activities. The home promotes positive relationships between residents and their relatives. Service users enjoy a range of appealing and nutritious meals. EVIDENCE: Conversations with relatives highlighted that community presence and participation in social activities was varied across the home. Some residents are able to go out in the garden and do so frequently. For others, staff support is required for all parts of daily living. The home provides entertainment on three mornings, one resident particularly likes the quiz, however one resident who was interviewed would have liked to attend these activities could not because he is unable to get up until 10.30 and the entertainment starts at 10.00. Another service user interviewed stated he would like more activities particularly in the evening. They would also like more ‘brain stimulating activities’. The registered manager informed the inspector that the company was exploring the possibility of employing an entertainment coordinator to work across all of the three homes in the district. Staffing levels were adequate for the number of service users and it was disappointing that across the 9 hours of inspection, service users were not engaged in more fulfilling activities. One relative who visit the home regularly informed the Inspector that there was very little in the way of an activity programme in the afternoon when they visit. However another relative who called the inspector after the inspection
Royal Bay Nursing Home H60-H11 S24205 Royal Bay V235852 120805 Stage 4.doc Version 1.40 Page 12 informed her that staff did sometimes undertake activities in the morning. It was evident from the comments received that residents would benefit from a more robust plan of activities – which would take place inside and outside the home. Royal Bay Nursing Home promotes an open door policy during the day. Residents spoke of visitors they had received and the home maintains a record of the contact each resident has with his or her relatives and friends. A lunchtime meal was taken with then residents and it was evident that choice and flexibility are paramount. Residents, if able, choose where to take their meals; this is seen as a social time by staff and relatives. The dining rooms are arranged into small tables and lots of positive interaction was noticed at this time. The food itself was appetising and nicely presented. Comments from residents were all very positive and included ‘the food is great’ ‘there is always lots of it’ the chef always comes to see us after a meal to make sure it is Ok’ a relative commented that what impressed them was the way the residents were encouraged to eat and the amount of fresh fruit and vegetables always available at the home. Good practice was noted in the way food was presented to residents who need to be encouraged to eat. Within the assessment process and care plans it was clear that nutrition of the residents is of high priority. The chef has just been presented with a twenty year long service award. Royal Bay Nursing Home H60-H11 S24205 Royal Bay V235852 120805 Stage 4.doc Version 1.40 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 standard(s) 16,17 Service users and relatives are able to express their opinions, which they know will be listened to. Adequate systems are in place to protect service users from abuse. EVIDENCE: All service users spoken with were able to explain what they would do if they were not happy about any aspect of their care. Similarly, the relatives expressed that should they wish to raise a complaint they would either inform care staff on duty or speak to the Manager. Staff were aware of the home’s complaints procedure and what to do if someone complained to them. The complaints file has been viewed and found to be appropriately maintained. The management team at Royal Bay Nursing Home have invested a large amount of time and effort over the past year in promoting the protection of vulnerable adults. The Inspector is confident that staff are fully aware of what constitutes abuse and the measures they need to take both to prevent abuse from occurring and what to do if an incident occurs. Royal Bay Nursing Home H60-H11 S24205 Royal Bay V235852 120805 Stage 4.doc Version 1.40 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 standard(s) 19,20,24,25,26,27 Service users benefit from a clean, comfortable and 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. 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. Similarly, a bath in a ground floor bathroom was broken and requires making good. There was a discussion with the registered manager regarding the locks provided to resident’s private accommodation, which can only be used from the outside. Two residents interviewed said they would like a lock they can use from the inside. The management’s rational for having locks that can only be used from
Royal Bay Nursing Home H60-H11 S24205 Royal Bay V235852 120805 Stage 4.doc Version 1.40 Page 15 the outside is that it might put the resident at risk should there be a fire. The inspector advised that advice should be sought from the fire safety officer. At the time of the inspection, all communal areas and the sixteen 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. All nursing residents at this home have the benefit of an adjustable bed. Royal Bay Nursing Home H60-H11 S24205 Royal Bay V235852 120805 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Residents are supported by a dedicated team of staff who are knowledgeable about their needs. EVIDENCE: On the day of inspection, there were sufficient staff to support the needs of residents as detailed in the care plans. Staff spoken with confirmed that staffing levels were adequate at this time. The residents who spoke with the Inspector commented how nice staff were and how they felt relaxed and happy to ask for help. The Inspectors observed lots of positive interaction between residents and staff. Staff spoken with confirmed that core training, such as first aid, infection control, adult protection, food hygiene for those who handle food, moving and handling is on schedule, and it is hoped that all staff will have had this training within the next few weeks. Staff training is ongoing; many staff are looking forward to starting their NVQ National Vocational Qualifications level 3 in care. New staff undertake an induction in line with the National Training Organisation. Staffs spoken with were very positive about the manager and now she has motivated them to undertake many different forms of education. Royal Bay Nursing Home H60-H11 S24205 Royal Bay V235852 120805 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,35,36,38 The registered manager has provided leadership; guidance and direction to staff to ensure residents receive a consistent quality of care. The outstanding issues regarding lack of supervision of staff could lead to poor practice and potentially put the resident at risk. EVIDENCE: The manager is very experienced having worked in nursing and residential homes for many years. Mrs Ward is a registered nurse, with the City and Guilds Registered Managers Award. Residents said the home is run efficiently and they said this they thought was down to strong leadership. Staff made positive comments about the registered manager and gave good examples of best practice. Staff confirmed that regular meeting’s; handovers were held where the manager informed them of any changes in legislation. However there was insufficient evidence to prove that supervision was being undertaken six times
Royal Bay Nursing Home H60-H11 S24205 Royal Bay V235852 120805 Stage 4.doc Version 1.40 Page 18 a year. It was also noted that senior nursing staff were not receiving supervision. This standard will be assessed on the next inspection. Throughout the inspection, a number of issues in relation to health and safety and infection control were identified. Hoists needed to be cleaned, hot water checks not being undertaken or not recorded. Some flip top bins, and bottle holders need to be replaced. The staff on duty demonstrated that they were aware of their responsibilities under Health & Safety. A maintenance person is employed to undertake a variety of checks and audits and to keep the home in a good state of repair. Royal Bay Nursing Home H60-H11 S24205 Royal Bay V235852 120805 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 x x 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 2 13 3 14 x 15 4
COMPLAINTS AND PROTECTION 2 3 x x x x 3 2 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 Standard No 16 17 18 Score 3 x 3 3 3 x x 3 1 x 3 Royal Bay Nursing Home H60-H11 S24205 Royal Bay V235852 120805 Stage 4.doc Version 1.40 Page 20 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Op12 Regulation 16(2)(m) (n) 18(1) Requirement The Registered Person must consult with and provide a programme of activities service user want. All care staff, including trained nurses must receive formal Supervision at least 6 times a year Timescale for action 01/12/05 2. Op36 01/12/05 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 10,24 Good Practice Recommendations A review should be undertaken regarding the types of locks provided by the home to unsure they can meet the service users requests. Royal Bay Nursing Home H60-H11 S24205 Royal Bay V235852 120805 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection 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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