CARE HOMES FOR OLDER PEOPLE
Royd Hill Nursing Home Royd Hill Nursing Home Sutton Lane Sutton in Craven Keighley West Yorkshire BD20 7AJ Lead Inspector
Mary Slattery Unannounced Inspection 23rdJanuary 2006. 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Royd Hill Nursing Home DS0000064544.V275295.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. Royd Hill Nursing Home DS0000064544.V275295.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Royd Hill Nursing Home Address Royd Hill Nursing Home Sutton Lane Sutton in Craven Keighley West Yorkshire BD20 7AJ 01535 633499 01535 633499 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) www.roydhill.co.uk Royd Hill Nursing Homes Ltd ****Post Vacant**** Care Home 46 Category(ies) of Dementia - over 65 years of age (10), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (10), Old age, not falling within any other category (36), Terminally ill (4) Royd Hill Nursing Home DS0000064544.V275295.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: None This is the first inspection since the home was registered in November 2005. Date of last inspection Brief Description of the Service: Royd Hill is a care home providing nursing care for up to 46 service users who have general nursing care needs, dementia and mental illness and those who are terminally ill. The accommodation provided is in single and double bedrooms and there is a passenger lift and a stair lift giving access to the upper floors. The home is located in Sutton-in-Craven and is situated in well laid private grounds with ample parking facilities for visitors and staff. Royd Hill Nursing Home DS0000064544.V275295.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report relates to an unannounced inspection carried out on the 23rd January 2006. The inspection took 2 inspectors five hours plus 2 hours preparation time. A tour of the premises was carried out, which included the service users private accommodation. A selection of the home’s records were looked at and time was spent observing the activity in the home, talking and listening to service users, staff and visitors. The focus of the inspection was on a number of key standards, inspecting the case records of a number of service users to establish if they corresponded with their experiences of life in the home. The qualified nurse in charge was available throughout the inspection and the findings were discussed and agreed at the close of the inspection. What the service does well:
Royd Hill provides nursing care, person care and respite care and accommodation for older people with general nursing care needs, dementia and mental health needs. The statement of purpose gives information about the home, the facilities, the staff and the type of care service users should expect to receive and there was information about how to make a complaint about any aspect of the service. This information is made readily available to service users visitors and other stakeholders. The staff that are employed have the relevant nursing qualification to provide care for service users with general nursing needs, dementia and mental health needs. There is a training programme in place for the care and ancillary staff. Parts of the home have been redecorated and refurbished bringing the service users bedrooms up to a good standard. The case records showed that service users needs are assessed before they are admitted to the home and there was a range of equipment provided to assist the service users with their mobility both in the home and outside in the ground and local community. There was also a range of specialised seating for those service users who are frail. The staff were observed speaking to people in a respectful manner and knocking before they entered their rooms.
Royd Hill Nursing Home DS0000064544.V275295.R01.S.doc Version 5.1 Page 6 The service users said that the staff were kind and helpful and that their visitors were always made welcome. What has improved since the last inspection? 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.
Royd Hill Nursing Home DS0000064544.V275295.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 Royd Hill Nursing Home DS0000064544.V275295.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): 1,3,5. People are provided with information about what the home provides and arrangements are made for assessments to be carried out before people are admitted. EVIDENCE: A statement of purpose has been produced and is available in the entrance hall of the home and in each of the service users bedrooms. There is information about the home’s aims and objectives, the premises and facilities and the staff employed. Service users are provided with information about how to make a complaint against the service. The policy of the home is that pre admission assessments will be carried out to establish the needs of the prospective service users and to determine if their need can be met in a safe manner prior to the admission being agreed. People are invited to visit the home to look at the accommodation and to discuss the services offered before making a decision to move in. The home is registered to provide nursing care and accommodation for a number of service users with dementia and mental health problems. These service users may not always have the capacity to make informed decisions
Royd Hill Nursing Home DS0000064544.V275295.R01.S.doc Version 5.1 Page 9 and therefore may need the support of their family and/or representative in making the decision to move into the home. The home is also registered to provide nursing care for service users who have a terminal illness. There are no qualified nursing staff currently working in the home with the training and skills needed to provide palliative care. Royd Hill Nursing Home DS0000064544.V275295.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, 8, 9 and 10. Improvements need to be made to the care plans, the risk assessments and the medication records. EVIDENCE: The service users looked well cared for and the staff were observed attending to their needs in a respectful manner. A number of the service users said that they were well cared for and that the staff were always willing to assist them. There was a range of specialist seating for service users who are frail and at risk from falls and equipment to assist with their mobility around the home. Some of the service users had their own wheelchairs for use in the home and outside. The care plans looked at gave information about the nursing and personal care needs of the service users. The care plans were generic and were not personalised in a number of cases. All of the care plans need to be reviewed to make sure that where assessments have been carried out and needs are identified e.g. in relation to nutrition, tissue viability and continence, a specific care plan is put in place with a clear plan of action to assist staff in delivering the appropriate care. Some of the care plans had risk assessments in place with action plans to minimise risk in
Royd Hill Nursing Home DS0000064544.V275295.R01.S.doc Version 5.1 Page 11 relation to falls, prevention of pressure ulcers, use of bed safety rails and water temperatures other care plans did not. The service users care plans must be maintained in individual files and the paperwork used should be consistent in its format. Where care plans had been reviewed there was no information about what had been reviewed or about the findings of the review. The qualified nursing staff maintain the daily care plan records about the care delivered and information about any changes in the service users condition. The care staff are fully involved in providing personal care and attention to the service users and are in position to make observations about their health and welfare but there is no system in place for them to contribute to the care plan records. The medication system and facilities were inspected and gaps were found in the medication administration records, the codes were not being entered correctly and there were no records kept where external creams had been applied or eye drops instilled. Royd Hill Nursing Home DS0000064544.V275295.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): 13, 14 and 15. The service users are able to keep good and regular contact with their family and friends. The menu did not show the choices that were available at mealtimes. EVIDENCE: The care plans gave information about the service users family and friends and how they could be contacted. Visitors are made welcome and the service users spend private time with their relatives. Some of the service users go out with their family and a number of activities are arranged by the staff. A physiotherapist visits the home and carries out group armchair exercise classes for the service users. The post of activities organiser has not yet been filled. A number of the service users said they get up each day at a time suitable to them and they can have their meals in their room if they wish. The menu looked at did not show the choice of meals available and did not give details of what was available for the evening meal and there was no evidence to show if service users were consulted about the menu or their views sought about the quality of the food. There was no evidence to confirm that the nursing staff and the catering staff meet to discuss the nutritional needs of the service users prior to the menu being made available.
Royd Hill Nursing Home DS0000064544.V275295.R01.S.doc Version 5.1 Page 13 The service users views about the food were mixed some wanted more choice and larger portions. Staff were observed attending to the service users at lunch time, one member of staff remained standing whilst assisting a service user. One service user did not like the drink that was offered and the staff did not provide an alternative drink. To enable service users to maintain independence at meal times, plate guards were in use but a number were put on the plates the wrong way round so service users were spilling food on to their laps. Where service users were taken to the dining rooms in wheelchairs they were not transferred to a dining room chair. If this is at the request of the service user it should be recorded in their care plan. The dining room on the Cricket Wing is not big enough to accommodate the service users. Items of crockery were found to be unsuitable; they appeared old and scratched and need to be replaced. Royd Hill Nursing Home DS0000064544.V275295.R01.S.doc Version 5.1 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 and 18. The home has a relevant complaints procedure and some of the staff have attended abuse awareness training. EVIDENCE: Service users and their families are given information about how to complain about any aspect of the service. A number of the staff group have attended abuse awareness training and were clear about the reporting procedure. Further training is planned for those who have not attended. Royd Hill Nursing Home DS0000064544.V275295.R01.S.doc Version 5.1 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): 19,21,22,25 and 26. Improvements have been made to parts of the premises but action needs to be taken to make sure people are safe. EVIDENCE: Parts of the home have been redecorated and refurbished - this includes the dining room, the lounge, WC’s and a number of bedrooms. A quiet lounge has been made available and redecoration work in other communal areas was underway at the time of the visit. There is a member of staff employed who is responsible for the routine maintenance of the premises and facilities. A number of the bed safety rails were incorrectly fitted to the beds and posed a risk to the service users. This situation was addressed at the time and arrangements are to be put in place for the bed safety rails to be checked frequently in accordance with the guidance, a copy of which was left at the home. A recent Health and Safety inspection identified that there was no evidence to show that the moving and handling equipment had been examined, that
Royd Hill Nursing Home DS0000064544.V275295.R01.S.doc Version 5.1 Page 16 assessments had not been carried out to identify which slings were being used and no information in service users care plans for staff about the type of equipment to be used for individuals. Action was however being taken by the staff to address these issues. There are sufficient numbers of bathrooms and toilets but not all of the bathrooms are usable as there are problems with the water pressure and the water temperatures. Where the water temperature is cool, staff are transporting hot water across the home so that service users can wash in warm water. This practice is unsafe and leaves people at risk. In other parts of the home, the water temperature exceeds 43 degrees centigrade and poses a risk to service users. There are two sluice disinfectors but staff were not clear if they were in working order but clear that they had not been used for some time. Commodes were being emptied in the toilets and then cleaned in the sluice sink. Changes need to be made to improve the infection control practices including the safe disposal of waste matter. A freestanding heater was in use in one of the bedrooms. If this is to continue to be used, it must be fixed to the wall to reduce the risk to the service users. Most of the home was clean and free from offensive odours but attention must be given to bedrooms 37 and 42. The vanity unit in room 33 needs to be repaired and a full fireproof door needs to be fitted to the COSHH cupboard. Royd Hill Nursing Home DS0000064544.V275295.R01.S.doc Version 5.1 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, 29 and 30. The number of staff on duty were sufficient to meet the needs of the service users. EVIDENCE: The home employs qualified nursing staff with mental health and general nursing qualifications and care staff a number of whom have achieved NVQ Level 2 and 3 and others who are working toward NVQ qualifications. There were sufficient numbers of staff on duty to carry out catering and domestic duties. The records of three members of staff were looked at two of which were in good order. The third staff record did not show a work history, there were no references in place, no current CRB, no POVA check and no evidence that the PIN had been verified. Staff said that they enjoyed working with the service users and that the changes in the environment and the provision of more equipment have made their work more manageable and raised the morale. They said that NVQ training is ongoing and that a number had attended POVA training, moving and handling, fire and health and safety. Royd Hill Nursing Home DS0000064544.V275295.R01.S.doc Version 5.1 Page 18 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, 32, 36 and 38. There is no registered manager in post at this time but there are arrangements in place for the day-to-day management of the home. EVIDENCE: There is currently no manager in post but the position has been advertised and the recruitment process has commenced. One of the qualified nurses has one day each week supernumerary to carry out some administrative tasks and the responsible individual visits the home up to 4 days each week. We were informed that the responsible individual meets with the service users and the staff during the visits to the home and makes arrangements to ensure that the management tasks are carried out. Royd Hill Nursing Home DS0000064544.V275295.R01.S.doc Version 5.1 Page 19 All staff are supervised on a daily basis but there is no system in place for them to receive supervision on a one to one basis. The home has a health and safety policy in place and staff attend health and safety training. The issues reported on in the section of the report relating to the environment are health and safety matters and need to be given attention as a matter of priority. Royd Hill Nursing Home DS0000064544.V275295.R01.S.doc Version 5.1 Page 20 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 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X 1 3 X X 3 1 STAFFING Standard No Score 27 3 28 X 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 X X X 1 X 1 Royd Hill Nursing Home DS0000064544.V275295.R01.S.doc Version 5.1 Page 21 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 OP9 Regulation 13(2) Requirement The registered person is required to keep accurate medication records to evidence that medication has been administered as prescribed. The registered person is required to produce a full detailed menu. To make arrangements to ensure service users are able to use any aids to assist them at meal times. The registered person is required to produce a plan with timescales to address the issues regarding the premises and safety of service users as detailed in the Environment section of this report. The registered person is required to provide sufficient numbers of safe, usable bathing facilities for the number of service users accommodated. The registered person is required to keep all parts of the home free from offensive odours and to have the sluice disinfectors in working order. Timescale for action 28/02/06 2 OP15 16(j) 28/02/06 3 OP19OP25 16 and 23 30/03/06 4 OP21 23(2)(j) 30/05/06 5 OP26 16(k) 28/02/06 Royd Hill Nursing Home DS0000064544.V275295.R01.S.doc Version 5.1 Page 22 6 OP29 17 Schedule 4. 8 13(a)(c) 7 8 OP31 OP38 The registered person is required to undertake the required checks on all staff and to have the required records in place. The registered person is required to appoint a manager for the home. The registered person is required to ensure that all parts of the home are free from hazards and unnecessary risks to the health and safety of service users are eliminated as detailed in the body of the report. 28/02/06 30/03/06 30/03/06 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 OP7OP8 Good Practice Recommendations It is recommended that all the care plans be reviewed to make sure that there are specific care plans and risk assessments in place for all identified needs and written information about the outcomes of reviews. To have individual files and a consistent paperwork format in use. It is recommended that all staff receive formal supervision. 2 OP36 Royd Hill Nursing Home DS0000064544.V275295.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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