Inspection on 19/04/06 for Summer Lodge

This inspection was carried out on 19th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Summer Lodge 20/11/08

Summer Lodge 29/05/08

Summer Lodge 30/11/07

Summer Lodge 01/05/07

Summer Lodge 28/11/05

Summer Lodge 23/06/05

Summer Lodge 14/12/04

Summer Lodge 09/06/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Sackville Nursing Home 2 - 4 Sackville Road Hove East Sussex BN3 3FA Lead Inspector Elizabeth Dudley Key Unannounced Inspection 19th April 2006 09:30 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 Sackville Nursing Home DS0000014051.V288835.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. Sackville Nursing Home DS0000014051.V288835.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Sackville Nursing Home Address 2 - 4 Sackville Road Hove East Sussex BN3 3FA 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) 01273-775577 Mr Joginder Singh Vig Mrs Beant Kaur Vig Post Vacant Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Sackville Nursing Home DS0000014051.V288835.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users must be older people aged sixty-five (65) years or over on admission. The maximum number of service users to be accommodated is twenty-eight (28). To admit one service user with a dementia type illness Date of last inspection 28th November 2005 Brief Description of the Service: Sackville Nursing Home provides nursing care and accommodation for up to twenty-eight older people. The home is owned by Vig Care, who own four other care homes in East Sussex. The home is situated in Hove, and is close to the town centre and local transport links. Sackville is a detached residence with accommodation provided over three floors. Residents are able to access all areas of the home via a passenger lift. Accommodation is provided in twelve single and eight shared rooms. There is a lounge/dining area on the ground floor, with a garden at the rear that is accessible to service users. The fees for the home (on the 19th April 2006) range from £454-£650. Sackville Nursing Home DS0000014051.V288835.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 on the 19th April 2006 over a period of nine hours and was facilitated by the home manager, Mrs Linda Geraghty. During this time a tour of the home was undertaken and records including care plans, personnel files, health and safety records and catering records were examined. The written care records of six residents were examined, and their care followed. Seven residents were spoken with in depth (all residents, except two who were sleeping, were spoken with). There were two visitors to the home that day and conversations took place regarding how their expectations of the home were being met. Seven members of staff were also spoken with regarding their perception of their responsibilities towards the staff. What the service does well: What has improved since the last inspection? Improvements have taken place within the home since the last inspection especially in relation to the cleanliness and tidiness within the home. Systems such as staff supervision, recruitment documentation and documentation which informs prospective residents about the home, show an improvement. The home has provided insulated jugs for serving beverages and this is ensuring that residents receive drinks at a palatable temperature. Sackville Nursing Home DS0000014051.V288835.R01.S.doc Version 5.1 Page 6 The standard of medication administration is good. 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. Sackville Nursing Home DS0000014051.V288835.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 Sackville Nursing Home DS0000014051.V288835.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): 1,2,3,4 and 5 Quality in this outcome area is good. The home provides sufficient information to enable residents to be confident in their choice of home. Assessment of prospective residents confirms that the home can meet the resident’s needs. EVIDENCE: The home provides a statement of purpose and service users guide which meet the standard and regulations, and serve to provide sufficient information to inform both prospective and present residents about their choice of home. Copies of the statement of purpose, service user guide and current inspection report are available in the reception area, and there was evidence that all residents in the home have a copy of the service user guide. Evidence gathered from the care plans, tour of the home and talking to staff and residents identified that all information contained within the statement of purpose reflected the physical conditions and amenities offered to residents at this time. Sackville Nursing Home DS0000014051.V288835.R01.S.doc Version 5.1 Page 9 The manager stated that she takes a copy of the service user guide with her when going to meet and assess a resident, prior to them being admitted to the home, and this was verified by a recently admitted resident. These documents will be regularly reviewed and amended to reflect any changes within the status of the home. All service users guides include a copy of the statement of terms and conditions with the home, including space for information of the amount of fees payable. These met the standard and regulation. However these were sample documents in the service user guide, and no evidence of individual residents or their representatives having received an individualised copy or having signed and agreed with the conditions was present. This requires to be evidenced either by copies of the signed conditions being kept with residents’ financial details, or by other evidence such as a checklist kept with their care plans. Two residents’ representatives have stated that they had not received a copy of the terms and conditions. Care plans contained comprehensive pre–admission assessment forms which identified the physical, psychological and social needs of the prospective resident, and formed the basis of the care plan. The manager stated that she visits all prospective residents in their current place of residence, be it the hospital or their home, and assesses them to ensure that the home can meet their needs and for the resident to be able to judge whether they wish to move into this particular home. This assessment can take place with relatives or friends present, and information from other health care professionals will form part of this assessment if relevant. Relatives of present residents within the home identified that they had visited the home prior to the resident’s admission and had been welcomed into the home. All residents are initially admitted for a month’s trial period, apart from emergency admissions that will have been admitted prior to an assessment being undertaken. The length of trial period in these cases is dependant upon whether the home can meet their needs and a permanent placement may not be offered. The home will also admit residents for short-term placements to offer respite care. Sackville Nursing Home DS0000014051.V288835.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 Quality in this area is adequate. Although residents appear well cared for, care plans need to reflect the current care being given and reflect changes in care required in order to ensure that residents care needs are being met. EVIDENCE: The format of the care plans is good, giving sufficient space for adequate care planning with individualised headed pages to ensure that all information needed is covered. This includes Waterlow Scores ( a table for identifying whether a resident is at risk from pressure damage), moving and handling, risk assessments, wound care and nutritional care plans as well as general care planning and daily records. The document also includes consent forms for bedrails, and identifies whether residents wish to have locks on their bedroom doors. During the inspection 6 care plans were examined in detail and these included care plans belonging to two recently admitted residents. Although the care plans had the nurse’s signatures to show that they had been reviewed on a monthly basis, in some instances the care plan had not been Sackville Nursing Home DS0000014051.V288835.R01.S.doc Version 5.1 Page 11 updated to reflect the current care that was being given. The care plan of a resident who had recently returned from hospital following surgery did not reflect the additional care she would need, particularly in regard to her mobility and exercises, and although the hospital had stated that they would see her in six weeks, no attempt had been made to identify a physiotherapist for this resident or to commence her mobility. Care relating to the present function of a parenteral gastric feeding tube was not detailed in the plan; any nurse not familiar with the resident would assume that her total nutrition was through this tube, whereas this is only used for part of the nutrition. The care plan for a resident admitted during the past two weeks had not been completed and was difficult to read. The nurse completing the plan had not accessed the wound care nurse although the need for this was identified in the plan, and it was not clear which dressings were to be used on the pressure wound (the resident had the pressure damage prior to admission to the home). Registered nurses must be aware of their accountability in accessing relevant health care specialists. Although this resident and two others would benefit from physiotherapy, and the manager confirmed this, no effort to access a physiotherapist had been made. Details of the physiotherapist available for nursing homes were given to the manager. There was evidence of consent for the use of bedrails having been gained from residents and representatives, and evidence of the reasons for these being required. However the accident book detailed that some residents had fallen after having climbed around these bedrails, and the manager was asked to review the appropriateness of bed rails on all residents within the home. It is recommended that where there is a danger that a resident will fall out of bed, but bed rails do not prevent this, that other methods of ensuring that the resident will not sustain injury are put in place. The manager was asked to liaise with the Older Persons Nurse Specialists regarding this. There was evidence of dynamic pressure mattresses and pressure relieving equipment in some rooms and the manager stated that no residents have pressure damage. However it is recommended that the wound care nurse is contacted to undertake a mattress audit, which will advise the home on the best type of mattresses to be used on their residents. There was a recent incident which would have benefited by the wound care nurse having been involved, and the manager must look towards using this service which is provided for nursing homes in this area. A Dentist, Chiropodist and optician visit the home and residents spoken with said that they had seen the chiropodist recently. Sackville Nursing Home DS0000014051.V288835.R01.S.doc Version 5.1 Page 12 All residents appeared clean and tidy apart from one resident who had not been shaved, the manager stated that this was his choice and this was identified in the care plan. It was seen that the home has a number of residents that are nursed in bed and the manager must monitor whether this is necessary in all cases. Although over bed tables are still being used in the lounge, these were not being used as a form of restraint as residents stated that they could push them away easily. The manager must continue to monitor this, and in the one case where it is used to stop a resident falling out of the chair, efforts must be made to enable this resident to mobilise safely. The home provides lifting aids including hoists, lifting belts and turntables, and there was evidence of staff using these. Residents stated that staff used the appropriate equipment when moving them. Residents and visitors spoken with said that they felt they were well looked after and that they received a good level of care. They said that the staff were very kind, that their call bells were answered promptly, and that communication with staff in regard to any language difficulties, had improved. One resident said that her mother always looked well looked after and that the staff responded very well to her needs. Both residents and relatives said they felt that their privacy was respected. Care plans identified the privacy requirements of some residents and the home now has a cordless phone that residents can use to make phone calls. The standard of medication administration was good, with all medications being within their expiry dates and stored at the correct temperature. Temperatures of the drug fridge and clinic room have been recorded on a regular basis and were within recommended parameters. All medications had been signed for following administration, and the records in the controlled drug register were also complete. Sackville Nursing Home DS0000014051.V288835.R01.S.doc Version 5.1 Page 13 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 and 15 Quality in this outcome area is adequate. The standard of activities is varied and relates to the interests of the residents and the quality of catering is of an adequate standard. Presentation of food when it leaves the kitchen must be improved. EVIDENCE: The home has a varied activities programme, which is displayed, in a prominent position in the home with participation in these activities also being recorded. There was evidence that the activities person has consulted with residents about their preferred way of spending their time and also taken past interests into account. In some of the care plans it was identified that residents preferred one to one conversations, reading or watching television, this was shown to be respected and to be taking place. Residents and their relatives spoken with said they thought the standard of activities provided was good and that they enjoyed them. On this day a music therapist was visiting the home and a visitor was overheard telling the manager that she thought they were very good and hoped that they would come again as most of the residents joined in with this. Sackville Nursing Home DS0000014051.V288835.R01.S.doc Version 5.1 Page 14 One resident said that she ‘likes the music and the painting best, but there is always something interesting to do’, whilst another stated that they preferred to stay in their room ‘I like watching the TV and I don’t mind talking to people sometimes’. However comment cards received by CSCI identified that the relatives of some bed bound residents wished that the activities could include these residents and would like to see these take place in the individual rooms. Residents said that they could choose when they rise and retire. It was not noted whether their chosen times of retiring or rising were in the care plans, and this will be checked at the next inspection. As well as some activities being brought in the statement of purpose also states that residents can be taken out and it is expected that this will take place in warmer weather. The activities person also goes shopping for residents and collects shopping requirements from them. There is an open visiting policy and relatives said that they are always made welcome. Ministers of religion visit the home. Residents are able to bring personal possessions into the home and this gives their rooms a homely feel. The manager will contact financial advisors or solicitors for residents if required and the details of an advocacy service are available in the home. There are still concerns about the televisions being left on in residents’ rooms with the residents being unable to switch them off, and the television in the lounge was tuned to a children’s programme. Staff must ensure that the residents are able to have the choice of whether they wish the television and the radio being left on all the time. This has to be monitored closely to ensure resident’s preferences are met. The daily menu is written on chalkboard in the dining room and displayed. The cook also goes around the home daily and informs residents of the choice of meals. However some residents stated that they had not been asked their choices and one said he didn’t know what he is getting ‘until it arrives’. The cook keeps records of the menu and the residents choices. A cooked breakfast is available on a daily basis and the manager stated that several of the residents partake of this. The main meal provided on the day of the visit was Roast lamb, roast potatoes broccoli and carrots. This was very Sackville Nursing Home DS0000014051.V288835.R01.S.doc Version 5.1 Page 15 well presented by the cook and looked very appetising on the plates, as did the liquidised version of this. The supper meal was soup, hash browns, tinned macaroni cheese, a choice of sandwiches and small cakes. On this occasion the cakes were bought in but the cook states that he does make them sometimes. However this was not well presented and was lukewarm. Visitors and comments received by visitors described the evening meals as ‘poor’, ‘lukewarm’ and ‘terrible’. One resident stated that ‘the supper is a bit strange and I never know whether its tea or soup in the cup’. Although the supper menu has been reviewed this comment may indicate the need for further review. Information received from relatives indicated that the home needs to ensure that the food reflects the tastes and choices of residents. The amount of tinned tomatoes used was commented on both at inspection and further on questionnaires and this should be reviewed along with the supper menu. There was fresh meat, fruit and vegetables in the kitchen (the meat being delivered fresh by butcher and not frozen) and evidence of good quantities of dried food. One comment from relatives stated that more fresh fruit should be given to residents. It was noticeable that although the home makes use of tinned food such as macaroni cheese and spaghetti, that the bought food was of a good quality including the bread. The kitchen was clean with the few requirements made at a recent environmental health visit having been complied with. All of the kitchen staff require to undertake their food hygiene course, and the chef is waiting for his to be updated. Insulated jugs have now been provided to ensure that beverages are hot when they reach the resident. The amount of supper provided to residents has been increased following the last inspection when one resident did not think they had enough to eat at suppertime, and snacks such as sandwiches are available at any time of evening. The standard of catering in the kitchen and presentation of food at lunchtime by the cook is good, the downfall being in the presentation of the trays given to residents. Some method of ensuring that trays are prepared and given to Sackville Nursing Home DS0000014051.V288835.R01.S.doc Version 5.1 Page 16 residents before the food is ready to be served would ensure that food does not become cold and speed up the delivery. It would also allow the carers to spend time laying up the trays to appear attractive. Methods of ensuring that the supper meal is well presented and hot when given to residents must be found and implemented. There is some improvement since the last inspection, but as residents look on mealtimes as one of the most important times of the day and that it has a great implication on the health of the resident, both the manager and the catering staff must address the presentation and delivery of the food once it has left the kitchen. The evidence suggests that whilst lunch is well prepared and looks appetising it is not served quickly enough to keep hot. As breakfasts had been served, no evidence was available regarding these. The supper meal needs a complete review both in content and presentation, with a view to offering a balanced wholesome diet for residents. Advice about this must be gained from the community dietician. Sackville Nursing Home DS0000014051.V288835.R01.S.doc Version 5.1 Page 17 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): 16,17 and 18 Quality in this outcome area is poor; Lack of knowledge relevant to the reporting protocols in adult protection may result in residents being put at risk. EVIDENCE: The complaints procedure is on display in the main hallway and is also included in the statement of purpose and service users guide. The home has had three complaints since the last inspection, two of these were adult protection issues but found to be unsubstantiated following investigation by social services. The third complaint was not adult protection and reported to and investigated by social services, this was found to be substantiated and the home has addressed this. Records of complaints and the documentation relating to these are at present kept in the office on an open shelf; these must be kept in a secure environment to conserve their integrity and confidentiality. Although the home addressed the third complaint in a satisfactory manner, there were concerns over the manner in which one adult protection issue was addressed insomuch that the correct reporting protocols were not adhered to, the manager and staff showing lack of understanding in the procedure to be followed. Concerns were also raised with the manager relating to the lack of reporting significant events to the CSCI. Sackville Nursing Home DS0000014051.V288835.R01.S.doc Version 5.1 Page 18 Although informal adult protection training within the home has taken place, no staff have, within the past two years, attended the formal training provided by social services. Senior staff must attend this to ensure that they are familiar with the national reporting protocols. The manager is now enrolled on the course. This must be cascaded to the care assistants and the domestic staff and it is recommended that in due course they also enrol on the formal training. Residents can take part in the civic process by the means of postal votes, and solicitors can be accessed for residents if required. Sackville Nursing Home DS0000014051.V288835.R01.S.doc Version 5.1 Page 19 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): 19,20,21,22,23,24,25 and 26 Quality in this outcome area is adequate. There have been improvements in the maintenance and cleanliness of the home and further work must be undertaken to ensure that residents live in a pleasant environment. EVIDENCE: Over the past seven months there has been an improvement in the cleanliness, tidiness and maintenance within the home. Some areas have been redecorated but there is a need for this to continue throughout the home and carpets within corridors and some rooms are in need of renewing. Other maintenance required includes fitting of light bulbs, checking washbasins for chips and cracks and replacing and repairing some furniture around the home as it is becoming old and worn. The provider was required to provide a maintenance plan by 20th January 2006 but has not done so and a further requirement has been made for a plan, which addresses the renewal of carpets and general decoration within the home. Sackville Nursing Home DS0000014051.V288835.R01.S.doc Version 5.1 Page 20 The garden is laid to grass and is reasonably well maintained. There is a large lounge in the home but only a small portion of this is in use, which appears crowded with the number of residents using it, the manager is concerned that using the rest of the lounge may obstruct the fire exit. It is recommended that she seek the advice of a fire officer who may allay these fears and enable the rest of the lounge to be used, therefore permitting residents to have a view of the garden. The tidiness in the lounge has been much improved giving it a more comfortable feel and one resident commented on this saying how much more pleasant it was ‘to be able to sit in it without all the mess’. Some redecoration of rooms and replacement of carpets has taken place, but there are still some rooms where the carpet is in need of replacement and stained. The replacement of light bulbs needs to be monitored as two residents stated that they had not had bulbs in specific lights in their rooms for some time (although there were working bulbs in other lights within the rooms). All residents have been offered a lockable door and keys to their rooms, although none have taken up this offer and records identify this. Likewise all rooms except one had a lockable facility, this was discussed with the manager as the resident said she would like to have one. There were still two rooms where curtains were coming away from the rails and this must be rectified. The manager must put systems in place to ensure that these are checked on a regular basis and action taken. All windows examined had window restrictors and there was evidence that water temperatures from basins and baths had been tested and records kept. These were all within recommended parameters. Some bed linen has been replaced but some sheets in the linen cupboard were very thin and the comfort of the resident when lying on an impermeable mattress with a thin sheet must be addressed. The manager states that she is at present looking for new bed covers, and the inspector looks forward to seeing these at the next inspection. Bathrooms were clean and tidy but an unprotected used razor had been left in the top floor bathroom. The underneath of the bath hoists showed an improvement in cleanliness. In general there were no noxious odours within the home, but there were two areas in which this needs to be addressed. The home has been assessed by a qualified occupational therapist. Sackville Nursing Home DS0000014051.V288835.R01.S.doc Version 5.1 Page 21 Comments regarding the dried food on the arms of chairs in the lounge have been received from a visitor. The home has infection control policies and there were ample supplies of gloves and aprons available. Staff were seen to be wearing blue aprons when serving food. Sackville Nursing Home DS0000014051.V288835.R01.S.doc Version 5.1 Page 22 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 and 30 Quality in this outcome area is adequate. Excessive amount of hours worked by some staff could compromise the safety and care of residents. The increase in staff training and attention to recruitment systems will benefit the residents. EVIDENCE: The duty rota shows that the amount of care staff hours on a daily basis appear sufficient to meet the needs of the residents. However the home has a high number of residents are being nursed in bed and this must be taken into consideration. The manager must take this into consideration when planning staff numbers. Staff spoken with stated that at times they were very busy but ‘manage to get the work done although many residents are in their beds, and its very busy’, ‘that we do have to rush to get the through the work sometimes’. It was particularly noticeable at mealtimes that staff struggled assist all the residents and it was difficult to find staff when required. The staff rota showed that there are two registered nurses on duty on for the daytime shifts with one registered nurse on night duty. Four morning carers and two afternoon carers support the nurses with two carers at night. Discussions relating to the adequacy of the number of staff on duty were held with the manager. It was noted that some staff are working 72 hours per week, which is excessive and could have implications for the care of the residents. The manager stated that this was a temporary measure to cover staff holidays and Sackville Nursing Home DS0000014051.V288835.R01.S.doc Version 5.1 Page 23 some staff having left, and that she is recruiting staff at present. Although all staff have signed the working time directive, the manager must monitor the amount of hours individual members of staff work. There is evidence that only one cleaner is employed for the home. Although the standard of cleanliness in the home was adequate on this day, it is a geographically large home in an old building, and the manager must consider this when planning staff cover. All members of staff from overseas that were spoken with, apart from some members of kitchen staff, demonstrated reasonable fluency in the English language. The member of kitchen staff is undertaking English lessons. Three members of care staff are in possession of their NVQ 2 certificate with others about to enrol on the course. The manager and deputy are enrolling for the management part of the NVQ 4 and the Registered manager’s award. In house training in matters related to care has been undertaken by both Registered nurses and care staff. This includes the mandatory training in safety matters and other clinical matters including supra-pubic catheterisation (Registered nurses), constipation, and record keeping. Registered nurses are in the process of accessing phlebotomy training. The manager is reminded that all staff including the maintenance person and catering staff should continue to have moving and handling training and fire training. All staff undertake an induction course at the commencement of employment. It is recommended that the cook undertake extra training in the benefits of nutrition in health care. During the course of the day ten personnel files were examined, these were seen to include all documentation required by the regulations and to ensure safety of residents. Some photographs of staff are unclear and is recommended that staff be asked to provided a photograph when they commence work. A member of staff recently employed by the home was spoken with; he is at present working under supervision whilst his full CRB is awaited. He confirmed that he has undertaken an induction course, is fully supervised and received a copy of the GSCC guidelines. All members of staff have now received a copy of this booklet. The manager must ensure that all new staff attend training sessions held within the home. Sackville Nursing Home DS0000014051.V288835.R01.S.doc Version 5.1 Page 24 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): 31,32,33,34,35 and 38 Quality outcomes in this area are adequate. Management is promoting recognition by staff of the issues required to ensure that residents’ health, safety and comfort are of paramount importance. EVIDENCE: The acting manager, Mrs Linda Geraghty, has been in post since November 2005; prior to this she worked as relief manager in the home. Her past experience includes working with older people within a hospital setting and managing another nursing home. She is a registered nurse and has commenced a foundation degree course in health and social care. She is commencing the management modules of the NVQ 4 in care in August. The home appeared to have a more settled atmosphere than previously with the manager having commenced staff supervision and introduced some structure to systems and work within the home and commencing staff Sackville Nursing Home DS0000014051.V288835.R01.S.doc Version 5.1 Page 25 meetings and resident satisfaction surveys. Staff spoken with appeared more satisfied with their role within the home than at the last inspection. Residents and relatives made positive comments about the home stating that staff were ‘very kind, respond to the bell as quickly as possible’, ‘lovely atmosphere within the home’, ‘always made welcome when we visit’. The two negative comments received were relating to the resident’s perception of their prognosis of their illness and of the pain relief being given, which their care plans and medication charts showed as being addressed correctly at this time. The manager has a system of quality monitoring by which she monitors the cleanliness and maintenance of the home, the staff training, the review of policies and procedures and some resident questionnaires. This must now be extended to include questionnaires being sent to visiting health care professionals and relatives or representatives of residents. Other systems within the home, i.e. presentation of meals to residents when the meals have left the kitchen, should be included in the quality monitoring audits. Resident questionnaires received by the home showed that not all residents or representatives were aware of the complaints procedure or of the inspection report. These are in place in the hallway, and the manager is ensuring that everyone is aware of this. Although staff meetings have been held, it is evident that few staff are attending and a method of ensuring that staff are well represented must be put in place. The records relating to residents finances within the home are satisfactory, a safe is now put in place for resident’s money. The provider is appointee for seven residents, but individual interest bearing accounts are now in place. Staff supervision has now commenced and will be continuing at intervals dictated by the standard. Regulation 26 visits are ongoing and reports received have been completed to a good standard. The manager has reviewed all the policies and procedures earlier this year. The manager must ensure that the office door is locked when not in use as much sensitive and confidential information relating to residents is stored there. The provision of mandatory training, i.e. moving and handling, fire training and first aid is now being put in place, some staff having attended these. Catering Sackville Nursing Home DS0000014051.V288835.R01.S.doc Version 5.1 Page 26 staff have places booked on the next food hygiene course, and some care staff will be attending the food handlers course. Most COSHH (Control of substances hazardous to Health) data is in place alongside the substances to which it relates, and the manager is aware of the importance of this, COSHH information relating to bleach tablets must be put in place. All certificates relating to the servicing of utilities and equipment were in place with the exception of the ‘Landlords Gas Certificate’. There was no evidence that the requirements stated on the gas inspection record had been complied with, and an immediate requirement to ascertain this and to inform the CSCI of when the gas certificate is in place has been made. There was evidence of a used razor left in the top floor bathroom, which could be dangerous to residents. Sackville Nursing Home DS0000014051.V288835.R01.S.doc Version 5.1 Page 27 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 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 1 2 2 3 3 3 2 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 3 3 3 2 2 Sackville Nursing Home DS0000014051.V288835.R01.S.doc Version 5.1 Page 28 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 OP2 Regulation Reg 5(1)I Requirement That evidence that all service users or their representatives have received a statement of terms and conditions is provided. (This was a previous requirement 10/01/06) That service users plans are reviewed regularly and reviews identify the current care that is being given and reflect any changes in care that are required. That all new service users care plans are completed to include the basic care to be given, within 48 hours of admission. That specialist health care professionals including the wound care nurse, physiotherapists and the older persons nurse specialists are accessed for advice, information and a mattress audit. That staff are aware of the choices of service users regarding controlling their DS0000014051.V288835.R01.S.doc Timescale for action 30/05/06 2. OP7 Reg 14(2)a b Reg15 (2)I 30/05/06 3. OP8 Reg 13(1)(b) 30/05/06 4 OP14 Reg 12(2) 12(3) 30/05/06 Sackville Nursing Home Version 5.1 Page 29 environment such as televisions being left on in rooms and in the lounge, and the restriction that is imposed on service users by over bed tables and aim to monitor this. (This was a previous requirement 20/12/05) That activities are taken to those who are unable to leave their rooms 5 OP15 Reg 16 (2)(i) That the staff are aware of the importance of presentation of meals. That a further review of supper menu takes place. (This was a previous requirement 28/11/05) That senior staff attend adult protection training and that the CSCI is informed of all incidents affecting the service users. 30/05/06 6 OP18 Reg 13(6) Reg 37 30/05/06 7 OP19 Reg 23 (2)(b) That the registered provider 30/05/06 prepares a programme of refurbishment for the home which relates to redecoration, repair and replacement of carpets curtains and bed linen within a reasonable timescale, this is supplied to the CSCI for discussion. (This was a previous requirement 20/01/06). That repairs and maintenance as identified in the main body of the report are undertaken. That linen is replaced and all bed linen in use is adequate for use. 30/05/06 8 9 OP24 OP26 Reg 23(2)(b) Reg 13(3) 10 OP28 Reg 18(1) That all catering staff undertake 30/05/06 the food hygiene course. That measures to control noxious odours in the rooms identified are put in place. That the amount of hours staff 30/05/06 DS0000014051.V288835.R01.S.doc Version 5.1 Page 30 Sackville Nursing Home are allowed to work are of a reasonable amount, that the amount of staff, including domestic staff are relevant to the needs of the home. 11 12 OP37 OP38 Reg 17(1) Reg 13(4) That records are in maintained in 30/05/06 a secure environment. That the Landlords Gas Certificate is obtained and the CSCI informed when this is in the home. That razors are not left in bathrooms and that COSHH information is obtained for the cleaning tablets. 19/04/06 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 2 3 4 5 Refer to Standard OP15 OP9 OP31 OP18 OP33 Good Practice Recommendations That the chef attends courses in the role of nutrition in ensuring the health of older people. That a facsimile machine is provided for the home. That a facsimile machine is provided for the home. That care assistants and other staff attend the formal training in the protection of the vulnerable adult. That the quality monitoring system is expanded. Sackville Nursing Home DS0000014051.V288835.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Sackville Nursing Home DS0000014051.V288835.R01.S.doc Version 5.1 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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