Inspection on 29/05/08 for Summer Lodge

This inspection was carried out on 29th May 2008.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Summer Lodge 20/11/08

Summer Lodge 30/11/07

Summer Lodge 01/05/07

Summer Lodge 19/04/06

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Sackville Nursing Home 2 - 4 Sackville Road Hove East Sussex BN3 3FA Lead Inspector Jennie Williams Unannounced Inspection 29th May 2008 10:15 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.V363302.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sackville Nursing Home DS0000014051.V363302.R01.S.doc Version 5.2 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 sackville@vigcare.com Mr Joginder Singh Vig Mrs Beant Kaur Vig Manager 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.V363302.R01.S.doc Version 5.2 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). That no further service users are admitted (or readmitted) to the Home until a suitably qualified and experienced manager is appointed and is registered by the Commission in respect of the service. 30th November 2007 Date of last inspection Brief Description of the Service: Sackville Nursing Home is a care home registered for twenty-eight (28) places for residents, of either gender, aged sixty-five (65) or over. Nursing care is provided at the home. The Registered Providers own seven care homes throughout the South of England, predominantly older people services. The home is located in a residential area of Hove. There are local amenities in the area and there is nearby access to public transport. There is no parking available at the home and restricted paid parking in adjacent streets. There are twelve (12) rooms for single occupancy, of which five (5) have en suite facilities. There are eight (8) double rooms, of which one is provided with en suite facilities. Rooms are located over three floors. There is a passenger shaft lift that assists residents to access all areas of the home. There is a lounge/dining area on the ground floor. There is a garden at the rear of the building that is accessible to residents. There are suitable numbers of toilet and bathing facilities located throughout the home to meet the needs of residents. Fees range from £465 to £600 per week. Additional fees are: hairdressing, chiropody, toiletries and newspapers/magazines (at cost). This information was provided to the CSCI on the 29 May 2008. Additional information regarding additional costs is provided in the Service Users Guide. Sackville Nursing Home DS0000014051.V363302.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. It should be noted that following CSCI consultation, it was identified that service users prefer to be called people who use services. It was confirmed that the home uses the term residents. For the purpose of this report, people who use the service will be referred to as residents. The home has been without a Registered Manager since approximately June 2005. A person appointed by the registered providers to manage the service has been in post. This person has applied for registration with the CSCI however was refused registration. Appeals were lodged, which resulted in the Care Standards Tribunal becoming involved. This appeal was struck out, therefore the Commissions decision stands for the refusal of registration. This person confirmed they were still managing the service at the time of the site visit. For the purpose of this report this person will be referred to as the appointed manager. Due to the concerns the CSCI has had regarding this service, imposed conditions of registration have been placed on the service. The providers appealed against this decision, however did not comply within the legal timescales. The imposed condition is “that no further service users are admitted (or readmitted) to the Home until a suitably qualified and experienced manager is appointed and is registered by the Commission in respect of the service.” This unannounced site visit took place over two days, 29 May 2008 and 04 June 2008. Evidence obtained at this site visit, previous information regarding this service and information that the CSCI have received since the last inspection forms this key inspection report. Information from Regulation 26 visits and the improvement plan required following the last inspection were used throughout the inspection. Surveys were sent to the home prior to the last inspection, which were not returned in time for inclusion in the last report and information provided has been used for this inspection. Six residents were spoken with throughout the inspection process. The Inspector had limited verbal communication with some residents. Ten surveys for residents to complete were sent to the home, of which nine were returned. One of these was completed independently, whilst all others identified that they were completed with support from friends/relatives. Care plans were not viewed in detail, as health professionals from social services and the Older People Nurse Specialist team had reviewed all care plans prior to the last inspection and no new resident has been admitted since then. Specific areas Sackville Nursing Home DS0000014051.V363302.R01.S.doc Version 5.2 Page 6 of care were viewed in eight care plans. Three visitors were spoken with throughout the site visit. Seven staff were spoken with at the site visit including: the appointed manager, six nurses/care staff and the cook. Two new staff files were viewed and training records inspected. Ten surveys for staff to complete were sent to the home, of which six were returned. A survey had been returned from a care manager. A tour of the environment was undertaken and some individual rooms were viewed. Medication procedures were inspected. The quality assurance system was discussed and recent results viewed. Complaint records and Safeguarding Adult procedures were viewed/discussed. Copies of the staff rota and menus were viewed. The Inspector visited head office to view the procedures in place for the safe handling of residents monies. There were fifteen residents residing at the home on the day of the site visit. What the service does well: What has improved since the last inspection? Four of the five requirements made at last inspection have been addressed and work is continuing to ensure compliance is maintained. Any minor shortfalls identified at the last inspection of which no requirement or recommendation were made were observed/confirmed to have been addressed. Care plans and information in use regarding the care of residents now provides consistent information and guidelines on what individuals needs are and action staff need to take to meet these needs. Sackville Nursing Home DS0000014051.V363302.R01.S.doc Version 5.2 Page 7 Risk assessments are in place for all residents and provide guidance for staff on how to reduce the risk, ensuring the safety of the service user. Suitable recruitment procedures are being followed to ensure residents are safeguarded. The registered providers have become more pro active in monitoring the service and the sharing of information required by legislation with the Commission has improved. 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. The summary of this inspection report can be made available in other formats on request. Sackville Nursing Home DS0000014051.V363302.R01.S.doc Version 5.2 Page 8 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.V363302.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1&4 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective and current residents/representatives do not have access to current information in respect if the conditions of registrations to make an informed decision about residing at the home. Previous pre admission assessments ensure that those currently residing at the home have their needs met. EVIDENCE: The CSCI has imposed conditions of registration on the service “that no further service users are admitted (or readmitted) to the Home until a suitably qualified and experienced manager is appointed and is registered by the Commission in respect of the service.” Sackville Nursing Home DS0000014051.V363302.R01.S.doc Version 5.2 Page 10 The home has a Statement of Purpose and Service Users Guide that provide prospective residents/representatives with information regarding the services and facilities that are available at the home. These must be amended to reflect the current imposed conditions of registration. Residents and their representatives need to be aware that if a resident is admitted to the hospital, they will not be able to return to the home. Copies of these documents are available at the home. It is recommended that the information contained in the brochure/pamphlet be reviewed as it states the majority of bedrooms have en suite facilities, which could be misleading. There are 20 bedrooms, of which six have en suite facilities. The pre admission assessment process was unable to be assessed at this inspection as no new residents have been admitted to the home. The appointed manager confirmed that a resident who had spent time in hospital returned to the home (prior to the imposed conditions), did not have another pre admission assessment undertaken to ensure that their needs could continue to be met at the home. The appointed manager confirmed via telephone following the site visit that she had provided the wrong information and confirmed a registered nurse had gone to undertake another assessment to ensure that the home could continue to meet the needs of this individual. Staff confirmed that the appointed manager takes necessary action if someone’s needs can no longer be met at the home. Some staff and the appointed manager confirmed that one resident has requested that he wants to move on from the home and other options are being explored. The individual’s social worker, GP and a member of the community mental health team are involved in this process. The appointed manager confirmed that there was no one residing at the home from any minor ethnic community, social/cultural or religious groups with any specific needs or preferences. A copy of the most recent CSCI report was observed to be located by the visitors signing in book, along with results from the homes’ quality assurance surveys. A copy of the improvement plan required from the last inspection is also available for visitors to view. The home does not have dedicated accommodation to provide intermediate care. Sackville Nursing Home DS0000014051.V363302.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ needs are being met with the information provided in the care plans on the assessed needs of individuals. Residents/representatives are provided with an opportunity to be involved in the reviewing process to ensure choice and preference is taken into account. Residents are generally safeguarded by the medication procedures in place. EVIDENCE: Care plans were not looked at in detail. The Older People Nurse Specialist team and health professionals from social services visited the home prior to the last inspection to undertake a review of all care plans due to the concerns being raised within the home at that time. No new resident has been admitted to the home since the last inspection. Care plans have been maintained and reviewed on at least a monthly basis since this period. Sackville Nursing Home DS0000014051.V363302.R01.S.doc Version 5.2 Page 12 Specific areas of care identified were viewed to be reflected within individual care plans. Shortfalls on specific areas of care identified at the last inspection have been addressed and there are guidelines in place for staff on what action to take to meet these needs. Examples of this are: staff have commenced better documentation for those residents who may display signs of aggressive behaviour and there are guidelines in place for staff on how to address this, information within risk assessments provide clearer guidelines for staff on action to take to reduce the risk. It was confirmed that all staff have undertaken risk assessment training. Malnutrition Universal Screening Tools were in use for monitoring individuals nutritional needs. These were based on scoring outcomes, however no information was provided in the care plan to identify what the scoring meant. This information was found in another folder and the appointed manager confirmed that she would ensure that the guidance to be used with this assessment tool will be attached to the assessment tool for each individual. She confirmed that staff knew what the different scoring pertained to. The appointed manager confirmed that continence assessments are being updated to be more specific to the nursing home. The home currently has no access to a continence nurse or training, the appointed manager is still pursuing this. The improvement plan provided following the last inspection identified that monthly reviews are continuing and that two monthly audits are carried out on care plans. Results from these audits reflected good areas and areas for improvement. The named nurse for an individual is notified of the audit results and must sign when the changes have been made. The appointed manager confirmed that a social worker has undertaken a review of a resident and there were no shortfalls identified in the care records. Risk assessments are also included in these audits. Of the residents that were able to be verbally communicated with confirmed that staff discuss their care with them and felt that their needs were being met. Comments made were ‘I am overall satisfied’ and ‘I am looked after well’. Six of the resident surveys received identified that they always receive the care and support they need and two usually receive the care and support they need. The survey received from a care manager identified that they felt the individuals’ health care needs are only sometimes properly monitored and attended to by the care service. At a review the resident stated that they couldn’t always see a GP when they wished or receive pain relief. It was confirmed that all issues the care worker raised at the review were addressed and resolved promptly. Records are maintained of any visits from health professionals within the multidisciplinary team. Sackville Nursing Home DS0000014051.V363302.R01.S.doc Version 5.2 Page 13 It was confirmed that care plans continue to be reviewed with the resident/representative and there is documentation in place to identify who wishes to be involved in this process. This ensures that choice and preference is taken into account. At the last Inspection it was observed that information on care plans that carers were using on a daily basis was found to be inaccurate. These additional care plans have now been removed to ensure all staff are working with current information pertaining to an individuals’ needs. A nurse from the Older People Nurse Specialist team was visiting the home and confirmed that there were currently no concerns regarding the practices within the home. She provides training sessions for staff at the home when requested. Medication Administration Records (MAR) charts viewed demonstrated that staff are signing for medicines at the time of administration. It is recommended that clear guidelines be in place for prescribed creams/lotions. Prescriptions were written to ‘apply to affected area(s) when required’. There were no guidelines to say where to apply or indications on when to apply and no information was reflected in the care plans. No requirement or recommendation has been made in relation to this as the appointed manager confirmed this will be addressed. It is recommended as good practice that any hand written prescriptions are double signed by staff who are trained in medication administration to ensure residents and staff are better safeguarded. One handwritten prescription was not signed at all. An incident report was sent to the CSCI regarding a medication error. A resident was prescribed a new medicine and another medicine should have been ceased on commencement of the new prescription. It was confirmed that there was a delay in the new medication being supplied to the home, resulting in information becoming mislaid and both medications were being administered. It was confirmed that the resident suffered no ill effects. The appointed manager has reviewed the procedures on receipt of new medication to ensure a similar incident does not occur again. Where staff have not administered a tablet they have written ‘O’ meaning ‘other’, however no information was provided to explain this. It was confirmed that weekly monitoring checks are done on MAR charts and blister packs. This procedure should be reviewed, as the above shortfalls should be identified during the monitoring checks. It was confirmed that the appointed manager undertakes the medication rounds when she is on duty and registered nurses administer the medication in her absence. A sample of controlled drugs were checked and demonstrated that clear records were being maintained for these. Records are maintained of incoming and outgoing medications at the home and it was confirmed that medication is disposed of through a licensed company. There was no one self-medicating at the time of the site visit. Sackville Nursing Home DS0000014051.V363302.R01.S.doc Version 5.2 Page 14 Of the residents that were asked, all felt that their privacy and dignity are respected. Staff were observed to have a good professional rapport with the residents. The care manager’s survey identified that the client they had placed at the home was happy with the care and respect they received. Comments written on the resident surveys stated ‘ staff always make sure mum is wearing her jewellery which she loves’. Whilst sitting in the lounge room, the Inspector overheard staff talking in front of the residents about other individuals. One was heard to state ‘Have changed pads for those in their rooms’. Staff then talked about who else needed changing. (This is in relation to continence of the residents). No requirement or recommendation has been made in relation to this, however staff should be reminded to be mindful of speaking about residents in front of others to ensure privacy and dignity are better promoted. It was noted that there is a list of residents’ names and room numbers by the front door. Staff need to ensure that all the residents/representatives are happy for this information to be on public display or be kept confidentially elsewhere within easy access. Some residents may not want others to know they are residing at the home Sackville Nursing Home DS0000014051.V363302.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ lifestyles within the home are their own choice and are provided with sufficient stimulation to fulfil their interests and needs. Residents receive a choice of balanced and freshly prepared meals. EVIDENCE: The appointed manager confirmed that there is now a social care plan in place for all residents. Residents spoken with and surveys received identified that there are activities provided at the home should they choose to be involved. The provision of activities is discussed at residents meetings. Some residents spoke positively about the recent outings that have been provided. There is an activities person employed at the home for three days a week for four hours. The home is still trying to locate a visiting hairdresser to visit the home on a regular basis. It was confirmed that residents are supported to visit a hairdresser in the community if they wish. Sackville Nursing Home DS0000014051.V363302.R01.S.doc Version 5.2 Page 16 There are advertisements at the home on what activities are arranged for the near future and paintings that residents had done were noted to be on display in the lounge room. Some of the activities provided at the home are: painting, arts and crafts, music, quizzes, skittles and cards etc. A variety of outside entertainers are arranged to visit the home. Regulation 26 reports undertaken by someone external to the home observed that interaction between staff and residents on occasions could be improved. The appointed manager confirmed that this was discussed with the staff and improvements have been noted. This improvement in interaction was also observed and reported on in the Regulation 26 reports. Visitors are welcomed at the home and this was observed throughout the site visit. Visitors and residents spoken with confirmed that there are no visiting restrictions imposed. There has been a new cook employed at the home. Residents were complimentary about the provision of food and confirmed that they are provided with a choice. Seven of the resident surveys identified that they always like the meals at the home. There is a daily control sheet that is completed to obtain the views of the residents on what the meal was like. It was confirmed that the menus are currently being reviewed. The cook confirmed that there were no restrictions with the provision of food. Other suggestions/issues identified by the cook were shared with the appointed manager. The Inspector did not feel the need to be involved in some areas and has suggested that the cook and appointed manager liaise with each other on ideas/suggestions on how to improve the food and benefit the residents. Residents eat in the lounge room from portable tables or in their rooms. Since the last inspection, an area within the lounge room is being painted and the appointed manager has requested chairs and a dining table. It was confirmed that a table and four chairs would initially be provided. This may assist meal times to become a more social event for residents. The appointed manager confirmed that she initially chose the colour for the dining area. It was suggested that she obtain a colour chart and involve the residents in the choice of colour for their communal area within the home. She confirmed via telephone following the inspection that she has ordered a colour chart and will involve the residents in this choice. Sackville Nursing Home DS0000014051.V363302.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents feel comfortable to complain, reassuring them that they are being listened to and that action will be taken, if necessary and further protection is provided by the Safeguarding Adults procedures. EVIDENCE: There has been one complaint made to the home since the last inspection. This was anonymously made from a member of the community regarding the basement light being left on at night. Records are maintained of all complaints and action taken to address any concerns, where necessary. Surveys received and residents spoken with identified that they know who to speak to if they are not happy. Residents spoken with confirmed that they would feel comfortable to raise any concerns and are confident that appropriate action would be taken. One comment a relative wrote on a survey was ‘ I have had to complain about the smell of urine, but this was immediately solved’. All staff surveys received identified that they know what to do if a resident/relative/advocate or friend has concerns about the home. A registered nurse has recently undertaken training on how to manage complaints. Sackville Nursing Home DS0000014051.V363302.R01.S.doc Version 5.2 Page 18 Information provided by staff identified that they were familiar with Safeguarding Adults procedures and received training for this. Not all staff spoken with were familiar with the terminology whistle blowing and confirmed that Safeguarding Adults training did not cover this subject. Kitchen staff are currently booked on a Safeguarding Adults training session. Following the medication error, previously identified in the report, a Safeguarding Adults alert was made, which was found to be upheld. There have been no other Safeguarding Adults alerts made since the last inspection. The appointed manager confirmed that she has attended a two-hour briefing on the Mental Capacity Act. There is a folder containing information on the Mental Capacity Act available at the home for staff to read. The appointed manager confirmed that an advocate has been accessed for two residents. Sackville Nursing Home DS0000014051.V363302.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Work has been done and continues to be undertaken to improve standards within the home, ensuring residents live in a comfortable and suitable environment. EVIDENCE: Work has been done and is continuing to be done to improve the maintenance within the home. There was documented evidence of what the home has completed to date and what the future plans are in relation to improving the standards within the home, with identified timescales. The appointed manager confirmed that the redecoration plan for the home that they sent us has fallen behind schedule by a month due to areas of improvement having been identified by environmental health when they visited the home. Sackville Nursing Home DS0000014051.V363302.R01.S.doc Version 5.2 Page 20 Of the residents that were asked, all confirmed that they were happy with their rooms and found their beds comfortable. A staff member commented that a bath hoist was currently not working, however confirmed that all residents residing at the home prefer to have a shower. Management needs to ensure this equipment is useable. Adjustable beds are provided wherever needed. The home appeared clean and free from offensive odours on the day of the site visit. Regular cleaning of the base of the beds will assist in promoting infection control. It was observed and confirmed by kitchen staff that a lot of care staff enter the kitchen area. It is recommended that this is reviewed to reduce the amount of people entering the kitchen. This will further promote safety in the kitchen and assist in promoting infection control. Sackville Nursing Home DS0000014051.V363302.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ needs are being met with the number of staff on duty. Recruitment procedures in place ensure that residents are safeguarded. EVIDENCE: The majority of staff and residents spoken with felt there were sufficient staff on duty to meet the current needs of the residents. It was confirmed that with the current numbers of residents there are three staff working during daytime hours and two staff working a waking night. The appointed manager works daytime during the week and is additional to these hours. There is always a registered nurse working on duty. Of the residents who felt that there were not enough staff on duty confirmed that there was always someone available when they required assistance. Four of the resident surveys identified that staff are always available when they need them and three stated that staff are usually available. Feedback from residents were complimentary about the staff working at the home. Comments received were ‘nice’, ‘very pleasant’, ‘they do all they can to help’ and ‘staff seem usually polite and conscientious’. Sackville Nursing Home DS0000014051.V363302.R01.S.doc Version 5.2 Page 22 There is currently seven care staff (excluding registered nurses) employed, of which three have National Vocation Qualification (NVQ) level 2 or above. An additional three staff are undertaking NVQ training and one carer is waiting to enrol on a course. Two new staff member files were viewed that identified all recruitment checks had been undertaken. Both staff commenced working prior to a full Criminal Record Bureau (CRB) being returned. A Protection of Vulnerable Adults (POBA) first check had been obtained. The appointed manager confirmed that staff are supervised until the CRB is returned. One of these staff members was employed in the kitchen and it was confirmed that the other member worked for one hour at the home, then left employment and has not returned to the home. Other shortfalls noted at the previous inspection have been addressed. Some of these were; ensuring the interview form is completed, exploring gaps in employment and having risk assessments in place where information had been provided by the CRB, to ensure residents safety. Feedback from staff confirmed that there are sufficient training opportunities provided at the home and are kept up to date with mandatory training. Registered nurses receive additional training relevant to their roles. The appointed manager maintains a training matrix. Some training undertaken in house for a new staff member were: Fire safety, infection control, Control of Substances Hazardous to Health (COSHH). A written comment by a staff member identified that there are ‘training programmes like catheterisation, risk assessment, medicine & drug control, first aid, health & safety etc.’ The appointed manager provides some training to staff using training materials and discussions and other training is provided by external trainers. Common Induction Standards, as set by Skill for Care, has been commenced for all new staff. Feedback from staff identified that their induction covered everything they needed to know to the job when they started. Sackville Nursing Home DS0000014051.V363302.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is not run and managed by a person who is fit to be in charge to benefit staff and residents. EVIDENCE: The home has been without a Registered Manager since approximately June 2005. A person appointed by the registered providers is currently managing the service. This person has been refused registration by the CSCI and her appeal to the Care Standards Tribunal was struck out, therefore the Commissions decision stands. This person was still the appointed person managing the service at the site visit. This is an offence in accordance with the Care Standards Act 2000. Sackville Nursing Home DS0000014051.V363302.R01.S.doc Version 5.2 Page 24 The registered providers must ensure that an appointed manager is fit to manage the service and meets the legislative requirements for this role. The registered providers confirmed to the Commission that the appointed manager continues to manage the service and they have employed another person to provide support and supervision for the appointed manager. There were mixed feelings from staff regarding the current management arrangements at the home. The appointed manager confirmed that she has completed the Registered Manager Award since the last inspection. The appointed manager confirmed that she had not continued with her clinical supervision. She has had one clinical supervision at the beginning of the year and has not pursued to undertake anymore. She confirmed to the Inspector via telephone following the site visit that she has now arranged to undertake more. A Registered Manager of another service owned by the same providers provides clinical supervision. This home has been involved in management review meetings as part of the Commissions enforcement policy. These were related to all the services owned by the registered providers/Responsible Individual. Warning letters have been sent and additional conditions of registration have been imposed. Regulation 26 visit reports from the registered provider were available at the home for viewing. In light of the concerns the CSCI had in respect of the level of supervision within the home and the registered providers not monitoring their services, it had been advised that these reports be forwarded to the CSCI on a monthly basis. Management have also been reminded of their legal obligations to inform the CSCI of significant events that may occur within the home. This sharing of information has improved. There is a quality assurance and quality monitoring system in place to assist in ensuring the home is run in the best interest of residents. Surveys are asked to be completed every six months by residents, relatives and other stakeholders. The most recent analysis identifies positive and negative comments. Where a shortfall is identified, action is taken to address this, where applicable. Internal monthly audits are undertaken on medicines, care plans and a health and safety environmental check. Residents meetings are held and minuted. Recent health professional surveys undertaken by the home did not identify any concerns within the home. The home has commenced representative meeting and propose to do this every two months. No one attended for the first meeting and the appointed manager said that she will be asking head office to print a message regarding the meetings when they next send out invoices. It is recommended that opportunities are provided to staff to voice any ideas/concerns through an anonymous process so management can obtain Sackville Nursing Home DS0000014051.V363302.R01.S.doc Version 5.2 Page 25 their viewpoints. Feedback from staff identified that some individuals would not feel comfortable addressing issues with the appointed manager in person. Residents’ monies are held at head office of the registered providers. Procedures in place and records viewed identified that suitable procedures are in place to monitor residents personal allowances, ensuring residents are safeguarded. Since the last inspection, the home is now provided with petty cash for use in the event that any residents wishes to access money when the head office is closed. It was confirmed that all staff, including night staff have undertaken fire drills. No other health and safety records were viewed at this inspection as no other shortfalls were identified at the last inspection, six months ago. The previous AQAA identified that equipment in use has been serviced or tested as recommended by the manufacturer or other regulatory body. The CSCI has had management review meetings regarding this service and will continue to monitor the home to ensure compliance with statutory requirements, that the outcomes for people who the service improve and to monitor the effectiveness of the management of the home. Sackville Nursing Home DS0000014051.V363302.R01.S.doc Version 5.2 Page 26 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 2 X X 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 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 1 X 2 X 3 X X 3 Sackville Nursing Home DS0000014051.V363302.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES 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 OP1 Regulation 4, 5 & 6 Requirement Timescale for action 15/07/08 2. OP31 8, 9, 10 3. OP31 Care Standards Act, 12 (1) That the Statement of Purpose and Service Users Guide be amended to reflect the current imposed conditions of registration. Residents and their representatives need to be aware that if a resident is admitted to the hospital, they will not be able to return to the home. The registered providers must 23/07/08 take appropriate action to ensure a fit person who has the qualifications, skills and experience necessary manages the home. (This is an outstanding requirement) That an application is sent to the 23/10/08 Commission to process in respect of the person managing the service. Sackville Nursing Home DS0000014051.V363302.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Sackville Nursing Home DS0000014051.V363302.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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