Inspection on 30/11/07 for Summer Lodge

This inspection was carried out on 30th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Sackville Nursing Home 2 - 4 Sackville Road Hove East Sussex BN3 3FA Lead Inspector Jennie Williams Key Unannounced Inspection 30th November 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sackville Nursing Home DS0000014051.V350374.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.V350374.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 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.V350374.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). To admit one service user with a dementia type illness Date of last inspection 1st May 2007 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 eight 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 at 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 19 December 2007. Prospective residents find out about the service through social services, living in the area and word of mouth. Sackville Nursing Home DS0000014051.V350374.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. It should be noted that following recent CSCI consultation, it was identified that service users prefer to be called people who use services. The manager confirmed that they use the term service users/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. For the purpose of this report this person will be referred to as the appointed manager. This unannounced site visit took place over eight and a half hours on the 30 November 2007. Evidence obtained at this site visit and information that the CSCI have received since the last inspection forms this key inspection report. Eleven residents were spoken with throughout the inspection process. The Inspector had limited communication with five other residents. Ten surveys for residents to complete were sent to the home, of which none were returned at the time of this report. Care plans were not viewed in detail, as health professionals from the Older People Nurse Specialist team had reviewed all care plans two to three months prior to this inspection. Specific areas of care were viewed in seven care plans. Five GP comment cards were sent out, of which one was returned. Four care manager comment cards were also sent out, of which two were returned. Four staff were spoken with at the site visit including: the appointed manager, three nurses/care staff and the activities person. Three staff files were viewed and training records inspected. Ten surveys for staff to complete were sent to the home, of which none were returned at the time of this report. Two visitors were spoken with on the day of the site visit. A tour of the environment was provided and some individual rooms were viewed, with the resident’s permission. Medication procedures were inspected. The quality assurance system was discussed and results viewed. Complaint records and Safeguarding Adult procedures were viewed. Copies of the staff rota and menus were viewed. An Annual Quality Assurance Assessment (AQAA) was received from the home prior to the site visit that provided the CSCI with information regarding the service. Due to the concerns raised at the last inspection, an improvement plan was requested and the progress of this was assessed during the site visit. There were twenty residents residing at the home on the day of the site visit. Sackville Nursing Home DS0000014051.V350374.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Work has been done to comply with the requirements made at the last inspection. Two of the requirements had been partially met. These are not reflected as outstanding as improvements are being made and a new timescale has been made in which compliance must be met. Effort has been made to improve care plans and some risk assessments to ensure all risks and needs of individuals are identified and addressed. Care records confirmed that daily nutrition records are maintained for each resident to evidence if the diet is satisfactory and nutritional assessments are undertaken. Advice is sought from a dietician when needed. Medication procedures and practices within the home have improved, ensuring residents and staff are safeguarded. Residents are provided with an opportunity to self medicate if they wish and a risk assessment identifies it is safe for them to do so. This helps to promote individuals independence. Sackville Nursing Home DS0000014051.V350374.R01.S.doc Version 5.2 Page 7 Procedures for the storage and disposing of controlled drugs are improved, promoting the safety for staff and residents. The maintaining of information and correspondence for complaints has improved, evidencing that the home deals with these appropriately. Safeguarding Adults procedures have been amended and provides clear guidance and contact numbers for staff in the event of an allegation being made. A refurbishment programme has been implemented and work has been undertaken and is continuing to improve standards within the home, ensuring residents live in a comfortable and suitable environment. Staff now complete induction and foundation training that complies with the Skills for Care expectations to ensure the aims and objectives of the home are met. Training provision for staff has improved. Regulation 26 visits are being undertaken and reported to the manager to ensure the registered providers are monitoring the running of the home. What they could do better: The Commission has started a legal process to require the registered provider to take certain actions and provide necessary information to make sure that the home is run in the best interests of the residents. The reader is advised to read the full content of the report for a clear understanding of the issues within the home. Further work is required to ensure that care plans and information used regarding the care of the residents are kept up to date to ensure consistent information is provided to staff and all needs are identified and met. Risk assessments needs to be further developed to identify all areas of risk to an individual and provide clear guidance for staff on action to take to reduce the risks, promoting the safety of residents. Robust recruitment procedures must be followed to ensure residents are safeguarded and evidence that staff have the skills and experience necessary for such work. The home must be suitably managed to ensure that staff and residents benefit from the ethos, leadership and management approach of the home. Action must be pro active and not reactive. Management must ensure that information required to be sent and requested by the CSCI is provided within the given timescales. Areas identified by care managers in what they feel the home could do better are: “Evidence of maintaining high risk nursing needs consistently”, have a Sackville Nursing Home DS0000014051.V350374.R01.S.doc Version 5.2 Page 8 regular visiting hairdresser and for staff to recognise residents have differing needs ie: those with mental health needs. Care managers felt that daily sheets could reflect more factual information on nursing needs and other narrative daily information to be more detailed with clear actions for the next staff coming on duty, with clear time frames specified. This will assist promoting better communication within the home and help to ensure residents receive continuity in care and all needs continue to be met. Improvements are slowly being made, but not at the speed that is expected of a service committed to providing good quality care. Any other shortfalls noted during the site visit of which no requirement or recommendation has been written is highlighted throughout the report. 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.V350374.R01.S.doc Version 5.2 Page 9 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.V350374.R01.S.doc Version 5.2 Page 10 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, 3 & 6 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. The home has information available for prospective residents/representatives on the facilities and services provided to make an informed decision if their needs can be met at the home. The pre admission process ensures that only residents whose needs can be met are admitted. EVIDENCE: 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. The AQAA identifies that these are regularly reviewed and amended as changes are made. Copies of these documents are available at the home. The pre admission assessment form has been expanded since the last inspection to include additional questions regarding specific areas of care. Sackville Nursing Home DS0000014051.V350374.R01.S.doc Version 5.2 Page 11 These forms cover information regarding the activities of daily living and social needs of individuals and any specialist needs that may be prevalent to the individual. The appointed manager or a registered nurse will undertake the pre admission assessment of all prospective residents. 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. The home does not have dedicated accommodation to provide intermediate care. Following the concerns that have been raised regarding practices within the home, the local purchasing authority are currently not making any new placements at the home until improvements are identified. Sackville Nursing Home DS0000014051.V350374.R01.S.doc Version 5.2 Page 12 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 adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Recent intervention from other health professionals and the reviewing of care plans ensure health needs are identified. Inconsistent information maintained at the home may cause confusion for staff, resulting in current needs not being met. Residents are generally safeguarded by the medication procedures in place. EVIDENCE: Care plans were not looked at in detail. Safeguarding Adults alerts and concerns raised by other health professionals regarding care practices within the home resulted in health professionals from social services and the Older People Nurse Specialist team visiting the home and undertaking a review of all the care plans. This process took place approximately two to three months prior to this site visit. No resident had been admitted to the home since then. Sackville Nursing Home DS0000014051.V350374.R01.S.doc Version 5.2 Page 13 Care plans briefly looked at still had some shortfalls noted. One residents risk assessment identified that they can be verbally aggressive. There was no care plan in place to provide guidance to staff on action to take or what may trigger the aggression. Another individual who demonstrates aggressive behaviour had a care plan in place. Information pertaining to individual needs is not consistent throughout all the residents. One resident’s risk assessment identified that the individual had wound dressings and the reviews being undertaken demonstrated that these were still in place. The appointed manager was not aware of any current wounds being present. Staff are recording when wound dressings for residents are changed, however not all are writing clear descriptions of the wounds. The documentation in place makes it difficult for the next nurse to ascertain if the dressing being used is effective and if the wound is healing. The improvement plan provided following the last inspection identified that monthly reviews are continuing and that regular audits will be carried out. The timescales provided identified that this was already in place and reviewed on a monthly basis. The appointed manager confirmed that she is in the process of reviewing all care plans. Eleven had been done to date. Registered nurses have been doing the monthly reviews. Most residents spoken with confirmed that staff discuss their care with them and felt that their needs were being met. The home has implemented a form for relatives/representatives to sign to identify if they wish to be involved in the reviewing of their friend/relatives care plan on a monthly or six monthly basis, or not at all as some may choose. This is to ensure that choice and preference is taken into account as required at the last inspection. A staff member commented that some residents have enjoyed being involved in the reviewing of their care plans. Information on care plans that carers were using on a daily basis is not accurate. It was identified at the last inspection that information contained in different areas was not consistent in providing accurate information. The appointed manager confirmed that the second care plans should not be there and will address this with the staff. Further work is required to be undertaken on risk assessments and this should better improve when senior staff have undertaken risk assessment training. Clear guidance must be in place for staff on actions to take to reduce the risk. The information in risk assessments was not consistent for all residents. Some risk assessments were suitably completed. The appointed manager confirmed that she is proposing to review the risk assessments for all residents. The improvement plan provided following the last inspection identified that new documentation is in place, which has been expanded to provide guidance for Sackville Nursing Home DS0000014051.V350374.R01.S.doc Version 5.2 Page 14 staff and these would be reviewed on a monthly basis. Information shared with the CSCI in August, through Safeguarding Adults procedures, identified that there were concerns regarding risk assessments. The information in the improvement plan is not being followed. Clear risk assessments need to be in place for the use of bed rails and if bed rail covers are used or not. Other health professionals have raised concerns about the inability of staff to identify significant changes in a resident’s health. Eg. Signs and symptoms are not readily picked up and not always addressing ‘end of life care’. No care plan had been put in place for pain management. A written comment from a care manager stated “Specialist nursing team intervention leading to in-house training of staff led to improvements especially around end of life care”. Some written quotes received from care managers are “some recent improvements have been made after the Specialist Nursing teams have been involved” and “Recent intervention from the specialist Nursing Team showed several omissions in monitoring medical needs”. The comment card received from a GP identified that there were no concerns they had in relation to care received at the home, “as far as I am aware”. Medication procedures have been improved since the last inspection. Medication Administration Records (MAR) charts viewed demonstrated that staff are generally signing for medicines at the time of administration. On occasions it was observed that medicines had been signed for and not given. Where it is prescribed to administer one or two tablets, staff are not regularly recording how many were being given. MAR charts viewed on the whole were sufficient. The shortfalls noted have not been reflected as an outstanding requirement and the appointed manager will be able to ascertain who was responsible for these errors and address it with the individual nurses involved. Monthly audits are being done to ensure correct storage and handling of controlled drugs. A sample of controlled drugs were checked and demonstrated that clear records were being maintained for these. Procedures for the disposing of unused medicines have improved and records are being maintained for this. The home ensures that there is not a large stock of medicines at the home at any given time. Residents are now provided with an opportunity to self medicate if they wish and a risk assessment identifies that it is safe for them to control their own medications. There was no one self-medicating at the time of the inspection. The improvement plan identified that a new procedure was in place for the controlled drugs and this was being followed. 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 and were heard to be calling them by their preferred term. Sackville Nursing Home DS0000014051.V350374.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. Visitors are welcomed at the home and the provision of meals has improved to ensure preference and nutritional value is catered for. EVIDENCE: Most residents spoken with confirmed that they felt their lifestyle within the home was their choice and were able to choose their own daily routines in relation to going to bed, getting up in the mornings and choosing their own clothes etc. Visitors are welcomed at the home. A care manager comment card identified that the staff always make visitors welcome by offering drinks and biscuits upon arrival. The warm welcoming visitors receive was also observed on the day of the site visit. Sackville Nursing Home DS0000014051.V350374.R01.S.doc Version 5.2 Page 16 The activities person was spoken with who works 3 days a week at the home, for four hours each time. This person demonstrated their enthusiasm, however confirmed that some residents are difficult to motivate to join in activities. Their choice to be involved or not is respected. Some resident were observed to be playing bingo on the day of the site visit, whilst others were observing this. Most residents felt that there were enough activities provided at the home, if they choose to be involved. Of those who did not feel there were sufficient, could not provide any information on what else they would like to be offered. Visitors spoken with confirmed that they felt there appeared to be enough activities provided. The activities person confirmed that they also visit residents who may remain in their rooms either by choice or due to medical needs. Some residents are taken out, however group outings are very rare. This is not reflected as a requirement, however the home should ascertain the wishes from the residents in relation to group outings are make these arrangements if it is identified as a need. The AQAA identifies that encouraging residents to participate in mini bus outings is an area they have identified in what they could do better. It was confirmed that some residents have mental health needs, however the nursing needs outweigh the mental health needs. A care manager’s written comment identified that “the staff of the [home] need to ensure they recognise residents have differing needs. eg. Clients with mental health needs may have different social needs purely than those residents with physical needs”. 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 once a week on a day that the activities person does not work. Written comments from care managers about what the care service does well were: “Focus on activities in-house to promote social inclusion” and “ the activities provided are quite good”. Most residents were complimentary about the food provided at the home and confirmed that they are provided with a choice. Comments from residents ranged from ‘OK’ to ‘very nice’. Staff spoken with confirmed that the provision of food has improved. The home has daily menu monitoring forms and record what the individual has eaten. Menus observed demonstrated that choice is provided. Residents are able to choose where they eat. There is no communal dining table for residents to sit at for meals. Residents eat in the lounge room from portable tables or in their rooms. The analysis undertaken by the home in relation to the food provided was viewed, which demonstrates there are improvements. Results for the provision of lunchtime meals for August 2007 showed that 84 of residents were satisfied and this had risen to about 91 in November 2007. A care manager confirmed that the home has a good choice of menu and will give the residents further choice if this is required. Sackville Nursing Home DS0000014051.V350374.R01.S.doc Version 5.2 Page 17 Nutritional assessments are now completed for individuals as required at the last inspection. On viewing a nutritional assessment, there was evidence that where a resident was at risk, a dietician had been contacted and visited the individual to provide advice for the home to assist in promoting the individuals nutritional status. The home has recently received new documentation to be implemented for the kitchen, as needed to comply with guidance from environmental health. Training was being arranged for use of this documentation. Environmental Health last visited the home in February this year. Sackville Nursing Home DS0000014051.V350374.R01.S.doc Version 5.2 Page 18 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 adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Complaints are dealt with by the home and action taken where necessary, ensuring those who raise complaints that they are listened to. There has been a significant number of Safeguarding Adults raised. The home co-operates with the leading authority in these investigations, assisting to ensure residents become safeguarded. EVIDENCE: There has been one complaint made to the home since the last inspection. Other complaints made resulted in being investigated through Safeguarding Adults procedures. Documentation is maintained at the home and there is evidence that the home responds to complainants and takes any necessary action that may result from their complaint investigations. The AQAA identifies that this complaint is still waiting for an outcome. The AQAA identifies that there have been 13 Safeguarding Adults alerts made in the last 12 months. Seven of these have been made since the last inspection in May 2007. Three of these were raised by the home and other alerts were made by health professionals external to the home. The home had not notified CSCI of all of these incidents. Four alerts were substantiated, two not upheld and one continues to be investigated with the assistance of the Sackville Nursing Home DS0000014051.V350374.R01.S.doc Version 5.2 Page 19 local coroner. The local Safeguarding Adults team did not investigate one Safeguarding Adults alert made by CSCI. This incident is not included in the above figures. These alerts have resulted in external health professionals to monitor the home and review all residents residing there. Training was provided to ensure that when they were not at the home, needs continued to be identified and met. A written comment from a care manager identifies “When I have raised issues with the acting manager of the Sackville Nursing Home she has been co-operative”. When they have telephoned the home or visited, the issues have been actioned and resolved. Another care manager identified that they have received full co-operation from the appointed manager with the investigations. The improvement plan identifies that a new policy for Safeguarding Adults has been drawn up since the last inspection. There is a flow chart in the office with contact details for staff to follow in the event of an allegation being made. The appointed manager confirmed that all but three staff have attended Safeguarding Adults training. Training is currently being accessed for them. The appointed manager is trying to access training for staff on the Mental Capacity Act. The AQAA identifies plans for the next 12 months is to arrange an advocate for residents who have no representative, if they wish to have one. Sackville Nursing Home DS0000014051.V350374.R01.S.doc Version 5.2 Page 20 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 adequate 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 refurbishment programme in place was until January 2008. Another programme will be implemented for the following year. This will be viewed at the next inspection. Sackville Nursing Home DS0000014051.V350374.R01.S.doc Version 5.2 Page 21 The refurbishment programme provided identified that new curtains and carpets etc have been placed in some rooms and some have been repainted. The AQAA also identifies areas that have been improved and their plans for the next 12 months. Of the residents that were asked confirmed that they were happy with their rooms and found their beds comfortable. A staff member stated that the home has been provided with more adjustable beds and these have been provided to the residents where the greater needs were identified. It is not reflected as a requirement, however work must be done to ensure all beds where residents are receiving nursing care are adjustable. This will continue to be monitored throughout the inspection process. Staff identified that it would be easier to meet the needs of residents if there was a hoist provided on each floor. This has been provided to them. The AQAA identifies that 26 staff have received training on the prevention of infection and management of infection control and that there is a policy in place for preventing infection and managing infection control. The home was clean and free from offensive odours on the day of the site visit. Sackville Nursing Home DS0000014051.V350374.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 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. Residents’ needs are being met with the number of staff on duty. Following robust recruitment procedures will better safeguard residents. Increased training provided to staff ensures residents and staff are better protected. EVIDENCE: The majority of staff and residents spoken with confirmed that with the current numbers of residents in the home there are sufficient staff on duty to meet the needs of the residents. Staff spoke positively about the recent changes within the home and all the training that has been provided to them. One commented that they felt there were clearer roles and responsibilities within the home. Residents spoken with were complimentary about the staff at the home and a written comment from a care manager also identified that residents speak highly of the carers and care received in the home. A comment card identified that some residents have expressed to a care manager that they have difficulty with communication and making their needs known to staff whose first language is not English. Sackville Nursing Home DS0000014051.V350374.R01.S.doc Version 5.2 Page 23 There is currently nine care staff (excluding registered nurses) employed at the home. Two have completed National Vocation Qualification (NVQ) level 2 training; five are currently undertaking this training and two staff are waiting to enrol for a course. The appointed manager confirmed that there has been a high turnover of care staff since the last inspection. The AQAA identifies that there has been eight care/nursing staff that have left employment in the last 12 months. It is not reflected as a requirement regarding the number of NVQ qualified staff working at the home as there is evidence that the home is working towards meeting the 50 recommended ratio. This will continue to be monitored through the inspection process. Three staff files viewed demonstrated that reasonable recruitment procedures are followed. Checks are undertaken on all staff prior to commencing employment. One staff member had commenced employment prior to a full Criminal Record Bureau (CRB) being returned. A Protection of Vulnerable Adults (POVA) check had been undertaken and the appointed manager confirmed that this person worked supervised until the CRB was returned. There is an interview form in use, however management are not ensuring that these are completed, evidencing why this person is suitable for the post they have applied for. Only basic personal information is being recorded on these forms. Gaps in employment were not explored. It is recommended that the health questionnaire identify current and past illness and not just request information about the past illnesses. Where it was identified that information provided by the CRB to the home regarding an individual, there was insufficient checks in place to ensure that information returned was being managed appropriately to ensure residents safety. This information had not been declared on the application form. The appointed manager confirmed that she will address this with the individual and ensure that a risk assessment is undertaken. For overseas staff, it was noted that there were only personal references in place and the home had not contacted the previous employer. The appointed manager had not contacted them for a reference due to them being located overseas. This should not be a barrier in obtaining professional references. The AQAA identifies that “nurses working in the home are suitably registered with the appropriate body”. A training programme was viewed at the home that identified training that staff have undertaken and proposed training being arranged. The appointed manager confirmed that she has provided some of the training to staff that involved using training materials and having discussions with staff. Other training has been provided by the local authority, following concerns raised. Other external trainers are accessed when needed. The registered providers have employed a trainer to assist in ensuring all staff are kept up to date with mandatory training. Sackville Nursing Home DS0000014051.V350374.R01.S.doc Version 5.2 Page 24 Common Induction Standards, as set by Skill for Care, has been commenced for all new staff. The improvement plan also identifies that an induction programme is undertaken by all new staff and will be completed within 12 weeks of commencing unless an individual requires more help. Sackville Nursing Home DS0000014051.V350374.R01.S.doc Version 5.2 Page 25 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 & 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. Management within and external to the home needs to be more proactive in improving outcomes for residents to ensure the home is run in the best interest of residents, staff are better supported and the aims and objectives and services advertised in the Statement of Purpose are provided. EVIDENCE: The home has been without a Registered Manager since approximately June 2005. There is an application for the appointed manager being processed through the CSCI registration procedures at present. Sackville Nursing Home DS0000014051.V350374.R01.S.doc Version 5.2 Page 26 Some concerns had been raised regarding the appointed managers competencies and the local authority have been supporting the appointed manager to improve areas of knowledge and management skills. The registered providers must ensure that an appointed manager is fit to manage the service and meets the legislative requirements for this role. Staff generally find the appointed manager approachable, listens and is now more open to ideas that staff may have on improving the service. Care manager written comments are: “Previous issues with manager’s competence. Improvements seen with support from Contracts Dept. of Local Authority”. Information provided to the CSCI regarding this service evidences that when professional support is withdrawn from the service, the situation within the home deteriorates and residents do not continue to receive good outcomes and needs do not continue to be met. Management should be learning and maintaining good standards from the support that is provided. A staff member commented “things have improved with people [local purchasing authority and CSCI] on the back of management”. Action must be pro active and not reactive. A letter has been sent to the registered providers from the CSCI, following a meeting held with them and the local purchasing authority, expressing our concerns regarding practices within the home and advising that the level of support this service is receiving from other health professionals cannot continue. They cannot rely on this support to manage the service. They should be learning and maintaining good standards from the support that is provided. We have concerns that good outcomes cannot be maintained when this support is withdrawn. The AQAA identifies that within the next 12 months they plan for senior staff to attend management training, ensuring that suitably skilled and experienced people are in charge of the home in the absence of a manager. The home has a history as a deteriorating service. The registered providers have neglected their duties for a long period of time. Improvements are gradually being made and the registered providers have recently employed a trainer and a consultant. Improvements are slowly being made, but not at the speed that is expected of a service committed to providing good quality care. Management meetings have commenced between all managers of the homes owned by the registered providers where documentation and ideas are shared, where it is demonstrated that a practice works well. The appointed manager has planned dates to receive clinical supervision from a manager of another care home, owned by the same providers. Visitor and resident questionnaires were completed in August 2007 and the appointed manager plans to repeat this process in February 2008. Results of quality assurance and quality monitoring surveys are available for viewing in the reception area, along with the latest CSCI inspection report. Action is Sackville Nursing Home DS0000014051.V350374.R01.S.doc Version 5.2 Page 27 taken where needed as a result of the surveys. Resident and staff meetings are held monthly and the appointed manager confirmed that next year they propose to have relative/representative meetings every two months. 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 current level of supervision within the home and the registered providers and Responsible Individual not monitoring their service, it had been advised that these report be forwarded to the CSCI on a monthly basis. Residents’ monies are held at head office of the registered providers. Processes in place and records being maintained were not viewed on this occasion. Residents are made aware that the money is accessible when the office is open. The appointed manager needs to ensure there is a process in place for residents to have access to money in periods when the head office is closed. This has not been identified as a problem to date. No requirement has been made in respect of this as the appointed manager confirmed she will discuss this with the registered providers. As stated in an earlier part of this report, a training programme is now in place to make sure that all staff received training in first aid, health and safety, moving and handling and food hygiene. The home has recently received folders of policies and procedures from an external company and the appointed manager confirmed that she will be going through these and personalising them to the home. The home is recording accidents/incidents and action is taken if identified as being needed. A fire risk assessment was undertaken in July 2007 that identified areas for improvement and these are currently being addressed. It was noted that fire drills were not being provided for night staff. No immediate requirement was made in respect of this as the appointed manger confirmed that she will seek advice regarding this. Written confirmation was received following the site visit that a fire officer has been contacted who will get back to the home to clarify the legal requirements in relation to fire safety practices. No other health and safety records were viewed at this inspection. The AQAA identifies 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 continues to improve and to monitor the effectiveness of the management of the home. Sackville Nursing Home DS0000014051.V350374.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 3 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 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X X X X 2 Sackville Nursing Home DS0000014051.V350374.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 15(1)&(2) Requirement That care plans and information in use regarding the care of service users is up to date to ensure consistent information is provided to staff and all needs are met. That clear risk assessments are in place for all service users and provide guidance for staff on how to reduce the risk, ensuring the safety of the service user. That robust recruitment procedures are followed to ensure service users are safeguarded and evidence that staff have the skills and experience necessary for such work. That the home is suitably managed to ensure that staff are appropriately supervised and service users benefit from the ethos, leadership and management approach of the home. That information required under legislation is provided to the CSCI within the given timescales. This relates to DS0000014051.V350374.R01.S.doc Timescale for action 28/02/08 2. OP8 13(4) (b&c) 28/02/08 3. OP29 19 Schedule 2 15/01/08 4. OP31 9, 10 & 18(2) 28/02/08 5. OP33 Care Standards Act 2000 Part II 31/12/07 Sackville Nursing Home Version 5.2 Page 30 31(1). Regulation 26 and Regulation 37 reports. 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.V350374.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Local 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. Extracts may not be used or reproduced without the express permission of CSCI Sackville Nursing Home DS0000014051.V350374.R01.S.doc Version 5.2 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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