Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 15/07/08 for Saltshouse Haven Nursing And Residential Home

Also see our care home review for Saltshouse Haven Nursing And Residential Home for more information

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home continues to be welcoming and has a relaxed atmosphere. People living there said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. The home ensures that people are only admitted after a thorough assessment so they can be sure they can meet needs. They also enable people to have trial visits or short stays. People spoken with stated the care they received was delivered in ways that promoted their privacy and dignity, and that staff were kind and friendly. One relative stated her mother felt, `loved` by staff in the home. Each of the lodges is well decorated and equipped and is a safe place for people to live in and work in. People living in the home said they are offered a good choice of meals and they enjoyed the quality of food. Specific wishes are catered for and they have plenty to eat and drink throughout the day. Relatives of the people living in the home can visit when they please, feel welcomed when they do visit and are kept well informed by staff. The home manages complaints and records them clearly. The manager meets with complainants and tries to address things quickly. The induction and training provided to staff is very good. It is well organised and clear records are kept of which staff members have completed training and when updates are due. The way the home manages peoples` finances is clearly documented and people receive interest on monies held for safekeeping.

What has improved since the last inspection?

A new and well-qualified manager has been appointed to the home. Since the last inspection there had been some important care and protection issues highlighted. The new manager has addressed these issues robustly and is aware of what needs to be done to improve the situation. The provision of activities in each of the lodges has improved although may not be quite right for everyone yet. A series of audits should help to identify any gaps. The provision of care and interaction with people with dementia care needs that live in Bilton lodge has improved. On the whole people are well stimulated and the lodge had a comfortable and relaxed atmosphere.

CARE HOMES FOR OLDER PEOPLE Saltshouse Haven Nursing And Residential Home 71 Saltshouse Road Kingston Upon Hull East Yorkshire HU8 9EH Lead Inspector Beverly Hill Key Unannounced Inspection 15th July 2008 09:00 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 Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.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. Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Saltshouse Haven Nursing And Residential Home Address 71 Saltshouse Road Kingston Upon Hull East Yorkshire HU8 9EH 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) 01482 706636 01482 376216 www.bupa.com BUPA Care Homes (CFHCare) Ltd Dianne Karen Parker Care Home 150 Category(ies) of Dementia - over 65 years of age (150), Old age, registration, with number not falling within any other category (150), of places Physical disability over 65 years of age (150) Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Registration includes one younger disabled person Preston Lodge, two younger disabled in Coniston Lodge A maximum of 7 people under 65 years of age, excluding those people referred to in condition 1 & 3, may be accommodated in PD, DE or TI categories. A maximum of 5 people under 65 years of age may be accommodated in the intermediate care facility in Preston Lodge. 19th July 2007 Date of last inspection Brief Description of the Service: Saltshouse Haven is a large care home with nursing, caring for people with a wide range of needs, covering old age, dementia, physical disability and terminal illness. It is part of the BUPA group of care homes, is situated in a residential area and is close to public transport routes into the city of Hull. The home is based in six separate lodges; all connected by footpaths and covered walkways. The main lodge contains the central facilities of laundry, kitchen, staff training, administration and management functions. The other five lodges are individually named and can accommodate up to thirty people. Preston Lodge and Meaux Lodge provide residential care. Sutton Lodge has fifteen nursing and fifteen intermediate care placements, with input from the Primary Care Trust health professionals. All thirty placements in Coniston Lodge are for nursing care and Bilton Lodge provides support for people with dementia care needs. All Lodges have ground floor, single bedroom accommodation, a large communal lounge/dining area with a built on conservatory and a smaller quiet room for those people that wish to smoke. The home is nicely decorated and well equipped. Well-maintained, landscaped grounds surround each lodge and there is ample car parking facilities. Information about the home and its service can be found in the statement of purpose and service user guide, which are available from the manager of the home. A copy of the latest inspection report for the home is on display in the reception area of the main lodge. The homes’ weekly rate is dependent on need and ranges from £348.50 to £570 depending on the care required. There is also an additional weekly top Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 5 up fee of £10 for people funded by the local authority. People will pay additional costs for optional extras such as hairdressing and private chiropody. Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key inspection of the home on 19th July 2007. It includes information gathered during a site visit to the home. Because of the size of the home two inspectors, Bev Hill and George Skinn stayed for twelve hours. This enabled us to speak to night staff as well as day staff. We spoke to several people that lived at the home in different lodges to gain a picture of what life was like at Saltshouse Haven and also spoke to one relative. We also had discussions with the manager, deputy manager, the housekeeper and several staff members. Information was also obtained from surveys received from ten people that lived at the home, two from their relatives, seven from staff members and three from visiting professionals. Comments from the surveys and discussions have been used throughout the report. We looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there. Also examined were intermediate care services, medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them. During the morning we carried out a two-hour observation with a small group of residents that have dementia care needs, as they would be unable to speak to us to tell us what life is like for them in the home. This is called a SOFI – short observational framework for inspection - and is used to give us information about how well staff interact with people, and we can observe for signs of wellbeing or distress. The providers had returned their annual quality assurance assessment, (AQAA) on time. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 7 Since the last visit there had been nineteen complaints raised with the home and all appeared to have been fully resolved. This told us that people and their relative’s felt able to raise complaints and the home documented them properly. Concerns and complaints raised with the Commission had also been resolved. Since the last visit there has been seventeen referrals made to the local authority for investigation under the safeguarding of adults procedure. Most of these had been referred by the manager, which told us she was aware of policies and procedures and used them properly. See the section on complaints and protection. We would like to thank the residents, staff and management for their hospitality during the visit and also thank the people who completed surveys and had discussions with us on the day. What the service does well: The home continues to be welcoming and has a relaxed atmosphere. People living there said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. The home ensures that people are only admitted after a thorough assessment so they can be sure they can meet needs. They also enable people to have trial visits or short stays. People spoken with stated the care they received was delivered in ways that promoted their privacy and dignity, and that staff were kind and friendly. One relative stated her mother felt, ‘loved’ by staff in the home. Each of the lodges is well decorated and equipped and is a safe place for people to live in and work in. People living in the home said they are offered a good choice of meals and they enjoyed the quality of food. Specific wishes are catered for and they have plenty to eat and drink throughout the day. Relatives of the people living in the home can visit when they please, feel welcomed when they do visit and are kept well informed by staff. The home manages complaints and records them clearly. The manager meets with complainants and tries to address things quickly. The induction and training provided to staff is very good. It is well organised and clear records are kept of which staff members have completed training and when updates are due. The way the home manages peoples’ finances is clearly documented and people receive interest on monies held for safekeeping. Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? What they could do better: Where intermediate care is provided, dedicated space should be made available for this service group. This will ensure that people that live in the home permanently are not disturbed by a constant turnover of people entering and leaving their home. People have plans of care to meet their need but these must be updated when things change so that staff members have up to date guidance about how to care for people. Staff must make sure that peoples’ health needs are met in relation to pressure relief and nutritional intake. Monitoring charts, obviously put there for a reason need to be completed consistently to evidence care is being provided in line with care plans. The way the home manages some medication needs to be improved so that it is administered as prescribed, is recorded accurately and stock controlled. The manager and deputy manager are very aware of constitutes abuse of vulnerable people and refer allegations to the local authority. The lodge managers and people in charge of shifts need to be equally aware and refer to the local authority or manager quickly any incidents or allegations they become aware of. The home could make sure there are more staff available to assist at peak times as some staff have told us that some care tasks are not being completed when they are really busy. There appears to be sufficient staff in terms of numbers but there is still a perceived shortage at times. This might be due to how staff and their tasks are organised during the day. The manager should check this out. Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 9 The way the home recruits new staff could be improved, as staff are routinely employed after a check against the protection of vulnerable adults register but prior to the return of full criminal record bureau checks. This should only be done in exceptional circumstances and not as a matter of routine. The home sends out surveys for residents to complete but the consultation process could be expanded to include relatives and visiting professionals. The home must ensure that care staff are supervised properly and could improve the frequency with which staff members receive supervision. 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. Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 10 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 Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 11 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): 3 and 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. People are only admitted into the home following a comprehensive assessment of their needs. This means the home has full information about people to enable them to decide if they can meet their needs. People admitted for intermediate care are supported to regain their independence but their needs are not fully reflected in care plans and they do not have designated space to assist in the process of rehabilitation. EVIDENCE: We examined nine individual care files during the visit, some of which were for people recently admitted to the home and one was for a person admitted for intermediate care services. The home evidenced that they always obtained assessments of need and care plans completed by the local authority for people funded by them. The homes Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 12 in-house assessment documentation was comprehensive covering a range of health, personal and social care needs. The manager, deputy manager or senior nurses visited individuals in the community to carry out the home’s assessment of need for all people wishing to use the service. The information from the assessment process was used to formulate the individuals care plan. Those residents at the home who received nursing care have undergone an assessment by a registered nurse from the Health Authority, to determine the level of nursing input required by each individual. The manager confirmed that it was possible for prospective residents and their families to spend time at the home talking to people who live there, meeting the staff, enjoying a meal or spending the day there. The home also had the capacity to admit people for respite care and short breaks. The home had recently relocated fifteen beds specifically for intermediate care services from Preston Lodge to Sutton Lodge. Intermediate care is available to prevent a hospital admission or to facilitate a speedy discharge from hospital. People admitted for intermediate care have their needs assessed by health professionals prior to admission and they also produce a plan of care. Health professionals such as doctors, nurses, occupational therapists, physiotherapists and dieticians provide expertise but care staff members within the unit provide the day-to-day care. When one care file was examined the care plan documentation was basic had three elements to it; monitoring pain following a heart attack, mobility issues and regaining former independence. There did not appear to be a care plan covering all areas of need reflecting goal planning over the estimated length of time for intermediate care. Also the evaluation sheet was a report of daily issues rather than an evaluation of any goal setting care plan and achievements towards independence. Recording evidenced the person had emotional and psychological needs associated with a recent major bereavement, had insulin dependent diabetes, was experiencing some incontinence and was a devout catholic but there were no plans of care to meet these needs. The care staff did not appear to have a cohesive care plan to guide them through all the tasks they needed to carry out. This was mentioned to the manager to check out and address with health colleagues. There was no designated area within Sutton Lodge for intermediate care services. The fifteen bedrooms were located at one side of the ‘H’ shaped building but people admitted for intermediate care shared communal space with residents who lived at the home. This meant that for the permanent residents there was a constant turnover of people in and out of their home. There was no rehabilitation kitchen or therapies room for people to be Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 13 assessed for, or to practice, their independent living skills throughout their stay in preparation for a return to their home. People spoken with were happy with the intermediate care service, ‘it’s a good service – both day and night staff are marvellous’. Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 14 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 and 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. Although residents and relatives were satisfied with the care provided, gaps in updating care plans, recording in monitoring charts, obviously put there for a reason, meant that staff members did not have full information and some care needs were not met. In some instances the management of medication was not sufficiently robust to ensure people received their medication as prescribed. EVIDENCE: Nine care files were examined during the visit and the new documentation used provided a wealth of assessment information on which to build plans of care to meet peoples’ needs. Each care file had good details about the persons’ daily routine and personal profile. Risk assessments were seen to cover pressure ulcers, nutrition, moving/handling and activities of daily living. Information about a person’s social interests, likes and dislikes, spiritual needs and wishes regarding death and dying are included within the individual’s care Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 15 plan. The funding authorities carry out yearly reviews of the care plans and the minutes of these meetings show that people have input to this process (where possible), and family/representatives are also invited to the reviews with the person’s permission. Evaluations of care plans are taking place but the information about peoples’ changing needs is not forwarded to the care plan. This means that the care plan may not have all the required information for staff and care needs may be missed. For example, one care plan stated that the person did not require bed rails but information in the daily records was that they had bed rails, ‘at all times’. Similarly in another persons’ care plan it stated they could be given liquid or small tablets because of swallowing difficulties but the person received nutrition and medication via a percutaneous endoscopic gastrostomy and nothing orally. Both care plans had not been evaluated and updated thoroughly. Other examples of evaluations and changes not inputted into the plans of care were, tissue viability, mobility needs, mouth care, continence management and personal care. As the care plan evaluation sheets have new pages placed on top of them staff would have to sift through them to get the most up to date information rather than going straight to the care plan. It was also noted in the previous section of the report that people admitted fro intermediate care do not have a care plan that addresses all their needs and gives clear guidance to staff on how to meet them. Since the last inspection there had been allegations that one particular nurse in one of the nursing lodges, had not fulfilled their responsibilities regarding the management of pressure ulcers and ignored requests by care staff to see a person they were concerned about. There was also another incident when the district nurse was not called in a timely manner to assess the pressure damage to a resident in one of the residential lodges. The manager dealt with these issues by referring them to safeguarding of adults team and they were investigated. See the section on complaints and protection. Several people have monitoring charts in place for pressure relief and nutritional intake. These were completed inconsistently with large gaps in the ones examined in the lodges providing nursing care, Coniston and Sutton. The charts were kept in the persons’ bedroom but some had no name on. One examined was there to record the persons’ food and fluid intake including when the person received a prescribed fortisip food supplement. When crossreferenced with their medication administration record (MAR), which, stated the person needed two fortisips daily, there were shortfalls. In the previous twelve days the person was recorded as receiving 14 fortisips, rather than the 24 they should have received. The MAR chart was signed as if the person had received the full amount as prescribed. Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 16 One person was assessed as having a high-risk factor for tissue damage and nutritional input. Similarly their charts were inconsistently completed with large gaps in recording when the person was turned in bed. The person had not received prescribed nutritional supplements for ten days as the MAR indicated they were out of stock. This is not acceptable practice and must be addressed in light of previous concerns about managing pressure ulcers. Discussion with people showed that staff respected privacy and dignity by knocking on doors prior to entering bedrooms, toilets or bathing facilities. People’s preferred term of address was recorded in care plans and was used by the staff. General observation throughout the day showed good staff interaction with people. Staff members were polite and friendly, and sensitive to peoples’ needs. It was noticed in Sutton lodge that nail care had been missed for several of the people in the lounge. Relatives in discussions and via surveys returned from them felt that people’s needs were generally met. One relative stated care needs were met, ‘sometimes’. Some comments were, ‘the care home provide a very good service, I have peace of mind that my dad is well looked after and safe’, ‘they always contact me whenever they have called the doctor or he is admitted to hospital’ and ‘I’m very impressed with the level of care and feel that she is safe’. The registered nurses managed all parts of the medication processes in the lodges providing nursing care and senior care staff administered medication in the lodges providing residential care. The medication practices on Coniston lodge, which provided nursing care was examined. The medication was signed in on receipt into the home and on administration and stored well. The deputy manager completed monthly medication audits, which had picked up some missed signatures and resulted in an action plan for staff. There were several medication issues that required attention on Coniston lodge. • Shelf–limited products such as Calogen liquid need the date of opening. • Some medication such as Gaviscon liquid and analgesia had, ‘as directed’ on the medication administration chart but requires full instructions to guide staff. • Handwritten entries on the medication administration chart mid-cycle require two signatures. This was a recommendation from the last visit and will remain. • One person had not been administered a prescribed dietary supplement for the previous ten days as the home had ran out of stock. Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 17 • There was a discrepancy noted on the medication administration chart when tallied with the controlled drugs register regarding the administration of Fentanyl patches for one person. They had not received the right dose at the right time. This was checked out with the persons’ GP during the visit and rectified for the next dose due. • One person was required to take a specific tablet a half hour before food and another tablet with food in the morning. Nursing staff advised that they gave all the medication out at the same time in the morning. This meant that the person was not receiving at least one of her tablets as prescribed and it needs to be addressed. Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 18 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 and 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. People continue to have choice and diversity in the meals provided by the home with individual wishes and needs catered for. The home provides flexible routines and the opportunity for people to participate in activities. People with dementia care needs on Bilton lodge are provided with good social stimulation that enhances their wellbeing. EVIDENCE: Of the ten surveys received from people living in the home, seven stated there was sufficient activities, ‘always or usually’, one person said this was ‘sometimes’, one stated, ‘never’ and one person stated they didn’t join in at all because their legs were too painful. Staff members in surveys and discussions also stated more stimulation would be desirable and a relative commented that staff were too busy to provide the individual attention some people needed and that some people appear to be left sitting for long periods. Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 19 The home provided an activity coordinator for each of the lodges and there was evidence of activities such as flower arranging, gardening, nail care, reminiscence, outings, crafts and even a dog show. It may be that the home has not got it quite right for everyone but this is going to be difficult given the size of the home. Regular discussions with people and the quality monitoring surveys the home uses should highlight any changes in needs or requests for activities. We completed a short two-hour observation of residents in Bilton lodge on the morning of the visit. Bilton lodge supports people with dementia care needs. Five specific residents were the focus of the observation. One person remained asleep for the whole two hours only waking for a drink of tea and then for lunch. Another of the observed group kept looking around the room when she heard a conversation but never instigated one or joined in anyone else’s and no one initiated one with her. A third person fiddled with her cardigan for the entire observation and again undertook no interaction with anyone. One member of staff did engage the observation group and asked if they would like to watch the “Sound of music” film. One of the observation group said they would like this and the staff member but it on. Two of the people who were part of the observation watched the film and joined in the songs. In other areas of the lounge staff members were heard to compliment people on their attire. The staff discussed their own lives outside of the work place and recounted trips to London shopping. People responded well to this and they recounted times when they had been to London and other holidays. This was done in a 1:1 setting but others were encouraged to join in. Staff members were encouraging residents to play games and some people were set up in the conservatory area and played dominoes for the majority of the observation. The staff supervised this from afar and occasionally asked who was winning and how it was going. Other people were colouring books at the dinning room table, which they seemed to enjoy. The observation showed signs of well being in the room for most of the people present with only one or two people having limited or no interaction during the short space of time. The observer did comment that staff interacted more with people they received a positive response from and those people with more advanced dementia care needs were left with insufficient stimulation. However it was recognised that this was a small snapshot of observation and the lodge has had ongoing involvement with the Alzheimer’s Society for guidance and advice regarding social stimulation needs for people with dementia. Observers from the Alzheimer’s Society visited the home two days after the inspection and were very impressed with the level of stimulation and interaction in the home. They commented on the, ‘warm and welcoming natural home life set-up’ and the ‘gold standard’ achieved. This is a very positive achievement for Bilton lodge and should be commended. Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 20 Relatives could visit at any time and those spoken with, and surveys received from them, indicated they were always kept informed of important incidents. Newsletters were sent to people informing them of forthcoming events. Another relative stated in a survey, ‘although there are some negatives, the main concern is her wellbeing and in this I cannot fault the home – she always feels loved and has been happy with the staff looking after her’. There was some evidence that people could make choices about aspects of their lives and in discussions staff members showed a good understanding of how enable people to make choices and to be as independent as possible. One person spoken with on Meaux lodge did state they ‘helped’ staff by going to bed early. Staff in discussions also stated that some bathing choices couldn’t always be accommodated because of staff shortages. These points mentioned to the manager to check out. The menus were varied and provided an alternative to the main options. Food was prepared in the main lodge and arrived in individual lodges for staff to serve to people. This enabled staff to provide suitable amounts to people as required. We observed that the meal on the day was presented well and suitable for peoples’ needs. The menu was on display in dining rooms. Each lodge also had a small kitchen stocked with cereals, biscuits, drinks, bread and items for sandwiches. Staff in one lodge stated they did not have many items for sandwiches yet in another staff said all they had to do was request items and they could have them. People spoken with confirmed there were alternatives and they were generally satisfied with the meals. Comments were, ‘the food is very good’, ‘they come around the day before and you order food’, ‘yes there are choices and it is cooked and presented well’, ‘all meals are very good, all of the time’, ‘always hot’ and ‘the food is really good, you are always given a choice’. One person did state in a survey, ‘there is not much choice for diabetic puddings’ and another person in a discussion on the day thought that there could be, ‘more imagination’ as he had fish for lunch and pilchards on toast for tea. Eight people stated in surveys they liked the meals, ‘always or usually’, whilst one person stated this was, ‘sometimes’. The home catered for specialist diets such as diabetic and soft diets and there was evidence of dietetic input as required. A survey from a dietician did suggest that staff were more likely to use food supplements rather than make milkshakes or other high calorific snacks, which would be more appropriate in some cases. The home had received the very high score of ‘A’ from the local authority after an assessment for food management. Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 21 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 and 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. People live in an environment where they feel able to complain and management respond appropriately to complaints when they receive them. There have been instances where poor health care practices have affected the health, welfare and safety of people living in the home and although staff had received training in safeguarding adults from abuse in some instances this had not been put into practice. The new measures put in place by the manager should address the shortfalls. EVIDENCE: The home had a complaints policy and procedure that was displayed in the reception. All ten surveys received from people indicated they knew how to complain and that they knew who to go to if they were unhappy. One person spoken with on the day felt able to complain and stated, ‘I would if I had to but I haven’t had any complaints yet’. Six of the seven staff surveys also stated they knew what to do, and how to record it if someone complained to them. Since the last key visit there had been nineteen complaints from people using the service. These had all been looked at by the manager or social services and resolved. Appropriate action has been taken where necessary to improve staff practices and training. Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 22 Since the last visit there have been seventeen referrals made to the local authority for investigation under the safeguarding of adults procedure. Two of these were regarding people admitted from hospital to the home with pressure ulcers and six related to incidents between residents. Eight concerned staff practices regarding health care issues and neglect of their caring duties, on the lodges providing nursing care. One referred to a delay in contacting the district nurse for advice and treatment of a pressure ulcer in one of the lodges providing residential care. In one instance we found a referral to the local authority had not been made quickly enough but in every other instance the manager of the home had made referrals when she became aware of them and this evidenced she was guided by multi-agency policies and procedures regarding referral and investigation. An emergency care practitioner made one referral and a visiting health professional made another. All investigations, except the latest referral, which related to an error with medication, have been completed. One referral resulted in a staff members’ dismissal and their name forwarded to the protection of vulnerable adults register for possible inclusion and also reported to the Nursing and Midwifery Council. Two referrals related to staff members verbally abusing residents and resulted in complete retraining. Each lodge manager must be aware of what constitutes a safeguarding issue and be proactive in alerting the manager so they can refer to the appropriate agency quickly or making the referral themselves. The manager has set up new monitoring and recording systems so each day she, or the deputy manager, is updated with any issues that occur on each of the lodges, including which residents have pressure ulcers. All staff members have received training from the manager in how to safeguard vulnerable people from abuse. The manager has completed a, ‘train the trainers’ course regarding safeguarding and has the knowledge and skills to pass this information onto staff. This focus on safeguarding and new measures put in place by the manager will address previous shortfalls in this area and the manager, and a visiting health professional assure us, that there has been a recent improvement in health care practices. Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 23 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, 24 and 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. People were provided with a comfortable, safe and clean environment with opportunities to personalise their own bedrooms. EVIDENCE: The home comprises of six separate lodges. The main lodge contains the central facilities of laundry, kitchen, staff training, administration and management functions. The remaining five lodges offer accommodation for up to thirty people in each. Preston Lodge and Meaux Lodge provide residential care. Sutton Lodge has fifteen nursing and fifteen intermediate care placements. All thirty placements in Coniston Lodge are for nursing care and Bilton Lodge provides support for people with dementia care needs. Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 24 All Lodges have ground floor, single bedroom accommodation, sufficient bathing/showering facilities and large communal lounge/dining areas with a built on conservatory. There is also a small kitchen for staff to use entered from the dining area. The lounge areas are provided with wide screen televisions, music centres and comfortable furnishings. There is also a smaller quiet room for those people that wish to smoke. The home is nicely decorated and well equipped. Well-maintained, landscaped grounds surround each lodge and there is ample car parking facilities. We visited each of the lodges and all were clean and, apart from a lack of designated intermediate care facilities on Sutton Lodge, suitable to meet the needs of the people using the service. The recommendation made in the last two key inspection reports (June 2006 and July 2007), ‘where intermediate care is provided, dedicated space should be made available for this service group’, will remain in this report. The home has an ongoing maintenance and refurbishment programme, which was evident throughout. On Sutton Lodge the door to the small kitchen requires the self closer to be adjusted as it slams shut quite loudly each time it is used, which is frequently throughout the day. Some staff members still appear to have some difficulties with low, nonadjustable beds on the lodges providing residential care. This was mentioned in the last report and it stated, ‘discussion with the manager indicated the other lodges have a number of specialist care beds with adjustable heights and that there is a rolling programme for these to be put onto all lodges. She assured the inspector that a health and safety assessment around moving and handling would be carried out for the lodge and action taken on the outcomes’. Although it was noted that Meaux Lodge had some adjustable beds the situation does not appear to be resolved for all staff yet and the manager needs to check this out. People spoken with were happy with the home in general and with their bedrooms. They told us they were able to bring in personal items and small pieces of furniture with which to personalise their bedrooms and this was seen to varying degrees. Comments about the home from surveys and from discussions were, ‘the home is very clean and tidy’, ‘the room is cleaned every day’, ‘the cleaners are very thorough – its always clean’ and it’s a nice pleasant place – I like to see out into the garden’. All ten surveys from residents stated the home was clean and fresh either, ‘always’ or ‘usually’. One relative did state that they had observed a decline in the last three years in that obvious things are not done every day in bedrooms. The laundry was well equipped with industrial washing machines and driers. The housekeeper told us that each lodge has colour-coded bags and all clothes are marked by the home to aid identification. People were satisfied with the laundry service provided by the home. Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 25 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 and 30 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. Although the home appears to have an appropriate number of staff on duty, there is still a perception that shortfalls occur leading to some gaps in care for residents. The home had a good staff induction and training plan and ensured staff members were given the skills to complete their roles. A gap in the homes recruitment processes means that some staff start work prior to the completion of full checks, which could compromise residents’ welfare. EVIDENCE: Staff surveyed stated there was enough staff on duty either, ‘usually or sometimes’ and problems arose when staff members rang in sick at short notice. This impacted on the nursing lodges as they had more care staff on duty and tended to provide cover to other lodges in these circumstances. In discussions staff stated that sometimes people do not get up at the time they wish, do not have baths as care planned and on some occasions have not had a mid-morning drink due to staff shortages. Examples from staff were mainly attributed to weekends. Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 26 Discussion with the manager and area manager during feedback indicated that there remains a need for some staff to manage their time better and to ensure jobs are done effectively and efficiently. There had been training done in this area of practice, but more is required and the deputy manager who is responsible for training is aware of this. Management need to audit the issues identified above by staff and devise ways to address them, either by having access to more staff for use in emergencies or considering how staff are deployed during peak times of care, for example meal times. Discussions with people using the service brought to light mixed views about staffing levels. One person receiving intermediate care services on Sutton lodge stated that staff responded quickly to buzzers but one person spoken with on Meaux lodge stated that response was slow. Another person stated, ‘I go bed early at 7.30pm to help the staff’ and ‘I don’t like to be up for the night staff coming on’. Staff members were described as caring and friendly. Relatives commented that although they thought the home was short staffed at times, the staff worked very hard, were polite and, ‘do a good job’. The deputy manager had responsibility for auditing the training needs of staff and arranging induction for new staff and ongoing training for all staff. New staff members complete a comprehensive induction and foundation-training programme when they first start at the home and they complete several shifts as supernumerary. There was a good staff training programme in place that offered access to mandatory training and some subjects linked to the needs of the people using the service, including customer care (personal best), skin care, care planning, dementia and safeguarding of adults. There were also courses specifically for nurses such as, phlebotomy, enteral feeding, medication, wound management and catheter management. Community health professionals such as the tissue viability nurse and infection control nurse have provided advice and guidance and staff have contacted McMillan nurses for additional support when required. There have, on occasions, been instances when specific staff have not utilised their skills, especially around wound management. This has been mentioned in the sections on health and personal care and complaints and protection. The home had four people on site that were qualified to train staff members in moving and handling and one person able to train staff in mental capacity issues. The home could look at expanding the range of courses covering conditions affecting older people. The home was committed to supporting staff to gain a qualification in care. The homes AQAA stated that thirty-six care staff out of eighty (45 ), had completed a national vocational qualification in care at level 2 or above with thirteen staff working towards the qualification. This is good progress and the home will have achieved the required 50 when those progressing have completed the course. Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 27 The home had a recruitment policy and procedure and four of the most recently recruited staff files were checked. Although the majority of checks were in place one care staff member had one reference from a colleague at the home and a second reference from their last place of employment but they had only worked there for a very short space of time. They had previously worked in the care sector prior to this and it would have been more a robust process if a reference had been obtained from them regarding their care practice. It was also noted that staff were routinely employed after a clear povafirst, (a check against the protection of vulnerable adults register) but prior to the return of the full criminal record bureau check (CRB). This should only be done in exceptional circumstances and not as routine practice. Stringent supervision arrangements must be in place so care staff members do not work alone with residents until the CRB is returned. This is not possible for night care workers as in three of the lodges there is only two care staff on duty at night and staff would work alone with residents at intervals. Three of the four staff files did not have a photograph of the staff member. One had a passport photograph. The home verified nurse’s registration with the Nursing and Midwifery Council to ensure they were able to practice and had details of registration renewal dates. Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 28 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, 36 and 38 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 management of the home is satisfactory overall and new auditing and monitoring systems put in place by the new manager should help to address shortfalls mentioned in the report. However there were gaps in staff supervision that could mean residents welfare and safety could be compromised. EVIDENCE: The manager is a Registered General Nurse with twenty years experience in the health care sector. She has completed registration with the Commission. She gained a diploma in management in 2005 and also has a health and safety management qualification. She has completed a, ‘train the trainer’ course in Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 29 safeguarding adults from abuse and cascades this training to staff within the home. Information provided by the manager showed that she regularly updated her skills and knowledge through attending relevant in-house training sessions such as fire safety, first aid and moving and handling. She was very organised and had a clear sense of direction for the home. The regional manager, as the ‘responsible individual’ visits on a monthly basis and the manager stated she had avenues of support she could use when required. Staff spoken with and surveys received from them indicated the manager was firm but fair, ‘she is strict but you know where you stand – if you have done something wrong she will tell you but she also praises you’. The home has an up to date quality assurance award from the local council (QDS 1 and 2). ‘Investors in People’ status has also been achieved and is ongoing. The home has a monthly audit plan of staff practice and records within the home and ten surveys for each lodge are sent out each month regarding a different topic, for example activities, housekeeping, privacy and dignity and meals. One staff member in a survey did state that highlighted problems were resolved for a short while but often reoccurred and required more consistent follow up to ensure they were resolved permanently. Staff meetings and residents/relatives meetings take place although the last residents meeting had nil participants so a staff member visited each resident to check they were happy and did not have any complaints. There was evidence that a survey in February regarding activities had highlighted some shortfalls, which resulted in the employment of a further activity coordinator. The home should broaden the quality assurance system to include obtaining the specific views of other people visiting the home such as, GP’s, district nurses, other health professionals, care management, as commissioners of the services, and relatives. The management of peoples’ finances was well managed and recorded on a computerised system. Money left for safekeeping for any resident was maintained in one specific account. Each person receives interest from the account, on a monthly basis, according to the amount of money each of them has in the bank. Each person has their own individual account record and receipts were issued for monies in and out. People were able to access their money when they needed to. Residents or the person managing their finances were invoiced for hairdressing and chiropody services should they receive them. The manager had supervisory responsibility for the deputy manager and each lodge manager. These supervision records were in place and up to date. The lodge managers were responsible for one to one formal supervision of their staff teams. However it was clear from documentation and discussions that some care staff members were not receiving supervision up to six times a year. Some staff also indicated that on one specific lodge they were asked to Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 30 sign a pre-written supervision sheet on the day of the inspection site visit. This is not acceptable and was mentioned to the manager to address. We did accept the managers’ assertion that the other lodges had more robust supervision arrangements in place. Since the last inspection there have been incidents where some residents’ health and safety have not been promoted by particular staff working in the home. This has been covered in the complaints and protection section of the report. However the manager has been proactive in addressing these issues by putting in place daily and weekly monitoring and reporting systems to ensure such incidents do not reoccur. Staff members have received training in safe working practices. Accident books were filled in appropriately and audited for patterns, and risk assessments were carried out regarding fire, moving and handling, bed rails and activities of daily living. The accident audit did not have an action section to detail how the process had been followed through. Maintenance certificates were in place and up to date for all the utilities and equipment within the building. Regular fire drills and, alarm and fire equipment checks are carried out. The home notified the appropriate agencies of incidents that affected the health and welfare of people living in the home. Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 31 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 X X 3 X 3 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 3 X X X X 3 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 3 X 2 X 3 2 X 3 Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 32 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 Requirement The registered person must ensure that care plans detail all needs identified in evaluations. This will ensure care staff members have full and up to date information regarding peoples’ needs. The registered person must ensure that people receiving intermediate care have full plans of care to meet all their assessed needs to guide staff in how to support them. The registered person must ensure that staff evidence health needs are met in relation to pressure relief, nutritional intake and nail care. The registered person must ensure that medication is administered to people as per their prescriptions and information written on MAR charts, ‘as directed’ is stopped and full instruction provided. This will ensure the health, safety and wellbeing of people is protected. The registered person must DS0000000951.V368610.R01.S.doc Timescale for action 30/11/08 2 OP7 15 30/11/08 3 OP8 12 22/08/08 4 OP9 13(2) 22/08/08 5 OP9 13(2) 22/08/08 Page 33 Saltshouse Haven Nursing And Residential Home Version 5.2 6 OP18 13(6) 7 OP29 19 8 OP36 18 ensure that the home does not run out of prescribed items and when transcribing medication onto the MAR two signatures are recorded. This will ensure a checking system is in place and service users receive the medication as instructed by their GP. The registered person must ensure that all staff in charge of shifts are fully aware of what constitutes abuse or neglect of vulnerable people, is aware of the safeguarding of adults procedures and protects people by putting these in action. The registered person must ensure that the practice of recruiting staff after a povafirst check but prior to the return of the full criminal record bureau check is only completed in exceptional circumstances and not as a matter of routine. The registered person must ensure that all care staff members are supervised. This will enable staff practices to be monitored and give them an opportunity to raise any issues. 31/08/08 22/08/08 31/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP6 OP8 Good Practice Recommendations Where intermediate care is provided, dedicated space should be made available for this service group. Accurate information on the amounts of food and fluid consumed should be recorded when using monitoring charts for this purpose. DS0000000951.V368610.R01.S.doc Version 5.2 Page 34 Saltshouse Haven Nursing And Residential Home 3 4 OP8 OP27 5 6 OP28 OP33 7 OP36 Monitoring charts should be completed consistently to give an accurate picture of the care provided. In light of comments received from some residents and staff about perceived staff shortages the manager should consider how staff are deployed throughout the home to provide more support at peak times. The home should continue to work towards 50 of care staff trained to NVQ Levels 2 and 3. The manager should enlarge the scope of consultation about the quality of the services provided by including relatives, visiting health professionals and care management in the distribution of questionnaires. The registered person should ensure that all care staff members receive at least six supervision sessions a year that covers the philosophy of the home, care practices and training needs. Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Saltshouse Haven Nursing And Residential Home DS0000000951.V368610.R01.S.doc Version 5.2 Page 36 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!