Inspection on 19/07/07 for Saltshouse Haven Nursing And Residential Home

This inspection was carried out on 19th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Saltshouse Haven Nursing And... 27/01/10

Saltshouse Haven Nursing And... 25/11/09

Saltshouse Haven Nursing And... 09/07/09

Saltshouse Haven Nursing And... 15/07/08

Saltshouse Haven Nursing And... 20/07/06

Saltshouse Haven Nursing And... 06/12/05

Saltshouse Haven Nursing And... 15/06/05

Saltshouse Haven Nursing And... 05/01/05

Saltshouse Haven Nursing And... 11/06/04

Saltshouse Haven Nursing And... 26/02/04

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

CARE HOMES FOR OLDER PEOPLE Saltshouse Haven Nursing And Residential Home 71 Saltshouse Road Kingston Upon Hull East Yorkshire HU8 9EH Lead Inspector Eileen Engelmann Key Unannounced Inspection 19th July 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000000951.V346609.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. DS0000000951.V346609.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) Limited Kathleen Carroll 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) DS0000000951.V346609.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. 20th July 2006 Date of last inspection Brief Description of the Service: Saltshouse Haven is a large registered care home with nursing, caring for residents 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. The home is based in six separate lodges; all connected by footpaths and covered walkways. Five of the lodges are individually named and can accommodate up to thirty people. The Lodges are named Preston, Meaux, Sutton, Coniston and Bilton. The remaining lodge contains the central facilities of laundry, kitchen, staff training, administration and management functions. At the time of this visit Bilton Lodge was not in use but is being refurbished to open as a dementia unit later this year. All Lodges that accommodate people using the service provide ground floor, single bedroom accommodation, a large communal lounge/dining area and a smaller quiet room. There are well kept, landscaped grounds around each Lodge. The home provides 15 intermediate care beds on Preston lodge, which are for rehabilitation purposes. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents 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 Saltshouse Haven. Information provided by the home during the inspection indicates the home charges a range of fees for different types of care. Weekly fees are from £327.50 to £501.50 depending on the care required. There is also an additional weekly top up fee of £10 for all people using the service. People will pay additional costs for optional extras such as hairdressing and private chiropody. A full list of the above costs and fee structures is available from the home on request. DS0000000951.V346609.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit was carried out with the manager, staff and people using the service of Saltshouse Haven. The visit took place over 2 days and included a tour of the premises, examination of staff and resident files and records relating to the service. Informal chats with a number of residents and staff took place during this visit; their comments have been included in this report. Information was gathered from a number of different sources before the inspector visited the home. Questionnaires were sent out to a selection of relatives, residents and staff and their written response to these was good. The inspector received 6 back from relatives (24 ), 16 from staff (40 ) and 17 from residents (68 ). The manager completed an Annual Quality Assurance Assessment and returned this to the Commission within the given timescale. The views of outside professionals and other visitors to the service have been listened to and analysed as part of the inspection process. In January 2007 a short focused thematic visit took place to assess the quality of information given to people about the care home and whether people experience open and fair conditions of care. The outcomes of this visit were very positive about the service. Since the last key visit in June 2006 the Commission for Social Care Inspection has received two concerns about personal care, food and cleanliness from relatives of people using the service. These were passed onto the manager of the home to investigate and give a response to the person making their concerns known. Some issues were looked at as part of this inspection. Two formal complaints were made to the Commission around care of people living at the home. The manager dealt with one complaint and Hull Social Services dealt with the other: both were investigated thoroughly and feedback given to the complainants, no further action was needed. There have been six safe guarding of adults referrals made since the June 2006 visit, three put forward by the home and three by relatives of people living in the home. Two referrals related to the actions of two specific staff members and four were around poor staff practices in care. The Safeguarding of Adults team from Hull Social Services has investigated five referrals and the home and manager have worked co-operatively with the team to take appropriate action as required. Outcomes of the investigations are that staff training has been revisited and monitored and communication between the staff groups has been improved. One referral is still being investigated at the time of this visit. What the service does well: DS0000000951.V346609.R01.S.doc Version 5.2 Page 6 The home is 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. 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 said that they are made to feel welcome by the people working in the home and that they can visit when they please. The home has an enthusiastic team of people working within the service, who like doing their jobs and learning more about how to do it well. The people working in the home want to make sure that the people who live in the home receive good care. What has improved since the last inspection? What they could do better: DS0000000951.V346609.R01.S.doc Version 5.2 Page 7 People in the home who have dementia, physical disabilities or sensory disabilities must be given a better choice of social activities to keep them happy and able to join in with others. The inspector would like to thank everyone who completed a questionnaire and/or took the time to talk to her during this visit. Your comments and input have been a valuable source of information, which has helped create this 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. DS0000000951.V346609.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000000951.V346609.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, and 6. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wishing to use the service undergo a full needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met by the service. EVIDENCE: People spoken to felt they had been consulted and had input into the decision to come into the home. They received support from their families, friends and Social Services (where applicable) to help them make their choice, and had access to detailed information about the home and its service before making their decision. One person said ‘ I am quite satisfied that the home can meet my needs, the staff are very good and I am settled and happy in my room’. Discussion with staff indicated that they are aware of the process of information giving to prospective users of the service, and they know where the brochure, statement of purpose and service user guide information is within the home. DS0000000951.V346609.R01.S.doc Version 5.2 Page 10 The administrators within the home send out satisfaction questionnaires to people who have recently come into the home and the responses to these show individuals are receiving the necessary information, contracts and assessments required by the Care Standards Act. At the last visit in January 2007 a requirement was made ‘For people admitted through Care Management arrangements the registered person must obtain a summary of the Care Management (health and social services) assessment and a copy of the Care Plan produced for Care Management purposes’. At this visit the evidence showed this has been met. On enquiry to the home, individuals are offered a brochure and are able to visit the home to look around and talk to staff and people already living there, and the manager or her senior nurses will visit individuals in the community to carry out the home’s assessment of need for all people wishing to use the service. Each person has their own individual file and eight of those looked had a need assessment completed by the funding authority or the home (for privately funded individuals) before a placement is offered to the person. The home develops a care plan from the assessments, identifying the individual’s problems, needs and abilities using the information gathered from the person and family. Those individuals referred to Preston lodge for Intermediate Care are assessed in the hospital before coming to the home and the home is provided with a short summary of their needs. On admission to the lodge the Intermediate Care Team send in a team member to assess the person, and produce a full care plan. Those people at the home who receive nursing care have undergone an assessment by a National Health Service registered nurse from the Primary Care Trust, to determine the level of nursing input required by each individual. At the last key visit in June 2006 there were some inconsistencies in care being given that resulted in a requirement being made ‘The registered person must be able to demonstrate the homes capacity to meet the assessed needs of individuals admitted to the home, ensuring that staff individually and collectively have the skills and experience to deliver the services and care that the home offers to provide’. Evidence looked at during this visit indicates the requirement has been met. The staff-training files show that new staff members are given intensive induction and foundation training to meet TOPSS specification, in addition to training around safe working practices. Those from other cultures and/or countries are given support and assistance to improve their written and spoken English if necessary to ensure they can function as effective care staff and team members. Staff training and supervision has been improved and updated since the key visit in June 2006, staff practices are regularly DS0000000951.V346609.R01.S.doc Version 5.2 Page 11 monitored and audited by the Clinical Nurse Supervisor and the lodge managers and the outcomes are fed back to the training department. Information from the files and matrix indicates that the majority of staff are up to date with their basic mandatory safe working practice training, and have access to a range of more specialised subjects that link to the needs of the people living in the home, including wound care, dementia care, stroke awareness, palliative care and personal best. The employment records show that the manager is using a selective approach to recruitment; ensuring new staff have the right skills and attitude to meet the needs of the people using the service. People using the service and their relatives are very pleased with the care and support given by the staff: one person said ‘the staff are excellent and the service very professional’. Survey responses show that the majority of people using the service are confident about the care and satisfied that the individual needs of people are being met. One relative said ‘If I have a problem I speak to the person in charge and they take on board my comments and these are usually acted on’; another person commented that ‘My mother is treated with the utmost respect’. One individual was concerned that ‘my mother has been handed hot drinks by the staff’, however, observation of the units showed that notices are in place reminding staff to ensure people are given fluids at appropriate temperatures and staff were seen to be checking temperatures before offering drinks to individuals. The home employs fifteen staff from overseas including India, Africa, Philippines and Poland. People are able to make a limited choice of staff gender when deciding whom they would like to deliver their care, as the home has six male care staff as well as the 75 female members. The manager said that she would discuss this with people during the assessment process. Information from the Annual Quality Assurance Assessment and discussion with the people living in the home indicates that all of the people are of white/British nationality. The home does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. No changes to standard 6 have taken place since the last visit. Preston Lodge has fifteen intermediate care beds that are constantly in demand and have a regular turnover of people. Average stays on the lodge are two to three weeks and the people referred here receive regular input from the physiotherapist and occupational therapy team. A member of the intermediate care team visits the lodge every day and liaises with the staff about the care and progress being made by the people using the DS0000000951.V346609.R01.S.doc Version 5.2 Page 12 service and each week there is a visit from the GP’s/Consultants involved in the people’s care. Care plans for the intermediate care people are kept in their own bedrooms and those spoken with were aware of the information within them and they are given the opportunity to discuss the content and input to them. Communal facilities remain the same as at the last visit, where the intermediate care people share the same lounge/dining room as the permanent people. DS0000000951.V346609.R01.S.doc Version 5.2 Page 13 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, personal and social care needs of the people using the service are clearly documented and are being met by the service and staff. The medication at the home is well managed promoting good health. EVIDENCE: At the last key visit in June 2006 a requirement was made around the care plans: ‘The residents care plans must be reviewed and updated to reflect the changing needs and current objectives for health and personal care, and actioned’. At this visit it was seen that action has been taken to improve the quality of documentation and the requirement is now met. The home is busy implementing a new format for their care plans called Quest. This has clear sections for different aspects of care and senior staff have already received training and guidance in using this new system. It is hoped that all care plans will be transferred to the Quest format within 30 days of this DS0000000951.V346609.R01.S.doc Version 5.2 Page 14 visit. The clinical nurse supervisor audits the care plans on a 1-2 monthly basis and this has improved the quality of the written work and content of the plans. Individual care plans are in place for all people and the four examined set out the health, personal and social care needs identified for each person. The plans looked at have been evaluated on a monthly basis and any changes to the care being given is documented and implemented by the staff. Risk assessments were seen to cover pressure sores, 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 plan. The funding authorities are carrying 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. At the last key visit in June 2006 a number of requirements were made around standard 8: ‘Care staff must maintain the personal hygiene of each resident by offering regular baths’. ‘The registered person must promote and maintain the resident’s health including those who wish to remain as independent as possible’. ‘Nutritional screening must be undertaken on admission and subsequently on a periodic basis’. At this visit it was seen that action has been taken to address these issues and they are now met. Discussion with people and checks of the care plans showed that individuals are able to have baths and showers on a weekly basis or more often if they wish. Bathing facilities and equipment are varied to offer a range of different baths, showers and hoists to meet the needs of the people using the service. One person said ‘ I am able to choose which member of staff gives me a bath and I like to wait until evening as it is nice to get straight into bed afterwards’. People using the service are encouraged by the staff to retain as much independence as possible, one person commented that they like to take their own medication and staff will check with them if they need a repeat prescription and discuss any issues on a daily basis. Others said they like to take inhalers or nebulisers themselves, and these are all charted onto the medication records and staff monitor that they are taken appropriately. Locked drawers are provided in the bedrooms to keep their medication in. Risk assessments are completed for each individual and their GP’s have given consent for the self-medication. All staff have access to nutritional screening training called MUST, and care plans were seen to have appropriate risk assessments in place. A dietician sees individuals at risk of poor nutrition or fluid intake and appropriate treatment and supplements are recorded in the care plans. Where individuals are using bed rails, a risk assessment is completed and signed by the person DS0000000951.V346609.R01.S.doc Version 5.2 Page 15 or their representative and bumpers are provided to prevent injuries from the rails. At the last key visit in June 2006 there were two requirements made around medication practices: ‘The staff must administer medication at the right time and in accordance to UKCC/NMC guidance’. ‘Accurate records must be kept of all medications received into the home and those administered to the residents’. Checks of the records at this visit showed improvements have been made and only slight inconsistencies in staff practices were noted on two lodges. These requirements are now met. The medication policy for the home says that individuals can self-medicate if they want to and after a risk assessment has been completed and agreed. Checks of the medication records showed that overall these are well maintained and kept up to date, however some staff on two lodges (Sutton and Coniston) are not always following best practice and there are two areas where they could improve their documentation. • It was noted that medication already held in the home when a new medication sheet is started is not added to the supplies on the medication record sheets. This should be done so as to ensure a running total is available at all times and an audit of stock is easy to carry out. • Where staff are hand writing medication onto the sheets (transcribing), they are not following best practice. Staff should include the amounts of medication received or brought forward, and have two staff sign the entry to indicate they have both witnessed that the information on the sheet is correct. Checks of the controlled drugs and register showed that these are up to date, accurate and well managed. The clinical nurse supervisor is auditing the medication records and asking staff to ensure these are up to date and accurate. The two lodges mentioned above were due a check the week of this visit and the inspector is confident that issues are being dealt with immediately and there is no risk to peoples’ health. Recommendations in the last key report of June 2006 asked that: ‘Staff should receive medication training around pain-relief, the types of drug available and how these can be used to meet the needs of the resident’. ‘Staff should receive training in the Disposal of waste medication in respect of the new legislation from the Environmental Health Department’. These recommendations are now met and will be removed from this report. Since the visit in June 2006 the staff have spoken to the pharmacist and Macmillan nurses around medication and pain relief and there have been no further concerns brought to the attention of the inspector. Staff spoken to during this visit are aware of how to dispose of medication, although some DS0000000951.V346609.R01.S.doc Version 5.2 Page 16 lodges did not appear to have disposal kits for controlled drugs. This was discussed with the manager and action to supply these was taken immediately. At the last key visit in June 2006 a requirement was made in regard to standard 10: ‘The registered provider must ensure residents privacy and dignity are respected at all times whilst staff are providing care’. Checks at this visit show that action has been taken to improve staff practices and this requirement is now met. People and relative comments show they are very satisfied with the care and support offered by the staff. Chats with people using the service revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Information from the surveys indicates that people using the service and their relatives feel that overall the home gives the support and care that individuals require. One person said ‘ the staff give my mum the best care they can. They make her feel the lodge is her home. My mum cannot communicate well, but staff are always popping into her room and talking to her. Staff treat people as individuals and are very helpful’. Other people commented that ‘ the staff are there when you need them and are caring, friendly people. The atmosphere on Sutton Lodge is brilliant, warm and caring’, ‘all needs are looked after and the care is spot on’. Relatives commented that they are kept informed of their relative’s wellbeing by the staff; they are regularly consulted (where appropriate) on their care and feel involved in their lives. DS0000000951.V346609.R01.S.doc Version 5.2 Page 17 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with choice and diversity in the meals provided by the home. Individual wishes and needs are catered for and people have the option of when and how they participate in mealtimes. Improvements are needed to the range of activities on offer for people with dementia, physical disabilities and sensory impairment, to ensure they are given the opportunity for stimulation or recreational activities to suit their interests or abilities. EVIDENCE: At the last key visit in June 2006 a recommendation was made: ‘The acting manager should consider how more 1-1 activities could be provided for those residents who remain in their own room through choice or ill health’. It was seen at this visit that this has been acted on, but further work is needed to succeed in this area. The recommendation will remain in this report. DS0000000951.V346609.R01.S.doc Version 5.2 Page 18 Information gathered from the surveys and discussion with nine people indicated that levels of satisfaction with the activity programme and social events provided at the home ranges from ‘very satisfied’ to ‘I would like more activities for the deaf and blind’. The home has dedicated activity co-ordinators who run a planned weekly activity programme in the lounges of the four lodges and currently they are employed for 60 hours a week. People are able to visit the different lodges to participate in a range of group activities, but there is some reluctance from individuals to move off their lodge to access activities elsewhere. Discussion with the people in the home reflected that they have a wide range of interests and likes/dislikes regarding activities and keeping busy. The majority of people have access to a television in their own room and a number of them have radios and music equipment. One lady said ‘I like to do knitting and read my large print books’, and others enjoy meeting up in the lounges for a good chat and a laugh with the staff. One person commented that ‘If I want to join in with the activities the staff keep me informed of what is going on’. The activity co-ordinators told the inspector that they are aware that not everyone wishes to come down to the lounges or indeed are able to due to their medical conditions. This is where some of the people feel dissatisfied because they become bored in their rooms. Since the last visit in June 2006 the activity staff have started to do more 1:1 work with individuals although this is a slow process given the size of the home and the large number of people who live there. Discussion with the manager indicated she is aware of the need to improve the activities for the more disabled individuals in the home and with the opening of Bilton Lodge for dementia clients this becomes more of an issue. The responsible person must ensure that appropriate activities are provided for those people with dementia and those with physical disabilities and sensory impairment so they can enjoy social stimulation and interact with others in the home. Discussion with the people living in the home indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family or staff would take them into the town. Visitors were seen coming and going during the day, staff were observed making them welcome and there clearly was a good relationship between all parties. Relatives and visitors to the home are very positive about the service and the staff. Written and verbal comments given to the inspector showed a high level of satisfaction. Individuals said ‘my wife is well looked after, there is always a warm welcome when you come into the home’ and ‘staff are always on hand if you need anything’. Information about advocacy services is on display in the home and discussion with the manager indicated that no one at the home is currently using an DS0000000951.V346609.R01.S.doc Version 5.2 Page 19 advocacy service, although these have been accessed in the past. Six people spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. People spoken with are satisfied that they can access their personal allowances when needed. All the people spoken with said that the home encouraged them to bring in small items of furniture and personal possessions to decorate their bedrooms. There are regular meetings where the viewpoints and opinions of those living in the home can be expressed and the management team will listen and take action were needed. Visitors said they are kept informed of any important issues affecting their friend/relative and felt that staff did a good job of supporting people to live the lives they choose. At the last key visit in June 2006 a requirement and recommendation were made around standard 15: ‘The registered person must ensure that staff give, read or explain the menu and/or choice of meals available, in a way that suits the capabilities of the resident’. ‘The acting manager should monitor the way in which food is served and delivered to the service users to ensure it meets with the expected standards of the home’. Observation of the lodges and staff practice showed that action has been taken to improve the service and the requirement and recommendation are now met. Observation of the lunchtime meal over the two days of this visit showed that the majority of people enjoyed the meals they were offered. Three individuals said ‘we get lots of choice and the food looks and tastes good’, another individual told the inspector that ‘I don’t always like the food, but that is just my preferences and me. I have travelled a lot and like spicy meals, but this is not suitable for everyone’. The chef spoke with the inspector and said his team have worked really hard to improve the quality of food on offer and that sometimes he got frustrated when staff on the lodges did not offer people different alternatives or tell them what was available on a day to day basis. One person told the inspector that she had asked for a meeting to discuss the food in the home and this had taken place. Individuals were welcome to talk about any problems they had and the manager and chef listened to these and took immediate action to resolve the issues. Menus were seen on every dining table and clearly indicated the choice of foods available every day if people did not like the main meals on offer. The home has introduced a ‘tuck box’ onto every lodge, which gives people a range of snacks and drinks 24 hours a day. Observation of the midday meal showed it to be well prepared and presented, and the kitchen staff had made an effort to provide soft/pureed diets in an attractive way. Staff were organised when serving the meal and a number of individuals were seen to offer assistance to people who need help with eating and drinking. DS0000000951.V346609.R01.S.doc Version 5.2 Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system with some evidence that peoples’ views are listened to and acted upon. Staff have good knowledge and understanding of Safeguarding of Adults policies and procedures, which protects people from abuse. EVIDENCE: At the last key visit in June 2006 two recommendations were made for standard 16: ‘The acting manager should ensure that staff are more proactive in telling people using the service how they can make their views and opinions known using the complaints process’. ‘The acting manager should take action to promote confidence in the complaints system and be proactive about listening to and discussing issues with the staff and residents’. In response to these recommendations the manager sent people a letter explaining the complaints process and encouraging individuals to ask staff if they had any issues. The survey responses show a big improvement in people’s awareness of the complaints procedure and demonstrate that individuals are confident of using this if needed. Only three out of the twenty-two respondents were a little unsure of the process, others said ‘It has never been necessary to use this as the care is excellent’, ‘ I have raised concerns and these issues were acted on there and then’. DS0000000951.V346609.R01.S.doc Version 5.2 Page 21 Staff are more conscious of the correct procedure to follow and know how to access complaint forms and who to give the information to for action to be taken. Since the last key visit the inspector has received two concerns and two complaints from people using the service. These have 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. At the last key visit in June 2006 a requirement was made around standard 18: ‘The acting manager must follow the guidance in the Protection of Vulnerable Adults Handbook regarding the reporting and investigation of suspicions or evidence of abuse to ensure the safety and protection of residents is maintained’. Evidence collected by the inspector since the key visit indicates the requirement is now met. There have been six safeguarding of adults referrals made since the June 2006 visit, three put forward by the home and three by relatives of people living in the home. Two referrals related to the actions of two specific staff members and four were around poor staff practices in care. The Safeguarding of Adults team from Hull Social Services has investigated five referrals and the home and manager have worked co-operatively with the team to take appropriate action as required. Outcomes of the investigations have been that staff training has been revisited and monitored and communication between the staff groups has been improved. One referral is still being investigated at the time of this visit. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of people’s money and financial affairs. The staff on duty displayed a good understanding of the safeguarding of adults procedure. They are confident about reporting any concerns and certain that any allegations would be followed up promptly and the correct action taken. Information in the staff training files showed that the majority have received Safeguarding of Adults training in the past twelve months, and this training is part of the rolling programme of staff development. DS0000000951.V346609.R01.S.doc Version 5.2 Page 22 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, 20, 21, 22 and 26. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of environment within the home is good, providing people with a comfortable and homely place to live. EVIDENCE: The inspector walked around the building and found it satisfactory and suitable to meet the needs of the people using the service. The home has an ongoing maintenance and refurbishment programme and the manager was able to show the inspector work that has been completed since the last visit in January 2007 and discuss work that is planned for this year. The home comprises of four lodges offering accommodation to people needing care DS0000000951.V346609.R01.S.doc Version 5.2 Page 23 Meaux Lodge is a residential unit and in the last key inspection report (June 2006) the lodge manager had said that new carpets for the lounge/dining room were due to be fitted. At this visit it was clear that this has not taken place as the carpet remains stained and dirty despite regular cleaning. The responsible person should make sure this carpet is replaced as soon as possible as it pulls down the overall appearance of the lodge and odours are noticeable in this area. Comments from the surveys indicate that staff are having some difficulties in giving good care to people who are bed bound on this unit. The beds available are fixed height and pushed against the walls of the bedrooms. Staff are having to bend, pull and push during care giving and this could result in health and safety risks to the staff. 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. Preston Lodge was seen to be clean and tidy, no odours were noted and discussion with the people living there indicated they were very satisfied with the cleanliness of the home. Information provided by the manager shows that there are plans to refurbish 13 bedrooms with new furniture, curtains, flooring and decoration within the next six months. Sutton Lodge was clean and tidy, equipment is working well and only two people were in bed. One individual spoken to said she was extremely comfortable and staff took good care of her. Rooms have been redecorated on this unit and the environment was warm and welcoming. Coniston Lodge has had repairs to its shower room flooring as identified in the last key report, and this is in full working order. There have been no changes to standard 20 since the last inspection. The recommendation made in the last key report (June 2006) ‘Where intermediate care is provided, dedicated space should be made available for this service group’ will remain in this report. Each lodge has a large lounge/dining room for people to sit in and enjoy the company of others at the home. These facilities are provided with wide screen televisions, music centres and comfortable furnishings. People on intermediate care placements (Preston Lodge) do not have any dedicated communal space provided for their service group, although the lodge managers have altered the seating areas in the main lounge to create a more relaxing and welcoming atmosphere. DS0000000951.V346609.R01.S.doc Version 5.2 Page 24 The recommendation made in the last key report (June 2006) ‘The acting manager should assess if moving and handling equipment is being used efficiently and if there is a need for further provision’ has been met. Inspection of the home showed that it has been designed and built to meet the needs of disabled individuals. Wide doorways are in place to bedrooms and toilet/bathing facilities. Corridors are spacious and have enough room for two people in wheelchairs or with walking frames to pass comfortably. The home is built on one level with flat walkways inside and out, providing safe and secure footing for people with limited mobility. Discussion with the staff indicates that there is a wide range of equipment provided to help with the moving and handling of people and to encourage their independence on the lodges. This includes mobile hoists, stand aids, slide sheets, turntables, moving belts and handrails. Discussion with the manager indicated two new hoists are on order for Meaux and Coniston Lodges to assist staff in giving more efficient care to the people who need assistance with mobilising. Bathrooms are fitted with rise and fall baths or fixed hoists and shower rooms are designed for disabled access. Specialist nursing beds and hospital beds are provided where people have an assessed need, and these aid staff in caring for these people and make life more comfortable for individuals who spend a lot of time in bed. Pressure relieving mattresses and cushions are provided by the community services and the home, where people are deemed at risk of developing pressure sores. In the last key report (June 2006) a requirement was made for standard 22: ‘The home must ensure that all call bells and cables used within the home are fit for purpose and do not expose any resident to risk of harm’. Discussion with the manager and people living in the home indicates that were needed new cables have been supplied and staff act quickly to repair any faults. This requirement has now been met. Overall the environment is clean, warm and comfortable with few malodours present. Comments from the surveys indicates that the people using the service find the home to be clean and hygienic and are satisfied with the laundry service provided by the home. DS0000000951.V346609.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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standards of recruitment, induction and training of staff are good with appropriate employment checks being carried out and staff demonstrating a clear understanding of their roles, ensuring that people are protected from risk and looked after by motivated and knowledgeable people. EVIDENCE: In the last key report (June 2006) a requirement was made for standard 27 ‘The acting manager must ensure that the staffing numbers and skill mix of qualified/unqualified staff are appropriate to the assessed needs of the residents, the size, layout and purpose of each lodge, at all times’. Evidence gathered during this visit indicates this is met. Comments from the people using the service and relatives are on the whole very positive about the staffing levels within the home, and individuals feel that there is a good standard of care being given to the people living in the home. Survey responses said ‘the staff are warm, welcoming and friendly’. Staff surveyed said they felt there was a need for more staff on each shift, but observation of the lodges during this visit showed them to be calm, quiet and well run. Discussion with the lodge managers and senior staff indicated that DS0000000951.V346609.R01.S.doc Version 5.2 Page 26 there remains a need for the majority of staff to manage their time better, to ensure jobs are done effectively and efficiently. There has been training done in this area of practice since the last visit, but more is required and the training officer is aware of this. The home has created a clinical nurse supervisor post since the last key visit in June 2006, this person is trying to improve communication between the staff groups and her hard work is paying off as staff are talking more to each other and ensuring the right people get the right information to make sure the home runs smoothly. One area of concern raised by staff and residents is the fact that Meaux lodge only has two people on duty at night. The majority of people needing assistance through the night require 2 care staff for most tasks, this leaves the rest of the lodge without cover. The manager said she is aware of the problems and would look at what could be done to improve staff cover. Information from the Annual Quality Assurance Assessment about the number of staffing hours provided, and information gathered during the inspection about the dependency levels of the people using the home, was used with the Residential Staffing Forum Guidance and showed that the home is meeting the recommended guidelines. Checks of the staffing rotas and observation of the lodges showed that the home employs an adequate ratio of male to female staff and a number of staff are from different countries and cultures. Discussion with the people using the service indicates that they have no difficulties communicating with the staff and that they can express their preferences of staff gender for individuals giving their personal care. There were four recommendations made for standard 30 in the last key report: ‘Staff should receive training around equality, diversity and disability rights and this should be included in the rolling programme of staff training and development’. ‘The home should consider utilising the knowledge and skills of the staff from different countries to promote cultural awareness amongst the staff and residents’. ‘Staff should receive training and supervision around customer care, communication with others, handling of complaints and use of the BUPA systems. Their performance at work should be monitored and reviewed on a regular basis’. ‘Staff should receive training and guidance around effective time management and efficient use of the workforce’. Evidence gathered throughout this visit indicates these have now been met. The home has its own training officer who is responsible for ensuring that all new staff complete a comprehensive induction and foundation-training programme, when they first start at the home. The staff-training programme offers staff access to mandatory training and a wide range of specialist subjects linked to the needs of the people using the service, including DS0000000951.V346609.R01.S.doc Version 5.2 Page 27 customer care (personal best), pressure care, care planning, dementia, safeguarding of adults and challenging behaviour. Over 50 of the care staff have achieved a NVQ 2 or 3 and there are eight staff going through this training at the moment. Staff are accessing equality and diversity training through the Hull Council training programme and overall the staff feel more positive about their roles and responsibilities. The clinical nurse supervisor and the lodge managers are auditing and monitoring the effectiveness of the training and feeding back their observations to staff during supervision and the training officer at regular meetings. This was the weak link in the training programme that was highlighted in the last key report and it is good to see the progress being made. The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of four staff files showed that police (CRB) checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Nurses at the home undergo regular registration audits with the Nursing and Midwifery Council to ensure they are able to practice. DS0000000951.V346609.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, 37 and 38. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is satisfactory overall and the home reviews aspects of its performance through a programme of audits and consultations, which includes seeking the views of people using the service, staff and relatives. EVIDENCE: Kath Carroll has been successful in her application to the Commission for Social Care Inspection to be registered as the manager for Saltshouse Haven. The requirement for Standard 31 in the last key report has been met. Kath is a qualified nurse with an active registration with the Nursing and Midwifery Council. She completed the Registered Managers Award in 2005 and has DS0000000951.V346609.R01.S.doc Version 5.2 Page 29 sufficient experience in a wide range of care settings to ensure that she can offer support and guidance to the staff at Saltshouse Haven. A recommendation was made for standard 33 in the last key report (June 2006): ‘The acting manager should actively promote an open culture where views and opinions are taken seriously. Action must be taken against those who harass those speaking out, so individuals feel confident and safe about expressing ideas and concerns’. Evidence gathered throughout this visit and documented in this report shows this recommendation has been met. 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 manager and the clinical nurse supervisor is responsible for completing monthly audits of staff practice and records within the home and the registered individual does spot checks and completes the regulation 26 visits. Meetings for the staff and people living in the home are taking place; minutes are kept and are available for any interested parties to read. Policies and procedures are up dated and reviewed as an ongoing practice and action is being taken to ensure the requirements of the inspection reports are met. Feedback is sought from the people using the service and relatives through regular meetings and satisfaction questionnaires, and the home publishes the results of the satisfaction survey results received from these individuals; this report is available to read in the administration/reception area of the home. Checks of the finance systems within the home found that accurate records are kept and the administrator, on a daily basis, up dates these. Discussion with the administrator indicates that no personal allowances are kept in the home and that families are responsible for managing their relative’s finances. The home bills each family for any monies needed to pay for hairdressing or chiropody. A few individuals do not have any family and they are unable to manage their own finances. Their money is paid into a separate account in the homes name, and the administrator will access funds for these individuals as requested. Each person receives interest from the account according to the amount of money each of them has in the bank. Receipts for all transactions are kept in the individual person’s file. A requirement was made in the last key report (June 2006) for standard 36 ‘Care staff must receive formal supervision at least six times a year, which covers all aspects of practice, the philosophy of the home and the career development needs of the individual’. Checks of the supervision records showed that this has been met. DS0000000951.V346609.R01.S.doc Version 5.2 Page 30 Individuals receive regular supervision, both formal and informal from their lodge managers. Staff said this aspect of support is useful and offers them an opportunity to discuss their views and get feedback on their performance. Yearly appraisals are completed and staff receive advice and constructive criticism on their work performance. A requirement was made in the last key report (June 2006) about standard 37 ‘The Registered person must ensure that the home maintains in respect of each resident a record, which includes the information, documents and other records specified in Schedule 3 relating to the resident’. Evidence gathered throughout this visit and documented in this report shows that care plans and medication records have improved and this requirement is now met. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff have received training in safe working practices or are due to attend later in the year, and the manager has completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding fire, moving and handling, bed rails and daily activities of living. DS0000000951.V346609.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 3 X 3 3 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 3 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 3 3 DS0000000951.V346609.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP12 Regulation 16(2)(m) (n) Requirement The responsible person must ensure that appropriate activities are provided for those people with dementia, physical disabilities and sensory impairment so they can enjoy social stimulation and interact with others in the home. Timescale for action 01/11/07 DS0000000951.V346609.R01.S.doc Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations The manager should make sure that where staff are hand writing medication onto the sheets (transcribing), they include the amounts of medication received or brought forward, and have two staff sign the entry to indicate they have both witnessed that the information on the sheet is correct. Staff should ensure that medication already held in the home when a new medication sheet is started is added to the supplies on the medication record sheets. This should be done so as to ensure a running total is available at all times and an audit of stock is easy to carry out.3. The manager should consider how more 1-1 activities could be provided for those people who remain in their own room through choice or ill health. The responsible person should make sure the carpet on Meaux Lodge is replaced as soon as possible as it pulls down the overall appearance of the lodge and odours are noticeable in this area. Where intermediate care is provided, dedicated space should be made available for this service group. The manager should consider what can be done to improve night staff cover for Meaux Lodge. 2. OP9 3. 4. OP12 OP19 5. 6. OP20 OP27 DS0000000951.V346609.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 DS0000000951.V346609.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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