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Inspection on 20/07/06 for Saltshouse Haven Nursing And Residential Home

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

This inspection was carried out on 20th July 2006.

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

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

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

Residents are provided with a warm, safe and comfortable environment that welcomes visitors and makes them feel at home. The home is clean and staff work hard to make sure the building is odour free. The home is welcoming and has a relaxed atmosphere. Residents said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. Residents have good access to professional medical staff and are able to access external services such as dentists and opticians.

What has improved since the last inspection?

Hygiene and infection control practices at the home have improved and staff showed a good awareness of their role and responsibilities around this area of care. The above area of practice was a requirement in the last inspection report, and now meets the standards.

What the care home could do better:

Concerns around staff care and conduct were received from relatives, residents and staff. As a result staff attitudes and competencies have been questioned during this inspection. Although most of the residents are happy with the care there is evidence that staff are not consistent in their approach to work, and there were a number of staff practices identified that could be detrimental to the health, safety and welfare of the residents. Care plans must be improved to clearly document where a resident`s health is deteriorating, and reflect the updated care and medical input required to meet their changing needs; making sure the resident receives the appropriate treatment and care in a way acceptable to them. Staff need to regularly assess that the personal and health care needs of the residents are being met with regard to adequate bathing being offered, carrying out nutritional assessments on admission and monitoring of diabetic care, to ensure the health, safety and welfare of residents is maintained. Staff practices regarding medication record keeping and administration are not safe and could place residents at risk of harm. Requirements and recommendations have been made to improve staff training and knowledge. Residents have asked for a wider range of activities both within and outside of the home. Staff also say they would like the opportunity to spend more time with the residents. Some individuals living and working at the home are not confident about using the complaints system, fearing reprisals from others if they make their views and opinions known. Recommendations have been made for the acting manager to take action to promote confidence in the complaints system and be proactive about listening to and discussing issues with the staff and residents. Supervision of staff has lapsed and needs to be restarted to ensure that the quality and continuity of care is maintained and the health, safety and welfare of the residents is promoted and safeguarded.

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 20th July 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.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.V301332.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 (CFH Care) Limited Position Vacant 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), Terminally ill over 65 years of age (150) Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.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. 6th December 2005 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. In total, one hundred and fifty places are available, but at present Bilton Lodge is closed and not operational. All Lodges that accommodate service users 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 acting 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;£327.50 for personal care/accommodation, £368.50 for young physical disabled (YPD) residential care and £439.00 for private paying residential care individuals. There is an additional weekly “top up” fee of £10.00 for all residential care clients. Weekly fees for Nursing care including accommodation are as follows; Nursing medium band is £410.50, Nursing High Band £460.50, Private paying Nursing clients £500.00, YPD Nursing Medium band £451.50, YPD Nursing High Band £501.50, Intermediate Care £427.45, Continuing Health £460.50. There is also an additional weekly “top up” fee of £10 for all nursing care residents. Residents 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 Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.R01.S.doc Version 5.2 Page 5 from the home on request. Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The acting manager was away on annual leave at the time of this visit so the unannounced inspection was carried out with assistance from Chris Brown (a BUPA home manager from Leeds), Sheila Smith the senior nurse on duty, and staff, relatives and residents of Saltshouse Haven. The inspection took place over 2 days and included a tour of the premises, examination of staff and resident files and records relating to the service. Nine staff members, five visitors and sixteen of the residents were spoken to; 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 and residents and their written response to these was good. The staff response to the questionnaires was poor and the reasons for this were looked at during the inspection. The inspector received 16 back from relatives (52 ), 4 from staff (15 ) and 31 from residents (50 ). The owner of the home completed a pre-inspection questionnaire and returned this to the Commission within the given timescale. Since the last inspection (December 2005) the Commission has received one formal complaint and two expressions of concern about care given at the home. The inspector investigated the formal complaint and a number of requirements and recommendations around care practice, documentation, staff training and staffing levels were made. Checks at this visit show the home has worked towards meeting these requirements. The Social Service Team for Hull City Council dealt with the two concerns, the team carried out investigations and the concerns were resolved successfully. What the service does well: Residents are provided with a warm, safe and comfortable environment that welcomes visitors and makes them feel at home. The home is clean and staff work hard to make sure the building is odour free. The home is welcoming and has a relaxed atmosphere. Residents said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. Residents have good access to professional medical staff and are able to access external services such as dentists and opticians. Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Concerns around staff care and conduct were received from relatives, residents and staff. As a result staff attitudes and competencies have been questioned during this inspection. Although most of the residents are happy with the care there is evidence that staff are not consistent in their approach to work, and there were a number of staff practices identified that could be detrimental to the health, safety and welfare of the residents. Care plans must be improved to clearly document where a resident’s health is deteriorating, and reflect the updated care and medical input required to meet their changing needs; making sure the resident receives the appropriate treatment and care in a way acceptable to them. Staff need to regularly assess that the personal and health care needs of the residents are being met with regard to adequate bathing being offered, carrying out nutritional assessments on admission and monitoring of diabetic care, to ensure the health, safety and welfare of residents is maintained. Staff practices regarding medication record keeping and administration are not safe and could place residents at risk of harm. Requirements and recommendations have been made to improve staff training and knowledge. Residents have asked for a wider range of activities both within and outside of the home. Staff also say they would like the opportunity to spend more time with the residents. Some individuals living and working at the home are not confident about using the complaints system, fearing reprisals from others if they make their views and opinions known. Recommendations have been made for the acting manager to take action to promote confidence in the complaints system and be proactive about listening to and discussing issues with the staff and residents. Supervision of staff has lapsed and needs to be restarted to ensure that the quality and continuity of care is maintained and the health, safety and welfare of the residents is promoted and safeguarded. Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.R01.S.doc Version 5.2 Page 8 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. Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4, 6. Quality in this outcome area is adequate. All residents undergo a full needs assessment and are given sufficient information about the home and its facilities prior to admission, however poor arrangements around the support, guidance and supervision of staff means that residents do not receive consistent care and are potentially at risk of not having their needs met. EVIDENCE: Each resident has their own individual file and all twelve of those looked at had a full needs assessment completed within them. The information from the assessment process is used to formulate the individuals care plan. Discussion with the senior nurse indicated that she and the acting manager are responsible for undertaking assessments for the home, when prospective residents are referred for placement. 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 resident, and produce a full care plan. Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.R01.S.doc Version 5.2 Page 11 Seven residents from the four lodges were able to give the inspector detailed information about their care needs and the input they required from the staff, service and outside professionals, and this was found to be accurately documented within their care plans. Those residents 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. One aspect of the complaint dealt with by the Commission in January 2006 was with regard to staff not taking the dependency levels of prospective residents into account when accepting them for placement. Where residents needed more that two staff to help them with daily living tasks, they had to wait a long time for assistance. Discussion with the senior nurse indicates that staff are now more aware of the assessment process and recognise they must balance the dependency needs of individual against the availability and levels of staff on the lodges. Residents spoken to on Meaux and Preston lodges are satisfied with the assessment/admission process, and comments from the survey results indicate that the home provides a good level of information to individuals before they are given a placement. Information from the Pre-Inspection Questionnaire completed by the acting manager and discussion with the residents, indicates that the majority of residents are white, British and those from other countries have adopted British culture and ethnicity. Discussion with the residents and checks of the care plans indicated that their diverse needs regarding communication, diets and religion are being met. There is a mixture of experienced and inexperienced staff at the home, which is leading to some inconsistencies in care. Comments from the resident and relative surveys indicate there is some dissatisfaction with the quality of the care being given and one individual said ‘staff attitudes are poor, which affects the standard of care being given’. 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, but feedback from the lodges, to the training officer, around how effective the training has been is poor and highlights the need to develop better and more efficient communication within the staff team. Discussion with the lodge managers and checks on the staff development files, kept on the lodges, indicates that staff support and guidance through supervision is not always taking place. It is important that this aspect of practice improves to become more regular and structured, ensuring staff Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.R01.S.doc Version 5.2 Page 12 develop the necessary skills and knowledge to enable them to meet the needs of the residents in full, and to a high standard. 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 residents. Average stays on the lodge are two to three weeks and residents 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 residents and each week there is a visit from the GP’s/Consultants involved in the residents’ care. One resident spoken to, who is in the home on respite for three weeks, said ‘the nurses are wonderful and kind, the food is excellent and the care is first class’. Care plans for the intermediate care residents are kept in their own bedrooms and those spoken to 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 residents share the same lounge/dining room as the permanent residents. Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is adequate. The systems for care planning and medication must be improved as they contain practices that could potentially place the residents’ health and safety at risk. EVIDENCE: Since the last inspection there has been an additional visit to investigate a complaint about resident’s care. As a result of this the inspector made a number of requirements around documentation of care and accurate record keeping. Staff are able to access training around effective record keeping practices, and the inspector noticed some improvement in the way staff are writing and documenting the care being given. Examination of a selection of care plans indicates that these are being completed to a higher standard than at the last inspection. Individual care plans are in place for all residents and the twelve 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 risk assessments Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.R01.S.doc Version 5.2 Page 14 were seen to cover pressure sores, nutrition, moving/handling and activities of daily living. Information about the resident’s social interests, likes and dislikes, spiritual needs and wishes regarding death and dying are all included within the individuals care plan. Individual choices and decisions about how care is to be given is documented and for five individuals is very specific and detailed so staff can provide continuous care to meet their needs. A number of residents are using a type of chair that reduces their chances of falling/sliding out, and also prevents them moving independently. The individuals concerned have a risk assessment in their plan to indicate the reason for using this form of restraint and this has been discussed and agreed by them or their representative. Comments from three residents on Meaux lodge indicated that there are some issues around bathing, with staff forgetting to give residents baths even after asking individuals to get ready. Checks of the care plans showed that individuals are only getting a general bath every 1 to 2 weeks, which is not acceptable. This was discussed with the lodge manager and she assured the inspector that staff would be spoken to and improvements made. One resident on Meaux lodge discussed their diabetic condition with the inspector, and it became clear from checks of their diabetic records that there was some instability in their diabetes, which the staff had not recognised and taken action about. Concerns around the individual’s health were discussed with the lodge manager and a compromise was reached with the resident between respecting the individual’s independence and monitoring of their condition. One resident whose care was looked at by the inspector has deteriorating health needs and these were discussed with the lodge manager. Checks of their care plan showed the staff are not documenting the changes to this individuals care needs, which could compromise their health and welfare. The lodge manager assured the inspector that the care plan would be brought up to date. The family of one resident on Preston lodge were visiting at the time of the visit and expressed some concerns about the care their relative was receiving. This individual has some dietary problems and was not able to eat a number of items provided on the daily menu. Checks of the individual’s care plan showed that nutrition and dietary needs had not been discussed and documented (on his admission) by the Intermediate Care team and subsequently not picked up by the staff on the lodge. The inspector discussed the issue with the lodge manager and by the next day of the inspection the home had acquired a list of his likes/dislikes and had notified the kitchens. In discussion the following day, he said that he had enjoyed his breakfast and felt satisfied that he could talk to the staff if he had any further problems. Responses to the surveys indicated that the majority of residents and relatives are satisfied with the level of medical support given to the people living at the home. Seven individuals said they had good access to their own GP, district nurses, chiropodist, optician and dentists. Those individuals on the Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.R01.S.doc Version 5.2 Page 15 Intermediate Care lodge have access to physiotherapists and occupational therapists. They all attend outpatient appointments at the hospital and records show that they have an escort from the home if wished. Documentation of the wound care being given in the home shows that staff are making good progress in healing wounds and staff spoken to said they had good links with the tissue viability nurse for advice when needed. The Commission has received one complaint and two expressions of concern (since December 2005) around the care and service provided at the home. Investigations by the inspector and the Social Service Team have been carried out, and where recommendations to changes in practice where made, these have been acted on by the management team. 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. Ten of the residents spoken to prefer to have staff administer their medication and two individuals like to take their own medicine. This self-medication is accurately recorded and monitored by the staff. Checks of the medication records and the system used showed that documentation in these could be improved. The four lodges’ medication records had a few missing signatures, where staff have administered the medication but forgotten to sign on the sheet. Where staff are hand writing medication onto the sheets (transcribing), they are not following best practice. Staff must 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 must ensure that all medication received from the pharmacy is documented onto the MAR charts. The inspector observed one person administering medication in an unsafe manner, it was seen that the medication chart had been signed prior to the drug round and the staff member was giving out medication, without checking the medication record. This is not acceptable practice and was raised as an area of concern with the person in charge of the lodge, who assured the inspector that the individual would be spoken to and this practice stopped. Discussion with one resident about their pain relief and the way it is given showed that there may be some lack of staff knowledge around the way that different pain killers can be used together to relieve different types of pain. Checks of the individual’s care plan showed that staff are omitting some of the residents pain relieving drugs because they had renewed the individual’s controlled drug patch. The resident also said that he/she was reluctant to ask for prescribed ‘break-through’ pain relief outside of the set medication rounds as there was not always two senior staff on duty to administer it. This meant there was a delay in the individual getting their medication and involved another member of staff being brought across from another lodge. These concerns were brought to the attention of Chris Brown (BUPA home manager), who said she would take action to ensure staff improved their practice. Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.R01.S.doc Version 5.2 Page 16 Discussion with the person in charge on each lodge and some of the staff who administer medication, indicated that not everyone is sure about the new system for disposing of waste medicines. The inspector spoke to Chris Brown about this and recommended that staff are given training on how to use the system safely and comply with legal requirements. Looking at the information gathered before and during the inspection, the inspector noticed that there are some differences in the levels of satisfaction with the care provided in the home. All the residents spoken to felt that staff were meeting their personal needs most of the time, but said that ‘the level of care being given can be up and down’. Three residents said that ‘care at the home is generally good, but the way it is given can depend on how the staff are feeling when they come to work’. Where residents are fairly independent there is a good level of satisfaction with the care being given, but when individuals are dependent on staff to assist them with the majority of daily living tasks this level of satisfaction reduces. One individual who has restricted movement due to their disability said ‘ the staff are very friendly and kind, but I find I have to wait a long time for them to come to see me and this makes life very difficult on occasion’. One relative wrote that ‘I am not always consulted on the care of my relative and as they cannot speak up for themselves I feel this is an important issue’. Discussion with three relatives and four residents 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. Individuals said that ‘the care is ‘excellent’ and ‘the staff are very caring and supportive’. Two residents said that staff did not listen to them and were slow to respond to calls for help; one person wrote that ‘staff turn a deaf ear to residents requests’. Three other residents said that staff are always around to offer care and support where needed and response times to the buzzers was quick and efficient. Chris Brown told the inspector that the management team at the home were aware of the inconsistencies of residents feelings about the service at the home and were looking at different ways the issues raised could be monitored; improved and resolved. Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is adequate. Residents are provided with choice and diversity in the meals and activities provided by the home. Individual wishes and needs are catered for and people have the option of where, when and how they participate in both eating and leisure activities. EVIDENCE: Information gathered from the surveys and discussion with twelve residents indicated that levels of satisfaction with the activity programme and social events provided at the home ranges from ‘very satisfied to there is nothing to interest me’. The home has dedicated activity co-ordinators who run a planned weekly activity programme in the lounges of the four lodges. Residents are able to visit the different lodges to participate in a range of group activities. Discussion with the residents reflected that they have a wide range of interests and likes/dislikes regarding activities and keeping busy. The majority of residents 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 word searches and read the newspaper’, and another likes to go for walks out in the grounds of the home. One individual had attended a musical activity on another lodge the day before the visit, she said ‘it was wonderful and I thoroughly enjoyed myself’. Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.R01.S.doc Version 5.2 Page 18 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 residents feel dissatisfied because they become bored in their rooms. Attempts are being made to take some people out into the community and during the inspection a number of residents were seen out in the gardens and grounds enjoying the sunshine. Discussion with Chris Brown indicated that the acting manager is aware of the need to introduce more 1-1 activities for those who do not leave their rooms, and ways in which this could be achieved within the economic and staffing limits of the home are being explored. There were a number of visitors to the home during the two days of inspection and one individual said ‘ the staff are very welcoming and look after my relative very well’. Open visiting hours at the home enable individuals to come at times suitable for the residents and which fit into their own busy work schedules. Information from the residents’ files indicates that there are a number of individuals who follow different spiritual faiths, including Methodist, Catholic and Church of England. The lodge managers said that there are regular church services within the home and the catholic priest visits weekly to give communion to those who want to partake. Seven residents 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. The lodge managers said they are aware of the advocacy groups in the community that residents can access, and the contact information is on display within the home. All the residents said that the home encouraged them to bring in small items of furniture and personal possessions to decorate their bedrooms. Discussion with the residents showed that they were aware of their care plans and were able to input to them and access them through their key workers. Comments from the surveys received from staff, residents and relatives indicate that overall there is a good level of satisfaction with the meals provided by the home; although some individuals feel the food could be improved. One individual wrote that ‘the meals are satisfactory although the plates are too small and the food is bland’. Four residents said that they felt the food could be better and one person wrote ‘the menu and soft diets are rubbish, residents do not eat the meals much’. More positive comments were also received saying the meals are ‘ good and different options are offered’, ‘the menus have improved over the past few months and more choices are available’. Observation of the midday meal in the main lounge/dining room of the lodges showed that it was nicely presented, colourful and hot. It was noted that one lodge in particular was disorganised and staff had to return to the kitchen for Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.R01.S.doc Version 5.2 Page 19 forgotten items a number of times before the meal was served. A number of residents commented that food going out to the rooms is cold; small portions and poorly presented. Observation of the mealtime process indicates this may be due to the way the staff are actually serving the meal rather than how it is supplied by the kitchens. Information from the Pre-Inspection Questionnaire, person in charge and menus indicates that residents are able to ask for different options of meals if they do not like the two main meals at lunchtime, they can ask for second helpings of food and the kitchen will do everything it can to meet the dietary needs of the residents so long as chef is made aware of an individuals likes/dislikes. Discussion with the residents and relatives during the visit revealed that not all of them are aware of the options and choices available to them at mealtimes and that staff do not spend much time discussing this aspect of care with them. Chris Brown told the inspector that the acting manager is aware that communication between the staff, residents and kitchen needs to be improved to ensure the dietary needs and choices of the residents are being met. A recommendation made in the additional visit report (January 2006) was that the 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. The comments from the survey respondents and the residents during the inspection indicate that there is still a need to monitor the meal service, and the recommendation will remain in this report. Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is adequate. Improvements must be made to promote the complaints and whistle blowing processes within the home, to increase staff and residents confidence in using the systems and protect residents from potential risk of harm. EVIDENCE: Since the last inspection (December 2005) the Commission has received one formal complaint and two expressions of concern about the care given at the home. The inspector investigated the formal complaint and a number of requirements and recommendations around care practice, documentation, staff training and staffing levels were made. Checks at this inspection show the home has worked towards meeting these requirements. The Social Service Team for Hull City Council dealt with the two concerns, the team carried out investigations and the concerns were resolved successfully. Checks of the complaints record indicate the home has dealt with eleven complaints since the last inspection, details of the actions taken and responses to the complainants were seen. The home has produced a complaints process that is easy for residents to read and understand. This includes complaints leaflets on each lodge and forms for individuals to complete. The policy is on display within the home. Survey responses show that there are a number of individuals (relatives and residents) who remain unaware of how to use the complaints system or that it is in place. Staff need to be more proactive about telling people using the Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.R01.S.doc Version 5.2 Page 21 service how they can make their views and opinions known to the management team. During the visit it became apparent that some individuals were hesitant to speak up to the people in charge if they had any issues with the home or staff. Two residents said that ‘ I am worried about reprisals; when I spoke out before I was told off for making things difficult for the staff’. Staff members commented that the poor response to the surveys was due to fear that their views would be made known to the rest of the staff and there would be repercussions in their working lives. Overall the comments received indicate there is a lack of confidence in the management team, around their ability to take effective action to resolve issues and this has resulted in the poor communication of concerns between those living, working and managing the home. 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. There has been one Protection of Vulnerable Adults allegation made at the home since the last inspection. This allegation was reported to the Social Services team responsible for investigation, but the acting manager also commenced her own investigation without giving the team a chance to look at the evidence and involve the Police if appropriate. This is not acceptable practice and the acting manager must read the guidance provided in the Vulnerable adults handbook, which is based on the Government Paper ‘No Secrets’. The allegation is being looked at and the management team have been asked to liaise with the Social Service team and Police regarding the investigation. The staff on duty displayed a good understanding of the vulnerable adults procedure and four residents spoken to said they ‘felt safe at the home’. Staff training files show that Protection of Vulnerable Adults from Abuse training has taken place and is an ongoing process, and information from the staff surveys indicates they are aware of the whistle blowing procedure. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, management of service user monies and finances, physical intervention and restraint. Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 26. Quality in this outcome area is good. The standard of the environment within this home is good, providing residents with an attractive and homely place to live. EVIDENCE: Discussion with the lodge managers indicates that there is an ongoing programme of refurbishment and renewal taking place within the home. Recommendations in the last inspection report (December 05) asked that the carpets on Meaux and Preston Lodges should be cleaned and/or replaced, and the fridge on Meaux servery should be repainted or replaced. The lodge manager for Meaux said that new carpets for the lounge and corridors have been ordered and work is due to start within four weeks to fit these, and should be finished by the end of August 2006. The fridge has been replaced in the servery. Observation of Meaux lodge showed that the environment is basically clean and tidy, although dirty cups from the midmorning tea round were still in the residents rooms at lunchtime and beds were unmade in the rooms looked at by the inspector. Odours were noted in Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.R01.S.doc Version 5.2 Page 23 the entrance area of the lodge and in some of the bedrooms, one room had faeces on the carpet and this was brought to the attention of the lodge manager by the inspector. Domestic staff were seen to be cleaning the bedrooms and they had not yet reached the above mentioned room. Preston lodge was seen to be clean and tidy, no odours were noted and discussion with the residents indicated they were very satisfied with the cleanliness of the home. One individual said ‘the home is kept immaculate and windows are open making the place light, airy and fresh smelling’. Discussion with the lodge manager indicated that a new microwave has been ordered for the servery. The lodge manager for Sutton Lodge said that work was due to start next week on the refurbishment of the bedrooms. Ten rooms have been identified to receive different makeovers including new floors, wardrobes, decoration and furniture. A new smoke room carpet is to be fitted and the corridor walls decorated. It is expected that residents will be temporarily moved into vacant rooms whilst theirs are being decorated. Observation of Coniston lodge indicated that it currently has a problem with the flooring in the shower room. The waterproof strip that covers the walls and floor joints is coming away, despite repeated efforts by the maintenance man to re-glue it. The acting manager should ensure this is repaired as soon as possible, as this is a popular facility with the residents. Woodwork to the corridors and doorframes is showing signs of wheelchair and trolley damage, where these pieces of equipment have hit the wood and removed the paintwork. The acting manager should ensure these are redecorated. There have been no changes to standard 20 since the last inspection. Each lodge has a large lounge/dining room for service users 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. Residents 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. 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 the residents and to encourage their independence on the lodges. This includes mobile hoists, stand aids, slide sheets, turntables, moving belts and handrails. Comments from the staff indicate that they would like to have more stand aids on each lodge, as the demand for their use is higher than the equipment available and results in residents having to wait for attention. The acting manager should Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.R01.S.doc Version 5.2 Page 24 assess if equipment is being used efficiently and if there is a need for further provision. The call bell in room five on Preston lodge is faulty and although an engineer had been out and said it was now working the resident told the inspector that he could not use it. He had to shout to staff for attention and they were also doing regular checks of his room. This was brought to the attention of Chris Brown who assured the inspector that the call bell would be seen to straight away. Overall the environment is clean, warm and comfortable with few malodours present. Comments from the surveys indicates that the residents find the home to be spotlessly clean and are satisfied with the laundry service provided by the home. A recommendation from the last inspection report (December 2005) was that staff attend a refresher or up date course of training around MRSA and care of a resident in the community with this infection. Checks of the staff training files show that this has been carried out and appropriate equipment and hand washing facilities are provided in each person’s bedroom where necessary. Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is adequate. Staff morale is low, resulting in high staff turnover and poor attendance that does not offer consistency of care to the people using the service. EVIDENCE: Feedback from the staff, residents and relatives all mentioned concerns about staffing shortages that are impacting on the care being given in the home. Staff say they feel rushed and under pressure all the time and commented that not all the staff work as a team, which creates problems and an unfair distribution in the workload. Poor communication was also a factor that resulted in everyone feeling frustrated and misunderstood. Comments from the staff indicated that ongoing problems of staff absenteeism are creating unfair pressure on the rest of the staff, and there is a lack of quality time spent with the residents. Some individuals said that ‘ we are getting fed-up of the working conditions and the lazy attitude from other staff’. During the visit it was noted that one lodge in particular was extremely busy during the morning, but that the pace and workload eased during the afternoon. The other three lodges were busy but fairly well organised. Discussion with the lodge managers indicated that there is a need for staff to manage their time and workload more effectively and this is an area of training that they all wanted to take part in. Senior staff felt there are enough staff on duty at the moment, but sickness and absence had a big impact on this, especially when staff do not give the home sufficient notice to get anyone else Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.R01.S.doc Version 5.2 Page 26 in to cover the shift. The acting manager must ensure there is sufficient staff on duty at all times to meet the needs of the residents. Comments from staff and residents on Coniston indicate there are some difficulties in providing a high standard of care to individuals, due to the number of inexperienced staff on the lodge. These staff members need a lot of supervision and the senior staff, required for this task, has been moved to other lodges. Comments from all staff spoken to indicate they would like to see the rotation of staff around the lodges re-introduced, as they felt they gained experience and skills by doing this. The acting manager must assess the skill levels of staff on the units and ensure there is a fair mix for each lodge to provide appropriate care and meet the needs of the residents. Residents said the staff are lovely, but felt that those residents who are more independent faired better than those who needed more assistance as the staff did not have sufficient time to deal with everyone’s needs. Three staff spoken to said that ‘there is a need for more staff on duty so care can be person centred and not task orientated, and sufficient time can be spent with each individual to talk to them and discuss any issues’. The acting manager should discuss the above problems with the staff through supervision and staff meetings. Training issues must be identified and training implemented so all staff have the necessary skills and knowledge to provide care to a high standard, and know how to work effectively and efficiently to meet the needs of the residents and the aims and objectives of the service. Information from the pre-inspection questionnaire about the number of staffing hours provided, and information gathered during the inspection about the dependency levels of the residents, was used with the Residential Staffing Forum Guidance and showed that the home is meeting the recommended guidelines. This indicates that poor time management could be the major factor causing the above problems. Checks of the staffing rotas and observation of the lodges showed that the home employs a good ratio of male to female staff and a number of staff are from different countries and cultures. Discussion with the residents 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. One member of staff from overseas said that they had some difficulty in understanding the Yorkshire accent when they first came to the home, but staff and residents had been patient and they now had a much better grasp of the dialect. Information from the training department at Saltshouse Haven shows that the home employs individuals from Poland, India and South Africa. Discussion with the training officer indicated that where needed these individuals receive Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.R01.S.doc Version 5.2 Page 27 additional help with reading, writing and speaking English as part of their training within the home. There is no evidence that Saltshouse Haven actively promotes cultural awareness within the home and some staff commented that they felt there was a measure of racial discrimination amongst the staff. Comments were made that their religious and cultural needs were not recognised by other staff and that religion, beliefs and practice at staff level are not encouraged and are poorly understood. Other staff commented that ‘the overseas staff were given preferential treatment and had more weekends off than the British staff’. ‘Poor work standards are not acted on by the management team because the staff were from overseas’. Information gathered during the visit shows that there are some mixed feelings amongst the staff that could be resolved by them developing a more tolerant attitude towards each other. The home should consider utilising the knowledge and skills of the staff from different countries to promote cultural awareness amongst the staff and residents. . 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 service users. Over 50 of the care staff have achieved a NVQ 2 or 3 and there are seven staff going through this training at the moment. Staff comments indicated that some individuals find it difficult to obtain a place on the training for specialist subjects, and feel that there is some favouritism shown by the lodge managers as to who gets access. The acting manager should look at this to ensure everyone has an equal chance to participate. Issues were raised during the complaint investigation in January 2006 and in a more recent investigation by the manager (June 2006) into concerns raised by a relative, that staff skills are not to a high enough standard to provide the necessary care required by some of the residents. Discussion with the training officer showed that there is little or no feedback from the lodges around how well a staff member is performing once they have completed their initial training. The lack of a permanent manager within the home over the past year has hampered the ability of the management team to take action where individuals do not meet the required standards. The monitoring of staff skills and knowledge whilst on the lodges is essential and the acting manager must ensure this process is developed and implemented as soon as possible. It was recommended in the additional visit report (January 2006) that ‘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’. Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.R01.S.doc Version 5.2 Page 28 This is still valid based on the information gathered during the visit and will remain a recommendation in this report. The home has a comprehensive recruitment policy and procedure and when five staff files were checked it was evident that the acting manager follows the procedure, and ensures the interview process, police/CRB checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Two staff members whose files were looked at are from another country and have undergone all checks necessary for foreign workers including work permits, passport and immunisation records. Nurses at the home undergo regular registration audits with the Nursing and Midwifery Council to ensure they are able to practice. Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.R01.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37, 38. Quality outcomes in this area are adequate. The appointment of a registered manager for the home is necessary to ensure that the development plan and vision for the home remains on course and these values are effectively communicated to the staff, residents and relatives. EVIDENCE: There is no registered manager at the home and this has been the same for the past year and a half, currently Kath Carroll is the acting manager and has been in post since April 2006. To promote stability within the management team at the home, it is important that the Provider puts forward an application for Registered Manager, to the Commission, as soon as possible. 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. Feedback is sought from the staff, residents and relatives through regular meetings and satisfaction questionnaires. However, information Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.R01.S.doc Version 5.2 Page 30 gathered from individuals during this visit indicates some people are reluctant to speak up at meetings, fearing that they would face reprisals from others for expressing their views. The acting manager should address these fears and 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. The home publishes the results of the satisfaction survey results received from residents and relatives; this report is available to read in the administration/reception area of the home. Policies and procedures are up dated and reviewed as an ongoing practice and action is being taken to ensure the requirements of the previous inspection reports are met. 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 the residents’ finances. The home bills each family for any monies needed to pay for hairdressing or chiropody. Three 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 of the three residents 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 resident’s file. Staff supervision files showed that individuals are not receiving formal supervision sessions with their line managers. There is lack of consistency in the standard of work being provided by the senior and junior care staff that must be addressed through this process. The acting manager must ensure that all staff receive regular formal supervision, which is structured and covers all aspects of practice, philosophy of care in the home and any career or training/development needs of the individual. Checks show that records are generally up to date although some gaps were found in recording such as care planning and medication as discussed in standards 7, 8 and 9. Information from the Pre-Inspection Questionnaire indicates that 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 and the management team has completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding fire, moving and handling, cot sides and daily activities of living. Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.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 2 X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 2 2 3 X X X 3 STAFFING Standard No Score 27 2 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 2 2 3 Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.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 OP4 Regulation 18 Requirement Timescale for action 01/12/06 2. OP6 23 3. OP7 15 4. OP8 12 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. 01/06/07 Where residents are admitted only for intermediate care, dedicated accommodation must be provided, together with specialised facilities and equipment to deliver short-term intensive rehabilitation and enable residents to return home (given timescales of 07/06/04, 01/04/05, 12/09/05 and 01/06/06 were not met). The residents care plans must be 01/12/06 reviewed and updated to reflect the changing needs and current objectives for health and personal care, and actioned. Care staff must maintain the 01/12/06 personal hygiene of each resident by offering regular baths. DS0000000951.V301332.R01.S.doc Version 5.2 Saltshouse Haven Nursing And Residential Home Page 33 5. OP8 12 6. 7. OP8 OP9 14 13 8. OP9 17 9. OP10 12 10. OP15 12 11. OP18 12 12 OP22 23 13. OP27 18 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. The staff must administer medication at the right time and in accordance to UKCC/NMC guidance (given timescale of 01/03/06 was not met). Accurate records must be kept of all medications received into the home and those administered to the residents (given timescale of 01/03/06 was not met). The registered provider must ensure residents privacy and dignity are respected at all times whilst staff are providing care. 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 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. 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 (given timescale of 01/03/06 was not met). 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 DS0000000951.V301332.R01.S.doc 01/12/06 01/12/06 01/12/06 01/12/06 01/12/06 01/12/06 01/12/06 01/12/06 01/12/06 Saltshouse Haven Nursing And Residential Home Version 5.2 Page 34 14. OP31 8 15. OP36 18 16. OP37 17 each lodge, at all times. A manager must be appointed and registered with the Commission (given timescale of 01/04/06 was not met). 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. 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 (given timescale of 01/02/06 was not met). 01/01/07 01/12/06 01/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP9 OP9 OP12 OP15 OP16 Good Practice Recommendations 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. 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. 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. 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 DS0000000951.V301332.R01.S.doc Version 5.2 Page 35 Saltshouse Haven Nursing And Residential Home 6. OP16 7. 8. 9. 10. 11. 12. OP20 OP21 OP22 OP30 OP30 OP30 13. 14. OP30 OP33 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. Where intermediate care is provided, dedicated space should be made available for this service group. Repairs to the shower room on Coniston lodge should be carried out as soon as possible. The acting manager should assess if moving and handling equipment is being used efficiently and if there is a need for further provision. 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. 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. Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Saltshouse Haven Nursing And Residential Home DS0000000951.V301332.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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