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Inspection on 06/12/05 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 6th December 2005.

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

The inspector 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. Residents are kept safe from risk of abuse by the thorough and detailed policies and procedures for staff recruitment, and the high standard of practice from the management team in ensuring they are followed correctly.

What has improved since the last inspection?

Residents have been provided with a new shower room on each unit so they have a choice of bathing facilities to suit their needs.

What the care home could do better:

Medication recording needs to be improved to ensure all signatures are in place for medications received by the staff, so that there is no mishandling of medication and the residents health is looked after. The intermediate care residents do not have dedicated communal space within Preston lodge, so the individuals receiving this type of service tend to stay intheir bedrooms most of the time. This means that some residents could become socially and emotionally isolated during their time at the home. Records must be kept of all visits by healthcare professionals in each individual residents file, detailing any changes to care as a result of the consultation/meeting, to ensure residents health, safety and welfare are protected.

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 Unannounced Inspection 6th December 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Saltshouse Haven Nursing And Residential Home DS0000000951.V263796.R01.S.doc Version 5.0 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.V263796.R01.S.doc Version 5.0 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 BUPA Care Homes 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.V263796.R01.S.doc Version 5.0 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. 15th June 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 located on the outskirts of Hull, close to arterial and ring roads. Car parking is provided and a number of bus routes stop close by. 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, 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. Saltshouse Haven Nursing And Residential Home DS0000000951.V263796.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out with the acting manager, staff and residents of Saltshouse Haven. The inspection took 5 hours and included a tour of the premises, examination of staff and resident files and records relating to the service. Ten residents and two visitors were spoken to during the inspection and their comments and views have been included in this report. There have been three additional visits made to Saltshouse Haven since the last inspection; all three were to investigate complaints made to the Commission about care within the home. The investigating officer found the first two complaints to be unproven, but the third complaint showed some areas of care around recording of meetings with healthcare professionals and infection control practices could be improved. Requirements and recommendations have been made within this report for the registered provider to take action to resolve these issues. What the service does well: What has improved since the last inspection? What they could do better: Medication recording needs to be improved to ensure all signatures are in place for medications received by the staff, so that there is no mishandling of medication and the residents health is looked after. The intermediate care residents do not have dedicated communal space within Preston lodge, so the individuals receiving this type of service tend to stay in Saltshouse Haven Nursing And Residential Home DS0000000951.V263796.R01.S.doc Version 5.0 Page 6 their bedrooms most of the time. This means that some residents could become socially and emotionally isolated during their time at the home. Records must be kept of all visits by healthcare professionals in each individual residents file, detailing any changes to care as a result of the consultation/meeting, to ensure residents health, safety and welfare are protected. 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.V263796.R01.S.doc Version 5.0 Page 7 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.V263796.R01.S.doc Version 5.0 Page 8 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): 6. Residents who are assessed and referred for intermediate care placements on Preston lodge are given good support and assistance from a multi-disciplinary team to maximise their independence and return home. EVIDENCE: No changes to standard 6 have taken place since the last inspection. 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 said that he had been in for four weeks and was hopeful that he would be going home in time for Christmas. This individual said that ‘the staff are very helpful’ and that ‘he could not fault the care being given’. Saltshouse Haven Nursing And Residential Home DS0000000951.V263796.R01.S.doc Version 5.0 Page 9 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 inspection, where the intermediate care residents share the same lounge/dining room as the permanent residents. Saltshouse Haven Nursing And Residential Home DS0000000951.V263796.R01.S.doc Version 5.0 Page 10 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): 9. The system for recording and administration of medications must be improved, as current practices potentially place residents at risk. EVIDENCE: 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. All ten of the residents spoken to prefer to have staff administer their medication. Checks of the medication records and the system used showed that on the whole these are up to date, accurate and well managed. Meaux lodge records had a few missing signatures, where staff have administered the medication but forgotten to sign on the sheet. Coniston lodge records showed that 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. Saltshouse Haven Nursing And Residential Home DS0000000951.V263796.R01.S.doc Version 5.0 Page 11 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): 13 and 14. The home promotes the residents right to exercise choice and control over their lives and offers information and contact details so they or their families can contact external agents, who will act in their interests. EVIDENCE: Two visitors spoken to come to see their relatives on a regular basis and said that ‘the home is lovely and staff make you feel very welcome’. 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. Two visitors said that ‘the staff are very good at keeping us informed about our relatives, letting us know if he/she is unwell or if they need anything bringing in’. One individual said ‘ the staff are very welcoming and include you in all aspects of the residents care. The atmosphere within the building is friendly and makes you feel at home’. Four 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 acting manager said she is 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 Saltshouse Haven Nursing And Residential Home DS0000000951.V263796.R01.S.doc Version 5.0 Page 12 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. Saltshouse Haven Nursing And Residential Home DS0000000951.V263796.R01.S.doc Version 5.0 Page 13 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): The home has a satisfactory complaints system with some evidence that residents’ views are listened to and acted upon. Staff and residents are confident about reporting any concerns and the acting manager acts quickly on any issues raised. EVIDENCE: There have been three additional visits to investigate complaints made to the Commission since the last inspection. Requirements and recommendations have been made in this report in response to the third complaint (see standard 26 and 37). Five internal complaints have documented by the acting manager in the records, three have been investigated by the acting manager and resolved and two are still being looked into. A copy of the complaints policy is displayed on the individual lodge’s notice boards and copies of the complaints form were seen next to the information areas and easily available on each lodge. Five residents showed a clear understanding about how to make their views and opinions heard and said that ‘the staff and the acting manager were quick to take action’ where needed. Saltshouse Haven Nursing And Residential Home DS0000000951.V263796.R01.S.doc Version 5.0 Page 14 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 and 26. Residents are provided with a safe, comfortable and clean environment. They are able to personalise their own rooms, and the provision of door locks means that their personal belongings can be kept secure. EVIDENCE: There have been no changes to standards 19 and 20 since the last inspection. Observation of the premises showed that there are some areas needing attention including a number of the intermediate care bedrooms that have frayed and stained carpets, the smoking-lounge carpet in Meaux lodge is badly burnt and needs replacing, the corridor and dining room carpets on Meaux are stained and need cleaning and the fridge door in the Meaux servery is rusty and needs replacing or repainting. 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 Saltshouse Haven Nursing And Residential Home DS0000000951.V263796.R01.S.doc Version 5.0 Page 15 managers have altered the seating areas in the main lounge to create a more relaxing and welcoming atmosphere. New equipment has been purchased for the lodges since the last inspection including ten ‘air-flow’ pressure mattresses and five profiling beds (a new electric hoist has also been ordered). Residents said that the new beds were comfortable and staff felt that their adjustable heights made care giving easier. One bathroom on each lodge has been converted into a shower room and the staff said the new facilities were popular with the residents and made bathing a more enjoyable experience for those with disabilities. The Methicillin Resistant Staphylococcus Aureus (MRSA) guidance and policies for the home were looked at as part of the investigation into the third complaint received by the Commission. Staff spoken to had a reasonable understanding of how a person with MRSA is care for within the home. During the discussion with the acting manager the inspector suggested that it would be a matter of good practice to ensure all staff had refresher training and updates on MRSA from the Infection Control Team. The home is clean, warm and comfortable and no malodours were present. Domestic staff spoken to said that they ‘follow a deep cleaning rota to ensure that all bedrooms are thoroughly cleaned from top to bottom on a regular basis’. Four residents said they were satisfied with the cleanliness of their rooms and that staff went in daily to make sure all areas were checked and any spillages cleaned up. Saltshouse Haven Nursing And Residential Home DS0000000951.V263796.R01.S.doc Version 5.0 Page 16 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): 29. The standard of vetting and recruitment of staff is very good, with the appropriate checks being carried out, ensuring that residents are kept safe from risk. EVIDENCE: The home has a comprehensive recruitment policy and procedure and when four 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.V263796.R01.S.doc Version 5.0 Page 17 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, 35 and 37. 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. The company has withdrawn one application for registered manager as the individual was promoted within the group and moved to another BUPA home, currently Sheila Smith is the acting manager. To promote stability within the management team at the home, it is important that the Provider puts forward another candidate application for Registered Manager, to the Commission, as soon as possible. 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 acting manager indicates that no personal allowances are kept in the home Saltshouse Haven Nursing And Residential Home DS0000000951.V263796.R01.S.doc Version 5.0 Page 18 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. Receipts for all transactions are kept in the individual resident’s file. As part of the third complaint that the Commission received and investigated, the inspector looked at the communications sheet and professional visitors records of the care plan for one resident. These showed that although the majority of visits from outside professionals are recorded, there are gaps to this information. This is not acceptable practice as changes to treatment may result from these visits, and therefore a lack of recording could mean the care staff does not pick up these changes; which would potentially affect the health and welfare of the resident. Saltshouse Haven Nursing And Residential Home DS0000000951.V263796.R01.S.doc Version 5.0 Page 19 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 X X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 2 3 3 X X X 3 STAFFING Standard No Score 27 X 28 X 29 4 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X X 3 X 2 X Saltshouse Haven Nursing And Residential Home DS0000000951.V263796.R01.S.doc Version 5.0 Page 20 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 OP6 Regulation 23 Requirement Timescale for action 01/06/06 2 OP9 17 3 4 OP31 OP37 8 17, Schedule 3 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 and 12/09/05 were not met). Accurate records must be kept of 01/03/06 all medications received into the home and those administered to the residents. A manager must be appointed 01/04/06 and registered with the Commission. The residents care plan must 01/02/06 include details about any healthcare professionals visit and/or input to the individuals care. Changes to care as a result of these visits must also be recorded. Saltshouse Haven Nursing And Residential Home DS0000000951.V263796.R01.S.doc Version 5.0 Page 21 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 OP19 Good Practice Recommendations Carpets on Preston and Meaux lodges should be cleaned and/or replaced and the fridge on Meaux servery should be repainted or replaced to ensure the health, safety and welfare of the residents is maintained. Where intermediate care is provided, dedicated space should be made available for this service group. As a good practice guideline, staff at the home should attend refresher training and updates around MRSA from the infection control team. 2 3 OP20 OP26 Saltshouse Haven Nursing And Residential Home DS0000000951.V263796.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 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.V263796.R01.S.doc Version 5.0 Page 23 - 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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