Inspection on 15/02/06 for Sandown Nursing Home

This inspection was carried out on 15th February 2006.

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.

Other inspections for this house

Sandown Nursing Home 26/07/07

Sandown Nursing Home 21/11/06

Sandown Nursing Home 11/08/05

Sandown Nursing Home 25/02/05

Sandown Nursing Home 16/08/04

Sandown Nursing Home 16/02/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Sandown Nursing Home 28 Grove Road Sandown Isle Of Wight PO36 9BE Lead Inspector Mark Sims Unannounced Inspection 5th February 2006 11:00 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 Sandown Nursing Home DS0000012565.V250514.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. Sandown Nursing Home DS0000012565.V250514.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Sandown Nursing Home Address 28 Grove Road Sandown Isle Of Wight PO36 9BE 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) 01983 402946 01983 402975 Miss Belinda Jane Davies Mr Richard Henry Davies, Mrs Elizabeth Davies Mrs Teresa Joan Riley Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39), Terminally ill over 65 years of age (5) of places Sandown Nursing Home DS0000012565.V250514.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home can accommodate three service users between 18 - 65 years of age The registered managers are to within twelve months attain NVQ Level 4 in care and management as applicable 11th August 2005 Date of last inspection Brief Description of the Service: The home is located at the cross section of Grove Road and The Broadway, Sandown and is within walking distance of the main town, its facilities and amenities. The local railway station is situated some 500 metres from the home, which is also well serviced by the local bus company. The premises is a large Victorian residence that has been adapted across the years to meet the needs of the individuals accommodated, with rooms provided on two floors accessible via a passenger lift. Sandown Nursing Home DS0000012565.V250514.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was undertaken unannounced and formed the second statutory inspection of the year for Sandown Nursing Home. The inspection focused on those core standards not addressed at the 11th August 2005 inspection and various sources of evidence were considered in the formulation of judgements: records, observations and discussions with service users, their representatives, staff and management. Whilst details of the registered manager on Page 4 indicate that the home has one manager, Sandown Nursing Home has joint managers, Miss Belinda Davies and Mrs Teresa Riley. What the service does well: What has improved since the last inspection? What they could do better: Sandown Nursing Home DS0000012565.V250514.R01.S.doc Version 5.0 Page 6 The service is generally running well and both the service users and visitors met during the inspection appeared more than happy with the care and attention provided. However, whilst the general care and attention delivered by the staff is good the inspector noticed some practice issues, which potentially could be harmful to both the service users and staff, the concerns focused around moving and handling, with some staff undertaking manual practices without adopting safe moving postures or positions. On reviewing the home’s policy document it was clear that this was a good and concise procedure, which set out the home’s position with regards to all aspects of moving and handling practice. However, the risk assessment forms that accompany the policy, whilst reasonable, were not being completed appropriately with key information missing for staff; weight, height, medicines, clear plans of how to implement specific moves, etc. The risk assessments also failed to consider issues of how people should be moved in bed, etc. which for a nursing home is important given the dependency levels of the service users. Training for staff had been planned in February and March, although this was to consist of two one hour sessions, which is fine if the course is intended as a six monthly updating session but is not sufficient if the intention is to equip staff with the knowledge and skills required to safely undertake moving and handling procedures safely. 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. Sandown Nursing Home DS0000012565.V250514.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 Sandown Nursing Home DS0000012565.V250514.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): Standard 6. The service does not provide an intermediate care service. EVIDENCE: Confirmed by Registered Person. Sandown Nursing Home DS0000012565.V250514.R01.S.doc Version 5.0 Page 9 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): Standard 7. Work is required to improve the home’s moving and handling assessments. EVIDENCE: During the visit the inspector observed some moving and handling practice that raised concerns both for the service users’ and staffs’ wellbeing, with staff undertaking moves or lifts with incorrect posture or positioning of the body. As a consequence of these observations the inspector specifically targeted the area of moving and handling and proceeded to review both the home’s policies and procedure, risk assessment documentation, maintenance of equipment and the availability of training for staff. In conversation with service users it was discussed how most significant moves or lifts involving transfers, where the entire weight of the service user is a factor to consider, the staff use hoisting or stand-aid equipment, which people generally felt happy and confident about. Details of the equipment and numbers of staff to be involved in the moves clearly recorded on the individual risk assessment documents, located within the service user plans provided. Sandown Nursing Home DS0000012565.V250514.R01.S.doc Version 5.0 Page 10 However, when it came to less significant or major moves, i.e. staff lifting a client’s legs onto a footrest or lifting somebody’s leg to replace a slipper or place the foot on a wheelchair footplate, etc. the staff often bend from the waist instead of getting down closer to the area being manipulated or moved and thus placing straining on their lumbar spine and also leading to situations whereby they are required to hold or grip peoples’ limbs more tightly to reduce the likelihood of the limb slipping from the grasp or having to lift the limb higher in order that they can complete the task in question. It is these kinds of practices that should also be considered through the risk assessment and training process, with staff provided with guidelines on how to safely achieve a move or lift. The moving and handling assessment document employed by the home is a reasonably good assessment tool, although as with any document of its kind it is only as good as the person completing it, which during the inspection was noted to be inadequate, as vital information was missing from most assessments; height, weight, body shape, medication history, etc. The assessments were also noted not to be graded high, low or medium risk, which was confusing as the tool definitely allows for such a process to be completed and the methods for completing some of the moves required were poorly written, incomplete or the person completing the form had not considered all of the implications of the assessment undertaken, i.e. a client who is prone to aggressive outbursts, etc. should be considered unpredictable and should require two staff to safely complete a move, not one to two as indicated, this instruction leaving staff open to potential harm, as they may not be sure when one or two people is appropriate. Also the instructions of methods by which moves are to be safely completed should be far more prescriptive for staff, i.e. numbers of staff, equipment to be used, clear indication of potential hazards (physical disabilities, behavioural considerations, etc.), which should not include instructions like ‘Care to be given when moving’, which was listed under considerations for a person’s behavioural needs, this instruction provides no information for the staff around what to expect from the client or how to manage the behaviour safely for all parties. The above samples are given to highlight some shortfalls within the home’s moving and handling system and do not reflect all of the plans reviewed, some of which were completed more fully. However, consistency is important as a failure to provide staff with clear moving and handling instruction could lead to injuries to service users and staff alike. Sandown Nursing Home DS0000012565.V250514.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): Standard 14. Comments from patients and/or their visitors and observations of staff practice support the fact that the home promotes freedom of choice. EVIDENCE: Time was spent talking to several service users and their families during the inspection, when a variety of issues were discussed that directly affected peoples’ day-to-day life within the home. One of the most common themes to arise out of the conversations was the support and encouragement provided to families when taking patients out of the home, two of the visitors discussing how they are often helped to get their relative out of the home for walks around the Sandown area or to take their relative home for short visits. Another relative and service user discussed Christmas and how they had been able to get their partner home for a few hours Christmas day, something they both clearly enjoyed and appreciated. Observations of staff practice also provided further evidence of the staff’s willingness or keenness to promote autonomy within the staff team, staff witnessed asking the service users whether or not they would like to participate in the afternoon’s musical entertainment and also concerned to Sandown Nursing Home DS0000012565.V250514.R01.S.doc Version 5.0 Page 12 ensure a service user had a meal they enjoyed, the patient deciding that they did not want what they had ordered for lunch and the staff member providing a list of alternatives and seconds later for the person who obviously must have enjoyed the alternative selection. One issue the home should consider addressing is the amount of old / surplus clothing stored within the chest of drawers positioned around the home, as the temptation for staff might be to use these old clothes for current service users, a practice that should be avoided at all times. In conversation with one of the registered person(s) it was established that these items have just historically built up over the years and are not intended for use with any current clients. Sandown Nursing Home DS0000012565.V250514.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): Standard 16. The complaints process requires some attention, as aspects of its use appear confusing to staff. EVIDENCE: The home generally operates a very good, simple and straightforward complaints process for the service users, details of which are contained within the ‘service users’ guide’ and ‘statement of purpose’ documentation, which was reviewed and updated in February (2006). The home also provided staff with a detailed complaints procedure, which is designed to ensure that staff are equipped to support service users in making complaints, minor complaints (informal) being documented in complaints books located on each floor of the home and major issues (formal) recorded on complaints logging forms. However, on testing out how this process operated it was noted that the last minor complaint logged or documented was on the 18th September 2004 and that the entry, rather than referring to a complaint documented that a client required a new bar of soap for the bath. In conversation with service users it was apparent that whilst they would happily raise issues of concern with the nursing staff, they did not fully appreciate the home’s complaints procedure or the Commission’s role within the complaints process. Sandown Nursing Home DS0000012565.V250514.R01.S.doc Version 5.0 Page 14 It is also clear given the failure of staff to maintain the complaints record book (informal issues), in accordance with the home’s policy that work around promoting this issue is required both in house and with future service users. Sandown Nursing Home DS0000012565.V250514.R01.S.doc Version 5.0 Page 15 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): None None EVIDENCE: No environmental standards were reviewed during this inspection, as all core standards were considered at the 11th August 2005 inspection. Sandown Nursing Home DS0000012565.V250514.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): Standard 28. 50 of the home’s staff are trained to National Vocational Qualification (NVQ) level 2 or equivalent, however, other areas of their training require reviewing. EVIDENCE: In conversation with one of the registered person(s) it was established that 11 of home’s 16 care staff presently possess, as a minimum, an NVQ level 2 or equivalent. This means the home currently has a ratio of 68.75 of its staff qualified to National Vocational Qualification level 2, which meets the percentage rate set out within the national minimum standards. As mentioned earlier within the report, part of the inspection focused on moving and handling practice, as observations of staff performance within this area had raised concerns. With regard to the specific issue of staff training around moving and handling the registered person demonstrated that two sessions had been booked for the 27th February and 10th March 2006. However, each session is scheduled to last only one hour, which is insufficient to provide suitable or adequate manual handling training, unless these sessions are intended as bi-annual updates with more detailed training being arranged for later in the year. Sandown Nursing Home DS0000012565.V250514.R01.S.doc Version 5.0 Page 17 Ideally training courses should include information relating to moving and handling regulations, anatomy and physiology of the back, uses and maintenance of equipment (the need to visually inspect apparatus before use), risk assessments (both written and cognitively before use), policies of the home, reporting requirements, practical applications and details of current manual handling techniques and unsafe lifts, etc. Sandown Nursing Home DS0000012565.V250514.R01.S.doc Version 5.0 Page 18 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): Standards 31, 33, 35 & 38. The dual managers adequately share the responsibility for overseeing the dayto-day operation of the home. The home is run in the best interest of the service users and their views on the service delivered regularly sought. The financial interests of the service users are properly and effectively safeguarded. The management are failing to adequately safeguard the wellbeing of staff and service users, as manual handling practices are not being effectively monitored, assessed or delivered. EVIDENCE: At previous inspections the educational needs of the two managers has been discussed, as neither possess a managerial qualification, although the nurse Sandown Nursing Home DS0000012565.V250514.R01.S.doc Version 5.0 Page 19 manager possesses a professional qualification and the administration manager a vast portfolio of academic qualifications and professional qualifications from her work as a chartered surveyor. Given their combined experience and academic/professional achievements the manager(s) could be considered to possess sufficient educational and professional skills to run and operate the home effectively. However, for their own personal development and in order to comply with the Care Homes Regulations 2001 one of the managers as a minimum should seek to undertake one of the following courses: ‘Certificate in Management Studies’, Diploma in Management Studies, ‘Registered manager’s Award’, NVQ level 4 in Management or a Masters in Business Administration. From the perspective of the service users the home is considered to be running well and both Miss Davies and Mrs Riley are faces known to the service users and their visitors alike. During the tour of the premises the inspector, as previously highlighted, spoke with a number of service users and their relatives. During one such interaction the person clearly described how she is asked if she has any issues with the service or care of her relative, although she seemed unaware of any formal written surveys carried out by the home recently. In addition to the comments provided by this individual the inspector also established that the home has access to a detailed QA system provided by the Nursing Homes Association (NHA) and that the process of bench marking the home against the standards contained within the procedure had commenced this month (February 2006). Whilst this process is clearly being carried out, the inspector has reservations as to how the information gathered will be used, as the system created by the NHA is cumbersome and unwieldy and could take several months to complete in its entirety, it also fails to consider adequately the service users and no QA system within this sector should ignore their contribution to the process. The company historically prefers not to become involved in the direct management of service users’ finances, offering instead to support people through the provision of a tick system, the home purchasing all items required by a service user and billing or invoicing them at the end of the month. However, should no alternative be suitable for the service user the home will hold small amounts of money, all records of transactions monitored by the administrator, whose has a database for both systems. In conversation with service users this particular topic was not widely discussed, although it was established with a number of people that they have Sandown Nursing Home DS0000012565.V250514.R01.S.doc Version 5.0 Page 20 everything they want and that anything they need is provided, either by family or the home. The general approach to health and safety within the home is good, with the maintenance person largely responsible for monitoring the home’s compliance with routine health and safety issues, fire tests, completing of all ‘portable appliance tests’ (PAT) and performing routine maintenance around the home. Any maintenance issues are documented within a maintenance log, which is then addressed according to importance and a weekly report filed by the maintenance person, confirming the work has been completed. Details of all work undertaken is accessible within the administration office, along with copies of the home’s health and safety policies, external maintenance contracts for hoists, baths, lifts and information relating to visits from professional agencies like the Environmental Health Officer, who visited last on the 21st September 2005. However, despite the good work to ensure the premises remains fit for purpose, from the perspective of health and safety, the home cannot forget its duty to staff and service users under the manual handling regulations and should seek to address the issues raised in the report to ensure all areas of health and safety are managed effectively. Sandown Nursing Home DS0000012565.V250514.R01.S.doc Version 5.0 Page 21 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Sandown Nursing Home DS0000012565.V250514.R01.S.doc Version 5.0 Page 22 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 OP38 Regulation Requirement Timescale for action 19/03/06 2 OP28 3 OP16 4 OP31 Regulation The home must take steps to 12 review all moving and handling assessments and ensure they are appropriately completed. Regulation Moving and handling training 18 must be sufficiently detailed to provide staff with the skills and knowledge to safely move clients Regulation The home must review its 22 complaints process to ensure the staff have clear guidance on where and how to document complaints and that this is monitored to ensure complaints are effectively documented and managed. Regulation At least one of the managers 9 must complete a managerial award, equivalent to the NVQ level 4 or Registered Managers Award. 19/04/06 19/03/06 19/03/06 Sandown Nursing Home DS0000012565.V250514.R01.S.doc Version 5.0 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Sandown Nursing Home DS0000012565.V250514.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA 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. 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