Inspection on 21/11/06 for Sandown Nursing Home

This inspection was carried out on 21st November 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Sandown Nursing Home 26/07/07

Sandown Nursing Home 15/02/06

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 Janet Ktomi Unannounced Inspection 21st November 2006 10.30 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 Sandown Nursing Home DS0000012565.V311028.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. Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 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 407975 admin@sandownnursinghome.co.uk Miss Belinda Jane Davies Mr Richard Henry Davies, Mrs Elizabeth Davies Mrs Teresa Joan Riley Miss Belinda Jane Davies 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.V311028.R01.S.doc Version 5.2 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 15th February 2006 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. Sandown Nursing Home 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. The home is owned by Miss B Davies, Mr R Davies and Mrs E Davies. The registered manager is Miss B Davies who is supported by an experienced head of nursing care. Weekly fees range from £586.04 to £650.00. Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report contains information gained prior to and during an unannounced visit to the home undertaken on the 21st November 2006. All core standards and a number of additional standards were assessed. The inspector would like to thank the people who live at the home and the staff for their full assistance and co-operation with the unannounced visit. The visit to the home was undertaken by one inspector and lasted approximately six and a half hours commencing at 10.30 am and being completed at 5 p.m. The inspector was able to spend time with one of the proprietors, head of nursing care and care staff on duty and was provided with free access to all areas of the home, documentation requested, visitors and service users. Following the visit the inspector was able to telephone the registered manager Miss B Davies to clarify information not gained during the inspectors visit. Prior to the visit a pre-inspection questionnaire was completed by the home. External professional questionnaires were sent to people identified in the preinspection questionnaire as having regular contact with the home. Comment cards were returned from one GP and one care manager. Service user and relative comment cards were sent to the home. Five service user and one relative response were received. Information was also gained from the link inspector and the home’s file containing notifications of incidents in the home. During the visit to the home the inspector was able to meet with and talk to service users and two visitors. What the service does well: Service users stated to the inspectors that they were happy living at Sandown Nursing Home, and that staff treated them well. They confirmed that the home was always clean and they felt safe. Service users appeared relaxed and well cared for. All service users spoken with were happy and satisfied with the service provided and felt that their expectations had been met. Visitors confirmed that they were made welcome when they visit and that they were happy with the level of care provided to their relative. Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 6 The home was warm and very clean; the atmosphere felt relaxed, happy and friendly. The environment is well maintained with an ongoing programme of redecoration and renewal. All staff, nursing, care and ancillary are motivated and committed to ensuring service users receive a quality service. All staff were helpful and demonstrated compassion and a commitment to core values of dignity and rights of service users. Staffing levels appear appropriate for the number and level of care required by service users. Ancillary staff, housekeeping, kitchen, maintenance and administration, are available to support direct nursing and care staff. Service users were positive about the food provided, and this was seen to be of a good standard with choice and alternatives available at all meals. What has improved since the last inspection? What they could do better: Although service users and their relatives were happy with the service provided at Sandown Nursing Home there were requirements and recommendations made following this key inspection. The home must ensure that care plans contain all the necessary information as to how each service users specific care needs should be met. Records must conform to the Data Protection Act 1998. The home should consider requesting service users or their representatives to sign care plans to confirm their agreement to the care plan and risk assessments and demonstrate that service users have been consulted in how their care needs will be met. Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 7 Medication Administration Records must be fully completed with the head of nursing care implementing a checking system. Front sheets for Medication administration records must state if allergies are known or record nil known. Medication must only be administered to the service user for whom it has been dispensed. The Isle of Wight adult protection policy and procedure should be available at all times and must be kept in the nurse’s office. All staff, including ancillary and nursing as well as care staff must have adult protection training to ensure that they both recognise abuse may be or have occurred and are aware of the correct action to take to safeguard service users. All staff must receive infection control training. The home must review its induction programme and ensure that it complies with the skills for care guidelines and ensure that a suitable induction programme is provided for qualified nurses. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive relevant and useful information about the home prior to moving in. All service users are assessed prior to moving into the home to determine that their individual care needs can be fully met. Service users, or their representatives, are able to visit the home prior to admission to assess the quality, facilities and suitability of the home. Standard six is not applicable, as intermediate care is not provided at Sandown Nursing Home. EVIDENCE: The inspector was provided with a copy of the statement of purpose/service users guide. This was viewed during the inspectors visit to the home. This contained all the required information in a format suitable for most service Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 10 users or their relatives. The head of nursing care informed the inspector that a copy of this document is provided to all prospective service users or their representatives when they come to visit the home or when the pre-admission assessment is being undertaken. Comment cards were received from five service users, four of whom confirmed that they had received enough information about the home before they moved in, the fifth stating ‘no, because social services had to find the first place available, we were assured that this was a good home’. The head of nursing care explained the homes admission procedure. The head of nursing care or the deputy head of care undertake pre-admission assessments on all prospective service users. Pre-admission assessments for the two most recent admissions were viewed during the inspectors visit. The home has a comprehensive assessment tool which covers all the relevant areas necessary for the home to decide if it is able to meet a prospective service users needs. Included in the pre-admission assessment is a question about equipment necessary to support the service user. The head of nursing care stated that she would not admit a new service user if the necessary equipment was not available. The maintenance man stated that he frequently redecorates bedrooms prior to new admissions as he was doing during the inspectors visit. The head of care was clear about the level of care needs the home can accommodate. The inspector was unable to speak with the most recent people admitted to the home due to their level of health needs. Other service users confirmed that they had received a visit from the head of nursing care and written information prior to moving to the home. Most admissions are from hospital and visits to the home by prospective service users are not always possible. The head of nursing care stated that relatives or representatives are invited to visit the home and view the available room. The administrator provided the inspector with the administration files for new and longer-term service users. These contained contracts and admission sheets. The admission sheets provide a checklist to ensure that all preadmission work is completed including provision of service users guide and contract. Contracts were seen to contain all the necessary information in an appropriate format. Comment cards were received from five service users; all confirmed that they had received a contract. Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users health, personal and social care needs are set out in an individual plan of care which does not always contain sufficient detail as to how specific care needs will be met. Medication is appropriately stored but records must be fully maintained and medication only administered to people for whom it has been dispensed. Service users are treated with respect and are assured that at the time of their death, staff will treat them and their families with care and sensitivity. EVIDENCE: The inspector viewed five care plans for new and existing service users. Care plans are individual and relevant to the needs of service users, with sections covering all the areas of need identified in the assessment. Care plans are reviewed by the named nurse monthly or more often if needs change. The home does not request service users or their relatives to sign care plans. The Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 12 home should consider requesting service users or their representatives to sign care plans to confirm their agreement to the care plan and risk assessments and demonstrate that service users have been consulted in how their care needs will be met. During the inspectors visit nursing and care staff were observed making recordings of care provided in individual care plans. One care plan viewed was for a service user who required regular wound dressings. The care plan did not specify which dressings were being used. The head of nursing care showed the inspector the dressing book in which this is recorded. The book contained information about a number of service users, stating where their dressings were required, the nature of the wound and recorded observations and records of dressing changes. Recording all this information in one book could compromise confidentiality and does not comply with the Data Protection Act 1998. All records pertaining to an individual should be capable of being stored together and the use of a book for more than one person would prevent this. Care plans must contain all the relevant and specific information about how service users needs should be met. All recordings must be made such that the Data Protection Act 1998 is complied with. Following the previous inspection the home was required to review its manual handling assessments and ensure that staff have received appropriate manual handling training. New assessments were seen in all care plans that cover all the areas required. The pre-inspection questionnaire stated and care staff confirmed that they had received manual handling training. Care staff were observed using manual handling equipment during the inspectors visit and the techniques used appeared appropriate. The inspector was able to meet many of the people living at Sandown Nursing home. Those able stated that they felt well cared for; others whose level of disability made conversation difficult appeared comfortable and well cared for. The inspector spoke with two visitors who both stated that they were very happy with the level of care their relative received. Comment cards were received from five service users and all stated that medical and care needs were always met. One stating that her ‘dressings were always changed daily’. ‘That staff respond quickly and do what service users ask them to do’. Comment cards were also received from relatives, the homes GP and a care manager. No concerns about the level of care were raised in these comment cards. One relative stating ‘my husband could not have better care any where else’. Also on another comment card completed by a relative ‘he is extremely well cared for and very happy’. Another relative stated that she ‘knew her husband would be well cared for on the days she was unable to visit’. The inspector undertook a tour of the home with the head of care and was therefore able to meet service users who needs necessitated they remain in bed. Care staff stated that they felt they had enough time to meet service users health and personal care needs. Comment cards received from service users confirmed that staff are available when required. The home has a range of equipment to support service users with moving and handling as well as Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 13 pressure area management. A storeroom containing supplies of equipment was seen. The head of care informed the inspector that the community pharmacist had undertaken a medication review at the home the week prior to the inspectors visit. Medication is only administered to service users by qualified nurses. The inspector viewed Medication Administration Records, storage and administration procedures. All medication was seen to be appropriately stored in secure locked facilities. The home uses a pre-dispensed blister system where possible. The home has lockable medications trolleys that are used to dispense and administer medication to one service user at a time. The Medication and Administration records were viewed. Each record has a front sheet that should contain a picture of the service user, their name and a section for allergies or other relevant information. Some of these contained a record of allergies, others stated nil known, however a number had this section left blank. All medication front sheets must state either known allergies or ‘none known’ and be signed by the person completing the front sheet. Some did not contain photographs, these would appear to be new service users for whom photographs would be more important as qualified nurses administrating medication may not have met the new service user. The inspector noted a number of gaps in the Medication administration records where there was no indication if prescribed medication had been administered or not. The recording system contains a list of letter codes to indicate the reason why medication may have been omitted and these must be used in all cases when medication is not administered. Gaps must not be left in medication records and the head of nursing care must implement a checking system to ensure that all records are fully completed. The inspector also noted that although many of the service users are prescribed oral laxatives only one bottle (for a named service user) was in the medication trolley taken around the home. Other unopened bottles were seen in the storage cupboards. The head of care confirmed that one bottle is used for all service users. This means that medication prescribed, dispensed and the property of one service user is administered to other service users. Medication must only be administered to the service user for whom it has been dispensed. Comment cards received from service users confirmed that staff listen and act on what they say. The home provides both single and twin bedrooms. Twin bedrooms were seen to contain screens to ensure privacy during personal care tasks. Service users and relatives the inspectors spoke with confirmed that staff treat them with respect and that their privacy is maintained during personal care. During the inspectors visit staff were observed to treat service users with respect. As with most nursing homes the home supports some service users who have terminal care needs. The head of nursing care confirmed that the home has good links with the hospice and that advice from specialist nurses is sought when required. One service user was due to be readmitted to the hospice for a Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 14 short stay for specific treatment then to return to the home. The home also supports a number of people with advanced age related illnesses. Care staff stated that they have support as required and felt able to meet service users needs at this time. The head of nursing care stated that she is trying to arrange bereavement care training for staff. One relative stated that he was kept informed about his relatives increasing care needs and felt confident that staff could meet the high care needs. The inspector heard the head of nursing care informing one relative that she had requested the doctor to visit and would inform her of the outcome. As stated previously the home has a range of equipment that should ensure that a service users last days are comfortable. Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The routines for daily living and activities made available are flexible and varied to suit people’s individual needs. Family and friends are able to visit. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. EVIDENCE: The routines for daily living and activities made available are flexible and varied to suit people’s individual needs. Service users and relatives confirmed to the inspector that they are able to choose where in the home they spend their day, many were seen to spend time in the homes spacious and bright lounge with others remaining in their bedrooms. The design of the lounge means that it effectively has several areas such that service users can sit quietly or join in activities if they wish. Service users were observed being asked where they wanted to have their meals. Service users confirmed to the inspector that they are given choice over their meals with options being chosen on a daily basis. Bedrooms seen contained personal items brought into the home by service users. Comment cards received from service users confirmed Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 16 that staff listen and act on what they say. Care plans and assessments include information about leisure activities and religious needs. Comment cards received from service users confirmed that activities are arranged by the home and service users stated they could choose to participate or not. An activities list was noted on display in the lounge and in individual bedrooms. This listed activities planned for the morning and afternoon and provided by care staff and external groups from independent arts and the local vicar who provides a monthly church service at the home. The head of care stated that that Bingo is popular with prizes to winners. A list is maintained of who has attended different activities sessions and this was seen by the inspector. The pre-inspection questionnaire stated that activities’ training has been provided by age concern. The inspector was able to meet two visitors. The weather on the day of the inspectors visit was not pleasant and the head of nursing care stated that there are usually more visitors but she felt that as many visitors were elderly the weather would have put them off. Those relatives the inspector was able to meet and comment cards received from relatives indicated that relatives are able to visit at any time. Visitors are able to enjoy a meal with service users if they wish and a small charge is made for this. Meals received by relatives were seen recorded on one invoice viewed. In addition to the large lounge, whose design provides several distinct areas, the home has a smaller room that could be used for private visits when not in use on a Tuesday by the hairdresser. Menus were provided with the pre-inspection questionnaire and indicate that a varied, nutritious diet is available to service users. Options are available at all meals with the inspector overhearing care staff asking service users what they wanted for their next days lunchtime meal during the afternoon of the inspection. The home has a good-sized dining room where many service users choose to have their meals. The head of nursing explained that the home operates two sittings for meals due to the number of people who require support to eat. This ensures that adequate staff are available to support service users who receive their meal hot. Comment cards received from service users stated that the food provided is always/usually good and choice provided. Relatives confirmed that they are able to have meals at the home if they wished and that their relatives appeared to enjoy their food. The inspector was present for the main lunchtime meal and the lighter evening meal. The food appeared well presented and appetising. Drinks and snacks are also available throughout the day with service users confirming this as well as the inspector observing service users being given morning and afternoon hot drinks and biscuits. The need for special diets or supplements is recorded preadmission. One of the owners stated that he quality audits meals by eating them himself when at the home several days per week. The home has a large kitchen and full range of kitchen staff such that nursing and care staff do not have to prepare meals/snacks other than requested by service users during the evening or night. Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 17 Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users are protected from abuse, however the home must ensure that all staff have adult protection training and senior staff are fully aware of the locally agreed procedures to report and investigate allegations of suspected abuse. EVIDENCE: Following the previous inspection the home was required to ensure that staff know where to record complaints. Care staff stated that they would try to resolve any issues raised by service users or relatives, if they were unable to do so they would inform the qualified nurse. The qualified nurses stated they would record the complaint and inform the head of nursing care or manager. The pre-inspection questionnaire stated that the complaints procedure had been revised in September 2006. The complaints procedure is included in the service users guide. A record of complaints is maintained in a folder on forms that should ensure that all relevant information is recorded and complaints may then be investigated by the management team. Service users comment cards indicated that they were aware of the homes complaints procedure and all stated they were aware of how to complain and would raise concerns. Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 19 Service users the inspector spoke with also stated that although they had no concerns or complaints they would feel able to raise any issues with staff or the head of nursing care. The homes policies and procedures in respect of recruitment and service users personal finances should ensure that unsuitable people are not employed at the home and that service users will not be financially abused. The inspector viewed the induction information for care staff that included basic adult protection, however the home does not have an induction procedure for nursing or ancillary staff. Care staff stated that they had not received adult protection training, although some would have covered this in their NVQ studies. Care and ancillary staff stated they would pass on concerns to nursing staff or the manager. The inspector discussed with the head of nursing care what actions she would take in the event of a specific allegation being made to her by a service user. Although it was evident that this would be taken seriously, it was stated that this would be investigated internally by the management team and not referred as per the correct procedure to the local social services to investigate. The action suggested might allow the alleged abuser to the contact any witnesses or other staff and contaminate any investigation. The home has a copy of the Isle of Wight adult protection policy and procedure, however this is kept in the administration office not the nursing office. Out of hours nursing and care staff would not have access to the administration office that is kept locked to ensure confidentiality of information therein. This policy should be available at all times and must be kept in the nurse’s office. All staff, including ancillary and nursing as well as care staff must have adult protection training to ensure that they both recognise abuse may be or have occurred and are aware of the correct action to take to safeguard service users. Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23,24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a clean, safe, well-maintained environment that meets their individual and collective needs. EVIDENCE: The home is an extended older property suitable for the needs of the service users, staff and visitors. The home is clean and well maintained, with a housekeeping team and part time maintenance man. The home has a programme of routine maintenance and a renewal/development plan. The preinspection questionnaire listed the improvements to the home over the past year. These being, the completion of the lounge extension, various rooms redecorated, new lounge furniture, new TV, DVD and music system for lounge area and new bedroom furniture in the form of electric adjustable bed and three air mattresses. Externally the patio area outside the lounge extension, Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 21 car park and garden landscaping have been completed. Additionally a new Oxford hoist has been purchased. The home has appropriate disposal contracts for waste. As stated previously the home has a large lounge with pleasant views to the front of the home. Service users informed the inspector that they had enjoyed the new patio area and patio furniture in the summer months. Service users were noted to have chosen to sit looking out of the patio doors to the pleasant landscaped gardens. The home also has a good-sized dining room and a small room that could be used for private meetings or visits when not in use by the hairdresser on a Tuesday. Furniture within all communal areas was appropriate to service users needs with room for moving and handling equipment to access all areas. The home has a no smoking policy with an external covered area available for service users who smoke. Toilet and bathroom facilities are provided to meet the needs of service users. These were seen to be clean and well maintained. There are several sluice facilities located around the home. The home has a range of equipment and adaptations appropriate for service users. The head of care was clear that she would not admit any new service users unless she had the necessary equipment to meet service users specific needs. Equipment includes moving and handling, height adjustable beds, air mattresses for pressure relieve, passenger lift and hand rails along corridors. The home has suitable storage facilities for equipment. Some bedrooms have en-suite facilities with others having wash-hand basins. The home has a combination of single and twin bedrooms, twin rooms having screens to ensure privacy for service users during personal care tasks. Bedrooms were seen to contain all the necessary furniture, fixtures and fittings, were well decorated and had co-odinating attractive soft furnishings. Bedrooms have adjustable heating via covered radiators with service users confirming that their rooms and the home are always appropriately warm. The maintenance man was seen repainting a bedroom at the time of the inspectors visit; he stated that he frequently redecorates rooms prior to a new service user moving into the home. All bedrooms were clean with no offensive odours. A member of the housekeeping team explained to the inspector that they frequently shampoo carpets and showed the inspector the new carpet cleaner capable of washing carpets to a high standard and leaving them virtually dry. The housekeeper stated that she generally has sufficient time to complete all her tasks. The home has appropriate laundry facilities with the housekeeping staff being responsible for laundry. Care staff confirmed that they have adequate supplies of disposable aprons and gloves. The pre-inspection questionnaire listed staff training provided over the past year and that planned for the future. Infection control was not listed in either section. Care staff confirmed that they had not Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 22 received infection control training. All staff must receive infection control training. Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home employs appropriate numbers of nursing, care and ancillary staff that ensure that service users needs are met. Staff receive training but the induction and training programme must be enhanced to ensure that all required areas are covered. A very high number of care staff have NVQ or equivalent qualifications. EVIDENCE: Duty rotas were provided with the pre-inspection questionnaire. These stated that at least two and sometimes three trained nurses are provided in the mornings and one in the afternoon and at night. Five/six care staff are provided in the morning and five in the afternoon. Two care staff support the qualified nurse at night. In addition the home has a good compliment of ancillary support staff including administration, housekeeping, maintenance and kitchen. Comment cards from service users, relatives and professionals stated that there was appropriate numbers of staff on duty at the home. During the inspectors visit staff on duty corresponded to those on the duty rota. Service users and relatives spoken with during the inspectors visit stated that they felt there were sufficient staff available at all times. Nursing and care staff stated that they generally have sufficient time to meet service users Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 24 needs and throughout the inspection care staff appeared to have time to meet service users needs. The head of care and care staff explained to the inspector how work is organised throughout a shift. The nurse in charge allocates care staff to floors of the home and tries to ensure a level of continuity for service users. Care staff stated that they tend to work in pairs wherever possible; this would be the most appropriate method of working considering the high support needs of the majority of people who live at the home. The head of care and administrator stated that they do not use agency staff and required shifts resulting from annual leave or sickness are covered by the homes existing staff. Training and qualification information was provided with the pre-inspection questionnaire. This stated that thirteen of the homes seventeen care staff have at least an NVQ level 2 or above, this equates to approximately seventy-five per cent. In addition to staff with an NVQ some care staff have gained relevant qualifications, including nursing, overseas. The home continues to support care staff to achieve NVQ’s and at the time of the inspection the head of care stated that an additional two staff are to commence their NVQ level 2. The recruitment records for the three newest staff were viewed. These contained all the required information and confirmed that all staff are fully checked including references, CRB and POVA checks. The homes recruitment procedures should ensure that unsuitable people are not employed at the home. The pre-inspection questionnaire stated that members of the management team had attended recruitment training. Information about training was provided with the pre-inspection questionnaire. This included training for qualified nurses and care staff. Training has included syringe driver, continence, PEG feed updates, palliative care, loss and bereavement, tissue viability, games and activities (via age concern), fire training, moving and handling updates. Planned training includes further fire awareness and manual handling updates as well as manual handling study day. Discussions with qualified nurses indicated that they were happy with the amount of training they had received, however, care staff stated they would like more training. Care staff stated that they had not received adult protection or infection control training that they must receive. The head of care explained the homes induction procedure and showed the inspector the induction booklet in use at the home for care staff. Whilst the book is comprehensive the inspector felt that some aspects included in the Skills for Care guidance for induction are not included in the homes induction programme. The head of nursing informed the inspector that she had recently recruited a new qualified nurse who has yet to commence work at the home. The home does not have an induction programme specifically for qualified nurses and the one used for care staff would probably be inadequate, as it does not cover the additional areas a qualified nurse in charge of the home might need. The home must review its induction programme and ensure that it Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 25 complies with the skills for care guidelines and ensure that a suitable induction programme is provided for qualified nurses and ancillary staff. Staff are not provided with a copy of the General Social Care Council code of conduct. The manager has stated that she will ensure staff are provided with this document. Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a management team who between them have the necessary skills and experience to ensure that the service is appropriately managed. Service users financial interests are safeguarded. Staff are appropriately supervised however annual appraisals must be completed. Records are appropriately stored however records must be fully completed. The health, safety and welfare of service users and staff are promoted. EVIDENCE: The proprietors are frequently at the home and actively involved in administration and management of the service. One of the proprietors is the Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 27 homes registered manager and a head of nursing care supports her. The management roles and responsibilities are clearly defined with each knowing the extent of their roles and responsibilities. All staff and visitors stated that they felt able to discuss any concerns with members of the management team. The home has a deputy head of nursing who is to commence the Registered Managers Award as currently none of the management team has this qualification. The manager explained the homes quality assurance systems. Service users and their relatives have completed questionnaires however a formal audit or report from these has not been produced. The manager stated that the questionnaires had been positive and would consider how this could be reflected in a report to be available to service users and staff. The home has recently produced a web site with information and photographs. Information from the service users survey report could be included in this. The home has completed the Registered Nursing Home Association quality audit tool with the administration observed updating parts of this during the inspectors visit. The home does not become directly involved in service users personal finances and does not act as appointee for any service users. Services, such as papers, hairdressing and chiropody that are not included in the fees are either added to invoices, paid directly by service users or paid from small amounts of personal money held on behalf of a small number of people. The inspector viewed invoices and these were seen to detail any additional costs and the specific reason for them. Receipts were seen for additional services for individual people and could be available for relatives/representatives if they wished to view them. Records and receipts were also maintained for personal money spent on behalf of service users. Staff confirmed that they felt appropriately supervised. The home uses a cascade system for supervision with the head of nursing supervising the qualified nurses who in turn supervise the care staff. Records for supervision were seen in staff files. Staff should receive an annual appraisal, the records for this are held in a folder in the office. The inspector viewed the records and identified that many of the annual appraisals are overdue. Various records were viewed during the inspectors visit. All records were appropriately stored with access only available to people who should have access. As detailed previously in this report care plans require more specific detail in some section, Medication administration records must be fully maintained and overdue annual appraisals must be completed. Record keeping practises within the home must comply with the 1998 Data Protection Act. The home provides a safe place for service users, staff and visitors. The home is well maintained and clean, although staff requires training in infection control and adult protection. Individual manual handling risk assessments have Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 28 been reviewed and now provide a comprehensive assessment and management plan. Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 4 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 2 2 Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 (1) Requirement Care plans must contain all the relevant and specific information about how service users individual needs should be met. Gaps must not be left in medication records and the head of nursing care must implement a checking system to ensure that all records are fully completed. Medication front sheets must contain an up to date photograph and record if the service user has any allergies or none are known. Medication must only be administered to the service user for whom it has been dispensed. The Isle of Wight adult protection policy and procedure should be available at all times and must be kept in the nurse’s office. All staff, including ancillary and nursing as well as care staff must have adult protection training to ensure that they both recognise abuse may be or have occurred and are aware of the correct action to take to safeguard service users. DS0000012565.V311028.R01.S.doc Timescale for action 01/01/07 2. OP9 13 (2) 01/01/07 3. OP9 13 (2) 01/01/07 4. 5. OP9 OP18 13 (2) 13 (6) 01/01/07 01/02/07 Sandown Nursing Home Version 5.2 Page 31 6. 7. OP30 OP30 18 (1)(a) 18 (1)(a) 8. OP37 17 (1)(a) All staff must receive infection 01/04/07 control training. The home must review its 01/04/07 induction programme and ensure that it complies with the skills for care guidelines and ensure that a suitable induction programme is provided for qualified nurses. All recordings must be made 01/01/07 such that the Data Protection Act 1998 is complied with. 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 OP7 Good Practice Recommendations The home should consider requesting service users or their representatives to sign care plans to confirm their agreement to the care plan and risk assessments and demonstrate that service users have been consulted in how their care needs will be met. Sandown Nursing Home DS0000012565.V311028.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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