Inspection on 08/05/06 for Sanford House Nursing Home

This inspection was carried out on 8th May 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

Sanford House Nursing Home 08/05/07

Sanford House Nursing Home 18/10/05

Sanford House Nursing Home 20/05/05

Sanford House Nursing Home 19/10/04

Sanford House Nursing Home 26/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Sanford House Nursing Home Danesfort Drive Swanton Road East Dereham Norfolk NR19 2HH Lead Inspector Mrs Geraldine Allen Unannounced Inspection 8th May 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 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. Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Sanford House Nursing Home Address Danesfort Drive Swanton Road East Dereham Norfolk NR19 2HH 01362 690790 01362 690890 sanford@caringhomes.org 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) Sanford House Limited Mrs Susan Lancaster Care Home 43 Category(ies) of Dementia - over 65 years of age (42), Old age, registration, with number not falling within any other category (42), of places Physical disability (1) Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The home will only receive patients who are not liable to be detained under the Mental Health Act 1983. The home may accommodate one (1) male person with a physical disability, named in the Commission’s records, who is under 65 years of age. The home may accommodate up to forty-two (42) elderly people over the age of 65 years, of either sex, who may or may not have dementia. Maximum number not to exceed forty-three (43). Date of last inspection 18th October 2005 Brief Description of the Service: This home provides care with nursing to a maximum of 43 older people. The home is located on a private driveway close to the centre of the market town of East Dereham. The home was purpose built in 1998 and all accommodation is located on the ground floor. Wheelchair access and car parking are located at the front of the home. The building is divided into 2 units. The Carrick Unit cares for older people plus one person with a physical disability; the Shannon Unit cares for older people with dementia. There is a secure courtyard garden in the centre of the home, with access from some bedrooms. There are shrubs, flower borders and lawn areas to the front of the home. Garden seats and tables are located in the courtyard garden. The manager confirmed that the fee range for the home was between £434 and £550 dependent on needs. Prospective residents and their representatives are advised of the fee rates at the time of enquiry and also when assessments and other contacts take place. Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place during the day of 8 May 2006 and was conducted by 2 Inspectors over a period of 7 hours. The manager, Mrs Susan Lancaster was present throughout the day and the Regional Manager, Mrs Christine Scott was present from late morning onwards. During the inspection, residents from both the Carrick and Shannon Units were spoken to in private or briefly in the communal areas of the home. Members of staff from each unit were also spoken to, in addition to Mrs Lancaster and Mrs Scott. The opportunity was taken to speak with visitors to the home where possible and completed comment cards were received from 10 residents and 17 relatives. Mrs Lancaster completed and returned a pre-inspection questionnaire and various records were seen during the course of the inspection. The companies Audit Analysis and the home’s Quality Assurance Feedback documents were also received prior to this inspection. Previous inspection reports have shown that the home has not complied with all requirements in a timely way, however this inspection found that compliance has improved substantially in key areas and this is to be welcomed. Future inspections will look for sustained improvements and also compliance in the areas highlighted within this report. Overall, this inspection found that there has been some improvement in the recording of care needs and how they are delivered although it has been acknowledged that there is still significant work to do. However, some of the observations made in the Shannon Unit (dementia), raised concerns about staff understanding of people with dementia care needs and their ability to provide effective and appropriate care. What the service does well: The residents are generally cared for by a staff group that is committed to providing good standards of care. Most staff were observed treating residents with dignity and respect. Residents enjoy the food and the cook described how she makes all her own pies, cakes and pastries. Most areas of the home are well maintained and in a good state of décor. Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 Page 6 The home has a good complaints process that is known to residents and their relatives. The complaints procedure includes action points for further development and improvement. What has improved since the last inspection? What they could do better: 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. Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 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 Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 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): 1, 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has updated Statement of Purpose and Service User Guide available for residents and their representatives. The home has a pre-admission assessment in place that would benefit from more attention to social, emotional and dementia care needs. The preadmission assessments are not completed adequately in all cases. This home does not provide intermediate care. EVIDENCE: Mrs Lancaster confirmed that the fee range for the home was between £434 and £550 dependent on needs. Prospective residents and their representatives are advised of the fee rates at the time of enquiry and also when assessments and other contacts take place. Updated copies of the Service User Guide and Statement of Purpose were provided. Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 Page 9 Mrs Lancaster stated that all prospective residents are subject to a preadmission assessment unless the admission is an emergency. The home uses the corporate pre-admission assessment but there is no assessment devised specifically for use with admissions of people with dementia. The preadmission assessments are task orientated and do not adequately cover issues about the emotional, social and spiritual needs of the person. Information is obtained from the prospective resident, relatives, GP, social worker and hospital staff where approriate. Two care plans were case tracked and the pre-admmission assessment for each was seen. For 1 resident, very little of the pre-admission assessment had been completed, whilst the other provided details, mainly in the form of yes/no answers. The home does not provide intermediate care. Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 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): 7, 8, 9 & 10 Quality in this outcome area was poor in respect of standards 7 & 10, and good in respect of standards 8 & 9. This judgement has been made using available evidence including a visit to this service. Good care assessment and planning documentation is in place but is not consistently used and the standard of recording is variable. The dignity and respect of residents is not always protected and observed. EVIDENCE: Requirements were made in respect of care plans at the last inspection. Two have been met and 1 has been repeated. Two requirements made in respect of healthcare needs have been met. Mrs Lancster stated that there were 4 named nurses responsible for the writing and review of care plans. The care plans are audited by night staff. Care staff are involved in updating information about the hygiene care given by them. The care plans are legible and completed on a word processor. Each care plan is reviewed monthly by the named nurse and the home tries to involve families and residents in the process. A review form is sent to relatives in order that their views are sought. Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 Page 11 The care plan is the corporate one and includes various health assessments, risk assessments, input from other agencies such as GP, chiropodist, district nurses where appropriate, dietician and physiotherapist. Two care plans were case tracked. It was found that very little of the preadmission assessment for one resident had been completed, whilst the other had brief details only that comprised mainly of yes/no answers. The care plans demonstrated some good documentation for use but also raised some issues, particularly around the standard and consistency of recording. For example, one plan stated that the resident was unable to communicate but there was observational and anecdotal evidence that she was able to use nonverbal communication for some things. The care plans include a biography. This is a pre-printed document for recording significant events, family history, hobbies and interests. This is regarded as very good practice, however there was substantial work to be done before these biographies were completed in each case. Good assessments were also available regarding personal care needs but there was evidence that they were not necessarily adhered to by staff. For example, one resident has a good care plan regarding her appearance and the clothes she likes to wear, including liking to wear stockings or tights but on the day of inspection she was wearing neither. The risk assessments in respect of bed rails were not consistently completed. In one care plan there was no risk assessment although a written consent to use bed rails had been obtained from a next of kin. In the other care plan the assessment had been completed and the conclusions had generated a relevant care plan. There was a good care plan for one resident regarding nutrition and her specific needs around this and how her needs were to be met, whilst the other care plan referred to very specific dietry needs but not what feed the resident had. Other assessments included continence, manual handling, falls, pressure care, personal care and social interraction. In one care plan, only the assessments for manual handling, pressure care and personal care had generated care plans. Daily records were also seen for the 2 residents who were case tracked. These identified issues but did not necessarily generate clear care plans as would have been expected. For example, one entry referred to the resident having loose bowels but there was no record of what action was to be taken by staff. The care plans for the social, emotional and spritual needs of residents need to be developed to ensure a more holistic approach to care. Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 Page 12 Observations of care practice were made in the Shannon Unit during this inspection and revealed some issues around the privacy, respect and dignity of residents. For example, one resident had a catheter that had been strapped low on her leg and was therefore in full view of residents, staff and visitors. A member of staff was observed feeding a resident but there was no verbal communication taking place. Another member of staff was observed in the lounge with 5 residents whilst writing care plans. However, she was not seen to acknowledge any of the residents until 1 began shouting. Two residents were observed being transferred from their chairs into wheelchairs without staff explaining to them what they were about to do. During luch, all residents were seen wearing blue plastic aprons although none had been asked if this was acceptable. The dining tables were laid with yellow plastic cups although there were no tableclothes, napkins or cutlery to indicate where the residents were or what was about to take place. A visitor to the home stated that there were occasions when, because there were insufficient staff available, female relatives of his mother would assist her to the toilet. The inspection of the medication standard was conducted 11/05/06 by Pharmacist Inspector, Mr M Andrews. A further requirement and recommendation were made as a result of his inspection. A copy of the separate Pharmacy Report has been submitted to the provider and is available subject to request. Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is poor for standard 12, adequate for standard 14 and good for standards 13 & 15. This judgement has been made using available evidence including a visit to this service. Activities on the day of inspection were not taking place and some practice and interraction from 1 member of staff that was observed within the dementia unit was unacceptable. Other staff were seen interracting well There was evidence that choices and preferences were not always respected. Residents enjoy a good, varied diet that is well prepared. EVIDENCE: Observations of activity were made in the Shannon Unit throughout the day. These showed that very little meaningful activity was taking place, and it was not unusual for staff to speak between themselves and ignore the residents sitting around them in the lounge. Throughout the day, residents were often observed to be asleep or totally disengaged from their environment. There was little stimulation beyond the television that remained switched on throughout the day although there were frequent occasions when no-one was watching it other than members of staff. It was acknowledged that the activities co-ordinator was not at work on the day of inspection. Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 Page 14 The interaction between staff and residents was observed and it was noted that some staff communicated well and respectfully. This was not the case regarding 1 member of staff and concerns were raised with Mrs Lancaster and Mrs Scott about the attitude and conduct observed. Observations were made during the day that raised questions about the understanding and competence of staff to provide appropriate care for people with dementia. For example, residents were told by a member of staff, who was fully aware of what day of the week it was, that the day was Tuesday when it was Monday; and 1 resident was wearing a watch that was not set to the right time. Staff had made an attempt to adjust the watch, but as the resident liked to wear the watch all day, this should have been checked and adjusted at night. In addition, there was no signage about the unit to aid orientation and apart from 1 resident, no meaningful activity and very little good interaction was taking place. Some resident’s rooms were bare and had little personalisation or items that would prompt orientation or memories. In 1 bedroom, there were no pictures on the walls, soft toys were stored out of reasonable line of sight and dead flowers had been left in a vase. A resident who ate with her hands was given puréed food. Discussion with some staff showed they had little understanding of finger foods. Mrs Lancaster stated that the Shannon Unit is not staffed by people who have specific interest in the needs of residents with dementia and, apart from the nurse, the staff team changes frequently between the 2 units. It is suggested however, that a core of staff who have an interest in the needs of people with dementia and who can receive additional training around communication, meaningful activity and other relevant issues, should be considered. This would allow for the development of better standards and a continuity of practice that better reflects the needs of people with dementia and how they can be met effectively. Staff spoken to described how they try to establish and respect choices and preferences. Staff said that if residents are unable to express preferences for themselves, that they would speak with relatives or try various options until they had got it right. They show residents various items of clothing until they can establish what the person would like to wear. Staff appeared aware of some communication difficulties and described the use of gestures in an attempt to understand. Observation made in the dining room of the Carrick Unit during lunch showed that staff provided discreet assistance as needed. Staff sat beside the resident they were helping and spoke with them whilst helping them with their meal. There was a significant level of noise from the kitchen as the hatchway was left open after food had been served. This would be reduced if the hatchway were closed when not in use. Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 Page 15 Issues and concerns were however noted in the Shannon Unit, where the experiences for residents at meal times were different. Observations showed that, whilst 1 member of staff gave residents discreet and appropriate assistance with eating that was respectful and encouraging, another member of staff was brusque and condescending at times. This member of staff was seen standing over residents whilst assisting them, telling them to be quiet and telling 1 resident they could not go to the toilet until after they had finished eating. Discussions with the catering manager revealed that she speaks with each resident in the Carrick unit every morning to establish their choice for the main meal and evening meal. Staff from the Shannon unit advise her of residents preferences. The home uses a contract supplier for fresh fruit and vegetables that are delivered to the home twice per week. The catering manager was observed during the morning, advising the suppliers of a considerable list of ommissions from her order. This was to result in the need for a member of staff to make good the shortfall by visitng a local supermarket. It was confirmed that difficulties such as this are a regular occurrance. The quality of the fruit and vegetables delivered was also discussed and the catering manager confirmed that it is often necessary to use frozen vegetables midweek as the provisions supplied do not last. The catering manager stated that all cakes, pies, pastries and sauces are home-made. Special diets are catered for and at the time of inspection these included soft and diabetic diets. 80 of returned comment cards from residents showed that they liked the food provided by the home. Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good complaints procedure in place and there was evidence of its approriate use. Residents are protected by good practice and staff who are trained about adult abuse awareness. EVIDENCE: A requirement was made at the last inspection in respect of staff adult abuse awareness training and approriate conduct. This has been met. The homes complaints records were looked at. They clearly showed any issues raised and the action taken. The last complaint received at the home was dated 24 April 2006 and this was followed looked at in detail. Documentation showed a thorough investigation was undertaken with follow up actions identified. The investigation included interviews, statements, reassessment of staff competence and counselling. The complaint log showed that, at the time of inspection, the frequency of complaints was reducing. Completed comment cards showed that 84.5 of relatives and 80 of residents knew about the homes complaints procedure Discussion with staff demonstrated a good understanding of adult abuse awareness issues, however observation of the practice of 1 member of staff caused concern as it was highly inapproriate and unacceptable. These concerns were raised with Mrs Lancaster and Mrs Scott at the time of the Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 Page 17 inspection. Staff receive abuse awareness training as part of their induction and then annually, with the last training presented during April 2006. The home also uses abuse video training. All staff are subject to a Criminal Records Bureau (CRB) check. Where applications and/or disclosures show previous issues, staff files provide evidence that the home has thoroughly and appropriately followed through to ensure the residents are not put at risk. Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 Page 18 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, 23, 24 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment is generally kept in good order although there needs to be improvement in the upkeep of the external environment. There needs to be better awareness of the environment and how it impacts on the residents in the dementia unit. EVIDENCE: Five requirements were made at the last inspection regarding the environment. These have been met. A tour of the building was made with Mrs Lancaster. During the tour, it was noted that hoists were stored in corridors. The corridors are designated fire exit routes and must be kept clear. This issue was discussed with Mrs Lancaster and Mrs Scott and it was accepted that there is a lack of storage space for larger items such as hoists. Concern is expressed however as the corridors are further compromised by the wheelchair store door, a room with a Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 Page 19 fire door keep locked shut being left wedged open by a wheelchair and also the library doors with defective fire strips between the door seals. The standard of decoration in the Carrick Unit was good and the area clean. Residents rooms were approriate to their needs and provided a good standard of personal space. Improvements need to be made however to the bathrooms in this area as they are stark and institutionalised and would benefit from more domestic items such as pictures and cabinets. The pink bathroom was cluttered with various items, however Mrs Lancaster stated that these items are removed when the bathroom is in use. The decoration within the Shannon Unit is different to that of the Carrick Unit and as a result the Shannon Unit appeared more clinical and less homely although it is acknowledged this part of the home was redecorated at the same time as the Carrick Unit. Residents bedrooms are the same design throughout the home, however in the Shannon Unit they do raise some issues for the clients cared for. For example, the bedroom doors all look the same and would cause difficulty in orientation for some residents. This could be resolved by personal items, pictures or clear naming being displayed on or by every door. Within each bedroom, the doors to the en-suite could be easily mistaken for wardrobe doors and would benefit from clear signage. Some bedrooms seen did not have sufficient personalisation and would benefit from personal pictures and other items to re-enforce the ownership of the room as a personal space to be enjoyed. Other issues within this unit include the lack of signage of significant rooms such as lounge, bathroom and dining room. Within these rooms, there needs to be more thought for orientation such as nautical pictures and bathroom cabinets in the bathrooms; properly laid dining tables with napkins and cutlery in the dining room. Some chairs in the lounge had their seat cushions missing as they were being laundered. It is suggested that additional seat cushions are obtained so that laundering can take place without the need to leave chairs without seat cushions. The central courtyard was seen. This could be a very pleasant and sheltered area for residents to enjoy. However, weeds were growing through the cracks in the paving and represented a trip hazard. Tools, including garden forks and a rake were left out rather than being put in the tool store and these represented a risk to residents. The whole area would benefit from colourful and sensory planting. It was noted that some of the laundry equipment was in need of repair and had been out of commission for a considerable time. One industrial sized washer and 1 industrial sized dryer were out of order, leaving the laundry with only half its equipment in working order. Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 Page 20 Some of the corridor and bedroom carpets in the Shannon Unit were in need of vacuuming and the corridor carpet and some areas of the lounge carpet were stained and in need of cleaning. Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate in respect of standard 27, 28 & 30 and good in respect of standard 29. This judgement has been made using available evidence including a visit to this service. There are times of the day when the home would benefit from more staff being on duty. Residents in the dementia unit would benefit from a more settled staff team. The home has good recruitment practices in place. There was a general lack of understanding of the needs of people with dementia and how they should be met. Staff receive training that is relevant to their role but there is evidence they need further training in specific areas to enhance previous learning. EVIDENCE: Requirements were made at the last inspection regarding staffing levels and competence. One has been repeated in part. Apart from 1 qualified member of staff, no staff work exclusively in either the Shannon unit or the Carrick unit. Staff are designated to a unit on a daily basis. Staff spoken to confirmed that they expect to work 2 shifts on the Shannon Unit depending on their contracted hours. Issues around the competency of staff are referred to in standards 12 - 15. Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 Page 22 Staff rotas were provided and showed that the home routinely employs 2 qualified nurses and 5 care staff between 08:00 & 14:00, 2 qualified nurses and 4 care staff between 14:00 & 20:00. One qualified nurse and 2 care staff are employed between 20:00 & 08:00. The staff rota does not show in which unit each member of staff will be working. The staffing levels are in accordance with the Norfolk Health Authority staffing notice that was in place on 1 April 2006. These are the minimum levels to be employed at the home and do not necessarily reflect the changes in needs of the people living at this home. The staffing levels should therefore be reviewed to ensure that the home can meet all physical, health, social, emotional and spiritual needs. Observations and comments made by staff showed that more staff are needed in the Shannon Unit. Residents had to wait to receive assistance with eating as, at the time of inspection, 6 residents required help with eating but only 2 care staff were available. A member of staff was heard asking a resident to wait before being taken to the toilet, as there was no-one available to assist her. She eventually obtained help from a member of staff on the Carrick Unit. There was little evidence of social activity taking place, especially within the Shannon Unit, where residents were seen sleeping in significant numbers at various times of the day. Discussion with visitors suggested that they do not feel there are always enough staff on duty, particularly at weekends. This is consistent with the completed relative comment cards, which stated that 31.25 of relatives do not feel there are sufficient staff on duty, compared with 37.5 who feel there are sufficient staff available. Five comment cards did not have a response to this question. The staff files and training records for 3 staff were looked at during this inspection. One file was in respect of a senior member of staff due to commence post shortly and the other 2 were for well-established care staff. In each case, the staff had been subject to a good and thorough recruitment process. This included completed application form, interview notes, references, job description, staff contract and CRB disclosure. There was also evidence of the staff member receiving information such as a copy of the staff handbook and code of conduct. The staff training records showed that the home has a recorded induction programme although the perusal of staff files showed that these are not consistently signed off. During discussion, staff confirmed they had received induction training that had included moving & handling, medication, personal hygiene, food hygiene, responsibilities and communication skills. The home uses video training on issues such as manual handling, health & safety, infection control, 1st aid, fire prevention, food hygiene, adbuse awareness, fire drills and dementia. Mrs Lancaster advised that a further Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 Page 23 training video was awaited regarding palliative care. Staff also receive training on issues such as wound care, peg feeding and care of the dying. Mrs Lancaster stated that 80 of current staff have either completed or are about to completed care qualifications. This includes the nursing staff and NVQ qualified care staff. Currently, the home also has a member of staff training to be an NVQ assessor. A moving and handling trainer is also available at the home, however some poor manual handling practices were seen during this inspection, with residents being lifted under their arms, and it is recommended that all staff manual handling practice is monitored and updated as necessary Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is poor for standard 36, adequate for standards 33 & 38, good for standard 31. This judgement has been made using available evidence including a visit to this service. The home is managed by a suitably qualified and experience manager. The home has quality assurance audits in place that seek the views of residents and their representatives. There is very limited staff supervision taking place and this needs to be established as soon as possible. There needs to be an improvement in housekeeping issues, especially around fire safety. EVIDENCE: Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 Page 25 Mrs Lancaster is a suitably qualified and experienced manager who has been in post for a considerable period. A copy of the home’s recent Audit Analysis, and also the annual quality assurance feedback summary were seen. These showed quality assessments taking place on a local and also corporate level and action plans based on the audits were seen. Not all of the findings in the quality audits were in accordance with the evidence obtained through this inspection. For example, the Audit Analysis shows 100 compliance in respect of social needs, whereas the returned resident comment cards show only a 70 satisfaction rating in this area and observations supported this response. Discrepancies may be due to the wording of questions asked, however it should be noted that the responses received by the Commission are reflective of observations made during the inspection. The majority of concern for, for example, social needs, is based upon evidence gained within the Shannon Unit and it may be helpful for the organisation if they were to look at the specific issues within this unit separately to the rest of the home. The standard in respect of resident’s finances was not inspected on this occasion. At the inspection dated 18 October 2006, this standard was met and the Commission is not aware of any changes to practice since that date. No complaints or expressions of concern have been received. At the time of inspection, Mrs Lancaster confirmed that staff supervision is not taking place on a regular nor frequent basis. It is hoped that the situation will improve once the new deputy manager is in post. It is important that staff supervision takes place in accordance with National Minimum Standards and that the process is fully recorded. It was of particular concern that 1 member of staff, who was observed by Inspectors involved in unacceptably poor practice, has not received supervision despite the on-going concerns of Mrs Lancaster and Mrs Scott. Health and safety records were seen including accident records and monthly health and safety audit records. The accident records included a monthly accident audit that is sent to head office. Mrs Lancaster also conducts a monthly audit of accidents to establish any patterns and identify any remedial action to be taken. The fire records showed that the home has a service contract for bi-annual equipment checks. These were up to date. The fire risk assessments were seen and up to date. These documents are reviewed on an annual basis. Weekly testing takes place using a different call point on each occasion. Staff training, including the training of night staff, takes place. The last recorded fire safety training took place on 28 April 2006. There were 3 issues raised regarding fire safety and the need for action was identified. Hoists were seen stored in the corridors. These are designated fire escape routes and must be kept clear at all times. The fire doors to the library are not smoke resistant as there is a considerable gap in the seal on each of Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 Page 26 the doors. A wheelchair store door was found propped open by a wheelchair. The door clearly stated Fire door keep locked shut. Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 Page 27 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 1 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 X X 2 2 X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 1 X 2 Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 Page 28 Yes Are there any outstanding requirements from the last inspection? 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 OP3 Regulation 14(1) Requirement The registered persons must ensure that a relevant preadmission assessment of all needs, including physical, health, social, emotional and spiritual needs, is undertaken and fully recorded prior to any admission. The registered persons must ensure that personal care needs are appropriately met. Outstanding since 30 November 2005. The registered persons must ensure residents are treated with dignity and respect at all times. The registered persons must ensure that staff support residents to take part in meaningful activity, particularly within the Shannon Unit. The registered persons must ensure that the environment, particularly within the Shannon Unit, meets the specific needs of the residents accommodated there. The registered persons must ensure that the external environment is well and safely DS0000015678.V294388.R01.S.doc Timescale for action 01/07/06 2 OP7 12, 15 01/07/06 3 4 OP10 OP12 4(a) 16(n) 01/06/06 01/07/06 5 OP19 23(1)(a) 01/07/06 6 OP20 23(2)(o) 01/07/06 Sanford House Nursing Home Version 5.1 Page 29 7 OP20 23(b) 8 OP26 23(2)(c) 9 OP27 18(1)(a) 10 OP36 18(2) maintained. The registered persons must ensure that all fire exit routes are not impeded by equipment, fire doors to store rooms are kept closed & fire door seals well maintained. The registered persons must ensure that all laundry equipment is repaired without further delay. The registered persons must ensure that sufficient, competent staff are employed to meet the needs of residents in an appropriate, effective and timely way. The registered persons must ensure that all staff receive supervision that is recorded and in accordance with National Minimum Standards. 01/06/06 01/06/06 01/07/06 01/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP14 Good Practice Recommendations It is recommended that staff are reminded to provide care and support that is in accordance with the wishes and preferences of residents and that is recorded within care plans. It is recommended that all staff induction training is properly recorded and the record of training signed and dated as appropriate. It is recommended that the home’s and organisation’s quality audits are further developed so that they reflect the specific needs and aspirations of people who have dementia. 2 3 OP30 OP33 Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Sanford House Nursing Home DS0000015678.V294388.R01.S.doc Version 5.1 Page 31 - 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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