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Inspection on 16/10/08 for Saxlingham Hall Nursing Home

Also see our care home review for Saxlingham Hall Nursing Home for more information

This inspection was carried out on 16th October 2008.

CSCI found this care home to be providing an Excellent service.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is extremely well run with a committed team of staff who have the best interests of the residents at heart. The provider and manager ensures that the home is always well maintained and safe. The service carries out very good assessments prior to admission to the home to make sure that the service can meet the needs of prospective residents. This information is then used to plan care that addresses all the needs of the residents. One resident told us "I was given enough information before I came to the home and was able to make a decision about whether I wanted to live here". The provider and the manager are always keen to respond to recommendations by the Commission. The residents make positive comments about the food, the caring staff and the standard of care that they receive. One resident told us "I love it here, and am lucky to be here". A relative told us "there is good communication and are made welcome at all times. The staff are friendly and supportive". Another relative told us "the care home is sufficient, well run and staffed by a very talented, professional care team. They are always polite and extremely helpful no matter how busy they are".

What has improved since the last inspection?

More improvements have been made to the overall ambiance of the home and more electric profiling beds have been purchased. The home has an on going programme in place to ensure all areas of the home are not affected by energy loss. The kitchen staff have improved the presentation of meals for those people who have to have their food pureed.

What the care home could do better:

Ensure that they extend the homes system for monitoring the quality of the service.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Saxlingham Hall Nursing Home The Green Saxlingham Nethergate Norfolk NR15 1TH     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Marilyn Fellingham     Date: 1 6 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Saxlingham Hall Nursing Home The Green Saxlingham Nethergate Norfolk NR15 1TH 01508499225 01508499612 staff@saxlinghamhall.fsnet.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Theresa Dawn Parfitt Type of registration: Number of places registered: Saxlingham Hall Nursing Home Limited care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Saxlingham Hall is a large detached house dating back to 1880, and is situated in about two and a half acres in a rural setting, about two miles from the centre of the village of Saxlingham Green. Accommodation is on two floors with both floors being accessible to wheelchair users. Service users accommodation is provided within thirtyone single bedrooms and four double rooms, with the majority having en-suite facilities. The bedrooms are situated on both floors with access by two shaft lifts. All rooms have a television and telephone point. On the ground floor is a large lounge and dining room, with a further two small sitting rooms, and a conservatory leading out to the patio area overlooking spacious garden and woodland areas. There are ample parking places. 0 Over 65 41 Care Homes for Older People Page 4 of 26 Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this home is 3 star. This means that people who use the service experience excellent outcomes. This was an unannounced inspection that took place over seven hours. The key inspection for this service has been carried out using information from previous inspections, information from some residents, relatives, visitors to the home and people who work in the home. The main method of inspection used was case tracking. This involved selecting individual care plans and information available about people who live in the home and Care Homes for Older People Page 6 of 26 tracking their experience as a result of the support provided. During our visit a tour of the premises was undertaken and residents records and staff files were looked at. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents to the home are given sufficient information to make an informed decision about whether they want to live in the home. Evidence: We looked at two records of assessment for newly admitted residents, we noted that a full assessment of needs had been carried out for both these residents. The assessments were very detailed and contained relevant information pertaining to both residents. The home after having completed the assessments of need established that their needs could be met; we saw copies of letters that had been sent to residents confirming this. We spoke with both these residents who confirmed that they had received enough information about the home to enable them to make an informed decision about entry to the home. Prospective residents are given the opportunity to visit the home prior to admission and the residents we spoke with also confirmed this. Care Homes for Older People Page 10 of 26 Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The practice regarding the planning and delivery of care means that the residents can be sure that their health and personal care needs will be met. Evidence: We spoke with seven residents who were living in the home, they all commented that they felt that they were very well cared for; one said the staff are extremely kind and patient and nothing is too much trouble for them, another remarked I like it here and have been here awhile. One resident we spoke with said give the home good marks because it deserves it. We spoke with some relatives who were visiting the home and one relative told us my husband is always very well looked after and they are very patient with him and caring. One relative said my relative is so well cared for I could not wish for him to be looked after any better. We looked at care plans for the seven residents we spoke with, they were very detailed and covered all areas of assessed needs. The service has put a new care planning system into place which appears to be working very well. Each of the care Care Homes for Older People Page 12 of 26 Evidence: plans we looked at had records for manual handling, risk assessments for skin integrity and assessment documentation for their nutritional status. We also noted that the residents were weighed on a monthly basis and more if there is concern about the residents nutritional status. The home uses the Braden scale for predicting pressure sore risk and we saw care plans in place for pressure area care. There were care plans in place for the administration of medication and the use of p.r.n. (as required) medicines and also a rationale for pain relief. A random audit of medicines was undertaken and we found that the amount of medicines in stock tallied with the medicine record charts relating to the prescribed medication. The home carries out its own auditing of medication and records were seen for this along with the policies and procedures that are in place for the administration and handling of medication. All the residents care plans we looked at had assessments for their physical and psychological well being. The service has prepared documentation for assessing the mental capacity of their residents and the senior staff have attended sessions for this and are hoping to introduce the system. The service has also put in place record tracking system for review of care and we noted that the care plans we looked at had evidence of continual review and changes having been made when the needs of those residents changed. We also noted that there were care plans in place for palliative care to enable staff to give appropriate end of life care. Records are kept of all GP visits and also discussions with the residents and their families. The staff we spoke with have an overall understanding of the care planning process and knew how to use the care plans to give the care. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A wide range of activities within th home means that the residents have many opportunities to participate in stimulating and motivating activities. Meals and mealtimes are not rushed and appear to be a social occasion for all the residents. Evidence: We were able to discuss with a number of residents, staff and visitors about the activities within the home; we were also able to observe some social interactions and activities taking place. On the day of our visit eleven residents were joining in an exercise session, we noted that there was very good communication with the staff and residents during this session and that the residents were being treated in a dignified manner. There was a lot of laughter and it was obvious that all the residents were enjoying themselves. One resident told us there is so much going on I dont have time for anything else. Another said I have been outside for awhile and I love the reminiscence sessions. We learnt that one carer brought her art class to the home and the residents along with the art class members painted views of the home. One resident explained to us that they enjoyed having their hair done and that it was a social occasion when the people who were having their hair done all sit and have coffee together. Care Homes for Older People Page 14 of 26 Evidence: Visitors to the home told us that they were always made welcome and one relative told us that the staff not only look after my husband but me also. Opportunities are given to residents to entertain their visitors, including a meal or drink. Menus that were seen offered a variety of well-balanced meals and one resident told us that they can have a cooked breakfast or cereal, they have coffee mid morning then lunch. They went on to inform us that they also had afternoon tea with cakes a choice of hot meals for supper and a drink and biscuits last thing at night. They also told us that the food was very good. We observed lunch being served and those that needed assistance were being helped in a dignified way. The residents choose where they would like to eat their meals either in communal areas or in their own rooms, however the residents are encouraged to join others for meals so that they do not become isolated but ultimately the residents choose what they wish to do. Two residents were having lunch in a small sitting room, they told us that they liked the room and chose always to have their meals served there. The lunchtime appeared to be unrushed and an enjoyable social occasion. The staff appeared to be familiar with the likes and dislikes of all the residents as did the kitchen staff and the cook. We noted that those residents who needed their food liquidized were being served it in an acceptable way with the various pureed foods being individually served on their plates. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents feel safe and listened to. The staff have been given the knowledge to recognise all aspects of abuse, this means that every effort is made to protect the residents. Evidence: A complaints procedure is in place and is made available to the residents and other significant people. We spoke with some relatives and residents who said they knew how to air their concerns and who to go to. One relative rold us, I know who to go to to make a complaint and any issues I have raised in the past have always been dealt with: another relative told us if I have any concerns they never mind if I ring them or speak to them, they always listen to me and sort things out. A resident we spoke with told us I never have any complaints and I know who to speak to if I did. We looked at the records for complaints and one complaint had been made about the cleanliness of a room; the records showed how the complaint had been dealt with and the action taken. The home keeps a record of all incidents that occurr in the home and we noted that the manager keeps a record of any small concerns expressed by the residents or their relatives and how they are dealt with. The staff we spoke with were aware of the procedure for making a complaint. We also spoke with staff about all issues related to safeguuarding adults, they were well informed and new about their responsibility to raise any concerns with the manager. Care Homes for Older People Page 16 of 26 Evidence: We checked records for staff training and these indicated that staff have had training in issues relating to abuse. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The overall enhancement and refurbishment that has taken place and the providers and managers willinghness to ensure the premises remain safe means that the residents live in a safe and comfortable environment. Evidence: We undertook a tour of the home and found it to be very clean and tidy; comments in the surveys we received from relatives and residents included my room is always spotless and the home is spotless and one resident remarked to us that the standard of cleanliness was very good indeed. The home has a dedicated team of domestic staff led by a house keeper, the duty rosters we looked at confirmed that there were always sufficient domestic staff on duty to maintain the cleanliness of the home. All the residents we spoke with expressed satisfaction with their rooms and we noted one resident had a bird table outside their room so that they could watch the birds. We noted on our tour of the home that some areas were now in need of re decoration, however there is a planned maintenance programme in place. This includes the downstairs corridor to be re carpeted and also painted. A new bathroom has been installed on the ground floor. The provider is aware that a number of windows need replacing and has been attempting to resolve this as there are restrictions in place to prevent him from doing this. Care Homes for Older People Page 18 of 26 Evidence: On our tour of the home it was noted that the floor area by the main stairs was very uneven and could be hazardous to fragile residents; the manager said she would deal with it immediately to prevent any untoward incidents taking place. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are well supported by adequate numbers, skilled and knowledeable staff. The residents are protected by the homes recruitment practices. Evidence: The duty rosters were examined and showed that the home was more than adequately staffed; there are always three Registered nurses on in the morning and two for the evening shift and one on night duty. One resident told us I am so impressed by the ratio of care staff to residents and they are all very caring and helpful. Another resident said I feel I am well looked after. Members of staff we spoke with felt that they always have a good ratio of staff on duty to allow them to give the care required for each resident; this was also echoed in the staff surveys we received. Records for newly appointed staff were looked at, these were seen to reflect a robust checking system before staff are employed. This was also confirmed by new members of staff we spoke with who also told us about the thorough induction they had undertaken and the records we saw for this confirmed that all mandatory subjects had been covered. We also spoke with four members of staff including a student nurse who was undergoing a placement at the home. This student nurse told us what an amazing experience they had had at the home and it had been the best placement they had had so far had particularly in relation to the care that the residents received and the Care Homes for Older People Page 20 of 26 Evidence: attitude of the staff. The staff we spoke with confirmed that they had had training in infection control, manual handling, health and safety, first aid and safeguarding adults. We looked at the training matrix which is reviewed each year; we saw from this that the training contained subjects related to the residents conditions and we also noted there were certificates in place for all training that has been undertaken. Further discussions with staff confirmed that they had a good understanding of their roles and that they were well supported and that the management were keen to involve all staff in any study days that became available as part of regular on going training. We were laso made aware that some staff have undergone trainingin relation to the Mental Capacity Act. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an excellent management structure in place, which ensures, that these service is being well run and in the best interests of the people who use the service. The health and safety of the residents has been protected and promoted because of the management structure of the home. Evidence: Records were in place for formal supervision, one staff member commented that, along side productive and supportive yearly appraisals I am happy with the regular supervision that I receive from more senior staff. One resident told us thatthe manager is very approachable, whilst another said the management are always available if needed; another resident said in all this is a pleasant and efficient nursing home. A member of staff told us that the manager is always looking for new ways to improve the service. We noted that the communication system between staff and management was good and that minutes of meetings were in place that showed us that new ideas and information is continually passed onto the staff. Overall the Care Homes for Older People Page 22 of 26 Evidence: comments made to us suggested that the staff, residents and relatives were getting the support they needed from the management. We noted that whilst we were visiting the home the manager made herself available to all visitors and a number of them popped in to speak to the manager. One relative told us that she always knows where to go for advice about their relative and that the manager is always available for this. We looked at health and safety related information these showed that there are servicing arrangements for all equipment, these included the hoists and the lift. Fire safety records were in place and we saw records for all fire training. The service does carry out some form of quality monitoring of the service it offers, however this could be extended to all areas of managing the home. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 37 It is recommended that the homes quality monitoring system be extended to include all aspects of the service it offers including surveys from other agencies. Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!