CARE HOMES FOR OLDER PEOPLE
Saxlingham Hall Nursing Home The Green Saxlingham Nethergate Norfolk NR15 1TH Lead Inspector
Mrs Judith Huggins Unannounced Inspection 23rd February 2006 11:20 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 Saxlingham Hall Nursing Home DS0000015679.V281990.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. Saxlingham Hall Nursing Home DS0000015679.V281990.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Saxlingham Hall Nursing Home Address The Green Saxlingham Nethergate Norfolk NR15 1TH 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) 01508 499225 01508 499612 staff@saxlinghamhall.fsnet.co.uk Saxlingham Hall Nursing Home Limited Mrs Theresa Dawn Parfitt Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Saxlingham Hall Nursing Home DS0000015679.V281990.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7th September 2005 Brief Description of the Service: 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 thirty-one 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. Saxlingham Hall Nursing Home DS0000015679.V281990.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and lasted just over four hours. During the inspection a sample of records was checked, four residents were spoken to, and staff were heard interacting with each other and with residents. The inspector also attended part of the afternoon quiz session where two members of staff supported residents. The inspector acknowledges that the last three months have been a difficult time for the manager, who has had to deal with administrative matters and address a number of problems arising. This has meant it has been difficult for her to fully focus on wider aspects of running the home. She is aware of this and has some good ideas for how she will continue to develop the service now a replacement administrator is in post. What the service does well: What has improved since the last inspection?
Although still in progress, some work to the kitchen has been completed, with the lining of main walls. Recruitment records have improved although there remain gaps, and a new system of supervision has been set up. See also below. The appraisal records
Saxlingham Hall Nursing Home DS0000015679.V281990.R01.S.doc Version 5.1 Page 6 seen show that work performance is assessed and goals set with staff. These also show how these are to be achieved. This is good practice. There has been an improvement in the recording of social and recreational needs and activities, based on those care plans seen. This helps to show a more holistic approach to the care of residents. The home is making good progress to achieving 50 of its care staff being qualified to NVQ 2 or above. 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. Saxlingham Hall Nursing Home DS0000015679.V281990.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 Saxlingham Hall Nursing Home DS0000015679.V281990.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): 3, 6 No resident moves into the home without having his or her needs assessed. Standard 6 is not applicable. EVIDENCE: The manager makes visits to prospective residents and gathers a range of relevant information about residents’ needs, based on documentation seen. There is no dedicated rehabilitation service. Saxlingham Hall Nursing Home DS0000015679.V281990.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 Residents health, personal and social needs are set out, although there is some need to improve follow up of health related issues in records. There are some minor shortfalls in the management of medicines but the manager is acting proactively to address these. EVIDENCE: Care needs are set out and there are supporting assessments or risk assessments. However, in some cases, assessments are not clearly linked to actions. For example, one person has a continence assessment (provided by the continence advisory service). This shows that one objective of the care is to maintain skin integrity but there is no pressure area assessment linked with this. There are some omissions in records of the provision of personal care. Another person has had a change recorded on the pressure area assessment showing that their nutrition is “probably inadequate”, since November 2005.
Saxlingham Hall Nursing Home DS0000015679.V281990.R01.S.doc Version 5.1 Page 10 There has been no follow up showing how this is to be improved. There is no nutritional screening tool in use and the monitoring of weight is sporadic. The manager says that this has been discussed with the GP, who will provide supplements when a suitable tool is in place to determine whether these are necessary or would be beneficial. She is aware of this shortfall in assessing need. It is possible to download a suitable tool, and related guidance from the Internet. One person’s care plan shows the need to encourage fluid intake of at least 2 litres over 24 hours. Records do not fully support that this is achieved. However, given levels of satisfaction reported by residents with their care, records may not be doing justice to the service in that they do not reflect the true nature and extent of care, or monitoring that is taking place. The account given of the process of managing medication shows that there is no secondary dispensing, with medication being taken directly from each residents’ own locked cupboard in their rooms. Qualified nursing staff retain control of the keys. The storage of additional medication supplies and controlled drugs is in a separate, well lit and well-organised “walk in” cupboard, also appropriately locked. The manager has introduced and audit system for tracking supplies of medication in use. There are anomalies recorded although she attributes some of this to audits being carried out at different times (before or after administration) meaning that totals are not always correct. Given work being undertaken to ensure the audit process is consistent and provides for the safekeeping of medication, no requirement is made. Saxlingham Hall Nursing Home DS0000015679.V281990.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14 and 15 Residents are able to maintain contact with family and friends, as they would wish and to exercise choice and control over their lives. Residents receive a wholesome and appealing balanced diet. EVIDENCE: As at previous inspections, relatives and friends were noted as visiting throughout the duration of the inspection. Residents confirm this. Records also show that people receive regular visits from family, friends, clergy and legal representatives. Residents’ records show that there is flexibility of routines for residents. Observation shows that people are able to bring in belongings from home so that their rooms are homely and contain familiar items. Residents are able to access their records as they wish, although currently care records are not held securely where residents do not wish to hold these themselves. The residents speak highly of the food they are offered. Discussion with the cook and a check of records of meals served showed that a considerable range
Saxlingham Hall Nursing Home DS0000015679.V281990.R01.S.doc Version 5.1 Page 12 of meals had been served at lunchtime. This included roast lamb, cheese salad, omelettes or boiled eggs according to preference. She was in the process of making homemade leek and potato soup for tea. One person likes to have custard and sherry for tea. The cook says that where people need pureed food, the ingredients are processed separately to provide a more appetising appearance and the opportunity for choice. Saxlingham Hall Nursing Home DS0000015679.V281990.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None Key standards were inspected at the last visit. EVIDENCE: Saxlingham Hall Nursing Home DS0000015679.V281990.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None Key standards were inspected at the last visit. EVIDENCE: Saxlingham Hall Nursing Home DS0000015679.V281990.R01.S.doc Version 5.1 Page 15 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): 28, 29 and 30 Staff are trained and competent, although the ratio for NVQ trained staff is not quite met. Although improved, there is some shortfall in evidence that residents are fully protected by recruitment practices. EVIDENCE: There is evidence on file of staff undertaking induction. Ten care staff have NVQ level 2 qualifications or above. A sample of certificates for the listed names was seen. The manager says that four more staff are currently undertaking this. When achieved the home will have 14 out of 30 care staff with the qualification. This is close to the ratio set out in standards. There is increased evidence of proof of identity on staff records. However, files for staff do not all contain the required evidence of enhanced Criminal Records Bureau (CRB) disclosures and POVA First checks. The latter must be obtained before staff start work. One person, whose file was seen, had a CRB disclosure issued by a previous employer. These are no longer transferable. Not all files contained full employment histories. The requirement made at the last inspection cannot therefore be considered as wholly met.
Saxlingham Hall Nursing Home DS0000015679.V281990.R01.S.doc Version 5.1 Page 16 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, 37, 38 The home is run and managed by a person fit to be in charge. The home is not yet run fully in the best interests of residents. Residents’ financial interests are safeguarded. Although improved, staff are not yet appropriately supervised. Improvements are needed to ensure record keeping polices and procedures safeguard and protect residents. Health, safety and welfare of residents are promoted. Saxlingham Hall Nursing Home DS0000015679.V281990.R01.S.doc Version 5.1 Page 17 EVIDENCE: The manager is a registered nurse with considerable experience at the home. She is registered with the Commission and undertakes regular training to ensure her skills remain up to date. There are no visits on behalf of the registered provider, carried out and recorded in accordance with regulations. As yet there are no surveys of residents or other interested parties, to seek their views about the quality of the service. However, there is some attempt to audit the service (accident records, call bell responses – following the installation of a new system), and record actions necessary. Considerable work has recently been undertaken to review difficulties with managing the finances of the home – which have resulted in a backlog of invoices for the service. The manager and owner of the home say that this situation has now been resolved and there is an administrator in place to ensure that residents receive regular bills where this is needed. The home does not manage money on behalf of residents. The manager has devised a new form for setting out and recording supervisions. This covers an appropriate agenda. Staff receive regular appraisals, which set out goals for the forthcoming year and training or development needs. These records also set out how the goals are to be met. This is good practice. The frequency with which staff are supervised has improved but this is relatively recent and does not yet show that it happens a minimum of six times a year as set out in standards. There is no record kept of visitors to the home. This is a statutory record, required by law. There are also some omissions from statutory staffing records, required before staff commence employment at the home. (See standard 29.) As at the last inspection, care plan records are not secured. The manager says that residents have chosen not to have these in their rooms because staff would disturb them going in to make entries on the plan. Where this is the case, the registered persons have responsibility for holding these records in a manner that does not breach confidentiality or Data Protection requirements. As this is a nursing home, nursing staff also need to abide by NMC Codes of Practice for record keeping and for confidentiality. Additionally, the “service user’s guide” sets out that the home will promote privacy by “maintaining confidentiality in all matters relating to residents.” A sample of records relating to health and safety were checked. These included accident audits, maintenance of fire safety equipment and fire training Saxlingham Hall Nursing Home DS0000015679.V281990.R01.S.doc Version 5.1 Page 18 for staff, legionella tests on water, and records relating to cleaning products. These show that health and safety is promoted. The use of one product indicates the need for staff to wear goggles. The manager could not confirm that these are available. The records show that there has been some slippage in the checking of a few electrical appliances. Saxlingham Hall Nursing Home DS0000015679.V281990.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x x x x x x x x x STAFFING Standard No Score 27 x 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 2 2 3 Saxlingham Hall Nursing Home DS0000015679.V281990.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 12 Requirement The registered persons must make arrangements to ensure, so far as is practicable, the nutritional needs of residents are assessed and acted upon. The registered persons must ensure that visits on behalf of the registered provider are conducted in accordance with regulations. The registered persons must implement a system for monitoring and reviewing the quality of the service at the home (and supply reports from this to the Commission). Outstanding requirement The registered persons must ensure that all staff receive supervision with the agenda and frequency set out in national minimum standards. The registered persons must maintain a record of all visitors to the home. The registered persons must hold residents’ records in a manner which prevents unauthorised access and protects
DS0000015679.V281990.R01.S.doc Timescale for action 30/04/06 2. OP33 26 30/04/06 3. OP33 24 30/06/06 4. OP36 18(2) 31/12/05 5. 6. OP37 OP10 And OP37 17(2) Sch 4, 17 12(4) 30/04/06 30/04/06 Saxlingham Hall Nursing Home Version 5.1 Page 21 7. OP29 And OP37 19&Sch2 confidentiality. Outstanding requirement The registered persons must maintain all legally required records in respect of staff employed at the home. (See Schedule 2 of regulations as amended in 2004) 30/04/06 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. 2. 3. Refer to Standard OP28 OP38 OP38 Good Practice Recommendations The registered persons should ensure that 50 of care staff achieve NVQ level 2 training or above. The registered persons should confirm and ensure that personal protective equipment identified as necessary when using cleaning chemicals, is provided. The registered persons should ensure that electrical appliances not tested recently, are checked. Saxlingham Hall Nursing Home DS0000015679.V281990.R01.S.doc Version 5.1 Page 22 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
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