CARE HOMES FOR OLDER PEOPLE
Saxlingham Hall The Green Saxlingham Nethergate NR15 1TH Lead Inspector
Judith Huggins Announced 7 September 2005, 09:30
th 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 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 I55 s15679 Saxlingham Hall v241763 AN 070905(4).doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Saxlingham Hall Address The Green, Saxlingham, Nethergate, Norfolk. NR15 1TH. 01508 499225 01508 499612 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Saxlingham Hall Nursing Home Limited Position vacant Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41). of places Saxlingham Hall I55 s15679 Saxlingham Hall v241763 AN 070905(4).doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: There are no additional conditions of registration. Date of last inspection 7th February 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 I55 s15679 Saxlingham Hall v241763 AN 070905(4).doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was announced and lasted six and a quarter hours. During the course of it, the matron (who has applied to be registered with the Commission), the proprietor, two members of care staff, one nurse, two kitchen staff and three residents were spoken to. In addition, comment cards were received from 12 residents (some of whom had been helped by family members to complete them) one legal representative and two visiting health professionals. Where appropriate, their comments have been included in the report. A sample of records was examined, including four care plans, and a tour of communal areas and a few bedrooms was made. What the service does well:
Communal areas and residents’ own rooms are maintained and decorated to a high standard, and a high proportion of the good sized rooms have en-suite facilities, with further improvements planned. Residents clearly enjoy the surroundings both inside and outside the home, commenting on the view from their rooms and the facilities available. The gardens of the home are well maintained and tidy, and there is ramped access to patio areas. The home is well staffed, and there are very good working relationships between care and nursing staff. Several of the staff have worked for many years at the home, understand their roles well, and show commitment to meeting the needs of residents. Residents feel well cared for, safe, and treated well. The inspector was told that all the staff are good, and some are “marvellous”. Comments from relatives in thank you letters show that they feel their family members are looked after well and treated with dignity and respect. Despite the process of refurbishment of the kitchen, catering staff are commended for the high level of satisfaction expressed by residents, with the quality and choice of food. This is despite them working under difficult conditions at present. Although staff and residents had some anxieties about the departure of the former matron, they feel that the current matron is running the home well and that they are able to discuss concerns or problems with her.
Saxlingham Hall I55 s15679 Saxlingham Hall v241763 AN 070905(4).doc Version 1.40 Page 6 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. Saxlingham Hall I55 s15679 Saxlingham Hall v241763 AN 070905(4).doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Saxlingham Hall I55 s15679 Saxlingham Hall v241763 AN 070905(4).doc Version 1.40 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 standard(s) None None of the standards was inspected. Standard 6 is not applicable and standard 3 was inspected in February 2005. EVIDENCE: Saxlingham Hall I55 s15679 Saxlingham Hall v241763 AN 070905(4).doc Version 1.40 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 standard(s) 10 and 11 Residents feel their privacy is respected, although there are potential compromises. Residents and their families are treated with care, sensitivity and respect at the time of their death. EVIDENCE: All residents completing comment cards say that their privacy is respected. Staff were heard throughout the inspection to be knocking on doors before entering rooms, and where residents prefer their room doors to be kept open, this is clearly documented in care plans. Shared rooms are provided with screens for privacy when needed. Staff were heard speaking respectfully to residents while delivering care and policy guidance covers people’s right to privacy and dignity and the handbook given to all staff contains a section on the residents “charter”. However, staff assisting residents in bathrooms do not always bolt the door behind them, which allows for accidental intrusion (as happened during the
Saxlingham Hall I55 s15679 Saxlingham Hall v241763 AN 070905(4).doc Version 1.40 Page 10 inspection). Since the bolts can be opened from outside in an emergency, other staff would be able to access bathrooms to help when needed. Nursing staff are governed in this regard by the Nursing and Midwifery Council rules, and there is further guidance for all staff in the confidentiality policy. Additionally, the “service user’s guide” set out that the home with promote privacy by “maintaining confidentiality in all matters relating to residents.” However, care plans and records are left outside people’s rooms in some cases. One resident specifically commented that staff were always respectful. Two others confirmed that people knock. Letters from relatives of those who have passed away at the home specifically thank staff for the dignity and care offered to residents who are dying, and it is clear from these that people value the way in which these issues are dealt with by staff at the home. Saxlingham Hall I55 s15679 Saxlingham Hall v241763 AN 070905(4).doc Version 1.40 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 standard(s) 12 Residents feel the lifestyle at the home matches expectations and needs. EVIDENCE: Two staff confirmed the range of activities provided, as did the matron and the pre-inspection questionnaire. This shows that there is either reminiscence or exercise each week, bible study and religious services at intervals, and private visits from local clergy. One member of the clergy visited a resident during the inspection. A garden fete has also taken place recently. Two care staff have been trained in the delivery of “Extend” exercise sessions, and they and a member of nursing staff have been trained in reminiscence therapy. Care plans set out how social needs are to be met, but unfortunately records of participation are held separately, according to the manager, and were not available to show that people are encouraged to join activities in accordance with the goals of care plans seen, offered these, or decline. Overall, comment cards show that half the people completing them feel that activities are always suitable, with one third feeling that they are suitable “sometimes”. One person who was assisted to complete a comment card felt that they were not suitable.
Saxlingham Hall I55 s15679 Saxlingham Hall v241763 AN 070905(4).doc Version 1.40 Page 12 One person, whose notes were seen, has some elements of dementia, and this needs to be kept under review to determine whether there are developing difficulties meeting recreational and social needs. One comment card showed that the person regretted not having the opportunity to share mealtimes with others, as most people eat in their own rooms. The card was submitted anonymously so this issue could not be explored with the person concerned. However, the matron states that where people have their meals is a matter of preference and residents spoken to are happy with the arrangements. During the inspection, several residents attended the hairdressers, and were noted as chatting with one another and the hairdresser. Staff spent time during the inspection, talking with people while carrying out routine care tasks. One person preferring not to join in organised activities commented that a “reading circle” had developed with some of the staff participating, and that it was nice to be able to discuss the “classics” with them. Residents spoken to said that they preferred not to participate in the organised activities on offer, and when cross-referenced with comment cards it is clear that some people feel activities are not all “suitable” because they prefer to spend time reading, watching television in their rooms, or spending time with family members. One person told the inspector that they had not had a single unhappy moment since moving into the home. Staff are to be commended for their efforts. Saxlingham Hall I55 s15679 Saxlingham Hall v241763 AN 070905(4).doc Version 1.40 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 standard(s) 16 and 18 Residents and their relatives are confident their concerns will be taken seriously and acted upon. Residents are protected from abuse. EVIDENCE: All residents completing comment cards, and those spoken to, say that they know who to talk to if they have any concerns. Several commented specifically that they had no complaints and that staff always responded promptly to requests for anything. The complaints procedure is contained in the service user’s guide, although information regarding the outside body regulating the home is out of date, and the matron intends to revise all the information it contains. There have been no complaints in the last 12 months according to the matron, the pre-inspection questionnaire, and the complaints record. Residents say that they are very happy with the care staff and the care provided, in both comment cards and when spoken to. All residents completing comment cards say that they feel safe at the home and are well treated. Some staff have received training in abuse awareness and those spoken to had a commitment to high quality care and a good understanding of their role in delivery of this. Saxlingham Hall I55 s15679 Saxlingham Hall v241763 AN 070905(4).doc Version 1.40 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 standard(s) 19 and 26 Overall, the environment for residents is safe and well maintained. The home is clean and hygienic. EVIDENCE: All areas of the home seen and used by residents are well decorated and maintained to a high standard. Work is in progress to refurbish one bedroom and a level access en-suite shower has been created. The owner has plans for further alterations to replace en-suite baths in this manner. One shared bathroom has already been converted. The owner acknowledges that some attention to exterior woodwork on the older part of the building is necessary and is liaising with the local council regarding options. Work to the kitchen is in progress. This is currently presenting difficulties for catering staff who are anxious for work to be completed. The local environmental health department has responsibility for food safety and health and safety at work.
Saxlingham Hall I55 s15679 Saxlingham Hall v241763 AN 070905(4).doc Version 1.40 Page 15 This work means that some surfaces (floor and walls) are temporarily not easy to clean although surfaces on which food is prepared and served were cleaned down following the serving of lunches. Other areas of the home seen are clean, and there were no odours associated with continence difficulties other than in one location following an emergency occurring earlier in the day, and being addressed. Sheets are sent out for laundering, with dedicated laundry staff attending to personal laundry and other bed linen. There are two machines, one of which has a sluice cycle. Staff have guidance for infection control, including the management of MRSA when this is needed, and have protective clothing provided. Saxlingham Hall I55 s15679 Saxlingham Hall v241763 AN 070905(4).doc Version 1.40 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 28 Residents’ needs are met by the numbers and skill mix of staff. Residents feel safe at the home, although the expected levels of NVQ qualified care staff has not yet been reached. EVIDENCE: Staffing levels are in excess of the minimum required. Staff confirm that they have sufficient time to spend with assisting residents who need high levels of support (for example with eating meals). There is a core of staff with many years’ experience of work at the home, and with a clear understanding of their roles. Feedback from qualified nursing staff, and from carers, is that the staff group works well as a team. Care staff say that nursing staff help them out with tasks, and a nurse interviewed commended the care task for their diligence in observation and recording so that the welfare of residents was properly monitored. Residents confirm that they feel well cared for and well treated, and that staff have time to spend assisting them with tasks or talking with them Saxlingham Hall I55 s15679 Saxlingham Hall v241763 AN 070905(4).doc Version 1.40 Page 17 Six care staff have completed NVQ 2 training or above. (Two have NVQ level 3 in care based on the pre-inspection questionnaire and discussion with the matron.) A further four are currently completing the training which, on completion, will mean 34 of care staff have the required qualifications. The home should continue to encourage the Care Staff to undertake the NVQ level 2 training in care by the end of 2005 to achieve this standard. The above numbers do not reflect the amount of Care Staff that have undertaken this training over the past few years due to some staff having left the home. Staff have access to other training, for example in first aid, fire safety and moving and handling. Saxlingham Hall I55 s15679 Saxlingham Hall v241763 AN 070905(4).doc Version 1.40 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 36 and 37 Residents live in a home which is well run. The new matron has yet to complete the registration process with the Commission. Residents benefit from the ethos and approach to the management of the home. Although supported, staff are not supervised as set out in standards. There are minor shortfalls in records held (and legally required) for safeguarding residents. Saxlingham Hall I55 s15679 Saxlingham Hall v241763 AN 070905(4).doc Version 1.40 Page 19 EVIDENCE: The current matron was formerly the deputy matron at the home. She has applied to the Commission for registration as a “fit person”, and the necessary checks and references are awaited before completion of the assessment process. Residents feel that all the staff group are approachable, and – although the former matron has left the home – that the current matron is approachable and continuing to run the home well. Staff clearly feel that the matron is approachable and are happy that the home continues to operate well. Those spoken to report that suggestions and views are encouraged and explored. The matron maintains a regular presence in the home, participating in some shifts to work alongside care staff. Morale is described as good, as are working relationships between nursing and care staff. Supervision records do not support that all staff receive supervision with the frequency and agenda set out in standards, although they say they do feel able to ask when they have difficulties or need advice. Staff records required by law are not held. For example, despite clearly set out requirements since April 2002, there is no proof of staff identity in personnel records. Saxlingham Hall I55 s15679 Saxlingham Hall v241763 AN 070905(4).doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 4 28 2 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 3 x x x 2 2 x Saxlingham Hall I55 s15679 Saxlingham Hall v241763 AN 070905(4).doc Version 1.40 Page 21 n/a 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 36 Regulation 18(2) 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 all legally required records in respect of staff employed at the home. Timescale for action 31/12/05 2. 37 19 and Schedule 2 as amended in July 2004 31/10/05 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. Refer to Standard 10 10 Good Practice Recommendations The registered persons should ensure that communal bathrooms are secured when staff deliver personal care, to prevent accidental intrusion. The registered persons should ensure that storage of residents records is reviewed to make sure practices protect confidentiality and comply with professional codes of practice as well as in house guidance. The registered persons should ensure that recreational and social activities offered, participated in or declined, are documented to show that care delivered is in accordance
I55 s15679 Saxlingham Hall v241763 AN 070905(4).doc Version 1.40 Page 22 3. 12 Saxlingham Hall 4. 28 with care identified as necessary in each persons care plan. The registered persons should ensure that 50 of care staff achieve NVQ level 2 training or above. Saxlingham Hall I55 s15679 Saxlingham Hall v241763 AN 070905(4).doc Version 1.40 Page 23 Commission for Social Care Inspection 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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