Inspection on 22/04/08 for Selena House Nursing & Residential Home

This inspection was carried out on 22nd April 2008.

CSCI found this care home to be providing an Adequate 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.

Other inspections for this house

Selena House Nursing &... 08/05/07

Selena House Nursing &... 28/07/06

Selena House Nursing &... 29/09/05

Selena House Nursing &... 20/04/05

Selena House Nursing &... 10/11/04

Selena House Nursing &... 13/05/04

Selena House Nursing &... 12/12/03

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The Vicarage

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Poldhu

Queensmount

Trevaylor Manor

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

CARE HOMES FOR OLDER PEOPLE Selena House Nursing & Residential Home 192 Oxford Road Stratton St Margaret Swindon Wiltshire SN3 4HA Lead Inspector Susie Stratton Unannounced Inspection 9:40 22nd April 2008 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 Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Selena House Nursing & Residential Home Address 192 Oxford Road Stratton St Margaret Swindon Wiltshire SN3 4HA 01793 822982 01793 822982 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) Mr Yogindrananth Abhee Mrs Lynnatte Cain Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28), Physical disability (2), Terminally ill (2) of places Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. No more than 2 physically disabled persons at any one time No more than 2 persons in receipt of terminal care at any one time No more than 20 service users in receipt of nursing care at any one time. 8th May 2007 Date of last inspection Brief Description of the Service: Selena House is registered to provide nursing and care. It accommodates up to 28 people over the age of 65. On the day of the site visit, there were 23 residents in the home. A registered nurse is on duty at all times supported by care assistants. Support services include catering, domestic, laundry and maintenance staff. Fees are currently £359.32 to £630 per week. Accommodation is provided on two floors. Residents’ rooms do not have ensuite facilities, but all rooms have wash hand basins. The main sitting room and adjoining dining room are situated on the ground floor of the building and there is access to a large garden to the rear of the home. Selena House is located in a residential area of Stratton St Margaret, on the outskirts of Swindon. All local amenities are a short drive away. Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. As part of the inspection, 35 questionnaires were sent out to residents and their relatives and four were returned. Comments made by people in questionnaires and to us during the inspection process have been included when drawing up the report. As part of this inspection, the home’s file was reviewed and information provided since the previous inspection was considered. An annual quality assurance assessment was submitted by the home prior to the inspection. This also informed the inspection process. The site visit took place on Tuesday 22nd April 2008, between 9:40am and 3:45pm. The manager, Mrs Cain was on duty during the inspection. During the site visit, we met with six residents, two visitors and observed care for seven residents for whom communication was difficult, including residents who had recently been admitted. We reviewed care provision and documentation in detail for five residents, one of whom had been admitted recently. As well as meeting with residents, we met with one registered nurse, five carers, the chef, the laundress, a domestic, the activities coordinator and the maintenance man. We toured all the building, observed care provided in individual rooms and the sitting room, an activities session and a lunch-time meal. We observed systems for administration of medicines and a medicines administration round. A range of records were reviewed, including staff training records, staff employment records, maintenance records and financial records. What the service does well: The new manager, Mrs Cain has worked hard to improve services to residents since she has been in post. Residents receive detailed pre-admission assessments, so that they can be assured that the home can meet their needs. Residents’ needs are regularly assessed and care plans drawn up to direct staff on how to meet their needs. Staff clearly knew how to meet the needs of the residents and followed care plans. All staff spoken with were able to describe apparently small but important matters for individual residents. Staff were observed to be particularly sensitive when looking after people who had additional mental health care needs. Mrs Cain has put systems in place to ensure that staff are trained in their roles and know what is expected of them. Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 6 Residents and their relatives expressed their appreciation of the care provided. One person reported “The manager and staff look after my [relative] very well” another relative reported that it was “Getting better here” and a resident reported on how they liked “mucking around” with the staff. What has improved since the last inspection? What they could do better: At this inspection, eight requirements and seventeen recommendations have been identified, one of which was unmet from the last inspection. The home needs to concentrate on making improvements to the environment, particularly in relation to prevention of spread of infection. All equipment, furniture and items used in nursing care must have intact surfaces, to enable them to be wiped down. All bedrooms and utility rooms must be provided with single use methods of hand washing and drying, to enable effective hand washing. Bedroom doors and door frames upstairs should be repaired or replaced, as they are marked and gouged. This matter was identified at the previous inspection. An action plan should be drawn up to identify all Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 7 deteriorated areas, equipment and furnishings in the home and detail when they are to be up-graded, repaired or replaced. When replacing furniture, it should be fit for the purpose of a care home with nursing. Equipment should be provided so that laundry can be separated at source, to avoid subsequent resorting. Where the home looks after money for residents, there must be full individual records of what is handed in and paid out on behalf of a resident. All such accounts need to be signed and counter signed. Systems for management of residents’ money should be modernised, with monthly invoices and individual accounts. The service users’ guide must include a copy of the summary of the most recent inspection report, so that people are informed of the home’s response to the inspection process. Revisions to the home’s statement of purpose should also be made, to more fully describe the services provided to residents, particularly staffing patterns and financial matters. The contract/terms and conditions needs to be revised so that it conforms to current regulations. The complaints procedure should refer to us, not the previous regulatory body and include our current contact details. Care plans should be written using measurable terms and include more details relating to continence care. All residents who have mental health care needs should have care plans in place to direct staff on how the need is to be met. Care plans need to be drawn up for medications prescribed on an “as required” basis and medication which can affect their daily lives, such as painkillers or mood-altering drugs. Where a resident is prescribed a variable dose of a drug, the actual amount administered should be documented. All creams and lotions used by/prescribed for residents should be labelled with the resident’s name, to reduce risk of communal use of creams. British Standard signage must be provided on the doors of all rooms where oxygen is used, to warn people of the additional risk in the event of a fire. Where safety rails or lap belts are used, each resident must have a full risk assessment for their use completed, including protection to safety rails, in accordance with guidelines. These assessments must be regularly evaluated. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. Selina House does not admit for intermediate care, so 6 is N/A Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. People admitted to Selina House have full assessment to ensure that their individual nursing and care needs can be met. Information on services provided needs to be revised, to fully inform people of services provided. EVIDENCE: Mrs Cain has revised the admissions process since she has been in post, with the aim of making it as person-centred as possible. Detailed pre-admission assessments were seen during the inspection. Mrs Cain reports that she aims to meet with every resident prior to admission. She also reports that she does admit people in an emergency, if she regards this as important to support the person and/or the family. During the inspection, we met with one person who had been admitted in an emergency. They were not able to remember the admission process; however they appeared to be comfortable and relaxed, Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 10 sitting next to a member of their family. Staff spoken with were fully aware of this person’s needs. The records relating to this person were reviewed. Assessments of the person’s needs had been drawn up promptly after admission and detailed information gained from significant other people involved in their care before admission was obtained as soon as possible. The manager had a detailed knowledge of why the person had needed to be admitted urgently and showed a very supportive approach towards family members. One person who had recently been admitted showed bruising. This was discussed with the person and staff and it was reported that it had taken place before they were admitted. The manager had already consulted the person’s GP about this person’s bruising and was taking steps to ensure that any medical or other cause was identified. There was some limited reference to this bruising in their records. This was discussed with the manager and she was advised that any bruising noted on admission should be clearly documented and photographs taken if indicated. Selina House has a statement of purpose and a service users’ guide to inform people of services offered. The service users’ guide is available in all rooms and in the main office. The service users’ guide does not include a copy of the summary of the current inspection report together with information on how the main report can be obtained. This is required, so that people are fully informed of the home’s response to the inspection process. The service users’ guide does include a copy of the home’s contract. This contract was reported to be the current contract issued to residents and/or their supporters. One relative reported “The owner put the charges up without informing me. I only found out when the monthly invoice arrived”. Systems for increases in charges needs to be referred to in contracts. The contract needs to be revised, particularly where residents are in receipt of nursing care, so that it conforms to regulations. The statement of purpose has been revised in some areas; however as at the last inspection, it continues to need some revision in certain areas, to fully inform people of services provided. Whilst the statement of purpose lists the number of staff employed, it does not detail the number and skill mix of staff employed per shift throughout the 24 hour period. The home is able to admit people for terminal care and this needs to be detailed, together with information on how the home is able to meet the complex needs of such people. The section on managing residents’ finances is brief and does not reflect practice in the home. Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 &10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents’ health and personal care needs are met by staff who are aware of their individual needs and who work to ensure that these individual needs are met. EVIDENCE: The new manager, Mrs Cain has put extensive work into improving this area since the last inspection and is to be congratulated for all the improvements that she and her staff have made. Residents have assessments of need drawn up, including manual handling, risk of pressure damage and dietary needs. Where a nursing or care need is identified, care plans are put in place to ensure that needs are met. Care plans seen were highly individual in tone and reflected the care that was provided in practice. For example one resident had a clear care plan about how their communication needs were to be met in relation to their deafness. It was observed that staff followed this care plan. It Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 12 is advisable that care plans are written in measurable terms and words such as “regularly” or “often” are avoided. It is advisable that rather than referring to “normal levels” for blood sugar levels in diabetic care plans, the actual higher and lower blood sugar levels aimed for be documented. Care staff spoken with were very aware of different residents’ needs. For example, one carer reported that a resident who had additional mental health needs needed support at lunch-time as they could loose concentration and stop eating. They were aware that while the person did not need physical assistance, they would need prompting to eat as the meal went on, to remind them to eat. This was observed to take place at the mealtime. Another resident reported on how the manager had given them a different walking frame to help them in becoming more independent in mobilising. One relative reported “from what I can see my [relative] gets all the support she needs” Where the home cares for very frail people who are not able to look after themselves, there was evidence that the needs of such people were met, with full documentation relating to changes of position, drinks and meals offered. It is advisable that care plans for such frail people specify how often they need to have their positions changed. A full range of equipment to prevent pressure damage was provided and correctly used. Some residents experienced incontinence, where this was the case, there were clear care plans relating to continence needs. As different people will need different aids, it is advisable that the type of continence pad is documented in care plans. There was clear evidence of consultation with relevant healthcare professionals, including the community matron, GPs, mental health team and tissue viability nurse. Where a resident had more complex needs, such as oxygen therapy or an indwelling urinary catheter, the manager had set up systems to ensure that such matters were fully documented. Where a resident needs an indwelling urinary catheter it is advisable that the reasons for its use (clinical indicator) is documented, to ensure that the use of such appliances is reduced to the lowest possible level. Records relating to diabetic residents were clear, together with actions to be taken to ensure stability of their medical condition. It was observed that several residents had additional mental health needs. Nearly all of these residents had clear care plans relating to meeting such needs, however one did not. Care plans that were in place were individual in style and person-centred. Staff were observed to follow care plans and show good practice in managing such people’s complex needs. For example, one resident showed noisy behaviours at times. Staff consistently approached this person in a quiet manner and did not elevate their voices when the person raised theirs. For another person a member of staff tried moving them to a different part of the room when they showed signs of distress, and distracted them with talking about what they could see. Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 13 All medicines were safely stored and there was a full audit trail of medicines brought into the home, given to residents and disposed of from the home. A medicines round was observed and it was performed in a safe manner, with the registered nurse not signing the medicines administration record until she was assured that the person had taken their medication. All limited life drugs were dated on opening, so that they could be disposed of on expiry. Some people were prescribed medications on an “as required” basis. Where this is the case, care plans need to be drawn up to direct staff on what the indicators are for these drugs to be administered. Where a resident is prescribed a variable does of a drug, the number given was not consistently documented and this should taken place. Several people were prescribed medication which could affect their daily lives, such as painkillers, mood altering drugs or aperients. Where this is the case, care plans should be put in place, so that staff can be in a position to assess the effectiveness of such drugs and inform external healthcare professionals if indicated. Staff were observed to ensure that resident’s rights to privacy were upheld. When Mrs Cain received a phone call on a mobile hand set from a GP about a resident when she was in a communal area, it was observed that she promptly went away from the public area to take the phone call and report the resident’s symptoms, so as to maintain their confidentiality. All personal care was provided behind closed doors. Residents were appropriately dressed and in their own clothes. Where a resident showed distress, this was quickly observed by staff and the person supported and offered a cup of tea, which it appeared was what they wanted. Where one resident was rude to a carer, telling them go to away using swear words, the carer respected their wishes and showed no signs of being distressed by the person’s comment, approaching the person again shortly after in a quiet, soft-spoken manner. Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents are supported in exercising choice in their daily lives and social activities. EVIDENCE: The home have employed an activities coordinator sine the last inspection. This person was very much in evidence during the inspection. She was observed to concentrate on providing individual or small group activities which were suited to the people involved’s needs. One resident said “she’s a nice girl, I like her” about the activities coordinator. The coordinator maintains clear records of activities which have been provided. These show a range of different approaches, to meet the different needs of residents in the home. As well as the activities coordinator, staff clearly also regarded meeting residents’ social care needs as part of their role. Most residents spent most of their time in the sitting room and it was observed that there were always two or three members of staff present in the room as well as the activities Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 15 coordinator. Staff sat with residents who were not taking part in activities, talking quietly with them or supporting them in drinking or moving their positions. Mrs Cain reported that she regarded maintaining contacts with people’s family a key area of care provision. One resident reported that their family could visit whenever they wanted to. The visitors’ book showed that a range of people visited the home and several different visitors were observed throughout the inspection. Two relatives reported on how they were “always” kept up to date with important issues relating to their relative. One relative came in at lunchtime to support their relative in eating their meal and staff reported on how much this was enjoyed by both people. Mrs Cain reported on other people who support the home, including a local school and local clergy. Staff work hard to support residents in exercising choice. One resident reported that they preferred to remain in their room and that this was supported. Another resident did not like to eat in the dining room and they remained where they preferred to be, in the quieter atmosphere of the emptier sitting room. A resident reported that they had a small appetite and that if they wanted a sandwich rather than a main meal, that staff were happy to give them one. Staff were observed to ensure that two family members who were both residents, could remain sitting close to each other, as that was what they wanted. A carer was observed during the morning to ask a person if they wanted to get up and respected the person’s wishes when they said that they did not. The carer also supported the person when they rang their bell shortly afterwards and asked for assistance. All residents were left with access to drinks throughout the inspection and were encouraged to drink. All residents had a choice of drinks. A mealtime was observed. Most people ate in the dining room, although a few people preferred to eat elsewhere. Staff had done their best to make the dining room an attractive place, with clean tablecloths and placemats. Flower vases were also in evidence. Unfortunately, this was detracted from by the quality of the furniture. The table legs were all visibly scraped, as were the doors and some walls, presenting an unattractive appearance. A range of dining chairs were provided, unfortunately the newer dining chairs did not have wipable surfaces, so although staff were observed trying to clean them, marking was clearly observed presumably where they had been handled by people who had food on their hands. Staff clearly regarded mealtimes as very important for residents. Staff were available throughout the mealtime, proving support where needed. One carer spoken with just before the meal was able to describe in detail the different supports needed by different people at mealtimes. For example they reported that they had to observe one person as they would stop eating if anyone else on their table stopped eating, even if they were still hungry. They also reported that another resident tended to eat too fast and needed observation Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 16 as they were at risk of choking due to this. A member of staff was observed to be very supportive to a resident who showed a reluctance to start their meal, encouraging them and then saying how well they were doing when they started to eat. A care assistant was observed to promptly note that a resident was at risk of pouring their drink over themselves by the way they were drinking and to take prompt action to support the resident. The meal smelt appetising and was clearly served hot. Where aids, such as plate guards were needed to support the resident in independence, these were provided. The chef reported that she cooks all meals up from raw ingredients and hardly ever uses any pre-prepared meals. The chef had a good knowledge of individual residents’ dietary needs, likes and preferences. Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents will be safeguarded by the home’s policies and procedures. EVIDENCE: The home has a complaints procedure which is available in the service users’ guide. This needs up-dating in one area as it refers to us by the incorrect title and gives a previous address. The manager was fully aware of her responsibilities under the complaints procedure. All of the people who responded to this section of the questionnaire reported that they knew how to make a complaint. The complaints log as reviewed and there was evidence that the home are following their own procedures. One complaint has been received by us since the last inspection. This related to practice on infection control. The home responded to the complaint within timescales and had taken action in relation to the specific area raised. The home has a policy and procedure on the protection of vulnerable adults, this complies with local as well as national guidelines. Records showed that all staff have been trained in the area. No safeguarding adults’ referrals have been made since the last inspection. Staff were observed to understand their roles within the procedure. One resident has bruising relating to a known medical condition. There were clear records relating to this in their record and Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 18 any new bruising was documented in their records. One resident showed occasional incidences of verbally aggressive behaviours towards staff. Staff were observed to consistently approach this person in a professional manner, taking what the person was saying seriously, disregarding the actual words used. They were also not observed to avoid contact with the person at any time, despite the person’s language towards them. At the same time staff took steps to ensure that other residents were not affected by this person’s behaviours. Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Residents of Selina House will benefit from an environment which is clean and where equipment is provided to meet their needs. However the environment needs up-grading across a range of areas and additionally a lack of certain facilities and the age of some equipment and other items means that there is a risk to cross infection presented by the environment. EVIDENCE: The home employs a maintenance man. He reports that he reviews all areas of the home each day, changing light bulbs, and other such small matters. He also reports that he performs painting and decorating as needed within his available hours. He was very motivated in his role and was observed to busily Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 20 carry out his duties during the inspection, including weeding areas of the garden. The home has one large sitting room, with an adjacent dining room. There is a large garden to the rear of the building. Most of the rooms are single, with a few double rooms. All double rooms are provided with screening. There is an assisted bathroom on each floor. Much of the home could do with redecoration and attention to carpeting. One relative commented “The building itself is dingy and dull inside. It looks as though it hasn’t been decorated in years. It’s a disgrace really” another “It needs an urgent lick of paint and a new sign outside”. The carpet in the large sitting room had two long tears in it which had been secured and made safe, but detracted from the atmosphere in the room. Some non-slip mats at entrances showed tears. Nearly all of the doors showed scraping as did many of the corridor walls. Some doors showed more damage such as dents and holes. Some of the bedside tables were scraped and old and would be difficult to wipe down. Some of the easy chairs had holes in their upholstery and others which were made of cloth showed some staining. One of the residents described the furnishings as “so worn out”. Nearly all of the commode chairs were old with deterioration in their covers, chassis and buckets. One of the bath hoists was old and showed in-grained brown staining on the undersurface. Many of the raised toilet seats and some of the hand grabs were old, with deterioration in their surfaces, making them hard to clean. Many of the wash hand basins in bedrooms and toilets are old and several showed ingrained staining, through limescale and ageing. Some refuse bins had deteriorated plastic coating on their lids. All the toilet brushes inspected were losing bristles, presumably due to their age and frequent use, so would not be effective for cleaning items. The home’s annual quality assessment did not note any of these areas or identify action plans for environmental improvements. It would have been anticipated that the home would have identified some of these matters and begun to take action to make improvements to the home environment before the inspection. A range of equipment is provided for people with complex needs. These include variable height beds, a some of which are fully profiling. Hoists are provided to aid manual handling with a range of slings and staff were observed to be competent in their use. Equipment to prevent pressure damage is provided, including air mattresses and air cushions. All residents in their own rooms had been left with access to the call bell system. Some rooms and areas had single use methods of hand washing and drying but not all. Where single use hand soap was provided, the walls under the dispenser were deteriorating in many areas, so could not be wiped down. Guidelines from the Health Protection Agency states that effective hand washing is the single most important factor in the prevention of spread of infection, therefore appropriate facilities to enable hand washing need to be provided in all rooms where nursing care may be provided or articles handled relating to resident care, such as the laundry. As people who need nursing care Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 21 may be admitted to any of the bedrooms in the home, all rooms need to be provided with single use methods of hand washing and cleansing, to prevent risk of cross infection. A cleaner was met with during the inspection, she reported that she had all equipment and chemicals needed to perform her role. She was observed to go about her work in an organised manner. All areas inspected were clean and free of dust and debris, this included under easy chair cushions and bedframes. Two rooms showed an odour. One related to the individual’s condition. The other may have also related to this but it was observed that the carpet was old and although it was regularly cleaned, its age may mean that surface under the carpet had deteriorated so odour could not be removed. The home has two sluice rooms, one of which now has a washer disinfector for bedpans and urinals. All laundry is performed in-house. The laundress had a clear understanding of her role. She reported that all potentially infected laundry is handled appropriately and that the washing machine has a sluice wash. At present she has to re-sort laundry as all items from residents are placed in the same bag. It is advisable that laundry be separated as source to reduce the amount of handling by staff and thereby reduce risks of cross infection. Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents are supported by a range of staff who have been trained in their roles and are recruited in a safe manner. EVIDENCE: The home employs registered nursing, care assistant and ancillary staff. Nursing and care staff are on duty throughout the 24 hour period. One resident reported “they’re not slow in coming when I ring my bell”. Another resident reported that staff were prompt in emptying their commode when they had used it. It was reported in the annual quality assessment that there has been some turnover of staff recently. This may have been occasioned by the opening of a new care home close by, rather than by changes in working practices in the home. The manager reported in the annual quality assessment that agency staff were not used. The home does have the benefit of a small bank of staff. A review of the staff roster showed that staff will cover for each other in the event of annual leave or sickness. All staff met with appeared to be highly committed to their roles and to be fully aware of residents’ individual needs. One relative when asked in the questionnaire if the staff had the right skills to look after their relative commented “From what I can see, I would say yes”. Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 23 Mrs Cain is keen to develop her staff. She ensures that all new staff undertake an induction programme. The programme conforms to current guidelines. Where staff are employed whose first language is not English, she enrols them in an appropriate course at the local college. Following this they commence National Vocational Qualifications. Mrs Cain has reviewed and revised training records since the last inspection. All staff now have individual training records. These show the range of training opportunities offered. These reflected what staff reported. Files relating to newly employed staff were reviewed. These showed that all staff provide an employment history and complete a health status questionnaire. All staff have police checks and have two references taken up. Staff are supervised after they have completed their induction and any issues followed up at that time. We met with one newer member of staff who reported that they had found their induction helpful and that they felt able to talk to more senior staff if they had any queries. Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The new manager has developed systems to ensure that residents’ needs are met. However residents’ interests may be put at risk by inadequate documentation relating to their money and certain areas relating to maintaining their health and safety. EVIDENCE: The manager, Mrs Cain has been appointed since the last inspection. She is an experienced registered nurse who has recently completed her managers’ award qualification. Mrs Cain has worked hard during the past year to improve all areas which relate to her role. For example, she has ensured that areas Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 25 relating to health and personal care, daily life and social activities and staffing at the last inspection were addressed, so that the outcomes for residents in these areas are now good, not adequate. The areas where improvement is still needed relate more to decisions from the owner of the home about improvements to the environment and modernisation of equipment. An annual quality assurance assessment was completed and submitted to us prior to the inspection. In this document the quality of care provided was reviewed. Mrs Cain has set up auditing systems, including audits of accidents, wound care and medicines management. Questionnaires are sent out to residents and their supporters. Mrs Cain also organises residents and staff meetings, to receive feedback. She also reports that she tries to work closely with family members, to receive their comments on the services provided. It was observed throughout the inspection that visitors appeared to be happy to bring up issues with staff, including Mrs Cain. The home looks after some money on behalf of residents. A review of records showed that while the amounts of money tallied, there was not an audit trail of money handed in, signed for, taken out and individually invoiced. This is required, to ensure that there are clear records of money handed in, to whom, and the date and amount of money given out, by whom, to whom and when. All such records need to be signed and countersigned by a second person. It was discussed with Mrs Cain that many homes use a full invoicing system to charge for additional items such as hairdressing or chiropody, with individual accounts, to reduce the amounts of money held in the home and improve financial security. Mrs Cain has set up a system for staff supervision since she came into post. Records are clear and include training needs. Mrs Cain also regularly supervises staff by working alongside them and encouraging her senior staff to do so as well, to ensure that all staff provide the care that the residents need. Mrs Cain was observed to gently and kindly support new staff by making suggestions and listening to what they said, making sure they understood the reasons for what they were doing. Her gentle, supportive approach to residents will act as a role model for carers who were observed to respond appropriately to residents who had additional mental health care needs. Mrs Cain has also worked some night shifts to review nursing and care and work alongside regular night staff. Mrs Cain has ensured that staff have been trained in areas relating to health and safety, including manual handling and fire safety. Equipment such as hoists had been regularly serviced. Door closing systems for people who wish to have bedroom doors held open have been provided. New blood testing equipment has been provided. One resident had oxygen prescribed via a concentrator. They did not have British Standard warning signage provided on their door as required. Several residents had safety rails on their beds and whilst this was documented and consent sought from relatives, as safety rails Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 26 and lap belts are regarded as a potential risk to health and safety for the resident, a full risk assessment for their use, including the need for bed rail protectors is needed. As specific guidelines have been drawn up by the Health and Safety Executive, it is advisable that documentation be drawn up with their advice in mind. As noted in Standard 26 above, the home needs to prevent risks of cross infection to residents by providing appropriate facilities for hand washing and drying. It also needs to ensure that old fixtures, fittings and equipment which can no longer be cleaned, are replaced, to reduce risk of micro-organism growth. Many residents use creams and lotions; as good practice, these need to be labelled with the resident’s name to reduce risk of cross infection, if they are inadvertently left in a communal area such as a bathroom. Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 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 2 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 2 3 X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 3 X 2 Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5(1)(d) Requirement The service users’ guide must include a copy of the summary of the most recent inspection report. The service users’ contract/terms and conditions must be revised so that it conforms to current regulations. Where a resident is prescribed a medication on an “as required” basis, a care plan should be drawn up to direct staff on the reasons for when such drugs are to be administered. All equipment, furniture and items used in nursing care must have intact surfaces, to enable them to be wiped down. All bedrooms and rooms which relate to nursing and care must be provided with single use methods of hand washing and drying. Where the home looks after money for residents, there must be full individual records of money handed in and paid out on behalf of a resident. All such accounts need to be signed. DS0000015943.V359278.R01.S.doc Timescale for action 31/05/08 2. OP2 5A 30/06/08 3. OP9 13(2) 31/05/08 4. OP26 13(3) 31/07/08 5. OP26 13(3) 30/06/08 6. OP35 17(2)S4(9 a,b) 31/05/08 Selena House Nursing & Residential Home Version 5.2 Page 29 7. 8. OP38 OP38 13(4)(a,c) 13(4)(a,c) British Standard signage must be 31/05/08 provided on the doors of all rooms where oxygen is used. Where safety rails or lap belts 30/06/08 are used, each resident must have a full risk assessment for their use completed, including protection to safety rails. These assessments must be regularly evaluated. 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 OP1 Good Practice Recommendations The statement of purpose should detail: • the number and skill mix of staff employed throughout the 24 hour period • how the home meets the needs of terminally ill people • how the home manages residents’ moneys for additional items such as hairdressing or chiropody. Where a resident is admitted with bruising, this should be fully documented. Care plans should be written using measurable terms. Where a resident has continence care needs, the care plan should state the type of aids used. Where a resident has an indwelling urinary catheter, the reasons for its use (clinical indicator) should be documented. All residents who have mental health care needs should have care plans in place to direct staff on how the need is to be met. Where a resident is prescribed a variable dose of a drug, the actual amount administered should be documented. Where a resident is prescribed a drug which can affect their daily lives, such as painkillers, aperients or mood altering drugs, a care plan should be drawn up so that the effectiveness of the treatment can be evaluated. The complaints procedure should refer to the Commission for Social Care Inspection, not the previous regulatory DS0000015943.V359278.R01.S.doc Version 5.2 Page 30 2. 3. 4. 5. 6. 7. 8. OP3 OP7 OP7 OP7 OP7 OP9 OP9 9. OP16 Selena House Nursing & Residential Home 10. OP19 body and should include our current contact details. It is recommended that the bedroom doors and doorframes upstairs are repaired or replaced as they are marked and gouged. Not addressed from the previous inspection. An action plan should be drawn up to identify all deteriorated areas, equipment and furnishings in the home and detail when they are to be up-graded, repaired or replaced. When replacing furniture, it should be fit for the purpose of a care home with nursing. The walls below hand wash dispensers should be repaired, so that they can be wiped down easily. Equipment should be provided so that laundry can be separated at source, to avoid subsequent re-sorting. Systems for management of residents’ moneys should be modernised with monthly invoices and individual accounts. Guidelines from the Health and Safety Executive should be used when drawing up risk assessments for the use of safety rails. All creams and lotions used by/prescribed for residents should be labelled with the resident’s name. 11. OP19 12. 13. 14. 15. 16. 17. OP19 OP26 OP26 OP35 OP38 OP38 Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Selena House Nursing & Residential Home DS0000015943.V359278.R01.S.doc Version 5.2 Page 32 - 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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