Inspection on 29/10/07 for Selly Wood House Nursing Home

This inspection was carried out on 29th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Selly Wood House Nursing Home 17/12/09

Selly Wood House Nursing Home 12/10/09

Selly Wood House Nursing Home 22/10/08

Selly Wood House Nursing Home 16/11/06

Selly Wood House Nursing Home 28/11/05

Selly Wood House Nursing Home 29/06/05

Selly Wood House Nursing Home 14/12/04

Selly Wood House Nursing Home 15/07/04

Selly Wood House Nursing Home 10/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Selly Wood House Nursing Home Selly Wood Road Bournville Birmingham West Midlands B30 1TJ Lead Inspector Ann Farrell Key Unannounced Inspection 29th October 2007 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Selly Wood House Nursing Home DS0000024887.V341285.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. Selly Wood House Nursing Home DS0000024887.V341285.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Selly Wood House Nursing Home Address Selly Wood Road Bournville Birmingham West Midlands B30 1TJ 0121 472 3721 0121 414 0731 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) Bournville Village Trust Patrick Joseph O’Keeffe Care Home 44 Category(ies) of Dementia - over 65 years of age (44), Old age, registration, with number not falling within any other category (44) of places Selly Wood House Nursing Home DS0000024887.V341285.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 44 beds of which 24 are for nursing care and 20 for residential care The home may accommodate one named service user for the reasons of mental disorder, MD (E). 16th November 2006 Date of last inspection Brief Description of the Service: Selly Wood House provides nursing and residential care for up to 44 persons of 65 years of age or more. The home is owned by Bournville Village Trust and is situated on the Trust land within the suburb of Selly Oak, South Birmingham. The building is set in a pleasant quiet residential area and has sufficient off road parking to accommodate eight vehicles. The main communal rooms are situated on the ground floor. Bedrooms are located on all three floors with both upper floors providing small lounges for residents use. Care can be provided for persons with limited mobility and wheelchair users. There is a shaft lift for access to each floor, assisted bathing facilities located on all floors, mobile hoists and a call bell system. All bedrooms are single status, seven of which include en-suite facilities. Toilets are situated directly adjacent to each bedroom. The home has a garden that may be accessed from the front of the premises or the ground floor lounge. There is a small parade of shops nearby and bus and rail services are within fairly close proximity. Information about the services and facilities was available on entering the home to enable anyone visiting to make an informed decision about moving in. Separate information was available about the fees on request and fees are reviewed annually. The scale of charges at the home ranged from £472 - £640.68 per week, which includes the nursing element that is paid by the Primary Care Trust. The fee information included in this report applied at the time of inspection and the reader may wish to obtain up to date information from the care service. Selly Wood House Nursing Home DS0000024887.V341285.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that needs further development. The inspection was conducted over one day commencing at 8.30 am and the home/provider did not know we were coming. The manager was present for the duration of the inspection. Information for the report was gathered from a number of sources: a questionnaire was completed before the inspection by the management team of the home which was sent to us; on the day of inspection a tour of the building was undertaken, records and documents were examined in relation to the management of the home, conversation with managerial and care staff plus visitors and some residents. Some residents were unable to communicate their views verbally to the inspector so direct and indirect observation was used to inform the inspection process. Three residents who live in the home were’ case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Written and verbal comments were also received from relatives and health professionals and the responses generally positive. What the service does well: The home was clean, warm, odour free and well maintained. Residents’ bedrooms were all single and some had en-suite facilities. Bedrooms were comfortable, homely and personalised according to individual’s preferences, so providing a pleasant environment for residents to live. On discussion with some residents they stated they liked their rooms. There were also a range of assisted bathing and showering facilities. The manager’s office was situated in the reception area, so providing easy access to visitors who wish to discuss progress or any concerns. Relatives stated they could visit at a time that suited them; therefore residents were able to maintain contact with their family and friends. Selly Wood House Nursing Home DS0000024887.V341285.R01.S.doc Version 5.2 Page 6 There were no rigid routines in the home and residents were able to exercise choice in their daily lives. Residents and relatives reported favourably on the standard of care and the friendly staff. Residents stated they enjoyed the meals, the food was of a good standard and they received a choice. The meals were culturally appropriate for the resident group and special diets were catered for. On discussion with residents who had recently moved into the home it was stated the process was organised and they had the opportunity to look around the home before moving in. Suitable systems were in place to meet resident’s personal care and health needs, so ensuring their needs were met appropriately. An activities coordinator was employed and there were a good variety of activities to stimulate residents. Staff recruitment procedures were robust with appropriate checks undertaken to ensure residents were protected by the employment of new staff. The home has quality assurance systems in place and this enables residents to have a voice about the home and helps planning for future improvements. Money held on behalf of residents was accounted for and there were robust systems in place to ensure resident’s finances were protected. The home was able to demonstrate a range of maintenance and servicing had or was taking place, so ensuring the safety of the building and equipment used. What has improved since the last inspection? A range of training had been completed in the last year and still ongoing, so enhancing staff knowledge and skills so they are able to meet resident’s needs appropriately. Some new flat floor showers had been fitted, so enhancing bathing facilities for residents with mobility problems. However further work is required to ensure all residents with limited mobility do not have their privacy and dignity compromised due to the distance they may have to travel to use a bathing facility. The home had secured a range of manual handling equipment for use with residents with poor mobility. Selly Wood House Nursing Home DS0000024887.V341285.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Selly Wood House Nursing Home DS0000024887.V341285.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 Selly Wood House Nursing Home DS0000024887.V341285.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): 1,3,6 Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Information was available for prospective residents and their representative in a range of formats enabling them to make an informed decision about moving into the home. Prospective residents have sufficient information to make an informed choice about moving into the home. The pre-admission assessment process was not sufficiently comprehensive therefore residents could not always be assured their needs would be met when moving into the home. EVIDENCE: The home had a notice board available in the reception area on entering the home with a range of information available about activities in the home. They had a service user guide which provided information about the services and facilities plus separate information about the fees. Selly Wood House Nursing Home DS0000024887.V341285.R01.S.doc Version 5.2 Page 10 The service user guide had also been produced on audiotape and CD for anyone who would prefer to listen to the information. This information enables prospective residents and their relatives to make an informed decision about moving into the home. Prospective residents have the opportunity to visit the home meet staff and other residents and view the facilities before they make a decision about moving into the home. On discussion with one resident they stated they had visited the home before moving in and the process of moving in was good. They had been able to take some of their own furniture in so providing a home from home environment. Residents admitted to the home usually require long term care for reasons of personal or nursing care. It was stated that the care manager or nurse undertakes a pre admission assessment for all residents before they are admitted to the home to determine if their needs can be met. On inspection of a sample of records it was noted that the assessment format was satisfactory covering all areas of need, but they had not been fully completed and were based on physical needs mainly. Feedback obtained indicated that information sharing could be improved following a residents admission to the home to enhance understanding of residents needs and it was suggested that it would be useful to have an information pack for relatives. Selly Wood House Nursing Home DS0000024887.V341285.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 adequate. This judgement has been made using available evidence including a visit to this service. Suitable arrangements were in place to meet resident’s health care needs and ensure their well being. The care planning system and recording systems need further development to ensure that residents’ needs are being identified and met in a consistent manner. Medication systems need some further development to ensure residents receive the medication prescribed to them. EVIDENCE: Following admission to the home a nursing assessment and risk assessments were completed in order to obtain adequate information to draw up a care plan. Care plans should outline in detail the action required by staff to meet resident’s needs. On inspection of a sample of records it was found that they had not consistently been signed and dated by the person drawing them up. There was no evidence that the residents or their representative had been included in the process. The assessments did not consistently include an assessment of continence or mental health where they were identified needs of residents. Selly Wood House Nursing Home DS0000024887.V341285.R01.S.doc Version 5.2 Page 12 There were some risk assessments in respect of falls, bed safety rails, manual handling, tissue viability and nutrition, but they had not been fully completed consistently. The manager has responded to the inspection indicating that staff have undertaken training in respect of care planning and they will be implementing all learning points The care plans were not comprehensive and statements were vague regarding the action required by staff to meet residents needs Some needs had not been included in the care plan e.g. management of continence, constipation, size of sling to be used with hoists. Reviews of care plans were not consistently being undertaken each month. Where reviews were undertaken and changes in residents needs were identified the care plans had not been consistently updated to reflect the changes and the action required by staff. The inspector was informed that one resident was having nutritional supplements. On inspection of the care plan there was no care plan indicating nutritional supplements were in use despite the fact that it had been noted that they had lost weight, the resident stated they were not taking them, none were prescribed on the medication chart and the kitchen was not aware of any residents who were to have any types of food boosters. It was concerning that their nutritional needs were not being met. Daily records were very brief and were task orientated e.g. assistance with bath/wash/ shave. They were not always comprehensive as a resident was complaining about pains and this had not been recorded on the daily records. At other times issues were raised in daily records, but there was no record of follow up or any action taken e.g. resident feelings and difficulty in swallowing. Care plans and records were not comprehensive and it cannot be guaranteed that residents needs will be identified and met effectively in a consistent manner. During inspection it was noted that care staff write daily records for all residents. Although this is accepted practice for residents who require personal care, it is usual practice for nurses to record daily records for residents requiring nursing care or to countersign records completed by care staff. This area will need to be reviewed and if this practice is to continue the management team must ensure care staff are appropriately trained and are competent to under take the role. Whilst touring the home it was noted that bed safety rails were in place on beds. However, when used with some pressure relieving equipment they were not of a sufficient height to prevent risks. In some cases the bed was placed next to the wall and there was only one bed rail in place and places residents at risk. This area will need to be reviewed and appropriate action taken. All residents were registered with a local GP practice and residents may choose from any of the local practices who visit the home. It was stated that there were regular visits by the chiropodist, dentist and optician and staff would Selly Wood House Nursing Home DS0000024887.V341285.R01.S.doc Version 5.2 Page 13 liaise with other health professionals as required. On discussion with some residents they confirmed visits by health professionals. However, on inspection of a sample of records it could not be confirmed that residents had opportunity for regular visits and in one case a resident had requested a dentist and there was no evidence that it had been actioned. Records of GP visits did not consistently indicate the reason for the visit and the outcome. Therefore it was difficult to track residents care. The inspectors could not evidence check ups in respect of chronic diseases such as diabetes, high blood pressure, asthma etc. and this area will need to be followed up to ensure residents health is maintained at optimum levels. The manager has responded indicating that documentation is now availabel and more accessible to demonstrate these checks are taking place. Whilst touring the home it was noted that a residents overnight catheter bag was on the floor and the end was not covered. On discussion with a nurse she stated catheter bags were changed every 2- 3 days. This was concerning as the bag may be used again and could increase the risk of infection. The arrangements for catheter care should be reviewed and action taken to ensure all staff know the correct procedures to reduce the risk of infection occurring and care plans clearly state the care required. The medication was stored in a medication trolley within a locked room on each floor. Storage was observed to be clean and organized so that medication could easily be located. The homes medication system consisted of a blister and box system with printed Medication Administration Record (MAR) sheets being supplied by the dispensing pharmacist on a monthly basis. The home had copies of the original prescription (FP10’s) for repeat medication, so they were able to check the prescribed medication against the MAR chart when it entered the home. The pharmacist from the Primary Care Trust undertake regular audits of medication. On inspection of the medication for the current month it was found that the blister system was satisfactory. However, some of the audits undertaken on the boxed medication were not accurate. It was stated that daily audits were undertaken, but it was not clear of the action that was taken if discrepancies were found. It was also noted that pots of creams were in residents rooms had not been dated when opened, so that they could be discarded within specific timescales to prevent the risk of bacterial contamination. One resident had been given medication and had not taken it, as it was still in a pot in front of them when the inspectors toured the home. The person administering medication should ensure medication is taken before leaving the resident Daily temperature recordings were kept in relation to the drugs fridge, so ensuring medication was stored at the correct temperature. A list of homely remedies was available detailing drugs that were not prescribed and could be administered by qualified nurses for short-term use. Selly Wood House Nursing Home DS0000024887.V341285.R01.S.doc Version 5.2 Page 14 Residents were well presented and dressed appropriately for their gender, age, culture and time of year. There was some mixed feedback received in respect of the staff, as it was stated that some staff were very good, other comments included, “Lovely home, staff good, it always smells fresh. “It is like being at home without the worries”. At one stage a member of staff was noted to rush past a relative who was trying to attract their attention. It was stated care staff were always very busy. There was some evidence to indicate incidents where staff did not interact appropriately with residents and this was discussed with the managers at the time of the inspection. Resident’s privacy was observed and staff knocked on doors before entering. Residents were able to choose what to do and where to spend time. Residents who wished to spend time on their own in their rooms were able to do so and there were a number of areas where residents were able to receive visitors in private. A private telephone kiosk was available on the ground floor and some residents also had a telephone installed in their room. Selly Wood House Nursing Home DS0000024887.V341285.R01.S.doc Version 5.2 Page 15 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. There were no rigid routines and visitors could visit at times that suited then enabling residents to maintain contact with them. The home is good at providing residents with a stimulating and purposeful life. Staff need to ensure that the range of food available s offered to residents to ensure a true choice is being offered. EVIDENCE: Arrangements for visiting were flexible enabling relatives to visit at a time that suited them and residents to maintain contact with them. There were no rigid rules in the home. Residents were able to make choices and spend time as they wished e.g. they could get up; go to bed when they wished, they had freedom of movement around the home and were able to return to their bedrooms when they wished. There was a suggestion box that is opened each month to obtain feedback from residents or visitors to the home. The activities co-ordinator is employed and works four days each week plus there are three volunteers who visit the home and assist with activities of residents. Selly Wood House Nursing Home DS0000024887.V341285.R01.S.doc Version 5.2 Page 16 Progressive mobility was arranged for the day when the activities co-ordinator was not working. The activities co-ordinator talks to residents to find out about their specific interests and tries to make arrangements where possible to meet these. In house activities includes arts, crafts, games, bingo, “Pat a pet “ visits twice a month, a reflexologist visits each week and the activities coordinator has one to one sessions with some residents who spent most of the time in their bedrooms. Birthdays are celebrated with a glass of wine and a present such as a bouquet of flowers and there were organised outings. These arrangements provide a range of activities in order that residents receive adequate stimulation. Recently the home has secured the services of a car that can be used to take residents out on activities. This had not been used much to date, but residents were very enthusiastic about it and it is hoped that it will enhance the range of activities/outings available to residents. Residents were able to go out shopping and for walks locally as they wished. Religious observance was encouraged and supported, and a Society of Friends (Quaker) meeting was held in the home once a week; this was also attended by a small number of people who live in the local community. Christian services also take place regularly and the home had strong links with a local Methodist church. The home had a small shop on the ground floor, stocking items such as toiletries, confectionery and cards etc. A small library was housed in the ground-floor lounge and Birmingham City Council Library Service serviced this. A range of large print books was available. A barber attended the home every month, and two hairdressers were available in the home each week on different days. The home employs separate catering staff who provide breakfast, lunch and evening meal. There was a three-week rotating menu that provides a range of choices. Special diets such as diabetic and puree meals were catered for. Breakfast consisted of cereals, fruit juice, prunes, grapefruit or a cooked breakfast according to resident’s choice. There was a choice of at least two meals at lunchtime with a range of fresh fruit and vegetables. Drinks were available between meals and in the evening. On discussion with residents they stated the meals were of a good standard, but they felt there could be more choices. On discussion with the managers it was stated that alternatives were available. It was suggested that residents and staff should be made aware of this, so that a wider choice is offered to residents routinely. The dining room was light, airy and pleasantly decorated. Tables were laid appropriately with tablecloth, condiments, fresh flowers etc. The meals were well presented, residents were treated respectfully and meals were not rushed. Selly Wood House Nursing Home DS0000024887.V341285.R01.S.doc Version 5.2 Page 17 The inspector had lunch with the residents and found the meal to be a pleasant unrushed experience. Carers were observed to offer discreet and sensitive assistance to residents. Specialist aids were available to residents to help them maintain their independence in relation to eating and drinking. Selly Wood House Nursing Home DS0000024887.V341285.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. Overall policies and procedures about safeguarding adults and complaints met the standard. However staff practice need to improve in order to ensure resident’s rights are fully protected and respected. EVIDENCE: The home had a complaints procedure on the notice board on entering the home and a copy was available in the service users guide. The information provided by the home indicated that they had received eight complaints since the last inspection. Some had been investigated thoroughly and responded to, but in some cases of minor concerns/complaints there was not a clear audit trail of the investigation and action taken. The management team will need to ensure records clearly demonstrate the audit trail for all concerns/complaints in the future. The Commission received concerns of a safeguarding nature. From the information received it appeared that the issues had been raised with a member of the management team in the home, but they had not taken the appropriate action as required under the safeguarding procedures, a referral had not been made to Social Care and Health and there were no records of the action taken by the manger of the home. Currently Social Care and Health are investigating this further under the adult protection procedures. Selly Wood House Nursing Home DS0000024887.V341285.R01.S.doc Version 5.2 Page 19 The home does have appropriate procedures in respect of safeguarding and whistle blowing and on discussion with a small number of staff they were aware of the procedure. However, it was concerning that the correct procedures were not followed in the incident referred to above. On inspection of staff records it could not be verified that all staff had received training in this area. The manager stated that the training records for all staff were in the process of beign updated to ensure the information is available in the home. As identified earlier in the health and personal care section of the report there had been an incident where staff had not interacted with a resident in an appropriate manner. There was no evidence that a senior member of staff had addressed it. This did raise concerns as to areas of practice and it was discussed with the managers. Selly Wood House Nursing Home DS0000024887.V341285.R01.S.doc Version 5.2 Page 20 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): 19,20,21,24,25,26 The quality outcome for this area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, well-maintained and homely environment. EVIDENCE: The home was a modern three-storey building, which was cleaned to a high standard, odour free and well maintained, so providing residents with a pleasant environment to live. There was limited parking space to the front of the home with a very pleasant garden to the rear of the building. On entering the home there was a spacious welcoming reception area with a range of notices and information for residents or anyone visiting the home. Copies of free local newspapers were available for residents to take. There was also a post-box for outgoing mail and individually named pigeonholes for residents’ incoming mail. Selly Wood House Nursing Home DS0000024887.V341285.R01.S.doc Version 5.2 Page 21 There was level access into the building and ramped access to the rear, which was suitable for residents who use wheelchairs or have mobility problems. There was a range of aids to assist with mobility e.g. handrails, grab rails, raised toilet seats and a passenger lift that gave access to all areas in the home All bedrooms were single and some had an en-suite facility. In other cases there was a toilet facility between two bedrooms and there were assisted bathing facilities on each floor (bath or shower) so providing a choice. The home was just in the process of upgrading some of the shower facilities with flat floor showers, so enabling easier access for residents. Some of the shower rooms may be small if the residents required assistance from two members staff and it was recommended that this area be reviewed as this impacts on the dignity of those living in the home. Whilst touring the home it was noted that some of the extractor fans required cleaning, some of the grab rails in toilets were not stable, bar soap and toiletries were found in some bathrooms. Personal toiletries should be returned to each resident’s room after use and bar soap should be removed as it poses a risk of infection. Some areas did not have liquid soap and paper towels for staff hand washing. Where infected materials or continence products are handled staff hand washing facilities should be available. The bedrooms were spacious, comfortably furnished and very homely. Residents could take their own furnishings into the home so providing a home from home environment. Residents had been able to personalise their own space to suit their needs and taste; pictures and fabrics had been used to good effect. All bedroom doors had locks and lockable facilities were available in each room, so enhancing the arrangements for privacy. On discussion with some residents they stated they liked their rooms and everywhere always smelt fresh. Bedrooms were individually and naturally ventilated and windows were provided with restrainers for safety and security reasons. Radiators and hot water temperatures were regulated to reduce the risks of accidents from scalds. Communal space consisted of a large lounge and dining room on the ground floor that was adjacent to the kitchen. In addition, there was a small lounge at the end of each corridor that could be used for a variety of occasions, family gatherings etc. The laundry area was viewed. This was a spacious area and found to be tidy and well organised. Three staff members were employed within the laundry. All equipment was in working order. Clothing worn by residents appeared to have been carefully and appropriately laundered. Residents were satisfied with the service and looked well presented. Selly Wood House Nursing Home DS0000024887.V341285.R01.S.doc Version 5.2 Page 22 The kitchen was adjacent to the dining room and was clean and well organised. It was noted that paint was peeling from the extractor canopy. Fridge, freezer and hot food temperatures were recorded to ensure food was maintained at the appropriate temperatures. At lunch time there was a second serving and the temperature of the food was not checked before serving and it was noted that a number of care staff were in and out of the kitchen. It is recommended that these areas be reviewed to ensure effective hygiene practices. The environmental health officer had visited and identified that frozen foods need to be dated and this remains outstanding. Staff were observed to be entering the kitchen at breakfast time to obtain food being kept warm in the kitchen. Staff did not wear any protective overalls or be seen to be washing their hands on entering the kitchen. This practice increases the risk of cross contamination within the kitchen areas and subsequently a risk to residents. Selly Wood House Nursing Home DS0000024887.V341285.R01.S.doc Version 5.2 Page 23 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. Satisfactory staff levels were maintained to meet resident’s needs. Robust recruitment procedures were in place; so ensuring residents were protected by the recruitment of new staff. Staff training had been provided in a number of areas, but this needs developing further with records to demonstrate staff have the knowledge and skills to enable them to meet resident’s needs. EVIDENCE: Duty rotas demonstrated that there was always two nurses on duty with seven to nine carers during the morning, six carers in the evening and three care staff at night, which generally appeared adequate to meet residents needs. There were a number of staff who have been working in the home for many years and were knowledgeable about residents needs. There have been a number of absences recently due to sickness and holidays and permanent staff cover periods of absence. Although this does ensure consistently in resident care caution should be exercised to ensure staff do not work excessive hours that may impact on their health and resident care. The home employs a robust recruitment procedure and undertakes all checks before staff commence employment, so ensuring residents are safeguarded. The system for checking nurses registration needs to be further developed by accessing information from the Nurses and Midwives Council. Selly Wood House Nursing Home DS0000024887.V341285.R01.S.doc Version 5.2 Page 24 All newly employed staff undertake a six-month probationary period. Staff are supernumerary for the first week for a period of induction in to the home. There was an induction training programme that meets the Social Skills Council standards. The information provided before the inspection indicated that approximately 60 of care staff were trained to NVQ level 2 in care. However, the record of training at the time of inspection had not been completed and this could not be verified. Training that had been undertaken this year included nutrition, food safety, fire awareness, bereavement, dementia care, verification of death, team building. Certificates were not consistently available to demonstrate this and it could not be verified that all staff had completed the basic core training. The manager stated that they planned to review all staff files and draw up a matrix of staff training so that information is easily accessible in the home. The manager will also need to consider training in other areas relevant to practice such as residents conditions e.g. epilepsy, diabetes, stroke etc. On discussion with staff and managers they stated staff meeting and one to one meetings were occurring with a senior member of staff regularly. Selly Wood House Nursing Home DS0000024887.V341285.R01.S.doc Version 5.2 Page 25 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): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally resident’s benefit from a well run home. The views and opinions of residents were sought and acted upon, helping to ensure that residents felt their voice was heard. The health and safety of residents was promoted and protected through regular maintenance and servicing of equipment. EVIDENCE: The home had a general manager, responsible for financial and ancillary functions within the home. There was also a clinical manager who was qualified in both general and mental health nursing and had substantial experience of working in a care home setting. The clinical manager demonstrated a good knowledge of the residents and their needs. Selly Wood House Nursing Home DS0000024887.V341285.R01.S.doc Version 5.2 Page 26 This management structure provides a strong management presence in the home and there were a number of management systems in place to ensure the smooth running of the home. However, it was concerning that a safeguarding issue had not been addressed appropriately and correct procedures followed. Feedback received from a sample of residents and relatives was positive about the care they received in the majority of cases. It was stated care staff work very hard. Relationships within the home appeared to be good and on discussion with staff they stated they enjoyed working there, generally staff got on well, there were regular meetings and they felt they were kept informed about things. The home has a quality assurance system in place and they have regular meetings and members of the group include residents. The manager is hoping to develop this further next year by setting up a relatives association. Some residents manage their own finances and the home does hold some money on behalf of residents in a safe facility. On inspection it was found that receipts and records were in place for all transactions and the money balanced. There are systems in place for regular checks to ensure resident’s finances were managed appropriately. Various records in relation to servicing and checking of equipment were undertaken and were generally found to be up to date, so ensuring the health and safety of residents, staff and visitors to the home. Service records were available for the passenger lift, hoists, fire alarm system, and gas equipment. Electric wheelchairs were serviced on a regular basis, but care staff checked others. It is recommended that these be serviced on a regular basis to ensure they are safe for use. The fire officer had recently undertaken an inspection and had identified that an alternative area was required for residents using hairdryers when the hairdresser visited and the manager had addressed the issue. The canopy in the kitchen was observed to be clean but paint was peeling from the metal structures, there is a risk of this falling into the food below and being a hazard to residents. Selly Wood House Nursing Home DS0000024887.V341285.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 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 3 3 X 3 3 3 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Selly Wood House Nursing Home DS0000024887.V341285.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15 Requirement Care plans must include a comprehensive assessment of needs to include continence and mental health where appropriate. The care plan must be comprehensive and clearly indicate in detail the action required by staff to meet residents needs. They must be signed and dated. Care plans must be reviewed at least once a month and updated when there are any changes to the care. These documents are required to ensure resident’s needs are met in a consistent manner. Risk assessments must be completed for all residents in respect of manual handling, nutrition and any other area where risks are identified. There must be a plan to reduce the risks, so resident’s safety is maintained. All care records must be fully completed, signed and dated by DS0000024887.V341285.R01.S.doc Timescale for action 15/03/08 2 OP7 13(4) 30/12/07 3. OP7 17(2) 15/12/07 Page 29 Selly Wood House Nursing Home Version 5.2 4 OP8 13(4) 5 OP8 12(1) 13(3) 6 OP9 13(2) the person completing them. Daily records must indicate follow up of concerns to demonstrate that appropriate action was taken and all staff are kept fully informed An audit of all bed safety rails 30/11/07 must be undertaken to ensure they are of sufficient height and there are two on all beds to reduce the risks of accidents to residents. Practices in respect of catheter 30/11/07 care should be reviewed and action taken where necessary to ensure all staff are aware of the procedures and residents are not put at risk of developing an infection. 30/11/07 Systems must be in place to ensure robust medication systems, so residents receive the medication prescribed to them to include: • Correct administration and recording of all medication. • Ensure medication given to residents is taken or discarded. • Ensure all creams are dated on opening and discarded after specific timescales to reduce the risk of bacterial contamination. There must be robust systems in place to ensure all residents are protected from any form of abuse. Where there is an allegation of such an incident the correct procedures must be followed, Social Care and Health informed and records completed. All Staff must receive training in 30/11/07 7 OP18 13(7) 12(1) Selly Wood House Nursing Home DS0000024887.V341285.R01.S.doc Version 5.2 Page 30 8 OP26 13(4) the safeguarding procedures to ensure they are aware of the nature of abuse, the signs of abuse, the action to take in the event of abuse and the whistle blowing policy. Cleaning materials should be kept in a locked cupboard when not in use. An audit of all staff training must be undertaken and training provided where any shortfalls are identified in basic core training to ensure staff have the skills to meet resident’s needs. 15/11/07 9 OP28 18(1) 30/12/07 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 It is recommended that the admission procedure be reviewed in order to enhance communication with relatives and look at the possibility of an information pack for relatives. Pre-admission assessments should be reviewed to ensure that a holist approach to assess needs is recorded. This will give both the resident and the home assurance that their needs can be met. The management team should review the arrangements for recording daily records. The record of visits by health professionals should indicate the reason for the visit and outcome are recorded. Records of regular health checks should be in place for residents with chronic diseases such as diabetes, asthma, high blood pressure etc, to ensure health is maintained at an optimum level and any complications identified at an early stage. Action should be taken to ensure staff approach residents in the correct manner and treat them with respect at all times. DS0000024887.V341285.R01.S.doc Version 5.2 Page 31 2 OP3 3 4 5 OP7 OP8 OP8 6 OP10 Selly Wood House Nursing Home 7 8 9 10 OP15 OP19 OP21 OP26 11 OP26 12 13 14 15 OP28 OP29 OP38 OP38 All staff to ensure that resident’s wishes are being met should actively promote food choice. All extractor fans should be maintained in clean manner It is recommended that current arrangements for shower facilities is reviewed and action taken to ensure there is adequate pace in them It is recommended the following areas are reviewed in order to reduce the risk of cross infection: • Bar soap should be removed from communal bathrooms. • Liquid soap and paper towels should be in all areas for staff hand washing. • Record the temperature of food at the second sitting. • Review the arrangements for care staff entering the main kitchen. • Ensure all foods in the freezer are dated. Staff entering the kitchen to obtain food must wear an overall and wash their hands. This reduced the risk of any cross infection and protects and promotes the well being of residents. Clear records and evidence of staff training should be retained in the home; to demonstrate that staff have the skills and knowledge required to meet residents needs. Verification should be obtained for nurses registration from the NMC, to ensure they are able to practice as a nurse All wheelchairs should be serviced on a regular basis. The kitchen canopy paintwork must be reviewed and it must be ensured that no peeling paint can fall into the food being cooked. Selly Wood House Nursing Home DS0000024887.V341285.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Selly Wood House Nursing Home DS0000024887.V341285.R01.S.doc Version 5.2 Page 33 - 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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