CARE HOMES FOR OLDER PEOPLE
Silloth Nursing & Residential Care Home Silloth Wigton Cumbria CA7 4JH Lead Inspector
Lorraine Frost Unannounced 01 August 2005 08:45 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Silloth Nursing & Residential Care Home F58 F10 s10106 silloth nursing home v215029 010805 ui stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Silloth Nursing & Residential Care Home Address Silloth Wigton Cumbria CA7 4JH 016973 31493 016973 31242 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Cumberland & Westmorland Convalescent Institution Elizabeth A Blair Care Home 40 Category(ies) of OP - Old Age registration, with number PD - Physical Disability of places LD - Learning Disability Silloth Nursing & Residential Care Home F58 F10 s10106 silloth nursing home v215029 010805 ui stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service must at all times employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. 2. 1 named service user in the category of LD (Learning disability under 65 years of age) may be accommodated in the overall number of registered places. 3. The home is registered for a maximum of 40 service users to include: up 40 service users in the category of OP (Old age, not falling within any other category) up to 5 service users in the category of PD (Physical disability under 65 years of age) Date of last inspection 24 January 2005 Brief Description of the Service: Silloth Nursing home is close to the Golf course with sand dunes and views across the sea to Scotland on one side and a protected conservation area on the other. The home is on one level providing spacious accomodation and ample communal areas. The interior courtyard with raised flower beds is tended to by a resident with a keen interest in gardening. The carpark has a smooth surface giving safer and easier access to the home. Silloth Nursing & Residential Care Home F58 F10 s10106 silloth nursing home v215029 010805 ui stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection starting at 08.45 and concluding at 1400 hours. The focus of the inspection was on the care and well being of the residents and included talking with residents and visitors, observing staff and reading relevant documentation. What the service does well:
Silloth nursing home has a relaxed and informal atmosphere, which visitors said made them feel welcome. The home is well maintained and decorated to a high standard. Staffing levels are high with most staff having attained NVQ level two in care. The staff were very busy, but did so in a quiet and controlled manner. They were clearly well organised and communicated well ensuring that residents were receiving the care they needed. Staff were seen spending extra time with those who needed a higher level of support and comfort. Residents said that they were treated well, that the staff were “kind, patient” and would “do anything for them.” The residents are treated with great respect and this was shown in many ways throughout the day including paying attention to detail regarding personal grooming, ensuring that residents were spoken to using the name that they liked to be known by and by making sure that doors were closed and curtains drawn when care was being delivered. Residents said how much they enjoyed the company of other residents and had made many friends in the home. Residents were seen chatting with each other in the lounges and others were seen visiting each other in their bedrooms for a cup of tea and a chat. The weekly coffee mornings are popular and people from Silloth attend too. One resident said, “there’s enough to keep me occupied.” Staff take a keen interest in monitoring psychological needs as well as health care needs and are quick to respond to changes. Choices, and independence in all aspects of life are encouraged and respected and assistance is given when necessary. Funding for equipment is provided promptly when it is requested and this has been proven on a number of occasions. Staff routinely use hoists and slide sheets to help residents and there were a large number of fully adjustable beds and pressure relieving mattresses available ensuring that the residents can be as comfortable as possible and that staff are able to move and handle residents safely. Many positive comments were received from the residents expressing their satisfaction at their choice of home.
Silloth Nursing & Residential Care Home F58 F10 s10106 silloth nursing home v215029 010805 ui stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Silloth Nursing & Residential Care Home F58 F10 s10106 silloth nursing home v215029 010805 ui stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Silloth Nursing & Residential Care Home F58 F10 s10106 silloth nursing home v215029 010805 ui stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 5 Residents’ needs are thoroughly assessed before they are offered accommodation in the home ensuring that staff will know the assistance each person will need on admission. Residents’ and their families are able to visit the home prior to making a decision to move to Silloth making the move an informed one. EVIDENCE: The manager carries out a comprehensive pre admission assessment that is very detailed and provides the information required to ensure that the home is suitable and can meet the identified needs of the resident. Staff were very knowledgeable of the needs of the people living in the home and the support they require. Residents said that they or their family had looked around the home and that they were very pleased with their choice. One person said that she felt “honoured and privileged to be living in this home.” Silloth Nursing & Residential Care Home F58 F10 s10106 silloth nursing home v215029 010805 ui stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, and 10. The manager and staff are very knowledgeable of the holistic needs of the residents and their requirements and utilise the care planning and monitoring systems to greatly enhance the lives of the people in the home. EVIDENCE: The care plans were much improved. They were clear, and very easy to follow. They were detailed and had been reviewed to reflect the current needs of the residents. There was evidence to show that residents and their families were consulted with and that they had been involved in the review of the care plans and risk assessments. The information regarding wounds and the care of pressure sores was not detailed enough to show the status and treatment of the wound. Each resident has a brief outline of care in their own room that is well used by staff who are encouraged to comment on its contents and notify the RGN when they feel that changes to the plans should be made. The daily progress notes provided evidence of good monitoring of changing health needs and showed that prompt referrals to other professionals were made when necessary. Staff support the residents to be independent and assist them when they are not able to manage.
Silloth Nursing & Residential Care Home F58 F10 s10106 silloth nursing home v215029 010805 ui stage 4.doc Version 1.40 Page 10 Residents said they were “very well cared for” and that they liked the staff and got on well with them. Another resident said she couldn’t “fault it here.” Silloth Nursing & Residential Care Home F58 F10 s10106 silloth nursing home v215029 010805 ui stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, and 15. Social preferences and interests are discussed with the resident ensuring that where possible interests can be accommodated and activities planned around them. Contact with friends and relatives is not restricted enabling residents to maintain friendships and relationships as they choose. The meals offered in the home are very good, and well-balanced giving residents’ choice, and variety. EVIDENCE: Residents files confirmed the comments received showing that staff consult with the residents about their interests their likes, dislikes, and how they preferred to spend their day. The residents said how much they enjoy each others’ company and how they can spend the day as they please and are kept informed of activities, events and outings. The weekly coffee morning held by the League of Friends gives the residents the opportunity to catch up on local news and to meet people from outside the home. Silloth Nursing & Residential Care Home F58 F10 s10106 silloth nursing home v215029 010805 ui stage 4.doc Version 1.40 Page 12 Residents said that the meals are of a high standard with choices available. Mealtimes are staggered ensuring that staff have time for those who need it and to ensure there is ample time for those who want to be independent. Silloth Nursing & Residential Care Home F58 F10 s10106 silloth nursing home v215029 010805 ui stage 4.doc Version 1.40 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The complaints procedure is good and readily available to residents and their relatives. The home follows the vulnerable adults procedure to ensure that people living in the home are protected from abuse. EVIDENCE: The complaints procedure is displayed on the notice board and residents said that they were sure that if they spoke to the matron or a member of staff that they would deal with any concerns raised. The visitors said that they felt that they had a good relationship with the staff and the matron and that issues were dealt with quickly. There was evidence within one set of records showing that a complaint had been listened to, investigated, followed up and an agreement reached by all parties. The Protection of Vulnerable Adults procedure is readily available and staff have received the training to ensure that they are aware of the procedure to follow if they have concerns about the welfare of residents. Silloth Nursing & Residential Care Home F58 F10 s10106 silloth nursing home v215029 010805 ui stage 4.doc Version 1.40 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24,25 and 26. Residents’ benefit from a very clean, comfortable, and well maintained home that is decorated to a high standard throughout. The grounds have improved further providing a very pleasant place for the residents to enjoy the air and making the home welcoming and attractive. Residents’ benefit greatly from the good provision of lounges, the large bedrooms, and the toilets and bathrooms, which are in the main, of a good size allowing aids and equipment to be easily manoeuvred. Equipment is purchased promptly to assist staff and residents. EVIDENCE: Residents said that they were very happy and that they felt they were living in a clean and homely environment with good-sized rooms. The committee would be approached for authorisation to purchase specialist equipment if was identified that residents and staff would benefit from it. The
Silloth Nursing & Residential Care Home F58 F10 s10106 silloth nursing home v215029 010805 ui stage 4.doc Version 1.40 Page 15 committee are very supportive of the home and promptly accommodate such requests. The paved area to the rear of the home has been finished and provides a very pleasant place for residents to sit and enhances the outlook from the dining room. Silloth Nursing & Residential Care Home F58 F10 s10106 silloth nursing home v215029 010805 ui stage 4.doc Version 1.40 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, and 29 Residents live in a home that is well staffed with trained, competent and knowledgeable staff who care about the work that they do. EVIDENCE: The staff were quietly busy throughout the day. They were well organised and communicated with each other ensuring that residents received the care and support that they needed. There were a number of residents who were unwell, but the atmosphere remained calm throughout with staff spending time with those who required extra comfort and assistance. Staff training has continued to be facilitated with a high percentage of staff having attained the NVQ level two in care award. The qualified nurses have maintained their registration with the Nursing and Midwifery Council and have attended courses to benefit the residents and to increase their knowledge. Two nurses are Palliative Care Link Nurses and another one has a keen interest in Palliative care and has attended courses on the subject. All staff receive a thorough induction upon commencement and are formally and informally supervised. Silloth Nursing & Residential Care Home F58 F10 s10106 silloth nursing home v215029 010805 ui stage 4.doc Version 1.40 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33 and 38. The home is run by an appropriately qualified manager who demonstrates her commitment to the residents and the staff by ensuring that the home is run according to needs of the residents. There is a clear commitment by all those involved in the running of the home to ensuring that the residents live in a place that is well maintained, well managed and is always considered as their home. Systems are in place to promote the safety and welfare of residents and staff. EVIDENCE: The Registered Manager (matron) who is a Registered General Nurse has achieved NVQ level 4 in management and has put strategies in place ensuring standards are maintained and that the home continues to plan for the future. There are regular staff meetings, management meetings, and trained staff meetings. This has improved communications between all concerned and has
Silloth Nursing & Residential Care Home F58 F10 s10106 silloth nursing home v215029 010805 ui stage 4.doc Version 1.40 Page 18 helped when developing new ways of working, evaluation of new documentation and helps to ensure consistency. The residents said that they felt the home was theirs and they thought that they were consulted about changes and plans. No obvious hazards were seen and staff training has included Moving and Handling, First Aid, Infection Control, Food Hygiene, as well as mandatory training such as fire safety. Staff moved residents safely using the equipment provided and guidance was available about each resident regarding risks to their safety and how to minimise or prevent harm to that person. Silloth Nursing & Residential Care Home F58 F10 s10106 silloth nursing home v215029 010805 ui stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 4 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 3 x x x x 3 Silloth Nursing & Residential Care Home F58 F10 s10106 silloth nursing home v215029 010805 ui stage 4.doc Version 1.40 Page 20 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 15.2b Requirement care of Wounds/ pressure sores must be more detailed to include status and treatment. Timescale for action 30.09.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Silloth Nursing & Residential Care Home F58 F10 s10106 silloth nursing home v215029 010805 ui stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith, Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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