CARE HOMES FOR OLDER PEOPLE
Silloth Nursing & Residential Care Home Silloth Wigton Cumbria CA7 4JH Lead Inspector
Colette Hibbert Unannounced Inspection 28th February 2006 08:45 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 Silloth Nursing & Residential Care Home DS0000010106.V280958.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Silloth Nursing & Residential Care Home DS0000010106.V280958.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Silloth Nursing & Residential Care Home Address Silloth Wigton Cumbria CA7 4JH 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) 016973 31493 016973 31242 Cumberland and Westmorland Convalescent Institution Mrs Elizabeth A Blair Care Home 40 Category(ies) of Learning disability (1), Old age, not falling registration, with number within any other category (40), Physical of places disability (5) Silloth Nursing & Residential Care Home DS0000010106.V280958.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The service must at all times employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. 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. 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 1st August 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 accommodation and ample communal areas. The interior courtyard with raised flowerbeds for residents to enjoy and plant out. The car park has a smooth surface giving safer and easier access to the home. Silloth Nursing & Residential Care Home DS0000010106.V280958.R01.S.doc Version 5.1 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 14:30. During the course of the day the inspector spoke with residents, visitors and staff and relevant documents were studied. The inspector toured the whole building and observed the daily routine. The registered provider was present during the visit. What the service does well: What has improved since the last inspection? Silloth Nursing & Residential Care Home DS0000010106.V280958.R01.S.doc Version 5.1 Page 6 The home has continued to make improvements to the décor throughout the building. It is light bright and homely. New carpets have been put down in some of the bedrooms. Staff development is progressing with training provided within the home as well as external courses. The home has a new Moving and Handling coordinator who provides training at induction and updates for other staff. There are only 2 or 3 staff left to work through their NVQ and they should commence this later on in the year. 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 DS0000010106.V280958.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Silloth Nursing & Residential Care Home DS0000010106.V280958.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,and 4 Residents have information, contracts and assessments prior to entering the home to ensure their needs will be met and allowing them to make an informed choice about the home. EVIDENCE: The home gives prospective residents comprehensive information prior to admission. The manager or senior staff member assess the prospective residents and find out their care and social needs. The residents spoken to said was very reassuring. One resident said that it ‘made it easier to make the difficult move and felt that the home would be able to prepare to provide the care that was needed’ Another resident knew the home before moving in but was still given all the information and invited to look around. Each resident has a written contract given to them and it states the terms and conditions of the home, one copy is kept on file by the home. Silloth Nursing & Residential Care Home DS0000010106.V280958.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 Each resident had a care plan but they had not been updated and some contained inappropriate documentation putting the residents at risk from not receiving the correct care. Medication procedures were in place with an audit system carried out to protect the residents. Some resident’s bedroom facilities were inadequate, reducing the amount of privacy they could obtain. EVIDENCE: The residents had care plans in place. They were clear and easy to follow and full of detailed information, however they had not been updated to show changes in the residents care needs and put the residents at risk from receiving incorrect care. Information regarding wounds had not been updated. This was a requirement at the last inspection and has been repeated. The administration of medications was observed and staff explained the new audit system in place. The medication charts were accurate and records were kept of any disposals and returns. Due to building work in progress some residents were being accommodated within a room that was inadequate to ensure that they could maintain their dignity and privacy. The inspector spoke to the Management and asked for this
Silloth Nursing & Residential Care Home DS0000010106.V280958.R01.S.doc Version 5.1 Page 10 to be rectified as soon as possible. A requirement has been made on this matter. Residents spoken with said they felt that they ‘received good care and did not have to wait for staff to help them’. One said that ‘nothing was to much trouble for the staff here’. Silloth Nursing & Residential Care Home DS0000010106.V280958.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): This standard was not assessed as it was met at the last inspection. EVIDENCE: Silloth Nursing & Residential Care Home DS0000010106.V280958.R01.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 Residents felt that their legal rights were protected by the policies and procedures within the home, and they had freedom of choice to lead a full life. EVIDENCE: Several residents said that they had been given the opportunity to cast a vote at the last election, either by post or the home would take them in the bus to vote. Many residents spoken with felt that they had freedom to make choices over the way they lead their lives and some said that they had been able to see their own solicitor in private to ‘put their affairs in order’. Silloth Nursing & Residential Care Home DS0000010106.V280958.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,and 26 The home is well maintained, clean and provides a pleasant environment for the residents to live in. EVIDENCE: With major building work underway the home still manages to maintain a clean and homely environment for the residents to live in. There were appropriate systems in place to keep the residents safe and away from harm. Hazards were highlighted and adequate safety precautions were in place. The residents said they liked living here as it was ‘like home from home’. One resident said that the ‘maintenance person had a hard job, rather like painting the forth road bridge, he just get finished and you have to start at the other end again’ Silloth Nursing & Residential Care Home DS0000010106.V280958.R01.S.doc Version 5.1 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 Staff receive appropriate training to enable them to have the knowledge to provide correct care for the residents within the home. EVIDENCE: Staff spoken with said they felt that on going training was an important part of their job. One staff member said ‘the home provided regular updating on specific topics that related to the residents within their care’. This made their work more interesting and understandable. Many staff have completed their NVQ training at either level II or III, and some were going on to do nurse training. Group clinical workshops take place within the home for all areas of staff to improve their knowledge and so benefit the residents’ care. During the course of the day the atmosphere was quiet and staff were seen to go about the daily routine in an efficient manner. The home has its own in house moving and handling co-ordinator and she was seen working with the staff during the morning. All training is noted within the staff files, which were seen to be up to date. Silloth Nursing & Residential Care Home DS0000010106.V280958.R01.S.doc Version 5.1 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36,and 37 The home has clear leadership and guidance form a management committee who safeguard the residents’ best interests. Staff do not receive supervision to identify training needs, which would enable the home to improve the service it provides for the residents. EVIDENCE: The home has a well-established management team and it provides leadership for the staff. There is a committee, which makes sure that the home is run in the best interests of the residents and oversees the financial arrangements for the home. Equipment and the general up keep of the home are two of there priorities. One member of staff said that they could make suggestions to the management for improvements to benefit the standard and quality of life of the residents within their care. There are systems in place to safeguard resident’s money and financial affairs, and these records were looked at during the inspection.
Silloth Nursing & Residential Care Home DS0000010106.V280958.R01.S.doc Version 5.1 Page 16 Staff receive regular group clinical supervision and annual appraisals, which were recorded within the staff files. The staff spoken with said that they found these of benefit. The home should look to providing staff with the opportunity for 1-1 supervision, which would enable the staff to discuss any work related issues and identify any training needs they may have. The staff did say that the manager operates an open door policy and they can talk to her any time, as she is ‘very approachable’ The home has policies and procedures in place which safeguard the residents’ rights and best interests and these are kept within the office for the staff to refer to if they need to. Staff spoken to said that they were notified if there were any changes or new policies within the home by the senior staff. Silloth Nursing & Residential Care Home DS0000010106.V280958.R01.S.doc Version 5.1 Page 17 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 3 x 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 3 18 x 3 x x x x x x 3 STAFFING Standard No Score 27 x 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 3 x 3 3 2 3 x Silloth Nursing & Residential Care Home DS0000010106.V280958.R01.S.doc Version 5.1 Page 18 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 2. Standard OP7 OP8 Regulation 15.2(b) 15.2(b) Requirement Care plans must contain relevant information and be reviewed regularly. Care of Wounds/ pressure sores must be more detailed to include status and treatment. (This is an outstanding requirement. Timescale 30/09/05 has been extended.) The home must insure that residents have accommodation that respects their privacy and dignity. Care staff must receive formal supervision at least 6 times a year. Timescale for action 08/05/06 08/05/06 3. OP10 12.4(a) 07/04/06 4. OP36.2 18.2 08/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Silloth Nursing & Residential Care Home DS0000010106.V280958.R01.S.doc Version 5.1 Page 19 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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