Inspection on 15/12/06 for Silverdale Nursing Home

This inspection was carried out on 15th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Silverdale Nursing Home 20/05/08

Silverdale Nursing Home 29/05/07

Silverdale Nursing Home 15/05/06

Silverdale Nursing Home 25/01/06

Silverdale Nursing Home 09/05/05

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

CARE HOMES FOR OLDER PEOPLE Silverdale Nursing Home Newcastle Street Silverdale Newcastle Staffordshire ST5 6PQ Lead Inspector Mrs Yvonne Allen 2nd Inspector Miss Dawn Dillion Key Unannounced Inspection 15 December 2006 10:30 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 Silverdale Nursing Home DS0000060541.V326689.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. Silverdale Nursing Home DS0000060541.V326689.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Silverdale Nursing Home Address Newcastle Street Silverdale Newcastle Staffordshire ST5 6PQ 01782 717204 F/P 01782 717204 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) Silverdale Care Homes Ltd Care Home 27 Category(ies) of Dementia - over 65 years of age (27), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (27) Silverdale Nursing Home DS0000060541.V326689.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Last key inspection done on 15/05/06 Random Inspections done on 27/06/06, 10/08/06 and 17/10/06. Brief Description of the Service: Silverdale Mental Nursing Home provides nursing care for up to twenty-seven older people, both male and female, requiring long stay, short stay and respite care with severe mental health or dementia care needs. The home is situated in the residential area of Silverdale and is approximately two miles from Newcastle town centre. There are local amenities in Silverdale village within walking distance of the home. The home provides single storey accommodation and comprises of single and shared rooms. The majority of rooms are single rooms and some of them have en-suite facilities. Bedrooms can be personalised by the individual service user. The home has assisted bathing and toilet facilities, a communal room, and a dining room. There are catering and laundry facilities on site. There are small car parking areas to the front and rear of the home. The grounds are not extensive and are easily accessible to the residents. There is a small safe enclosed patio area to the rear of the home equipped with garden furniture for residents to use during the summer months. The fees charged by this home are £334.00 for residential care and from £412.00 to £428.45 for nursing care. This is the current “A” list price for the local Social Services. No top up fees are charged by this home. Extra charges are made for Hairdressing, toiletries, escort duties and taxis. Silverdale Nursing Home DS0000060541.V326689.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit took place over four hours and was conducted by two inspectors. The provider had been given two day’s notice of the inspection visit. All the key standards were assessed as part of the inspection process. The acting manager was on duty and the provider was present throughout the visit. Feedback was given at the end of the visit. Requirements were discussed during the feedback and have been included in this report. Evidence was gathered using the following methods – Direct observation Examination of records and documentation Tour of the premises Discussions with staff Discussions with the provider and acting manager Discussions with residents The home did not receive a pre-inspection questionnaire before this second key inspection and so no comment cards were available from residents or relatives. There was one visiting relative present at the time of the inspection. A short discussion was held with him and he stated that he was happy with the care being given to his relative. Many residents were spoken to at the time but only two of those were able to give answers due to their reduced mental capacities. Both of these residents stated that they felt well cared for and were content at the home. The areas of strengths and weaknesses of this home, identified from this inspection are highlighted below. It was ascertained that residents were safe and that personal and nursing care provided was adequate. There are areas for improvement and these are mainly in relation to improving the quality of life for residents. Silverdale Nursing Home DS0000060541.V326689.R01.S.doc Version 5.2 Page 6 It was identified that the home had generally improved since the last inspection and that most requirements had been addressed by the provider. What the service does well: What has improved since the last inspection? The presentation of the environment internally has improved and the requirements left from the last inspection have been addressed. The provider has redecorated and refurbished all the communal rooms and a number of bedrooms. There has been re-carpeting throughout. The home appeared cleaner than at previous inspections and there were no mal odours present. The lounge and dining areas had improved and most of the residents now move into the dining area to take meals. This is more conducive to eating. The staff recruitment procedure had improved considerably and examination of a number of staff files identified that all the required information was included and the relevant checks had been carried out. It was encouraging to see that the provider had just recruited another Registered Mental Nurse to work at the home. The induction training programme had improved and this nurse stated that she was impressed and pleased with the content of the training she had received. The continuity of management within the last 12 months was having a positive effect on staff moral and on the delivery of personal and nursing care. Staff Silverdale Nursing Home DS0000060541.V326689.R01.S.doc Version 5.2 Page 7 were complimentary about the acting manager and stated that she was approachable and supportive. A staff member commented that she felt that communication from the provider had generally improved and other staff members stated that they had no problems with communication at all. What they could do better: The provider will need to demonstrate that this home can meet all the assessed needs of the residents accommodated. Personal and nursing care needs are met but these individuals are very vulnerable and their quality of life is sometimes not maintained, as it should be. There must be evidence that residents/representatives have a voice and are listened to. There was little evidence of autonomy being promoted and that choices and preferences are upheld. There must be more evidence of this. Adaptation of the environment must be improved upon. The home has improved in its general appearance internally but now needs to go a stage further to show that the specific needs of residents are met and that the presentation of the environment is geared to suit these needs. The introduction of another adapted bath is needed and this requirement has not been met by the provider within the timescale of the last report. The meeting of social and therapeutic needs to be more individually focussed. Training should be given to the person responsible for this and this will help her to understand needs and deliver activities suited to individuals. The provision of another care assistant is required to cover the morning shift as the home was running on full occupancy and dependency needs were high for some of the residents. The procedures for dealing with the laundry need to be reviewed and staff provided on the morning shift. The development of a structured staff training programme needs to be put into place and the training of staff must be geared to meeting the needs of the residents. It was concerning to note that the CSCI had still not received an application in respect of Registered Manager for this home. This was discussed with the acting manager – who stated that she had now decided to stay and apply for Silverdale Nursing Home DS0000060541.V326689.R01.S.doc Version 5.2 Page 8 registration. The provider was reminded of his legal obligation to provide a Registered Manager for the home. The procedure for the maintenance of personal allowances gave rise for concern. This procedure was not transparent and robust and an audit trail could not be easily carried out. There was no effective quality assurance programme in the home and this will need to be developed and must include seeking the views of residents and/or their representatives. 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. Silverdale Nursing Home DS0000060541.V326689.R01.S.doc Version 5.2 Page 9 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 Silverdale Nursing Home DS0000060541.V326689.R01.S.doc Version 5.2 Page 10 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): Standards 3, 4 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents entering the home can be assured that their care and nursing needs will be met although some improvements are required to ensure that autonomy and quality of life is maintained. EVIDENCE: A random selection of individual care plans was examined and there was evidence that assessments had taken place prior to admission. These had been carried out by the acting manager and were documented. Under Regulation 14 of the Care Standards Act - the provider must confirm, in writing to the resident (or their representative) that the home they are entering can meet their assessed needs. There was no evidence of these letters and this will need to be addressed. Silverdale Nursing Home DS0000060541.V326689.R01.S.doc Version 5.2 Page 11 Through assessment of other outcomes in this report, it was identified that, although basic care and nursing needs were met, there was a need to improve some outcomes in order to ensure that all individual assessed needs will be met fully and quality of life will be promoted at the home. The home does not admit residents for intermediate care. Silverdale Nursing Home DS0000060541.V326689.R01.S.doc Version 5.2 Page 12 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): Standards 7, 8, 9 and 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Care is planned and delivered with dignity and respect Consistency of documentation will need to be improved. EVIDENCE: The random selection of care plans identified that care was planned and delivered based on the assessment of needs. There was evidence that personal care needs were met. Individual residents were being attended to at the time of the visit and residents who were nursed in bed had received care and attention. There were records maintained to support this. Silverdale Nursing Home DS0000060541.V326689.R01.S.doc Version 5.2 Page 13 There was also written evidence of health assessments in relation to physical and mental health and there were records of multidisciplinary working. Risk assessments were in place including falls risk. In some of the care plans nutritional needs were assessed and care plans indicated the intervention and help required. Residents were observed receiving help and supervision over the lunchtime meal. There was evidence of involvement by the dietician. There was little evidence of residents and/or their representatives being involved in these evaluations and this will need to be improved upon. Individuals must be given the opportunity to participate in the planning and evaluation of their care. Care plans were somewhat inconsistent in their documentation and recording of evaluations. An individual had been assessed as moderate risk regarding nutrition but this had not been reviewed since 25/10/06. The moving and handling assessment had been carried out on 25/09/06 but had not been reviewed. For another resident – the care plan identified that the resident had a poor appetite and prone to dehydration but there was no evidence of fluid or diet monitoring in place. Another plan was detailed and identified a safe environment, mobility, communication, and mental and emotional health. The staff maintained a separate book for the recording of individual weights. There was evidence of GP intervention in relation to a resident with substantial weight loss. Where it was assessed that bedrails were needed, consent had been obtained from the representative but there was no detailed risk assessment in place for this. The provider will need to ensure that these are put into place. The medication procedure was assessed. There were no controlled drugs in use at the time of the visit. There was a controlled drugs cupboard in place, which appeared to be firmly fixed to the wall. However it did not appear to be rag bolted and the provider will need to investigate this. Temazepam was stored and recorded for audit purposes. It was identified that two medication products one a cream and the other eyedrops, were being stored inappropriately and a requirement has been made in relation to this. Silverdale Nursing Home DS0000060541.V326689.R01.S.doc Version 5.2 Page 14 Inspectors observed the interaction between staff and residents at the time of the visit. Staff were seen to be respectful and attentive and were mindful of privacy and dignity issues. Silverdale Nursing Home DS0000060541.V326689.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): Standards 12, 13, 14 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although there have been some improvements in this area individual autonomy and choices in relation to the daily life in the home are not actively promoted. EVIDENCE: The home employed an activities coordinator who worked part time and part time as a care assistant. There was a log of activities recorded for each individual. This demonstrated what activities or entertainment each resident had participated in. It is a recommendation that the activities coordinator receives training in this area as providing social and therapeutic activities for residents with mental health needs requires a great deal of understanding and planning. This was Silverdale Nursing Home DS0000060541.V326689.R01.S.doc Version 5.2 Page 16 discussed at the time of the visit. The local College is known to provide such training and the provider should make use of this. It was noted that spiritual and religious needs are assessed on admission and, since the last inspection; the promotion of these needs has been improved. For residents who are of the Roman Catholic faith the priest visits and for those who are of the Church of England and/or Methodist faith there are services and Holy Communion held in the home on a monthly basis. At the time of the visit there were no individuals with other religious/spiritual needs. There are Churches and Chapels located nearby and it might be that some individuals might prefer to attend the services. This should be ascertained and promoted wherever possible. Links with the local community are there but could be improved upon. Family and friends are able to visit at any time and a visitor present at the time of the visit confirmed this. The promotion of autonomy and choice for individuals still needs to be improved upon. There was little evidence of personal choices being promoted. Some bedrooms were more personalised than others and care plans did document some preferences but there was little evidence that preferences are upheld. In respect of meals and food preferences this was in need of improvement with most residents being served the same meals, albeit some had the soft diet option and there was one diabetic pudding being served. The likes, dislikes and preferences of individuals accommodated in the home need to be actively sought by the staff, documented and carried through and there needs to be evidence of this. Some of this information will need to be obtained from relatives due to the diminished mental capacity of most of the residents in the home. Silverdale Nursing Home DS0000060541.V326689.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There is a complaints system in place, which needs some amending. The systems in place help to protect residents from harm but staff do not have a clear understanding of the Whistle blowing Policy. EVIDENCE: There was a complaints procedure displayed in the entrance to the home. This was clear and accessible and contained details of the CSCI local office should this be required. The procedure did not display the timescale of 28 days for a complaint to be completed and this will need to be included. The procedure also mentioned that complaints must be received “in writing”. Some residents and/or representatives may not have the capacity to do this and it was discussed that this would need rewording. The CSCI had not received any complaints directly about the home since the last inspection. Silverdale Nursing Home DS0000060541.V326689.R01.S.doc Version 5.2 Page 18 The provider stated that he had not received any complaints within the last 12 months. The acting manager was advised to log all concerns raised and the actions taken to address them. A selection of staff members were interviewed at the time of the visit and some were questioned on their knowledge of The Whistle blowing Policy of the home and of their understanding of the procedures for the reporting of abuse. Although most of the staff were aware of what constitutes abuse they were a little vague about the Whisleblowing policy and more training is needed in this area. Staff questioned stated that if they had any concerns regarding mal treatment of residents and/or poor practice then they would report this to the manager of the home. Silverdale Nursing Home DS0000060541.V326689.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The provider continues to make the home more comfortable for the residents who live there. However the home requires further specialist adaptation in order to provide residents with the right kind of environment which is suited to meeting their specific needs. EVIDENCE: A tour of the home was undertaken during which all of the communal rooms and all bedrooms, bathrooms and toilets were examined. The kitchen and laundry rooms were also inspected. Silverdale Nursing Home DS0000060541.V326689.R01.S.doc Version 5.2 Page 20 The provider explained how much work had been carried out internally in the way of redecoration, refurbishment and re-carpeting. There was evidence of this throughout the home and this had improved the environment internally. Previous requirements in relation to the improvement of the environment had been addressed. The home also appeared generally clean and there were no mal odours present. The exception to this was the laundry area where laundry had not been started for the day and there were bags of dirty laundry waiting to be washed. This was unacceptable and contravened infection control policies. There was no laundry person on duty at the time and this needs addressing. Laundry staff must be present on the morning shift in order to start the laundry. This must not be left lying around until the afternoon. This was discussed with the provider at the time. The kitchen was clean and well presented at the time of the visit. The cleaning rotas were in place and had been completed. Food stored in the refrigerator and/or freezer had been wrapped and labelled accordingly. Residents were sitting in the main lounge and dining area. Some residents were nursed in bed. One resident was nursed in bed in her room and was lying quite flat. On visiting this resident it was apparent that she had no stimulation and was unable to look through her window or at anything else. The reason for this lady being nursed in bed was discussed with the manager at the time but this arrangement was not satisfactory as the quality of life for this lady was poor. This must be addressed and, following an assessment by the occupational therapist, a suitably adapted chair and bed must be provided. The bedroom must then be adapted to meet the needs of this lady and she must be assessed as to her wishes to join the other residents in the lounge areas. There were some pictures in place throughout the home, which the provider had introduced but the environment was still in need of further adaptation in order to meet the needs of the residents accommodated there. Advice should be sought from the Occupational Therapist as to what is needed. The surroundings need to be more stimulating and help residents with orientation. Colour schemes and themes should be introduced. Making bedroom doors and other rooms easily identifiable to individual residents should be considered with perhaps a colour, which they prefer, and/or a photograph of someone/something, which they can identify with. Silverdale Nursing Home DS0000060541.V326689.R01.S.doc Version 5.2 Page 21 At the previous Random Inspection a requirement had been left to provide another adapted bath. Discussions with staff identified that, as the home is now running on full occupancy, residents have to wait for a bath. This requirement had not been addressed up to the time of this inspection and must be addressed within the timescale of this report. Externally the home was in need of further improvement. Some of the window frames were very poor with rotten wood. The provider had progressed so far with the improvements and stated that he would be continuing with this throughout the forthcoming year. Silverdale Nursing Home DS0000060541.V326689.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements in induction training and recruitment procedure have helped to ensure that residents in the home are protected and supported. This would be further enhanced by the development of a structured training programme and the provision of another care assistant throughout the day. EVIDENCE: At the time of the visit there were 27 residents accommodated all with nursing mental health needs. The inspector was informed by staff members that some of the residents had very challenging needs at times. The staffing rota was examined. From 7am to 2pm there was 1 trained nurse and 4 care staff on duty. There was usually a senior care assistant counted in the care staff numbers. The numbers of care staff in relation to the numbers of residents, taking into account challenging behaviours and high dependency needs is just under what is required. Silverdale Nursing Home DS0000060541.V326689.R01.S.doc Version 5.2 Page 23 This was discussed with the manager and provider and it was decided by the provider that another care assistant would be provided during the day shift (From 9am-5pm). From 2pm to 9pm there was 1 trained nurse on duty supported by 3 care assistants. From 9pm to 7am there was 1 trained nurse and 2 care assistants on duty. The provision of domestic staff was adequate and the home was clean and well presented. The maintenance person was also one of the domestic staff. There was a cook provided and staff to cover when she was not on duty. The provider who attended the home most days carried out administration duties. There was a part time activities coordinator provided who also worked part time as a care assistant. There was staff training in place at the home but the training and development programme will need to be set up and documented and a copy provided to the CSCI. This programme will need to be directed at meeting the specific needs of the residents accommodated at the home. There is a need to incorporate onto the training programme, training in dementia care and challenging behaviour for all staff delivering care. One of the staff members spoken to expressed a wish to do NVQ training in Care. Another care assistant stated that she was undertaking NVQ training level 2. A number of the staff recruited from overseas have a nursing qualification, but as this is not recognised in this country, they are working as care assistants. Some nurses who work at the home undergo adaptation training through a university and are able, once they are issued with a PIN number by the UKCC, to work as a trained nurse. Prior to the inspection visit, the inspector spoke to a trained Registered Mental Nurse over the telephone. She had just been recruited to work at the home. She stated that her induction training had been very good and that she was impressed with the level of training she had received. A selection of staff files were examined and these were found to contain all the required checks and information. Criminal Records and Protection of Vulnerable Adults checks had been carried out prior to the individuals starting employment at the home. Written references had been obtained. Silverdale Nursing Home DS0000060541.V326689.R01.S.doc Version 5.2 Page 24 The recruitment procedure had improved considerably since the last key inspection. All the staff members interviewed stated that they did not have any problems with communication from the provider. The senior care assistant who was spoken to at the last inspection stated that she felt that communication had improved and that this was having a positive effect on staff moral. Silverdale Nursing Home DS0000060541.V326689.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): Standards 31, 32, 33, 35, 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the home has improved since the last inspection thus having a positive impact for the residents and staff. However, there is an outstanding requirement to register the manager with the CSCI and areas of weakness and concern remain. These include quality auditing and maintenance of personal allowances. Silverdale Nursing Home DS0000060541.V326689.R01.S.doc Version 5.2 Page 26 EVIDENCE: The provider had not yet put in an application for the acting manager to become registered by the CSCI. This was of great concern and was not in keeping with the previous requirement of the last Random Inspection report. This was discussed with both the manager and the provider. The acting manager has worked in this role for almost 12 months and has had a positive impact on the home since she started. The discussion with her revealed that it was her intention to stay at the home as manager. Discussions with staff members identified that they felt supported by the acting manager and that she ran an open door policy. The provider must apply to the CSCI for registration of the manager without further delay and within the timescale of this report. There was no evidence of an effective quality assurance programme within the home and this must be developed. Discussions with the manager and provider identified that there had been other systems which required their attention and were a priority – such as care planning and the recruitment procedure, but they stated that, as these were now up and running, the development of the quality auditing system would be addressed next. This system will need to evidence that the views of the residents and/or their representatives have been sought and that the results of surveys are displayed together with any action taken. The maintenance of personal allowances was examined. This system was not transparent and did not provide an effective audit trail. The system showed that there was a group shopping and no individual receipts for purchases. Examination of a selection of individual balances identified that these were correct at the time of the visit. This was discussed with the provider and the system must be reviewed and improved. Discussions with staff members identified that they were receiving formal supervision sessions but that these were haphazard and not each care staff member was receiving 6 sessions per year. Again, discussions with the acting manager identified that other systems had been a priority but that now these were sorted she would be able to concentrate and improve staff supervision. It was also identified that those who would be responsible for staff supervision – such as other trained nurses and senior care assistants would receive training in this area. This was planned for January 2007. Silverdale Nursing Home DS0000060541.V326689.R01.S.doc Version 5.2 Page 27 The examination of maintenance records for the home identified that general health and safety checks were being carried out and recorded. However there was no current certificate in place to confirm that the home was conforming to Legionella requirements. This test needs to be undertaken by a reputable recognised Company who specialises in this area. This was discussed with the manager who stated that he would address this without delay. There were certificates on display to confirm that Environmental Health had assessed the home on 19/10/06 and that Severn Trent Water Company had visited on 1/8/05. Silverdale Nursing Home DS0000060541.V326689.R01.S.doc Version 5.2 Page 28 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 x x 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 x x 2 2 x 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 1 x 1 2 x 2 Silverdale Nursing Home DS0000060541.V326689.R01.S.doc Version 5.2 Page 29 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 OP21 Regulation 23 (2)(j) Requirement There must be another adapted bath provided in the home PREVIOUS REQUIREMENT TIMESCALE OF19/12/06 NOT MET The CSCI must receive a competed application for Registered Manager for this home PREVIOUS REQUIREMENT TIMESCALE OF 19/11/06 NOT MET The recording in care plans must be up to date and consistent Residents and/or their representatives must be given the opportunity of participating in their care plan Reviews and evaluations must be carried out at least monthly and recorded The provider must inform the service user in writing that the home can meet his or her assessed needs The provider must ensure that medication is stored in accordance with the manufacturer’s instructions DS0000060541.V326689.R01.S.doc Timescale for action 12/02/07 2. OP31 8 and 9 31/01/07 3. 4. OP7 OP7 15 (1)(2) 15 (2) 31/01/07 31/01/07 5. 6. OP7 OP3 15 (2) 14(1)(d) 31/01/07 31/01/07 7. OP9 13(2) 31/01/07 Silverdale Nursing Home Version 5.2 Page 30 8. OP12 18(1)(c) 9. OP14 12(2)(3)( 4) 16(2)(i) 10. OP15 11 OP16 22(4) 12. 13. OP18 OP22 13(6) 16(2)(c) 14. OP26 16(2)(j) 15. OP19 23(2)(a) 16 17. OP27 OP30 18(1)(a) 18(1)(c) 18. OP33 24(1)(2)( 3) The activities coordinator must receive training in order to be able to meet the social and therapeutic needs of the residents in the home There must be evidence that autonomy and choice is promoted in all aspects of daily life There must be evidence of individual choices and preferences in relation to meals. Residents must be offered a choice at each mealtime The procedure for complaints must include the 28-day timescale for action and must not state that all complaints have to be in writing. The manager must also maintain a written log of all concerns and the action taken All staff must be informed of the Whistle blowing policy A suitably adapted bed and chair must be provided for the resident nursed in bed discussed with the acting manager. The procedure for dealing with the laundry must be improved and a laundry assistant provided on the morning shift The home must be further adapted to meet the needs of the residents accommodated there The number of care assistants on the morning shift must be increased by one There must be a structured staff training and development programme which is suited to meeting the needs of the residents in the home There must be an effective Quality Assurance programme developed by the home DS0000060541.V326689.R01.S.doc 31/03/07 31/01/07 31/01/07 31/01/07 31/01/07 31/01/07 31/01/07 20/02/07 31/01/07 20/02/07 20/02/07 Silverdale Nursing Home Version 5.2 Page 31 19. OP35 20(1)(2)( 3) 20. 21. OP36 OP38 18(2) 13(4)(c) The procedure for the maintenance of personal allowances must be transparent and robust and there must be a clear audit trail There must be documented evidence of regular formal staff supervision The provider must ensure that a Recognised Company tests the home annually for Legionella. This certificate of compliance must be available for inspection 31/01/07 20/02/07 31/01/07 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 OP19 Good Practice Recommendations It is recommended that the provider continues to improve the home externally as planned Silverdale Nursing Home DS0000060541.V326689.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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 Silverdale Nursing Home DS0000060541.V326689.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!