Inspection on 20/05/08 for Silverdale Nursing Home

This inspection was carried out on 20th May 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Silverdale Nursing Home 29/05/07

Silverdale Nursing Home 15/12/06

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Silverdale Nursing Home Newcastle Street Silverdale Newcastle Staffordshire ST5 6PQ Lead Inspector Peter Dawson Key Unannounced Inspection 20th May 2008 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 Silverdale Nursing Home DS0000060541.V364513.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.V364513.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 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 Vacancy 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.V364513.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide personal care (including nursing) and accommodation for service users of both sexes whose primary care needs are on admission to the home are within the following categories: - Dementia Elderly not falling into any other category (DE(E) 27) - Mental Disorder Elderly not falling into any other category (MD(E) 27) The maximum number of service users who can be accommodated is 27. 29th May 2007 2. Date of last inspection Brief Description of the Service: Silverdale Nursing Home provides nursing care for up to twenty-seven older people, both male and female, requiring long stay, short stay and respite care. It provides a service to people with dementia and other mental health 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 has single and shared rooms. The majority of rooms are single rooms and some of them have en-suite facilities. Most parts of the communal areas and all bedroom areas have been upgraded to provide improved accommodation and facilities. There is a small private garden/patio area where residents can sit or wander safely that is easily accessed from the lounge area. There are small car parking areas to the front and rear of the home. The home provides a good standard of nursing and care for people with dementia care needs based upon individual needs. The fees were not included in the Statement of Purpose. The reader may wish to contact the service for the current fee information. Silverdale Nursing Home DS0000060541.V364513.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced key inspection was carried out by one inspector on one day from 8.45 a.m. – 6.00 pm. The National Minimum Standards for Older People were used as the basis for the assessment of the service. Prior to the inspection the Acting Manager completed and returned the Annual Quality Assurance Assessment (AQAA), some information from that document is included in this report. Two feedback questionnaires completed by/with residents were returned to us prior to the inspection. Both commented positively about the care provided at Silverdale Nursing Home. Comments included “Everything is ok I cannot fault the home or the staff” and “I am looked after very well indeed, the home is well run and staff are extremely helpful and very pleasant”. A relative commented that his relative had not received a contract. Two visiting relatives were seen during the inspection and spoke highly of the care provided at the home and felt able to raise any areas of concern. They are both regular visitors and said that they were warmly received, offered drinks and had a good dialogue with staff. A Modern Matron visiting the home and providing staff training, commented positively about the home meeting the healthcare needs of its residents. All the communal areas and a sample of bedrooms were seen during the inspection. Standards of hygiene throughout were good. Bedrooms were comfortable and well personalised. The inspection was carried out with the new Acting Manager and the Provider. There was an open exchange of views throughout the day. Records relating to the inspection process were readily available, including care planning information, staff files, medication, and other records. All residents were seen and several spoken with - many in private. Those able to express a view were satisfied with the care they received and had no complaints. There was some discussion with staff on duty including nurses, carers and activities co-ordinator. Silverdale Nursing Home DS0000060541.V364513.R01.S.doc Version 5.2 Page 6 There were 22 people in residence at the time of this inspection. Observations indicated positive engagement between residents and staff in a relaxed atmosphere. The sole objective being to meet residents needs with support and re-assurance given fairly continuously. What the service does well: What has improved since the last inspection? A care plan to address challenging behaviours, including a record of chronological interventions and treatments has been established for a resident. Prospective residents are now informed in writing that the home can meet their needs following the initial assessment. Protocols for PRN (as required) medication have now been provided by prescribers. A further bathing facility has been provided in the form of a walk-in shower. This provides an excellent facility and is an alternative choice for residents. Fluid intake charts and now totalled daily and monitored by nursing staff. Action is taken where intake falls below required minimum levels. In addition residents with fluid intake deficiencies are offered drinks when awake at night to improve hydration. Silverdale Nursing Home DS0000060541.V364513.R01.S.doc Version 5.2 Page 7 Provision of bed valances has improved the presentation of some beds/ bedrooms. Meetings for relatives have been introduced allowing and opportunity for feedback about the service and input into plans for future activities. An Acting Manager has been appointed with a view to an application being made to CSCI for appointment as the Registered Manager. What they could do better: Complaints must be investigated within the required timescale of 28 days. Self funding residents must be provided with contracts to inform them of the services provided, fees payable, the rights and obligations of residents and the registered provider and who is liable if there is a breach of contract. All staff must receive training relevant to the work they perform. This includes both statutory and professional training. Hot water outlets in resident areas must be checked and recorded regularly to ensure safety of residents. Residents at risk of pressure damage must be turned 2 hourly which must be evidenced in recording. An improved system of recording pressure ulcers, treatment and progress must be established to required professionals standards. Care plans should continue to be updated with the new care planning format and social histories provided for all residents. Risk assessments must be reviewed following falls. A quality assurance system should be in place to establish feedback from residents, visitors, staff and external professionals and to generally monitor performance of the service. Prescribed and other creams in use must have clear instructions for their use and recorded. Silverdale Nursing Home DS0000060541.V364513.R01.S.doc Version 5.2 Page 8 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.V364513.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.V364513.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 1-5 were inspected on this visit. Quality in this outcome area is adequate. Improvements in pre admission information and procedures mean that prospective residents are able to make an informed judgement about the home and can be sure that needs are met. Contracts for self funding residents are needed and would clarify their position in the event of any dispute. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and Service Users Guide have been updated since the last report and copies are available to prospective residents and their families. They have also been distributed at a recent relatives meeting. Silverdale Nursing Home DS0000060541.V364513.R01.S.doc Version 5.2 Page 11 The Statement of Purpose does not make reference to dementia care and how those needs are met. Dementia care is the major service provided and should be included in the document. The current fees should also be included in the Statement of purpose. Following a requirement of the last key inspection report the home now provides a letter to all residents following the pre-admission assessment, stating that the home can meet the assessed needs of the person. Pre admission procedures are good. The homes own assessment is carried out in the persons existing setting. There had been a Care Management Assessment provided (by Social Services) prior to admission in the two records inspected. Funded residents have contracts provided by the Local Authority but selffunding residents were found not to have been provided with contracts by the home. This was reported in written feedback to us by a relative. This must be rectified and should always be provided. The daughter of a resident admitted several weeks prior to the inspection was seen and she stated that she had been invited to view the home and discuss her mothers needs prior to admission. An offer from the home for her mother to visit had been declined by herself. She also said that both she and her mother had been very warmly received by the provider and staff, the placement had been successful, her mother settling swiftly and well into the home. Silverdale Nursing Home DS0000060541.V364513.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 – 10 were inspected on this visit. Quality in this outcome area is adequate. The quality of care planning is improving - resulting in an improved service to residents. Changes to aspects of health care records and procedures would improve the service further. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A sample of care plans for recent admissions and long-stay residents were taken. Care plans have required review and updating for sometime. Efforts have been made by interim acting managers to do this. The recently appointed Acting Manager has introduced a new format for all care plans with revised documentation. This has been completed for one person and will now be Silverdale Nursing Home DS0000060541.V364513.R01.S.doc Version 5.2 Page 13 completed for all. This is an improvement on previous plans. The AQAA (Annual Quality Assurance Assessment) stated that social profiles were completed following admission, the information is basic and more detailed information in the form of social histories are required to inform staff and provide necessary information to meet needs. It is important to continue to review and update care plans and transpose them to the new care-planning format. There was evidence that care plans had been reviewed on a monthly basis. All residents are diagnosed or considered to have dementia care needs. Although the home has registration for people with mental health needs it was felt that none of the residents were in that category. Three people have been bedfast for over 1 year. Their records were reviewed. Two previous requirements to total fluid intake charts daily and for nursing staff to monitor them had been addressed in the records seen. One person presently has a pressure ulcer. An airwave (special) mattress is in place with regular turning and records of nutritional inputs. Whilst there were notes relating to this, they were inadequate and in different places. There was no grading (Sterling) of the wound and notes included such statements as “its getting better” – it is impossible to substantiate this without regular accurate recording of the grading of the wound. A care plan to address, record and monitor the progress of tissue viability care is vital. The records of a resident at risk of pressure damage and required to be turned at 2 hourly intervals showed that during the previous 2 nights she had not been turned from 9pm – 8 am. The Acting Manager was confident that the turns had taken place. No recording of this indicated that it may not have taken place. Staff should be made aware of the importance of regular turning and recording. A requirement of the Random Inspection on 16/10/07 to offer drinks to residents throughout the night who have fluid intake deficiencies has been addressed. Evidence was seen of this in records. Risk assessments were in place in relation to moving & handling and daily living. In relation to a resident who had fallen and sustained facial bruising in the days prior to the inspection there had not been a review of the risk assessment. This should always be completed following falls. It was pleasing to see that in relation to a resident prescribed Haloperidol prior to admission – that this had been reviewed by the GP and reduced. Her daughter said that she had been involved in this and understood that close Silverdale Nursing Home DS0000060541.V364513.R01.S.doc Version 5.2 Page 14 monitoring of her condition/medication was taking place and she was very satisfied with the actions taken and care being provided. The medication system is supplied in blister packs (monitored dose system) by Boots Chemists and a good service is reported. The use of creams in the home could be more clearly recorded/controlled. In one instance there were 4 tubes of the same prescribed cream for the same person - it was impossible to establish which was in current use. It is good practice to date creams when opened and in this instance would clearly identify the cream in use. There was a debate with the Acting Manager about medicated and non-medicated creams, - which should be on MAR sheets and which should be applied by non-nursing staff. There were no clear instructions for the use of the non-medicated creams and it was felt that care staff understood statements seen in care plans such as “barrier cream as required”. This is not satisfactory it is recommended that the use of creams should be reviewed. Clear instructions must be given to staff on the use of all creams and all prescribed creams should be recorded on MAR sheets. It is recommended that Co-danthramer prescribed for a resident is reviewed with the GP. The home have secured the services of a retained GP and feel that there is an improved service to residents as a result. A DNAR (Do not attempt to Resuscitate) instruction seen for one resident had been completed in the appropriate format and was reviewed by the GP on a regular basis as part of the required protocol. A Modern Community Matron from the PCT was present in the home during the inspection she was giving training for nurses in the administration of subcutaneous fluids. She said that the home had responded well to offers of training and were receptive to advice about health care issues in general. Silverdale Nursing Home DS0000060541.V364513.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 -15 Quality in this outcome area is adequate. Residents are having a greater choice of activities and are positively encouraged to maintain contacts and relationships with relatives. Community facilities being used more and improving quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A need to improve quality of life by means of additional appropriate activities for residents has been addressed with the recent appointment of an Activities Co-ordinator who works 15 hours per week flexibly in the home. She was seen during the inspection and brings experience and enthusiasm in this needed area. She has been keen to introduce changes slowly and been successful in establishing a broader range of internal activities suited to individual or small group activity. Many residents have limited concentration spans and many able only to engage on a 1:1 basis. A contact made with local church (needed as stated in the last report) and a group have visited the Silverdale Nursing Home DS0000060541.V364513.R01.S.doc Version 5.2 Page 16 home provided and provided pastoral experience which residents enjoyed. A group of residents are to visit a social lunch group at the church held weekly. Entertainment has been brought into the home that residents have also responded to positively. Records are kept of the activities programme and also recording (seen) of each residents involvement in 1:1 or other activity. A good start has been made in this area and will continue to improve the options available to residents and improving quality of life. There is an excellent small garden area which is well planned. It has good seating that is safe and pleasant for residents with easy access from the main lounge area. Being south-facing the garden/patio area has sun throughout the day and is being used daily during the summer months. This is particularly positive for those residents with a propensity to wander, allowing another dimension for their activity. Social histories are mentioned earlier in this report and vital documents for the knowledge and planning of activity and interest for residents. Relatives meetings have been established with the first meeting on 15th April (minutes seen). The new Acting Manager and Activities Co-ordinator attended and positive discussion/plans made about activities for the future. These meetings will be held bi-monthly and at different times to ensure all relatives have the opportunity to attend if they wish. This is a positive move and vehicle to provide feedback about the service. There is a large lounge area and adjoining dining area, both refurbished and providing bright and pleasant surroundings facing the garden area. Additionally there is a large reception area which has been improved since the last inspection with comfortable lounge seating, new lighting and large aquarium. This provides an additional area where residents can sit alone, in smaller groups or with visitors in away from the main lounge area. Some residents use this area in the evening and it is a quiet area in which to relax. A sensory room is being created to establish a place where residents can benefit from sensory stimulation in a relaxed, comfortable environment away from the distractions of the lounge area and communal living. There was some evidence of chosen lifestyles being accommodated with late rising for breakfast, resident using her bedroom throughout the day, visiting the dining area only for meals. Two relatives were spoken with during the inspection. One was very satisfied with the way her mother was received into the home only 2 months ago. She said that staff were “helpful and supportive” and assisted her mother to settle quickly and well into the home. Another relative of a longer-term resident said that she was quite satisfied with the care provided to her mother, that she was kept informed of any events affecting her life/well being. If she had any areas of concern, she expressed Silverdale Nursing Home DS0000060541.V364513.R01.S.doc Version 5.2 Page 17 them readily to staff or provider. They were taken seriously an resolved to her satisfaction. This inspection commenced at 8.45 a.m. around half the residents were in the lounge/dining area having or waiting for breakfast. Care staff were very busy at this peak time assisting people to rise, feeding people in their bedrooms and additionally they had to prepare breakfast for them. Frequent visits to the kitchen area meant that supervision of residents in the lounge/dining areas became limited. A requirement in the last key inspection report to provide catering facilities at breakfast-time to support staff was not in place on this inspection and a further requirement is made. The provider said that he would re-instate additional hours from 8a.m. for this purpose. Staff throughout the day were observed to engage positively with residents and respond to their individual needs. Soft toys brought in by a member of staff on the day of inspection provided residents with a focus of interest and discussion and also some solace. Some residents will rise and wander unsafely if not monitored closely and the principle of constantly monitoring particular people at risk in the lounge area was closely monitored. Silverdale Nursing Home DS0000060541.V364513.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): Standards 16 – 18 were inspected on this visit. Quality in this outcome area is adequate. The revised and readily available complaints procedure means that residents and relatives know how to make complaints. Complaint investigations must always be completed within prescribed timescales. This judgement has been made using available evidence including a visit to this service. EVIDENCE: to include all staff. The complaints procedures were amended prior to the last inspection and are available in the service users guide and also posted in the home. The recent introduction of relatives meetings provides an opportunity for feedback about the service. Planned questionnaires to residents/relatives will similarly inform about service delivery. Silverdale Nursing Home DS0000060541.V364513.R01.S.doc Version 5.2 Page 19 The home state that they have not received any complaints directly to them since the last inspection, however a complaint was recently received by us and forwarded to the home for investigation and completion within 28 days under the homes complaint procedures. This investigation has not been carried out as required and the provider gave an undertaking at this inspection that this would commence and be completed swiftly. A report concerning the investigation will be sent directly to the complainant and CSCI. The complaint surrounds areas of care practice, staff competency with potential implications for the care of residents. Delay in investigation of the complaint breaches Regulation 22 (4) There has been staff training in Safeguarding (The Protection of Vulnerable Adults) and Whistle-blowing. This needs to be ongoing Silverdale Nursing Home DS0000060541.V364513.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): Standards 19 – 26 were inspected on this visit. Quality in this outcome area is adequate. People live in a safe, comfortable environment with good facilities. Where possible they have their own possessions around them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Following the last key inspection an excellent walk-in shower room was completed and provides good facilities and choices for residents. The interior of this home has been vastly improved/refurbished over the past 2 years. Communal areas are bright, comfortable, well furnished and well maintained. Since the last inspection the large reception area has been Silverdale Nursing Home DS0000060541.V364513.R01.S.doc Version 5.2 Page 21 improved to provide comfortable lounge-seating, with improved lighting and large attractive aquarium which residents enjoy. This provides an alternative sitting area from the large main lounge area and also used for residents to meet visitors in private. A sample of bedrooms seen were well-furnished, comfortable and reflected individuality. It was noted that the hot water outlets in two areas exceeded safe limits. Whilst there are fail-safe valves fitted to all outlets, hot water temperatures should be checked manually on a phased basis. It was not clear in relation to one of the outlets mentioned whether a hot water control had actually been fitted. The provider will check this. The lounge and dining areas are bright, comfortable and inviting. The excellent small garden area provides opportunities for residents to sit or to wander safely if they wish. This area is well used during the summer months and provides a pleasant view from the lounge area throughout the year. At the last key inspection permission was given for one of the 4 bathrooms (unused) to be used for other purposes. – There are now 2 assisted bathrooms and a walk-in shower area – adequate for the maximum number of residents (27). The 4th bathroom is now being converted into a sensory room for residents and will provide a good facility. All areas of the home were clean and hygienic and there were no mal-odours detected during this visit. The external presentation of the building is poor and belies the many internal improvements made. Silverdale Nursing Home DS0000060541.V364513.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 – 30 were inspected on this visit. Quality in this outcome area is adequate. Provision of staff at peak times would ensure an improved service for residents at those times. Staff training has improved and more is planned, this will also improve the quality of service for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels for the 24 hour period are 4:3:2 care staff plus 1 nurse at all times. As stated earlier in this report additional catering assistance is needed in the morning to prepare breakfasts and assist carers at this peak time. It is a requirement of this report and must be maintained. It was a requirement of the last report, although the provider says that an additional person was provided from 8-4 until numbers of residents recently reduced to the present number of 21. A staff training matrix has now been provided highlighting training needs. There is also a training plan for the current year and courses booked to update Silverdale Nursing Home DS0000060541.V364513.R01.S.doc Version 5.2 Page 23 some training and also meet shortfalls. Training is required in: Food Hygiene, Health & Safety and Moving & Handling. Only 4 people are first aid trained, insufficient to ensure there is one first aid trained person on duty at all times. The Acting Manager is an approved Moving & Handling Trainer requiring updating training in June 2008, she will provide training for all staff. A requirement is made to ensure that all staff receive statutory and additional training to meet the needs of residents. On the day of this unannounced inspection, training took place for nurses in the administration of subcutaneous fluids and for care staff in Dementia Care. Efforts are obviously being made to meet shortfalls in training. There has been an improvement in the number of staff trained to NVQ level, this is now 67 of care staff. In the sample of staff files were seen all checks, references and documents required under Schedule 2 had been obtained with the exception of photographs of all staff members. These must be provided at the point of employment. New staff files had been provided with a checklist of recruitment procedures etc which is a great improvement. Silverdale Nursing Home DS0000060541.V364513.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31-33 and 36 – 38. were inspected on this visit. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The current temporary management arrangements are meeting the needs of the service and the quality of the service is improving. EVIDENCE: The home has lacked consistent management over the past 2 years. Several Acting Managers have ultimately left. There is now in place an Acting Manager appointed in March 2008 who is making application to CSCI to become the Silverdale Nursing Home DS0000060541.V364513.R01.S.doc Version 5.2 Page 25 Registered Manager. She has made positive moves in initiating the necessary changes to practice and procedures. These must continue and are necessary to improve quality and delivery of service to residents and to provide positive leadership and management of the home. She has the required experience and qualifications to run the home. There has been no quality assurance monitoring system in place for sometime. The Acting Manager has revised the format of questionnaires to residents/relatives and intends to distribute them on a phased monthly basis. The results will be made available in the home and in the service users guide in future. Another vehicle for feedback about the service has been established with meetings arranged on a bi-monthly basis with relatives. It is important also to seek feedback from other stakeholders e.g. Healthcare professionals, Social Workers and Staff on a formal basis. Staff supervision is not presently in place and the AQAA states that it is an objective to undertake supervision bi-monthly in the next year. The provider has a daily presence in the home, is known to and has positive relationships with residents and relatives. It is hoped that the provider and manager working together will be able to achieve the mutual goal of further improving the service to residents. Silverdale Nursing Home DS0000060541.V364513.R01.S.doc Version 5.2 Page 26 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 1 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 3 3 3 3 3 2 3 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 2 2 X X 2 2 2 Silverdale Nursing Home DS0000060541.V364513.R01.S.doc Version 5.2 Page 27 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 OP2 Regulation 5(1)(c ) Requirement Self funding resident must all be given contracts for the provision of service and facilities by the registered provider. Continue to update care plans on the new format and include social histories for all. Previous timescale not met. Risk assessments must be reviewed following falls Residents at risk of pressure damage must be turned 2 hourly as required. Records must be completed to evidence this. Improved recording to professionals standards is required for pressure ulcers. A grading system to accurately monitor this must be established Hot water outlets in resident areas must not exceed 43C. Regular manual checks of temperatures are required. Catering facilities must be provided to support care staff at peak times. Previous timescale not met. All staff must receive training appropriate to the work they DS0000060541.V364513.R01.S.doc Timescale for action 31/05/08 2. OP7 15(2) 31/07/08 3. 4. OP7 OP8 13(4) 12(1) 23/05/08 23/05/08 5. OP8 12(1) 23/05/08 6. OP25 13(4)(a) 23/05/08 7. OP27 18(1)(a) 23/05/08 8. OP27 18(1)(c ) 31/07/08 Silverdale Nursing Home Version 5.2 Page 28 9. OP33 24 10. OP16 22(4) perform. Plans to seek the view of residents/relatives and other stakeholders to be pursued. Results of quality surveys to be available to all. The Registered Person shall inform the person making a complaint within 28 days, of the action that is to be taken. 31/07/08 31/05/08 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. 2. Refer to Standard OP9 OP9 Good Practice Recommendations It is recommended that all creams are dated when opened and creams in current use clearly labelled. It is recommended that Co-danthramer prescribed is reviewed by the GP. Silverdale Nursing Home DS0000060541.V364513.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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.V364513.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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