Inspection on 29/05/07 for Silverdale Nursing Home

This inspection was carried out on 29th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Silverdale Nursing Home Newcastle Street Silverdale Newcastle Staffordshire ST5 6PQ Lead Inspector Peter Dawson Key Unannounced Inspection 29th May 2007 10:00 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.V341218.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.V341218.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 Teresa Pegg 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.V341218.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. That Mr Pynadath completes the RMA course. That Mr Pynadath completes the Dementia Awareness Training Course. 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 with with dementia care 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 which 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 and identities. Silverdale Nursing Home DS0000060541.V341218.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one inspector on one day between 8.30 – 5.30 pm. The recently approved Registered Manager came on duty at mid-day. Eight other members of staff were seen and spoken to during the inspection. The provider was not present during the inspection but spoken to by telephone the following day. Feedback was given at the end of the inspection to provider and manager. All residents were seen and many spoken to 2-3 were able to express a view about the care provided. One regular visitor was seen and spoken to at length. There was an inspection of the environment including a sample of bedrooms. Documentation relating to the inspection process was seen including a sample of care plans. The care provided for 3 highly dependent residents was reviewed by reference to care plans and discussions with a resident and staff. An Annual Quality Assurance Assessment was completed by the provider and given to the inspector on the day. Some information is used in this report. Residents able to express a view seemed happy with their care. Observations throughout the day supported the view that residents are treated as individuals with respect and supported positively by staff. The home has moved from a position of poor environment and some poor standards of care to an improved position with a vastly improved environment, more stable and effective management with a Registered Manager recently approved by CSCI and the care and quality of life issues that were of concern have also been improved with additional staffing and training programmes to heighten awareness of the needs of people with dementia. These factors need to be sustained and built upon. What the service does well: Silverdale Nursing Home DS0000060541.V341218.R01.S.doc Version 5.2 Page 6 A small unit providing nursing and care for people with dementia care needs and other mental health needs. The physical care and nursing provided showed good management of preventive health care matters including assessments for nutrition and tissue viability care. There are no pressure ulcers in the home and this is due to the good assessments, management and treatment. Several residents have high physical dependency needs requiring skilled general nursing care. This is evidenced in care plans seen, reviews of a number of residents and outcomes that indicate awareness of health care needs. The environment internally has been completely refurbished over the past year and presents a bright, comfortable, homely setting. There is an excellent small secure private garden area with good seating and a necessary facility for those people with dementia who choose to wander throughout the day. The building is secure allowing free movement within the home itself. There is evidence of good personal relationships between residents and staff. Staff initiate and engage residents in meaningful conversation and are treated with respect. What has improved since the last inspection? At the time of the last key inspection on 15th December 2006 – 21 requirements were made an action plan was required and provided by the provider to meet those requirements.– most were addressed at the time of the last random inspection on 14th March 2007 when 9 requirements were made. At the time of this inspection there were 3 outstanding requirements which are repeated with extended timescales, these relate to provision of assisted bathing facility, a quality assurance survey and continued review and updating of care plans. Considerable progress has therefore been made in the past 6 months with the additional advantage of a recently approved Registered Manager in post. Silverdale Nursing Home DS0000060541.V341218.R01.S.doc Version 5.2 Page 7 What they could do better: An additional assisted bathing facility must be provided. The provider intends to provide a walk-in shower which would provide and additional option for this group. Recorded challenging behaviours should all be reviewed. In a particular instance discussed a care plan to address those behaviours must be put into place with an updated risk assessment. The administration of PRN antipsychotic medication must be reviewed with the GP and protocols for its use put into place. Future administration must be recorded with date, reasons, dose and outcomes. In relation to new admissions all residents must be informed in writing, following assessment that their needs can be met by the home. The statement of purpose/service users guide should be completed, copy given to all relatives and a copy available in the home for visitors or prospective future residents and their families. The arrangements for processing infected laundry must be tightened to ensure good infection control practice. The updating and review of all care plans should continue. Catering facilities provided at breakfast-time would allow care staff the necessary time to provide the high level of personal care required at that time. Bedrooms have all been upgraded and improved. Bed valances would cover the metal bed frames and further improve presentation. Fluid intake charts are completed daily for several residents and are good and accurate. It is important that this information, which is completed by care staff, is totalled and reviewed daily by the nursing staff to ensure the minimum daily intake is achieved and referrals made to GP where there are shortfalls or concerns. Silverdale Nursing Home DS0000060541.V341218.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.V341218.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.V341218.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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The revised Statement of Purpose/Service users Guide must be available in the home for prospective residents. Confirmation in writing to prospective residents must be given to confirm needs can be met. Other pre-admission procedures have been followed adequately. EVIDENCE: It was not possible to see the Statement of Purpose/Service Users Guide on this visit. This has been revised/rewritten and the Manager reports is nearly complete. A copy must be given to all residents/relatives and also copy forwarded to CSCI when completed. Silverdale Nursing Home DS0000060541.V341218.R01.S.doc Version 5.2 Page 11 In a sample of documents seen in relation to people recently admitted, there was a pre-admission assessment carried out by the home and also a Care Management Assessment. These documents provided the basis for care plans. There was evidence of reviews of placement after 6 months also. Residents had not been informed in writing that the home could meet their needs as required under Regulation 14(1)(d). A requirement in relation to this was made in the last key inspection report and is repeated again in this report. This was discussed with the new Manager who understood the reasons for this requirement and will put appropriate letters in place. It is important for the home to confirm that assessments demonstrate needs can be met and in accordance with the Statement of Purpose of the home. Silverdale Nursing Home DS0000060541.V341218.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): Quality in this outcome area is good Care plans are now being reviewed regularly and some being updated/rewritten on an going basis. Progress has been made, should continue and involve residents/relatives. There has been an improvement in recording health care needs and the care of several highly dependent people showed good staff awareness with good results. Attention to some areas of medication administration are needed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A sample of care plans of new and existing residents were seen. New care plans were based upon recorded assessed need. Plans relating to longer term residents provided some good information but some required updating/reSilverdale Nursing Home DS0000060541.V341218.R01.S.doc Version 5.2 Page 13 writing. The Manager is presently working on these documents and intends to update them as required. At the time of the last random inspection evaluation and reviews of care plans and risk assessments were not being carried out on a regular basis, a requirement was made and there has been considerable improvement with regular monthly reviews. Evaluation and review of plans is an ongoing task and needs to continue. A care plan seen recorded the “challenging behaviours” of a resident. This judgement had been made some 2 years previously with a risk assessment that was questionable at the time and now dated. The person was prescribed Haloperidol PRN (as required) – this was not on the MAR sheet and there was no protocol or recording of circumstances in which it was given. Staff were unaware of a history of depression which could be a factor in the behaviours presented. A care plan must be established to address the behaviours with an appropriate risk assessment and chronological recording of details of any behaviours and the medication prescribed PRN must be reviewed with the GP urgently. A protocol must be provided for its use. It is suggested that the home reviews all care plans where challenging behaviours are recorded. Staff training in this area of work is arranged, about to take place and the concepts can be discussed/reviewed at staff meetings and in supervision with staff. Health care records of other residents seen were of a reasonable standard. All residents are weighed monthly, there are nutritional assessments and a good record on tissue viability care. - Many residents are high-dependency due to their deteriorating physical conditions. In fact 5 people are bedfast and have been so for very long periods. The care of 2 were reviewed and all aspects of health and physical care well documented and followed. There are no pressure ulcers in the home at all at this time and this is to the credit of staff. Food & fluid intake charts are provided for those at risk, pressure relieving equipment is available and in use (5 alternating mattresses) Those bedfast are turned regularly and this is recorded. It was recommended in relation to the fluid intake charts which are regularly completed by care staff that the nurse in charge checks and totals charts daily providing a daily summary of intake. Action can be taken where there are shortfalls. It was impressive to see that the 5 people bedfast were checked every 30 minutes throughout the day and night. This also applied to another totally dependent resident in the lounge area. Charts record the checks. Regular blood sugar levels were recorded daily for insulin dependent residents and some others. One resident has a PEG feed, monitored by the dietician who will also advise in relation to other residents. There is a retained GP service with 2 weekly visits or on demand as required. Silverdale Nursing Home DS0000060541.V341218.R01.S.doc Version 5.2 Page 14 It was particularly notable that all residents were well-dressed and wellpresented. A resident who chose to feed himself for breakfast was seen later changed to ensure his dignity and the floor discreetly cleaned – evidence of choice and dignity. The medication system is soon to be changed to Nomad (monitored dose system), which will be safer and easier to administer. Records seen showed some deficits – Haloperidol PRN mentioned above was not on the MAR sheet. There was no written protocol for Haloperidol or Lorazepam, both prescribed PRN. Eye drops had not been dated when opened. A care plan recording an allergy to penicillin had not also been recorded on the MAR sheet. A thermometer has been provided in the medication storage room following a requirement of the last report. Silverdale Nursing Home DS0000060541.V341218.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): Quality in this outcome area is adequate. Individual engagements between staff and residents were good and not simply task-related. Progress has been made in this area but the appointment of an activities leader could further improve quality of life. Staff show knowledge and commitment to the needs of people with dementia and the new Manager will promote and extend these skills. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Outcomes in this area have previously been considered poor. There was an un trained activities co-ordinator who has now left. Efforts are being made to recruit a replacement but this is proving difficult. It is important that activites are lead by a dedicated member of staff but in this setting all staff have a responsibility to provide engagement and occupation with residents as part of care provision. Large or small group activities are less effective than 1:1 activity in this setting where all residents are considered to have dementia and/or other mental health needs. Silverdale Nursing Home DS0000060541.V341218.R01.S.doc Version 5.2 Page 16 There was evidence on this visit of direct 1:1 engagement between staff and residents. This was not just related to physical care interventions but staff were seen sitting with residents during the day in the less busy times of the day and positively engaging with them. There were many observed conversations/communications initiated by staff in a natural and very positive way. This is a relatively small home accommodating 27 people. There is one large lounge/dining area with recessed areas. Five people are bedfast and the remainder spend the greater part of the day in this area. There are 5 staff on duty during the day and therefore contacts with the resident group are intense and provide many opportunities for 1:1 communications. Contacts with bedfast residents are recorded throughout the day with a maximum 30 minute contact. These residents require intense personal care which was observed to be good, all require intense staff support from when eating, this was observed to be relaxed and very positive. The communal areas have been refurbished recently providing a bright, pleasant and homely environment. There is an excellent small private garden/patio area with level access from the lounge area, residents are able to sit or wander as they wish in this pleasant area. The weekly visit by the hairdresser was seen to provide a service to 8 people during the day. In relation to pastoral care the Roman Catholic Priest visits several people and an additional priest for one resident has been arranged by the family. There is no current pastoral care for other denominations - this is being pursued by the Manager. Some residents spoke about previously attending church, choir etc and would clearly enjoy a religious service in the home or at church. Entertainers are arranged in the home on a monthly basis and enjoyed by residents. TV was restricted to selective times and unobtrusive. Bedrooms were generally well personalised reflecting individuality. Residents bedfast had soft back-ground music playing in their bedrooms, views from windows and personalisation in view. Visiting times are unrestricted. The wife of a resident seen during the inspection spoke highly of the care provided by the home, although she had some reservations at first, mainly relating to the external presentation of the home. She visits 3 times per week at varying times and other family members visit also, they have been satisfied with the service, care and staff attitudes at all times throughout the 12 month stay of their quite dependent relative. The Annual Quality Assurance Assessment (AQAA) provided by the home indicated frequent outings for residents. There was no evidence of this during Silverdale Nursing Home DS0000060541.V341218.R01.S.doc Version 5.2 Page 17 this inspection. This is an area which should be further developed. Attendance at church mentioned above is an example of need in this area. A new Monthly Newsletter was established in March and provides information to residents and relatives about changes, events and progress in the home. It also invites comments on matters that could be improved. The new Manager is arranging a relatives meeting to further promote involvement and feedback from relatives/visitors on the service provided. There was some evidence of residents making choices although chosen lifestyles were not recorded in care plans. This should be further developed with social histories as a guide to lifestyle and an aid to communication and conversation. Food provision has been reviewed and improved with greater choice - residents able to express a view confirmed this. Finger food was seen provided at breakfast and lunchtime for those residents unable to negotiate cutlery and some items of food, but chose to feed themselves without staff assistance. This was positive. Silverdale Nursing Home DS0000060541.V341218.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): Quality in this outcome area is good. The complaints procedures have been amended as required. Efforts are being made to solicit the views of relatives as a means of improving service. Improvements have been made in these outcomes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A requirement to amend the complaints procedure made at the last key inspection had not been complied with at the random inspection in March 2007 and was therefore repeated. This has now been done and a complaints procedure is posted in the home for residents/visitors. The home are reminded that a copy should be included in the revised Service Users Guide. Attention to the complaints procedure is also noted in the recent Newsletter and inviting relatives to make complaints/suggestions for improvement. There have been no complaints to the home or to the Commission during the past year. A system for recording complaints is provided. A meeting with relatives is being arranged at this time and the views of relatives will be sought to provide feedback about the service. Silverdale Nursing Home DS0000060541.V341218.R01.S.doc Version 5.2 Page 19 The provider intends to continue staff training and awareness in POVA (Protection of Vulnerable Adults). This will be monitored. Silverdale Nursing Home DS0000060541.V341218.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): Quality in this outcome area is adequate. Previous requirements and action plan agreed with the provider to improve the environment, internally and externally have been completed, resulting in a vast improvement to the environment. Further improvements need to be made to continue this progress. An additional assisted bathing facility is vital. Adaptations to meet residents needs and action to improve infection control practices in the laundry area are also required. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been vast improvements to the internal environment over the past year. Virtually the whole of the communal and bedroom areas have been refurbished including redecoration, re-carpeting and new furniture. The result is a bright, pleasing, comfortable environment. All bedrooms have been Silverdale Nursing Home DS0000060541.V341218.R01.S.doc Version 5.2 Page 21 recarpeted and new furniture provided. Bedrooms are generally well personalised reflecting individuality. The only detraction from the good appearance of bedrooms was metal bed-frames exposed with painted identification numbers on them. This would be vastly improved with provision of valances for all beds – the beds are robust and satisfactory their appearance could be improved. Efforts have been made following previous requirements to provide suitable adaptation to meet the needs of this resident group. Identification of communal areas and bedrooms should be clear for people with dementia. – The doors to the toilet areas have been labelled and colour painted for easier identification – there are male and female toilets. The Manager reported that photographs of residents on bedroom doors had proved unsuccessful as one resident removes them. This should be further pursued with suitable alternatives. The small private garden/patio area which has been created is impressive, providing a green pleasant area, easily accessed from the lounge area and where residents can sit comfortably or wander as they wish. There are 4 bathrooms in the home but only one suitably adapted to cater for the needs of this resident group. Two previous requirements have been made to provide an additional assisted bathing facility – residents have reportedly had to wait for baths and the location of only one assisted facility is not adequate. Two previous timescales have not been met and the recent timescale of 15/06/07 will also not be met. This was discussed with the provider who has made application through the providers association for grant aid to provide an assisted shower facility. It is the providers view that this has been approved but this has not been confirmed in writing to the provider who will check the progress and inform CSCI immediately and in writing on the progress of the grant. A further requirement is made to cover this interim period. An assisted shower facility would greatly improve bathing options for this resident group. In the past year a new hoist and stand-aid have been provided and cater adequately for the moving & handling needs of the current resident group. The external condition of this former commercial building has been greatly improved with double-glazed units and cladding of the building but parts are still incomplete and remain unsatisfactory and detrimental to the external appearance. This work has not been completed because the provider has commissioned plans for an extension to the building which are on display in the home but yet to be submitted for approval to the Local Authority – if approved this work would be considerable and completed in an approximate 2-4 year time span. It is suggested that cosmetic superficial work be considered to improve the external appearance. Silverdale Nursing Home DS0000060541.V341218.R01.S.doc Version 5.2 Page 22 Safe handling and movement of infected laundry has been of concern in previous inspections. On this visit the red bag system (degradable) for moving incontinent laundry were seen to be open in the laundry area with a strong mal-odour. These bags must be tied when filled – the main purpose being to isolate the contents from other laundry and areas of potential infection. Silverdale Nursing Home DS0000060541.V341218.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Staff recruitment procedures have been improved and adequately protect residents. Staffing numbers have increased, some additional catering hours would assist greatly at breakfast-time. Staff training has been improved also and included external training opportunities. Observations indicate a competent, adequately trained staff group. NVQ training should be further developed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care staffing level was increased following a requirement of the Key Inspection in December 2006 and has been maintained. There are now 4 care staff on duty (including nurse) on the morning shift and 3 in the afternoon – Plus an additional carer who works 9 – 4 each day. Additionally catering staff operate from 9.45 –2.0 pm and 4.30 – 6.00 pm. There is a domestic/handyperson 10 – 6 and Laundry assistant 9 – 2 each day. A total of 532 care staffing hours per week are provided. Silverdale Nursing Home DS0000060541.V341218.R01.S.doc Version 5.2 Page 24 During the early part of the inspection 8.30 – 10 a.m. which is clearly a busy time it was noted that staff were providing a high level of personal care, getting people up, washed dressed ready for breakfast and into the dining room/lounge. Others given personal care who were bedfast. Additionally care staff were going into the kitchen to prepare breakfast which put pressure upon the routines and staff were unable to see and supervise residents whilst in the kitchen. It is strongly recommended that a catering service to provide breakfast for residents is provided during this early period to support care staff providing considerable personal support to residents at this peak time. Occupancy levels in this home have improved recently and been to full occupancy for several months, this reflects the changes which have been made. . The additional catering hours would allow care staff the necessary time to provide the required personal care. A number of overseas staff are employed and a requirement to provide copy of a work permit for one was made at the last key inspection and faxed as required to CSCI. On this visit 3 staff files were inspected and all documents required under Schedule 2 in relation to the employment of those staff had been obtained and were present. This included POVA/CRB checks, references, proof of identity, work permits etc. Overseas staff seen and spoken with had good English skills and communication with residents. All staff seen were spoken with and observed during the inspection in their communication with and care of residents. There were high levels of engagement throughout the inspection day and the impression was of a committed staff group, with required skills providing a good service to people with dementia needs. A recently appointed member of staff without previous care experience was interviewed. She had deliberately switched from an office-based job to her preferred option in care. In post for 2 months she had completed a large part of the indication programme and was able to give a competent and detailed account of the care needs of identified residents and had undertaken an external dementia training course, completed moving & handling and fire training etc. Her induction was continuing and was well documented and advanced. A PCT Matron has recently completed a wound care training course at the home for staff and a wound care presentation arranged from Convatec (commercial). Twelve people have recently completed Moving & Handling training. A course on Challenging Behaviours has been arranged for 8 staff in late June 2007. First Aid training/updates were completed in February. Most care staff have also completed Food Hygiene Training. A staff training matrix is required and will be compiled by the Manager. Silverdale Nursing Home DS0000060541.V341218.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): Quality in this outcome area is adequate. A new Registered Manager has been recently approved by CSCI and making a positive contribution to the home. The management of the home has been strengthened and improved. This provides a positive basis for further improvements including a quality auditing process. The health, safety and welfare of residents and staff are promoted and protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Silverdale Nursing Home DS0000060541.V341218.R01.S.doc Version 5.2 Page 26 There has been an improvement in the management of this home. There has been no registered manager for over 12 months with 2/3 temporary appointments made by the provider but not submitted for approval by CSCI. A requirement to complete application for a Registered Manager made at the last two inspections has been actioned. A further Acting Manager was appointed in February. She was approved as the Registered Manager by CSCI in May 2007. The Manager is a Registered Nurse (RMN) and has the required experience to run the home. She also needs to complete the Registered Managers Award that she undertook on her approval to complete. She has provisionally registered with the local College to commence this course in September 2007. New nursing and care staff have recently been appointed. Two were seen during this inspection. Both impressed with their knowledge, commitment and skills in providing a service to people with dementia and mental health needs. There appeared an open and positive dialogue between staff at all levels. The Provider has a virtual daily presence in the home. He was not seen on this visit but was spoken to at length by phone following the inspection. The Registered Manager confirms that she has a positive working relationship with the provider and has the necessary authority and flexibility to run he home. A requirement to provide an effective Quality Assurance programme has not been met. There have been changes of manager as stated and the current Registered Manager has concentrated upon meeting the requirements of the last two inspections with some success. Some efforts have been made in preparing questionnaires to go out to relatives/stakeholders and a meeting with relatives is currently planned. Records relating to residents finances were not inspected on this visit. Silverdale Nursing Home DS0000060541.V341218.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 3 3 2 3 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 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 1 3 2 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x x x 3 3 Silverdale Nursing Home DS0000060541.V341218.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(2) Requirement Continue the review and update of all care plans involving residents/relatives where possible Establish care plan to address challenging behaviours, including record of chronological interventions and treatments. Confirm in writing to new residents that following assessment the home can meet needs. – Previous timescale not met. Protocols for PRN medication must be obtained from prescribers and records kept of date, reason for administration and outcomes. A further assisted bathing facility must be provided. Confirm in writing to CSCI immediately progress of negotiations for installation. –Previous timescale not met. Arrangements for processing infected laundry must be tightened to avoid crossinfection/odours. Catering facilities must be DS0000060541.V341218.R01.S.doc Timescale for action 31/08/07 2. OP7 12(1) 30/06/07 3. OP4 14(1)(d) 31/05/07 4. OP9 13(2) 30/06/07 5. OP21 23(2)(j) 31/08/07 6. OP26 13(3) 31/05/07 7. OP27 18(1)(a) 30/06/07 Page 29 Silverdale Nursing Home Version 5.2 available to support care staff at breakfast-time. 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 OP7 OP24 Good Practice Recommendations Fluid intake charts should be totalled daily and monitored by nursing staff. Provision of bed valances would greatly improve presentation of bedrooms. Silverdale Nursing Home DS0000060541.V341218.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Stafford Local 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.V341218.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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