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Inspection on 14/08/07 for Snaith Hall Nursing And Residential Home

Also see our care home review for Snaith Hall Nursing And Residential Home for more information

This inspection was carried out on 14th August 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

The new Flower wing has been added to the home. It provides twelve large single bedrooms with en-suite facilities that include walk in showers. It is connected to the main Hall by a covered walkway. The central gardens and terraced areas are now fully enclosed by buildings and walkways. This means that they are now a safe area for people of all abilities to be able to walk around outside and enjoy the views and fresh air.

What the care home could do better:

The home continues to provide a good service to people living in the home. From information provided in the AQAA it is clear there are systems in place to continue and improve. During the inspection some areas where changes should be made were identified, and recommendations of good practice have been made which can be found at the end of this report. These include: Making sure that the care plans have additional information about an individuals abilities, preferences and needs so that they are person centred and provide staff with clear guidance about that particular person. Changing the systems used for ordering prescriptions to make sure they are seen in the home before being sent to the chemist to make sure that the correct medications and amounts have been prescribed.

CARE HOMES FOR OLDER PEOPLE Snaith Hall Nursing And Residential Home Pontefract Road Snaith Goole East Yorkshire DN14 9JR Lead Inspector Nadia Jejna Key Unannounced Inspection 14th August 2007 10:15 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 Snaith Hall Nursing And Residential Home DS0000000953.V349351.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. Snaith Hall Nursing And Residential Home DS0000000953.V349351.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Snaith Hall Nursing And Residential Home Address Pontefract Road Snaith Goole East Yorkshire DN14 9JR 01405 862191 01405 869817 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) www.snaithhallcarehome.co.uk James Patrick McEnroe Mrs Adrienne Elizabeth McEnroe Simon James McEnroe Care Home 47 Category(ies) of Dementia (47), Old age, not falling within any registration, with number other category (47), Physical disability (47) of places Snaith Hall Nursing And Residential Home DS0000000953.V349351.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Physical disability - Code PD The maximum number of service users who can be accommodated is: 47 Registration includes 5 day places 2. 3. Date of last inspection 29th August 2006 Brief Description of the Service: Snaith Hall is a Regency historical grade two listed building in the village of Snaith, near Goole in East Yorkshire. It is close to the village shops and amenities. It is registered as a care home with nursing for up to 47 people. Over time extensions have been added to the hall that are in keeping with its age and character. The home is in three parts; up to twelve people are accommodated within the Hall, the Garden Wing accommodates twenty-four people and the Flower Wing twelve. Thirty-seven of the bedrooms have en suite facilities and eighteen of these include showers. The Hall and the Garden Wing both have passenger lifts provided to first floor rooms. Other areas of the home have had ramps and grab rails installed to make sure people can access all areas. There are two lounges, two quiet areas and two dining rooms in the and a large conservatory adjoining the Hall. Covered walkways join the Hall to the Garden and Flower Wings. A well-maintained and attractively planed large, private, enclosed garden is available for people to enjoy. Information about services provided by the home is available in the Statement of Purpose and Service User Guide. Copies are available in the home and can be posted out on request. The weekly fees for services provided at the time of the visit range from £334.80 to £533.00. Snaith Hall Nursing And Residential Home DS0000000953.V349351.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit was made on 14 August 2007 and lasted eight hours. The home did not know that this was going to happen. The purpose of this visit was to make sure that the home was being managed for the benefit and well being of the residents. During the visit residents, their visitors and staff were spoken to. Other records in the home were looked at such as staff files, complaints and accidents records. Before the visit was planned the provider was asked to carry out a quality assessment of the service stating what they did well, what was in place to prove this, what improvements had been made over the last twelve months and what was planned for the year ahead. This document is called the Annual Quality Assurance Assessment and will be referred to in the report as the AQAA. Other information asked for included what policies and procedures are in place, when they were last reviewed and when maintenance and safety checks were carried out. Questionnaires were sent to people living in the home, their relatives and healthcare professionals before the visit took place. These people were selected using information provided in the AQAA. When the visit took place surveys had been returned by four people who live in the home, four relatives/visitors, one care manager and three healthcare professionals. The information from these was used to inform the visit and is referred to throughout the report. What the service does well: Care is provided to people in a clean, tidy and well-maintained home. There are very pleasant, safe outdoor and garden areas for people to use and enjoy as the weather permits. Bedrooms and communal lounges and dining rooms have been nicely furnished and decorated providing comfortable places for people spend their rime in. People can bring in their own belongings to personalise their rooms and make them ‘theirs’ and more homely. The atmosphere in the home is warm and welcoming and visitors said they could call at any time. One comment was that staff would always take the time to offer them a drink, which was very welcome. Information from people living in the home, their relatives and visitors and health care professionals who visit the home said that: • They had been given enough information about the home and the services it provided and any questions asked were answered. Snaith Hall Nursing And Residential Home DS0000000953.V349351.R01.S.doc Version 5.2 Page 6 • • • • • They were satisfied with the services provided and felt that their or their relatives’ needs were being met. The services provided were ‘efficient yet homely and make each resident seem special, not just one of many.’ Staff promoted and respected people’s privacy and dignity. The meals are good and people are given choices. The wishes of people are considered and followed, for example they can stay in their rooms if they want to. The home is a family run business and it has got a stable staff team. Many have been there since it opened over fifteen years ago. It was clear that there are good relationships between the provider, management team, staff, people living in the home and their visitors. From talking to staff it was evident that they treated people as individuals and had a good understanding of peoples needs and what needed to be done to meet them. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Snaith Hall Nursing And Residential Home DS0000000953.V349351.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Snaith Hall Nursing And Residential Home DS0000000953.V349351.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have enough information to decide whether or not the home will be suitable to meet their needs. The home will get information about an individuals needs to be sure it can meet them. EVIDENCE: Copies of the homes Statement of Purpose and Service User Guide were displayed on a table in the entrance hall. In the AQAA the manager said that these documents have been revised since the extension was added to the home to show what changes had been made and comments from people living in the home would be added to it. Information from surveys sent out to people living in the home and their relatives said that: • They had been given enough information about the home and the services it provided and any questions asked were answered. • Contracts for services provided were in place. Snaith Hall Nursing And Residential Home DS0000000953.V349351.R01.S.doc Version 5.2 Page 9 • • They were satisfied with the services provided and felt that their or their relatives needs were being met. The services provided were ‘efficient yet homely and make each resident seem special, not just one of many.’ The care plan for somebody recently admitted to the home for a short period of time was looked at. It showed that a copy of the local authority assessment of needs had been obtained. This information was used to make sure the home would be able to meet the person’s needs before agreeing to their admission. Information from health and social care professionals said that assessments of peoples needs carried out by the home were ‘accurate and helped to make sure the right service was planned and given to people.’ Snaith Hall Nursing And Residential Home DS0000000953.V349351.R01.S.doc Version 5.2 Page 10 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): 7, 8, 9 and 10. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal, health and social care needs are met and they are treated with respect. EVIDENCE: It was very clear from talking to staff and observations made during the visit that staff had a good understanding of peoples needs. Care staff clearly described what they did to help different people and it was evident they treated them as individuals. Three care plans were looked at. Guidance was seen for peoples identified and assessed needs. But the information was general and not individual to each person. The documents seen were pre printed and staff add names and additional details or cross out sections that do not apply. The plans were evaluated at regular intervals. Any changes were usually detailed in this section rather than them prompting a full review and change of the plan. This was discussed during feedback and examples were given, such as: • There was a plan for reduced mobility due to the person’s condition but no information about what the condition was. The moving and handling Snaith Hall Nursing And Residential Home DS0000000953.V349351.R01.S.doc Version 5.2 Page 11 • • assessment was blank. The original plan had been written some ago and from talking to the person it was clear their abilities and needs had changed. They were now immobile and needed help to transfer from bed to chair, chair-to-chair etc. Advice was given about making sure that the moving and handling assessments are completed and updated as peoples needs and abilities change. Care plans about eating and drinking did not always provide information about people’s dietary likes, dislikes and preferences. Plans about personal care did not say what an individuals abilities were regarding personal hygiene, what help and support they needed and how they preferred it to be given. The manager and his deputy said that they would review the way the information is presented in the plans. Risk assessments around nutrition, falling, the risk of developing pressure sores, moving and handling were seen. Appropriate actions are taken and advice is sought if people are identified as being at risk. For example: • Where people are identified as at risk of developing pressure sores appropriate action is taken to minimise the risk and obtain specialist pressure relieving equipment. • The manager said that if people are at risk of falling action will be taken to reduce the risk and he would out if there is a specialist falls prevention team to contact for support and advice. If people have specialist healthcare needs but are ‘residential clients’ the district nursing teams are involved with meeting their needs. The district nurses records are usually kept alongside the main care plan for the person. Most people living in the home who are on regular medication are helped by nurses and care staff. The qualified nurses will look after medications for the ‘nursing residents’ and senior care staff can give medications to ‘residential residents’. The senior care staff have received certificated training around the administration of medications. The qualified nurses have not had any formal/certificated training or updates around dealing with medications; they update themselves using professional magazines and the internet. One was not aware of the Royal Pharmaceutical Guidelines for the administration of medications in care homes but the manager said that a copy was kept in the home. The policies and procedures around dealing with medications should be reviewed because repeat prescriptions are not dealt with in the manner recommended in the guidelines. At the time of the visit repeat prescriptions are sent from the GP to the chemist and are not checked and signed in the home. Information from people living in the home and their relatives said that: • Support and care is given as agreed. • They were usually kept up to date with changes. Snaith Hall Nursing And Residential Home DS0000000953.V349351.R01.S.doc Version 5.2 Page 12 • • Staff were ‘responsive to my relatives needs’ and ‘they take into consideration the individual needs of people in their care. The staff are fantastic.’ Staff promoted and respected privacy and dignity. Information from health and social care professionals said that: • Staff sought advice from other healthcare professionals as needed, included it in the care plans and acted upon it. Examples given included contacted community psychiatric nurses and specialist diabetic nurse. • People living in the home were treated as individuals and their privacy and dignity was respected. Snaith Hall Nursing And Residential Home DS0000000953.V349351.R01.S.doc Version 5.2 Page 13 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): 12, 13, 14 and 15. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can exercise choice and control over their lives and maintain contact with family, friends and the local community. EVIDENCE: The atmosphere in the home was warm, friendly and welcoming. Some visitors who arrived at the same time as the visit started said that they were always made welcome by the staff and could call in at any time. Information from surveys returned by relatives and health and social care professionals said that: • ‘They make us feel part of the family and even when they are busy take the time to offer visitors a drink, which is very welcome.’ • The meals are good and people are given choices. • The wishes of people are considered and followed, for example they can stay in their rooms if they want to. Staff said that people choose when to get up, go to bed, where to spend their time and where to eat their meals. Some like to sit in the lounges and communal areas most of the day and others prefer to spend more time in their Snaith Hall Nursing And Residential Home DS0000000953.V349351.R01.S.doc Version 5.2 Page 14 own rooms. People spoken to confirmed this and said that staff were very helpful and supportive. People are helped to stay in contact with their family and friends and some go out regularly. The home has minibus with a tail lift that is used to transport people of all abilities on trips out, to their friends/relatives houses, shopping, hospital appointments etc. A formal plan of social activities was not seen. But from talking to staff and people living in the home there are regular activity and entertainment sessions. For example on the afternoon of the visit a volunteer led an activity session in the Garden extension lounge. This takes place every Tuesday and all people are welcome to join in. The volunteer was knowledgeable about the peoples preferences and abilities and made sure that all were included if they wanted to be and that sessions varied each week. The different activities provided included craft sessions, scrabble, dominoes, quizzes and talking about the past. The session that afternoon was enjoyed by all. The lounge was decorated with pictures produced by people during past sessions and provided a talking point as well as being nice to look at. Other regular activities include a weekly ‘chair aerobics’ session, watching videos or DVD’s, a volunteer who comes to the Hall Thursday afternoons and brings in entertainers. The manager said plans are in place for more regular sessions to be provided when an activities coordinator starts in a few weeks time. A four weekly menu cycle is being followed. People living in the home are consulted about their dietary preferences individually and at ‘residents meetings’. People are asked in the morning what choices they would like to make for their lunchtime meal and alternatives are offered if they do not like or want what is on the menu. Lunch in the Hall was observed. Meals were served from the kitchen and it was clear the staff knew which people liked smaller or larger portions and that one person preferred their own jug of gravy. People who needed help to eat were given it discreetly on a one to one basis. Aids to promote independence when eating where used, such as plates with raised sides, adapted cutlery and cups. People who have poor appetites or at risk of losing weight are referred to the GP and nutritional supplements are used such as fortified milk drinks. Discussions about different methods of enriching meals for older were talked about and some of the techniques are being used already in the home, for example adding butter to mashed potatoes and cooked vegetables. Snaith Hall Nursing And Residential Home DS0000000953.V349351.R01.S.doc Version 5.2 Page 15 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): 16 and 18. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People feel safe living in the home and know who to talk to if the have any concerns. EVIDENCE: The home has a complaints policy and procedure in place. Information from surveys returned by people living in the home and their relatives said that they were aware of the complaints procedure and who to talk to if they had a concern. They said that the staff were responsive and would deal with things as soon as they had been mentioned. A healthcare professionals survey said that the staff helped people to feel ‘at home and safe’. The manager said that records of complaints/concerns received and any taken would be kept. Information from the AQAA said that no complaints had been received in the last twelve months. Just before the visit took place the provider had received a letter of concern about staffing levels and this was being responded to. There had been occasions when the home was short staffed due to sickness and absences but this had been resolved and the numbers of staff on duty were being maintained. The AQAA states that policies and procedures are in place around adult protection and abuse. The manager said they been updated in line with the local authority policy. Not all staff spoken had received training in this area but Snaith Hall Nursing And Residential Home DS0000000953.V349351.R01.S.doc Version 5.2 Page 16 were very clear that they would not hesitate to report suspected or actual abuse to the manager or the provider. They were aware that they can report concerns directly to the CSCI and social services. The manager said that dates for this training have been planned to take place in October and November for all staff needing it. Snaith Hall Nursing And Residential Home DS0000000953.V349351.R01.S.doc Version 5.2 Page 17 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): 19, 20, 21, 22, 24 and 26. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, tidy and well-maintained home that is suitable for their needs. EVIDENCE: The home is in three parts; up to twelve people are accommodated within the Hall, the Garden Wing accommodates twenty-four people and the new Flower Wing twelve. The Flower wing has been added to the home since the last inspection in August 2006. Thirty-seven of the bedrooms have en suite facilities and eighteen of these include showers with wall mounted shower seats. There are five communal bathrooms; three of these can be used with or without a mobile hoist, and five communal toilets. The Hall and the Garden Wing both have passenger lifts provided to first floor rooms. Other areas of the home have had ramps and grab rails installed to make sure people can access all areas. There are two lounges, two quiet areas and two dining rooms in the and a large conservatory adjoining the Hall. Covered walkways join the Snaith Hall Nursing And Residential Home DS0000000953.V349351.R01.S.doc Version 5.2 Page 18 Hall to the Garden and Flower Wings. A well-maintained and attractively planed large, private, enclosed garden is available for people to enjoy. A tour of the home showed that it was clean, tidy and well maintained. The communal areas were nicely decorated and furnished, providing comfortable places for people to sit. The provider and manager said that plans are in place to provide en suite facilities for four more bedrooms and to continue with a programme of redecoration and replacement of worn carpets. Some people were happy for their rooms to be seen. The rooms were well maintained, nicely decorated and provided with comfortable furnishings. It was clear that people could bring in their smaller pieces of furniture and other belongings to personalise the rooms and make them ‘theirs’ and more homely. Well equipped sluice rooms have been provided in each wing and help to promote good infection control practices. The domestic staff were wearing rubber gloves to carry out their duties. This was discussed with the manager as the prevention of cross infection would be better promoted if disposable gloves were used. The laundry in the garden wing was seen. It was well organised and suitably equipped for its purpose. Linen and clothing seen appeared well laundered. Snaith Hall Nursing And Residential Home DS0000000953.V349351.R01.S.doc Version 5.2 Page 19 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): 27, 28, 29 and 30. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff on duty to meet peoples needs. The changes being made to the staff training programme will make sure that they are all suitably qualified and competent to meet peoples needs. EVIDENCE: The home employs a stable staff team who are enthusiastic about their jobs. Some have been at the home since it opened over fifteen years ago. This is good for people living in the home because it helps to maintain consistency and continuity of care as well good relationships. Because the home is registered to provide care with nursing a qualified nurse is on duty at all times. However in order to utilise and extend the skills of care staff some have done NVQ level 3 and medication training. This means that can deal with medications for ‘residential’ people and help with evaluating and updating their care plans. They can also take ‘charge’ of either the Hall or the Garden wing under the supervision on the nurse in charge. Staffing rotas show that each day there are two qualified nurses on duty until from 8am till 1 or 4pm and then one nurse and one senior carer. In addition there are eight carers from 8am to 4pm and then three. The provider and the manager said that they were actively recruiting new staff as there had been some problems covering shifts due to long-term sickness and absences. When the home had sufficient notice of absences shifts would be covered by their own staff, agency staff have not been used. When all staff on the rota work as allocated there Snaith Hall Nursing And Residential Home DS0000000953.V349351.R01.S.doc Version 5.2 Page 20 are sufficient staff to meet the needs of people living in the home. The manager is aware that there must be enough staff on duty at all times to meet the numbers and needs of people in the home. Information from surveys returned, people and staff spoken to said that: • Staff were usually available when they were needed. • ‘The staff are fantastic and responsive to my relatives needs.’ • Staff usually have the skills and experience needed to meet peoples needs. Two recruitment files were looked at, one being for the most recent employee. The newest care worker was working in the home under the supervision of a more experienced carer. Their file showed that two satisfactory written references had been obtained. But there was no POVA first or CRB disclosure. These had been requested but were taking a long time to be returned. The provider said he had chased them and would do so again. He said four more potential staff had been interviewed and were waiting for their pre employment checks to be returned. The other file looked at showed that all required pre employment checks had been carried out before the person started to work in the home, including health check questionnaires, proof of identity along with proof that the person can work in the United Kingdom if applicable. The manager checks registration with the Nursing and Midwifery Council for all nurses and said that this will now be done every year. The application forms used do not ask for a full employment history. The provider said that they would look at this and make sure that any gaps in employment and the reasons for them would be recorded. Information from the AQAA said that from twenty-five care staff, seventeen have achieved NVQ level 2 or higher. From talking to staff it was clear that various training courses and opportunities have been made available to them. Some staff have attended dementia awareness courses, this should be provided to all staff as many people in the home have some from of dementia. Other courses attended have included mentoring training to work with nurses doing adaptation training to work in the United Kingdom, end of life care and fire safety. But some staff had not received training about health and safety, infection control or first aid. The manager said that an induction training programme is being used and he would make sure it was to Skills for Care common induction standards. He is updating individual training records to identify who needs what. He said that the training programme is being updated to make sure that staff receive all the training needed to help them do their jobs well. Snaith Hall Nursing And Residential Home DS0000000953.V349351.R01.S.doc Version 5.2 Page 21 One of the nurses has received training in order to provide moving and handling training and updates to staff. She is in the process of making sure all staff are updated. Snaith Hall Nursing And Residential Home DS0000000953.V349351.R01.S.doc Version 5.2 Page 22 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): 31, 33, 35 and 38. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run and managed in the best interests of people living there. EVIDENCE: The home has been owned and managed by the provider and family since it was first registered over fifteen years ago. The manager is a registered general nurse and is hoping to complete a management qualification equivalent to NVQ level 4 by the end of November 2007. The home is family orientated and the provider is very ‘hands on’, visiting the home most days. There are good relationships between the provider, management team, staff, people living in the home and their visitors. Staff and people said that they could approach them at any time for advice and support. Snaith Hall Nursing And Residential Home DS0000000953.V349351.R01.S.doc Version 5.2 Page 23 The home has got the Investors In People quality assurance award. They are due to be reassessed next year to see if they have maintained the standards needed for it. In the AQAA the manager said that they regularly analyse the quality of services provided. The information is used to put together plans for making changes and improvements that will be included in the annual development plan. The most recent survey of people’s views about the home was carried out in March 2007. Questionnaires were sent to people living in the home, their relatives and visitors as well visiting healthcare professionals such as doctors and district nurses. The responses from questionnaires returned was analysed and the summary was made available to people. A copy of the summary was seen which showed that people were satisfied with the services provided by the home. The home acts as agent for one person living in the home. Records kept for this person would benefit from additional information about the amount of benefits received, how much was paid to the home in fees and then the amount left over for personal use. The home will hold money in safekeeping for people if asked to. Records are kept of all transactions made and receipts are kept wherever possible. When money is returned to the person or their relatives they sign the records to acknowledge this. Accident records are kept. Discussions were had about additional information that would be useful when auditing and analysing accidents, for example the time the person was last seen before the accident and by whom. The manager said that fire alarm system checks are carried out every week and records are kept. The risk assessments used when identifying if a person needs bedrails need to be revised to show: • That the person and or their relatives have been involved with making the decision. • Who will be responsible for checking that the bedrails are well maintained, correctly fitted and in good working order. Information in the AQAA said that maintenance and safety checks of equipment and installations are carried out as required. The manager said the home had been visited by the Health and Safety Executive representative in January 2007 and there had been no concerns raised. Snaith Hall Nursing And Residential Home DS0000000953.V349351.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 4 4 3 X 4 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 Snaith Hall Nursing And Residential Home DS0000000953.V349351.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations The manager should look at making the information and guidance provided to staff in the care plans more individual and detailed. This will evidence what staff are already doing when providing person centred care to people living in the home. In order to make sure that safe systems are used when ordering peoples medications the manager should look at reviewing policies and procedures in line with the Royal Pharmaceutical Guidelines for the administration of medications in care homes. All staff involved with people’s medications should receive appropriate, certificated training, including the qualified nurses. 3. OP29 In order to make sure safe, robust recruitment procedures are in place and followed the manager should make sure DS0000000953.V349351.R01.S.doc Version 5.2 Page 26 2. OP9 Snaith Hall Nursing And Residential Home that: The application from asks for a full employment history and the reasons for any gaps in employment. Satisfactory POVA checks are in place as well as two written references before bringing new staff in to work under supervision. 4. OP30 In order to make sure that staff are qualified and competent to carry out their roles the manager should make sure that the revised training plans are put in place. These should include systems for tracking who has done what training and when updates or refreshers are due. The training programme should make sure that all staff receive training to help them maintain the health, safety and well being of themselves and people living in the home as well as the specialist health care needs of people. The manager should forward evidence to support that he has satisfactorily completed a management qualification to the CSCI when it is available. In order to protect the finances of people living in the home records kept when the provider acts as agency for somebody should include full details of how much benefit was paid to them, how much of it went to pay fees and then what was left over for personal use. In order to protect people when a need for using bedrails is identified the risk assessments and care plans used should show: The person and or their relatives/representatives have been involved in making the decision. How often the bedrails will be checked to make sure they are in good working order and correctly fitted, who will do the checks and where the outcome of any checks will be recorded. 5. OP31 6. OP35 7. OP38 Snaith Hall Nursing And Residential Home DS0000000953.V349351.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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. 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