Inspection on 14/07/05 for Snaith Hall Nursing And Residential Home

This inspection was carried out on 14th July 2005.

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

Snaith Hall Nursing And... 14/08/07

Snaith Hall Nursing And... 29/08/06

Snaith Hall Nursing And... 07/02/06

Snaith Hall Nursing And... 12/10/04

Snaith Hall Nursing And... 07/05/04

Snaith Hall Nursing And... 04/03/04

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

CARE HOMES FOR OLDER PEOPLE Snaith Hall Nursing and Residential Home Pontefract Road Snaith Goole DN14 9JR Lead Inspector Anne Prankitt Unannounced 14 July 2005 10:30 th 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 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 J53-J04 S953 Snaith Hall V231721 220605 Stage 4.doc Version 1.30 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 snaithhall@lineone.net Mr James Patrick McEnroe Mrs Adrienne Elizabeth McEnroe Mr James Patrick McEnroe Care home with nursing 36 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Category(ies) of OP Old age (36) registration, with number TI Terminally ill (36) of places DE (E) Dementia - over 65 (36) DE Dementia (36) PD Physical disability (36) PD (E) Physical disability - over 65 (36) Snaith Hall Nursing and Residential Home J53-J04 S953 Snaith Hall V231721 220605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 12th October 2004 Brief Description of the Service: Snaith Hall is a care home providing personal care, care with nursing and accommodation for up to 36 service users. The category of registration also permits the home to care for older people who suffer from dementia, who have a physical disability, or who are terminally ill. The home is owned by Mr and Mrs McEnroe, and is situated in a central position in Snaith. Up to 12 service users receive care within ‘The Hall’, which is a Grade II listed building. The ‘Garden Wing’ can accommodate a further 24 service users. There is a large conservatory adjoining ‘The Hall’, and a covered walkway joins ‘The Hall’ to the ‘Garden Wing’. A large well maintained garden is available for service users to enjoy. Snaith Hall Nursing and Residential Home J53-J04 S953 Snaith Hall V231721 220605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over six and a half hours, and was undertaken by two inspectors, Mrs Irene Ward and Mrs Anne Prankitt, with a previous four hours preparation having taken place prior to the inspection. Registered provider and manager of the home, Mr McEnroe, was available throughout, including the feedback session at the close of the inspection. A tour of the communal areas was undertaken, and a random sample of bedrooms inspected. Some staff and visitors were spoken with. Time was spent talking with service users, and also observing the general activity in the home. Some records were inspected, including care plans of specific service users identified at the time of the inspection. What the service does well: The home has produced good written information for people who are interested in learning more about Snaith Hall, and what care it can provide, which can be read before making a decision about moving in. Each person who lives at Snaith Hall has a care plan which explains to staff about the care they need to provide. Staff liaise closely with other professionals where they need additional help in meeting the needs of the people. There is a core group of long standing staff who work well as a team, and who are led by a family run management team who are actively involved in the home. The home provides sufficient staff to assist in ensuring that care is provided in an unhurried manner. The environment is clean and pleasant, and there is a beautiful safe and secure garden that residents are able to sit in and enjoy. Staff who work at the home have training to help them in meeting the needs of people who live there. This includes fire safety training. Snaith Hall Nursing and Residential Home J53-J04 S953 Snaith Hall V231721 220605 Stage 4.doc Version 1.30 Page 6 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. Snaith Hall Nursing and Residential Home J53-J04 S953 Snaith Hall V231721 220605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Snaith Hall Nursing and Residential Home J53-J04 S953 Snaith Hall V231721 220605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 Sufficient information is provided within the Statement of Purpose in order that prospective service users or other interested parties can understand the services that the home provides. EVIDENCE: The Statement of Purpose has been expanded upon to provide additional information about the facilities available for service users admitted with dementia needs. Snaith Hall Nursing and Residential Home J53-J04 S953 Snaith Hall V231721 220605 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and 10 The care needs of service users are understood by staff, and advice is sought from the multi disciplinary team in order to assist them. The practice in The Hall with regard to the administration of medication did not meet with professional guidelines, and could potentially place service users at unnecessary risk. The manager acts promptly when service users’ right to respect and dignity is in question. EVIDENCE: The care plans generally contained good information from which staff are able to deliver care. The plans and associated risk assessments are reviewed on a monthly basis, and include reference to holistic needs. Staff spoken to understood these needs, and visual observations made on the day concluded that staff treat service users with dignity and respect whilst providing care. The records evidenced that appropriate health professionals are referred to where advice is required. Snaith Hall Nursing and Residential Home J53-J04 S953 Snaith Hall V231721 220605 Stage 4.doc Version 1.30 Page 10 Discussion took place with regard to those care plans seen about the following matters: • Matters of historical concern relating to the challenging and aggressive behaviour of a service user were well documented in the daily records, and details were included which confirmed that advice had been appropriately sought from the consultant. However, the matters had not been reported to the Commission under Regulation 37 of the Care Homes Regulations 2001. The staff member spoken with was clear as to possible triggers which could escalate the behaviour, which they felt could still be a risk, and staff interaction with the service user was good. However, the recognised triggers, which would be very useful information for alerting staff who provide direct care, had not been included within the care plan. Whilst service users’ files contain a care plan for eating and drinking, it was confirmed that a record is not kept of any formal nutritional assessment carried out on admission. • With regard to the delivery of care, comments included that staff ‘look after us very well’, that the staff are ‘marvellous’. Relative comments included that ‘care is very good’, and that ‘staff are very caring’. Two service users raised a specific issue about their care, and in respect of one specific member of staff. This is referred to in the ‘Complaints and Protection’ section of this report. The manager was already aware of, and was dealing with, one of the issues raised. He took both matters very seriously, and intends to look into these further, and take the action appropriate following his investigation. Trained staff specialise in specific areas of care, such as palliative care, multiple sclerosis and dementia. The home has a good system in place whereby medication received and returned to pharmacy is documented. In addition to this, the ‘Nurse Consultant’ comes to the home on a regular basis to review the medication. The Medication Administration Records were clearly written. Service users who wish to self medicate may do so following an assessment of risk, and lockable facilities are provided for the safe storage of drugs. The Hall and The Garden Wing each have a separate medication trolley. An inspection of the systems was carried out in each area. The following matters were raised with the registered manager: The Hall The senior carer on duty explained that they were permitted to administer medication for service users who had been admitted for ‘residential care’. She stated that she was supervised by a trained member of staff during this process, and that she was not responsible for the administration of medication Snaith Hall Nursing and Residential Home J53-J04 S953 Snaith Hall V231721 220605 Stage 4.doc Version 1.30 Page 11 for service users who have been admitted for nursing care. She stated that she was about to embark on medication training in order to further update her skills. On the inspection of the trolley, which took place at 11.20am, it was evident that she had already ‘potted up’ the medication for lunchtime. She stated that this was done because time was short at lunch time. She had also ‘potted up’ medication for service users who receive nursing care. The manager stated that this practice would cease immediately. The trolley, which was not in use, was stored in the main entrance, and was not secured to the wall. The senior carer stated that the trolley would normally be stored in The Garden wing between medication rounds, but that the wheel was broken, and therefore it had been necessary for the trolley to remain in The Hall. The manager confirmed later that the wheel had now been fixed, and the trolley returned to The Garden wing behind lock and key. The Garden Wing The medication stock, including the controlled drugs for both areas of the home is held in The Garden wing. Record of the administration of Temazepam is now kept in a controlled drugs register, which is good practice. There was one occasion where the administration of a controlled drug had not been countersigned. However, another controlled drug for the same service user administered at the same time had been countersigned, and it was deduced that the witness had accidentally failed to sign the book. There was also one occasion whereby the number of tablets stored exceeded the recorded stock balance. The nurse agreed to look further into this matter in order to ascertain why the error had occurred. Snaith Hall Nursing and Residential Home J53-J04 S953 Snaith Hall V231721 220605 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 The meals at the home provide choice, and cater for special diets. EVIDENCE: There is a three weekly menu, within which the cook caters for special diets. The cook confirmed that they now serve liquidised meals in separate portions. Alternatives are available from the main menu of the day. The results of the Quality Survey completed in March 2005, confirmed that 90 of those whom replied stated that there was an alternative to the daily menu. On discussion, service users were generally happy with the meals on offer. Comments included that the ‘food is good’, and that service users are ‘well fed’. Five spoken to stated that they are only occasionally provided with fresh vegetables. One stated that ‘you always know what is coming’, and another stated that the food is ‘bland’. It was confirmed by the registered manager that fresh vegetables are only occasionally provided. He believes that frozen vegetables have the same nutritional value as fresh, and are therefore an acceptable alternative. There were systems in place to ensure that the kitchen remained clean and well maintained. Snaith Hall Nursing and Residential Home J53-J04 S953 Snaith Hall V231721 220605 Stage 4.doc Version 1.30 Page 13 It has been organised that the kitchen assistant will attend ‘Food Health and Hygiene Training’ in September 2005. Snaith Hall Nursing and Residential Home J53-J04 S953 Snaith Hall V231721 220605 Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The manager takes complaints seriously, and there was some evidence that service users’ views are listened to or acted upon. EVIDENCE: The manager has a complaints file in which he stated all complaints would be recorded. There had been one situation recorded since the last inspection, which had been considered by the home as a complaint. The matter was now closed. There have been no formal complaints made direct to the Commission for Social Care Inspection. Service users spoken to appeared confident in approaching the manager with any issues. On discussion with service users, it was apparent that there was one issue of complaint about a staff member which had been brought to his attention, and with which he was already dealing, and one which had not. He stated that both matters would be given serious address. These issues should be treated as complaints, and details of the outcome and any action required by the manager recorded. There were a number of letters of thanks and commendations from relatives and visitors, who were very pleased with the care provided by the staff at the home. Snaith Hall Nursing and Residential Home J53-J04 S953 Snaith Hall V231721 220605 Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 Service users live in a clean and comfortable environment. EVIDENCE: All communal areas and a random sample of private accommodation were inspected. All areas were clean and free from malodour. The carpet into the ground floor bedroom of The Hall was stained. However, the manager had already organised for all carpets throughout the home to be industrially cleaned. There is a lift to the first floor in the main building. Rooms in the garden wing have been built to accommodate people with a physical disability, and service users have access to a large garden, which has been made secure. Snaith Hall Nursing and Residential Home J53-J04 S953 Snaith Hall V231721 220605 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 The home benefits from a consistent supply of staff, and there were enough staff on duty to meet peoples’ needs in an unhurried way. The manager is keen to ensure that the appropriate checks are carried out during the recruitment of staff in order that service users are protected. EVIDENCE: There were sufficient staff to meet the requirements of the staffing notice. Staff on the day of the inspection appeared to have enough time to provide care in an unhurried manner. Two staff recruitment files were seen. Both contained two written references, one of which had been followed up by the manager. One file contained a Criminal Records Bureau Check (CRB) which had been completed approximately 10 weeks earlier at another place of employment. The manager believed that this was acceptable, but that another would be obtained if this was not the case. It was confirmed subsequently that CRB checks are not portable, and that a check must be carried out by the home. The manager has agreed to complete this forthwith. Snaith Hall Nursing and Residential Home J53-J04 S953 Snaith Hall V231721 220605 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 38 The manager is qualified to meet the needs of older people. Systems are in place to protect service users from the risks from fire. The systems in place for the checking of bed rails and subsequent recording is not sufficiently robust. EVIDENCE: The home is run as a family business. The registered provider also manages the home. He is present at the home on a regular basis, and service users knew that they could approach the manager should they have any issues that they wished to raise. He is doubly qualified as a Registered General Nurse and also a Registered Mental Nurse. The deputy manager is continuing his studies towards the Registered Managers Award. A review of the fire arrangements was undertaken. A recent visit from the fire officer concluded that there is an excellent fire safety risk assessment in place Snaith Hall Nursing and Residential Home J53-J04 S953 Snaith Hall V231721 220605 Stage 4.doc Version 1.30 Page 18 for the home. Some of the identified works within the subsequent report have been completed, whilst others are included within the business plan for the coming year, within which they will be completed. The in house fire records evidenced that the systems are regularly maintained, and that staff had recently been provided with fire training. The manager confirmed that the water boilers have now been fitted with a temperature gauge in order that it can be checked that water is stored at 60 degrees centigrade or above. The use of bed rails is well documented and reviewed, and the risk assessments consider a number of factors relating to their use. There was no written evidence available to confirm that the equipment was checked on a regular basis. Staff said that they were checked when they were fitted, and subsequently on use. However, the one set of bed rails inspected was loose. The manager confirmed that all equipment would be checked before next being used, and agreed that the regular review of the assessment would be a good opportunity to also document that the rails had been checked for their safety at the time of the review. The records in two service files, one in The Garden Wing and one in The Hall, included details of falls, and of the subsequent action taken. This information had not in all cases been transferred into the accident book. It is recommended that each area of the home be supplied with a stock of accident sheets. Staff must ensure that these are completed when accidents occur, in order that the registered manager has a full record of accidents which take place, so that they can be properly audited. Snaith Hall Nursing and Residential Home J53-J04 S953 Snaith Hall V231721 220605 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x x 3 x x x x x x 1 Snaith Hall Nursing and Residential Home J53-J04 S953 Snaith Hall V231721 220605 Stage 4.doc Version 1.30 Page 20 YES 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 7 Regulation 13,37 Timescale for action Staff must be provided with clear 14th July written guidance within the care 2005 plan as to how to deal with aggressive or challenging behaviour, and of any percieved triggers Requirement 2. 8 3. 9 Any event in the care home which adversley effects the well being or safety of any service user must be reported to the Commission for Social Care Inspection Regulation A record must be kept of 17(1)(a) nutritional screening undertaken on admission, which must be Schedule 3(o) kept under review 13 Medication kept for service users receiving nursing care must be handled by trained nursing staff only (timescale of 30.11.04 not met) Under no circumstances must medication be secondary dispensed The medication trolley for The Hall must be secured to the wall when not in use 31st August 2005 14th July 2005 Snaith Hall Nursing and Residential Home J53-J04 S953 Snaith Hall V231721 220605 Stage 4.doc Version 1.30 Page 21 The manager must investigate the anomoly with regard to the controlled drugs whereby the number of tablets held did not tally with the records kept The manager must ensure that the administration of controlled drugs is always countersigned by a suitably qualified member of staff Regulation The two issues reported by 17(2) service users must be dealt with Schedule following the complaints 4(11) procedure, and the outcome recorded 19 The manager must request a Criminal Records Bureau check for the member of staff whose file was discussed at the time of the inspection 13 All bed rails in use at the home must be checked before next being used. The manager must subsequently devise a system whereby it is recorded, that bed rails have been checked to ensure that they are safe, on a regular basis All accidents suffered by service users must be recorded within the accident book 7. 4. 16 14th August 2005 5. 29 31st July 2005 6. 38 14th July 2005 31st July 2005 14th July 2005 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 38 Good Practice Recommendations Both The Hall and The Garden wing should be supplied with a stock of accident report sheets J53-J04 S953 Snaith Hall V231721 220605 Stage 4.doc Version 1.30 Page 22 Snaith Hall Nursing and Residential Home Commission for Social Care Inspection Unit 4, Triune Court Monks Cross YORK YO32 9GZ National Enquiry Line: 0845 015 0120 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 Snaith Hall Nursing and Residential Home J53-J04 S953 Snaith Hall V231721 220605 Stage 4.doc Version 1.30 Page 23 - 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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