Inspection on 07/02/06 for Snaith Hall Nursing And Residential Home

This inspection was carried out on 7th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

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

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

Snaith Hall Nursing And... 14/07/05

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 East Yorkshire DN14 9JR Lead Inspector Anne Prankitt Unannounced Inspection 7th February 2006 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 Snaith Hall Nursing And Residential Home DS0000000953.V278525.R01.S.doc Version 5.1 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.V278525.R01.S.doc Version 5.1 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) James Patrick McEnroe Mrs Adrienne Elizabeth McEnroe Mr James Patrick McEnroe Care Home 36 Category(ies) of Dementia (36), Dementia - over 65 years of age registration, with number (36), Old age, not falling within any other of places category (36), Physical disability (36), Physical disability over 65 years of age (36), Terminally ill (36) Snaith Hall Nursing And Residential Home DS0000000953.V278525.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registration includes 5 day places Date of last inspection 14th July 2005 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 DS0000000953.V278525.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over six hours, and was conducted by two inspectors. Three hours preparation took place prior to the inspection. The registered provider and manager, Mr McEnroe, and deputy manager, Mr Simon McEnroe, were available to assist during the course of the inspection, and for feedback at the close. During the course of the inspection, discussion took place with some service users, staff and relatives, and observations with regard to the general activity of the home were made. Some records were looked at, including a sample of care plans, staff records, and complaints records. All communal areas of the home were inspected, plus a sample of private bedroom areas. What the service does well: The building is set in pleasant gardens which residents can enjoy. The home is run as a family concern. The registered provider and deputy manager are available at the home on a regular basis, and residents know them. Comments from service users about the registered provider included ‘he’s very good at his job’. A service user stated ‘I am very happy with my care’. The home has a core of long standing staff, which will assist in adding stability to the team and consistency to the care given to residents. Each resident has a care plan which staff begin to develop soon after admission, so that information is available about the care that needs to be provided to residents. The home measures the quality of the service that it provides to residents by asking people who use it, or who are involved with the home, about their views. Residents are able to keep contact with their friends and family, who are welcomed into the home. Care staff know that they must always report any concerns about the welfare of residents to someone more senior to them. Staff receive training to help them in the role of caring for residents. Snaith Hall Nursing And Residential Home DS0000000953.V278525.R01.S.doc Version 5.1 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 DS0000000953.V278525.R01.S.doc Version 5.1 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.V278525.R01.S.doc Version 5.1 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 the following standard(s): 3, 5 and 6 A visit by the home to all prospective service users in their current situation as part of the pre admission assessment process would provide additional information to assist in assuring that their needs will be met alongside the needs of others who live at the home. EVIDENCE: The deputy manager explained that referrals are mainly received by word of mouth or via social services. He confirmed that he visits prospective service users admitted through private arrangements as part of the assessment process. The preadmission assessments for three recently admitted service users were inspected. There had been information gathered prior to each admission from various sources prior to a decision to admit being made. Discussion took place about the range of care that the home is registered to provide, and the importance of ensuring that the pre admission assessment process is sufficiently robust to ensure that the balance of needs within the home remains appropriate and manageable. The registered provider confirmed that the home does not provide intermediate care. Snaith Hall Nursing And Residential Home DS0000000953.V278525.R01.S.doc Version 5.1 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 the following standard(s): 7,8 and 9 Access to health services is enabled for service users, all of whom have well developed care plans, although information about individual risks or behaviours which are peculiar to the individual concerned, and how they can best be managed, could be better explained. EVIDENCE: The care plans seen were kept up to date by regular review. They were signed by relatives where possible. Areas of risk including those relating to, for example, waterlow, falls and nutritional needs were included, and a care plan produced where risk was identified. Staff kept good daily records. A care staff member confirmed that they are provided with a handover so that they are aware of current needs of service users. Those service users who were able to comment felt that the care provided met with their needs. Discussion took place about ways in which specific needs of service users could be better identified, for example where their behaviour challenged staff, service users and the ambience of the environment, and where areas of risk and contact required a consistent approach. The deputy manager agreed to look into ways in which the plans could be further individualised to incorporate this information. Snaith Hall Nursing And Residential Home DS0000000953.V278525.R01.S.doc Version 5.1 Page 10 There have been good improvements made to the medication systems since the last inspection. Care staff now only administer medication to service users receiving personal care, a new medication trolley has been purchased to replace that which had a broken wheel at the last inspection, and the handling of controlled drugs is now witnessed in all cases, and records countersigned. Records seen were signed and kept up to date. Regular medication counts are carried out and recorded. An audit of two medications confirmed that the records tallied with the stock held. One medication used for the treatment of hypoglycaemic attacks had recently exceeded its shelf life. The deputy manager gave assurance that this would be replaced, and has subsequently confirmed that this has been actioned. It is recommended that a system is introduced as part of the medication audit which triggers the reordering of medication which is nearing its expiry date. Snaith Hall Nursing And Residential Home DS0000000953.V278525.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 12,13 and 14 Further development of the activities programme will assist in service users’ quality of life with regard to individual social and recreational preferences being further improved upon. EVIDENCE: The home is developing the social activities programme. In addition to the previous arrangements whereby a volunteer visits the home on a weekly basis, providing activities to a small group of service users in The Hall, there is also now an activities organiser recently employed to work two hours each week. The care plans highlight ‘quality time’ which is spent with service users whilst they have been assisted with bathing, or visited the hairdresser for example. A communion service takes place at the home on a fortnightly basis, following which there is an informal meeting of service users attended by the registered provider. Staff stated that other informal social activities take place, such as piano playing, dominoes and jigsaws. On the day of the inspection, service users in the Garden Wing were enjoying a reminiscence singing group. The care plans contain some information about the social preferences of individual service users. The registered provider is hoping that the activities hours can be increased upon, and appreciates that this will assist in providing a more regular and individualised service for service users. Service users who were able to comment stated that they were free to make choices about their life, Snaith Hall Nursing And Residential Home DS0000000953.V278525.R01.S.doc Version 5.1 Page 12 and that they are assisted where required by staff who are available if their help is required. Service users have the choice to individualise their rooms with their own belongings. Staff, visitors and service users spoken with were unanimous that there are no restrictions placed upon visiting. The visiting priest confirmed that he has longstanding contact with the home, and has always been welcomed. Snaith Hall Nursing And Residential Home DS0000000953.V278525.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 16 and 18 Service users are protected by staff who understand and take seriously their responsibilities about reporting issues which relate to their welfare. EVIDENCE: Following a requirement made at the last inspection, the registered provider has completed written documentation about two issues of concern raised by residents, one of which he was already aware of and addressing. The records confirmed that the staff member concerned had been spoken with, and that the service user was happy with the outcome of the registered provider’s action. There have been no complaints made direct to the Commission for Social Care Inspection during the period since the last inspection. Service users who were able to comment stated that they would approach the registered provider, deputy manager or staff should they have any concerns that they wished to raise. The registered provider awaits an updated copy of the local authority multi agency policy for the protection of vulnerable adults. He intends to seek additional training for his staff which is supplied by the local authority. The abuse policy within the home is reviewed on a regular basis. However, it does not fully support the local authority guidance, and requires amendment. Despite this, staff were very aware of the need to report matters of abuse, and that it was not possible for them to promise to keep ‘secrets’. Snaith Hall Nursing And Residential Home DS0000000953.V278525.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 21,24 and 26 Additional systems need to be introduced to ensure that all service users without exception are provided with private accommodation which is pleasant and fit for purpose. EVIDENCE: Those bedrooms seen were generally clean and tidy, and had been individualised with the service user’s personal belongings. Some are very spacious, allowing sufficient room for ease of moving and handling. However, the hot water supply to one service users’ bedroom was not adequate, and caused the service user difficulties with regards meeting their washing requirements. The room required a deep clean to remove staining from the carpet, removal of dust and cobwebs from the light fitting, and a build up of grime to plugs and the wheels of the bed. Two sets of drawers in the same room were in a state of disrepair, and the cover to the radiator guard was not securely fitted. The deputy manager stated that there had been ongoing problems gaining access to the room, but agreed to attend to the issues raised. He stated that he was already aware of the problem with the hot water Snaith Hall Nursing And Residential Home DS0000000953.V278525.R01.S.doc Version 5.1 Page 15 supply, and that a plumber had been contacted. One other bedroom seen contained a drawer set which was also in a poor state of repair. One room suffered a malodour. This was discussed with the deputy manager who was aware of the issue. The door handle to the en suite was loose. It is recommended that additional systems are put in to place in order to address the malodour, in conjunction with review of the care plan of the individual needs of the service user. (Please refer to standard 7) Snaith Hall Nursing And Residential Home DS0000000953.V278525.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28,29 and 30 Staff are provided with a range of training to assist them in meeting the needs of service users. However, the recruitment procedures need to be robust in all cases to ensure that service users are protected from unnecessary risk. EVIDENCE: Staff confirmed that they are provided with training opportunities, which includes statutory training. A recent starter confirmed that she had received induction training, which included fire training and safe moving and handling. Other staff were completing NVQ Level 2 training and medication training. The registered provider confirmed that 52 of staff have attained accreditation at NVQ Level 2 or above. Staff stated that they received fire training twice each year. Policies and procedures for the home are discussed with staff during supervision. Trained staff have additional training such as use of syringe drivers and back care for managers update. The nurse on duty stated that some care staff have completed training in dementia awareness and challenging behaviour. It was difficult to evidence the training that staff have undertaken, as the staff files did not include up to date information, and the home does not have a training matrix. It is recommended that this be developed, so that the registered provider can be satisfied that the training programme is up to date for all staff members. Two staff recruitment files were inspected. For one new recruit, two written references and a Criminal Records Bureau check had been obtained prior to the staff member being deployed at the home. In the second file, only one written reference had been obtained, and neither a CRB check nor a POVAFirst had been returned at the point of deployment. Snaith Hall Nursing And Residential Home DS0000000953.V278525.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35 and 38 There are self auditing systems in place to measure the quality of service and management of the home. However, the systems in place for checking that bed rails are safe for service users are not sufficiently robust. EVIDENCE: The home carries out a quality survey on an annual basis. Questionnaires are sent to relatives, visiting professionals, social services representatives and twenty service users. The results of the survey are analysed, and fed into the business plan for the home. Residents meetings are undertaken fortnightly on an informal basis. Notes are not currently kept. (Please refer to standard 12). The registered provider confirmed that staff meetings are held six weekly. The home has achieved the ‘Investors in People Quality Award’, and continues to hold the Quality Development Scheme Award for East Riding parts 1 and 2. Snaith Hall Nursing And Residential Home DS0000000953.V278525.R01.S.doc Version 5.1 Page 18 Relatives are encouraged to assist service users with their finances where they themselves are not able to do so. However, the home can safe keep monies on their behalf. The records seen were up to date and could be reconciled with monies held. The registered provider stated that he collects the pension for one service user, but does not act as appointee. Should service users wish to handle their own monies, they are provided with lockable facilities. Standard 38 was assessed only in respect of a requirement that was made at the last inspection that the manager must devise a system whereby it is recorded that bed rails have been checked on a regular basis to ensure that they are safe. This has not been carried out, and therefore remains outstanding. A routine visit was made to the home by Environmental Health during the period since the last inspection. The registered provider has submitted written confirmation that the requirements made within the report have been acted upon. Snaith Hall Nursing And Residential Home DS0000000953.V278525.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 X X 1 X X 1 X 1 STAFFING Standard No Score 27 X 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 1 Snaith Hall Nursing And Residential Home DS0000000953.V278525.R01.S.doc Version 5.1 Page 20 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 OP21OP24 OP26 Regulation 12,13,16, 23 Requirement In respect of the first room identified at the inspection: • • • • • The hot water supply must be restored. The drawers must be restored to working order. The carpet must be cleaned or replaced. The room must be deep cleaned. The cover to the radiator guard must be secured. Timescale for action 17/02/06 In respect of the second room identified at the inspection: • Additional systems must be introduced in order to attempt to eradicate the malodour within. The door handle to the en suite must be repaired. • In respect of the third bedroom identified at the inspection: The drawers must be restored to working order. Two satisfactory written DS0000000953.V278525.R01.S.doc • 2 OP29 19 07/02/06 Page 21 Snaith Hall Nursing And Residential Home Version 5.1 references must be obtained prior to the deployment of staff at the home. In any future appointments, a Criminal Records Bureau check must be obtained prior to the deployment of staff within the home. In exceptional circumstances where the registered provider has made the decision to deploy a staff member prior to the return of the disclosure, the registered provider must request a POVA First check which must be completed before the staff member commences duties. The registered manager must 14/02/06 devise a system whereby it is recorded on a regular basis that bed rails have been checked to ensure that they are safe. (Timescale of 31/07/05 not met) 3 OP38 13 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 OP3OP5 Good Practice Recommendations It is recommended that the registered manager consider visiting each prospective service user prior to their admission to collect additional information to complement the process of assessment. It is recommended that care plans be further individualised to include specific needs of service users, for example where their behaviour challenges staff, service users and the ambience of the environment, and where areas of risk and contact require a consistent approach. It is recommended that a system is introduced as part of DS0000000953.V278525.R01.S.doc Version 5.1 Page 22 2 OP7 3 OP9 Snaith Hall Nursing And Residential Home 4 OP12 5 OP18 6 OP30 the medication audit which triggers the reordering of medication which is nearing its expiry date. The registered provider should continue with the development of, and improvements made to, the activities programme, and consider documentation of the content of the residents’ meeting so that their views can be collected formally as part of the quality assurance programme. The registered provider should update the abuse policy written by the home in order that it supports the local authority multi agency policy for the protection of vulnerable adults and ‘No Secrets’ documents. Staff should sign at the point that they have read and understood the revised policy. It is recommended that the staff training records be updated so that the records can be used as an audit tool, and to evidence that all staff have received up to date training. Snaith Hall Nursing And Residential Home DS0000000953.V278525.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection York Area Office 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 DS0000000953.V278525.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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