CARE HOMES FOR OLDER PEOPLE
Somerset Nursing Home 1 Church Lane Wheldrake York YO19 6AW Lead Inspector
Wendy Dixon Unannounced 13 July 2005 11:00 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. Somerset Nursing Home J53 J04 S45154 Somerset NH V239314 130705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Somerset Nursing Home Address 1 Church Lane Wheldrake York YO19 6AW 01904 448313 01904 448022 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) Roche Healthcare Ltd Post vacant Care Home with Nursing 46 Category(ies) of Dementia (DE) - 46 registration, with number Dementia over age 65 years (DE(E)) - 46 of places Old Age (OP) - 46 Physical Disability (PD) - 46 Physical Disability over age of 65 years - 46 Terminally Ill (TI) - 4 Somerset Nursing Home J53 J04 S45154 Somerset NH V239314 130705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 17/03/05 Brief Description of the Service: Somerset Nursing Home is a care home for older people providing personal care , nursing care,dementia care and terminal care for up to 46 service users. The home is situated in the village of Wheldrake, approximately 8 miles from the centre of York, there are 14 elderly persons bunglows within the grounds of the home.The business is owned by Roche Healthcare Limited.The home provides both single and shared accommodation on two storeys and has a passenger lift. Somerset Nursing Home J53 J04 S45154 Somerset NH V239314 130705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report relates to an unannounced inspection that took place on Wednesday 13th July 2005.The inspection lasted 4.0 hours (11.00am to3.00pm). There were 42 service users resident in the home, 27 requiring nursing care and 15 receiving personal care. The inspection focused on a number of key standards and on the areas of concern identified at the last inspection. An inspection of the premises took place, including a number of bedrooms, the homes bathrooms and lounges. The care records of five service users were examined in detail and these service users were spoken with about the care they receive. There were also discussions with members of staff and one visitor to the home What the service does well:
Somerset Nursing Home provides a good standard of care. Good assessments systems are in place and this helps ensure that all the service users health and social care needs are identified and met. Service users said they enjoyed living in the home and that they found staff to be helpful and courteous. Service users said they enjoy the food provided and there was a range of meals available. Service users’ rights to privacy were well understood by staff; also care staff spoken to had a good knowledge of the service users needs.
Somerset Nursing Home J53 J04 S45154 Somerset NH V239314 130705 Stage 4.doc Version 1.40 Page 6 The visitor spoken to during the inspection said they were always made to feel welcome and were very satisfied with the level of care their relative was receiving. What has improved since the last inspection? What they could do better:
Five service users care plans were inspected. These contained a lot of good information about service users care needs, however in some cases the information was out of date and conflicting and could mean that service users did not receive the best treatment. A number of the service users at the home suffer from dementia. Service users care plans that suffered from dementia and had some difficult behaviour did not contain sufficient information about what staff needed to do to look after them.
Somerset Nursing Home J53 J04 S45154 Somerset NH V239314 130705 Stage 4.doc Version 1.40 Page 7 The home does not employ any specialist nurses with training specific to caring for people with dementia. In addition there is a shortfall of 56 hours a week in the number of qualified nurses deployed in the home. To ensure all the service users health and care needs are met and documentation is up to date the registered provider must ensure that there is the appropriate number of qualified nurses working in the home. 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. Somerset Nursing Home J53 J04 S45154 Somerset NH V239314 130705 Stage 4.doc Version 1.40 Page 8 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 Somerset Nursing Home J53 J04 S45154 Somerset NH V239314 130705 Stage 4.doc Version 1.40 Page 9 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) 3 The service user’s needs are well assessed before they are admitted to the home EVIDENCE: The assessment documentation inspected of five service users was of good quality and in sufficient deal of detail so as to make it possible for their care needs to be identified and then comprehensive care plans developed. The service user spoken to were able to confirm that these documented details about them was accurate and appropriate. There was also evidence that the service user their families and other professionals such as care mangers were involved in the assessment process. Somerset Nursing Home J53 J04 S45154 Somerset NH V239314 130705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 and 9 While health and personal care needs are being met in practice, poor out-ofdate documentation may pose a risk to service users. EVIDENCE: The service users looked well cared for with well-pressed clothes, tidy hair and the gentlemen were well shaved. The records of five service users were inspected, all had care plans in place. These contained detailed information about how service users needed to be cared for. However in some cases these were not being updated on a regular basis and daily progress notes showed that the care received by service users had changed and was not in the care plan. It is important to make sure that the care plan gives clear up to date information about how service users are cared for especially when a lot of agency and temporary staff work in the home, which is the case at present
Somerset Nursing Home J53 J04 S45154 Somerset NH V239314 130705 Stage 4.doc Version 1.40 Page 11 Risk assessments were in place regarding the prevention of pressure sores and to help prevent weight loss, again these were not always dated. Service users health needs were well met; where problems were identified advice was sought from the appropriate health professionals. Medication was well managed. Medicines were properly stored, documentation accurate and stock balances checked correct. Somerset Nursing Home J53 J04 S45154 Somerset NH V239314 130705 Stage 4.doc Version 1.40 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) 13 Visitors are made welcome in the home EVIDENCE: Service users can see their visitors in their own rooms or one of the homes lounges. Visitors are welcome throughout the day and the visitor spoken to said they were always made to feel welcome. Somerset Nursing Home J53 J04 S45154 Somerset NH V239314 130705 Stage 4.doc Version 1.40 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 standard(s) 18 People are protected against the risk ok of abuse. EVIDENCE: The registered provider has updated the homes policy and procedure about the prevention and reporting of abuse. Staff were aware of the policy and the majority have now received appropriate training so they are able to properly implement it. Somerset Nursing Home J53 J04 S45154 Somerset NH V239314 130705 Stage 4.doc Version 1.40 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 standard(s) 19,21 and 26 The home provides a comfortable and safe place for service users to life EVIDENCE: The home and gardens are well maintained. The homes grounds are easily accessible to service users and gardens pleasant and well kept. Parts of the home have been refurbished, the corridors downstairs have been re-carpeted and equipment replaced to make it easier for service users to have a bath. The home was clean and fresh smelling throughout. Service users confirmed they were able to bring in small items of furniture and mementoes to make their rooms feel more like home. Ventilation has been improved in the kitchen to improve the temperature control for staff. Somerset Nursing Home J53 J04 S45154 Somerset NH V239314 130705 Stage 4.doc Version 1.40 Page 15 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 There are not enough suitably qualified nurses deployed in the home EVIDENCE: There were 42 service users in the home on the day of inspection 27 requiring nursing care, 15 requiring personal care and 60 of these with a degree of dementia. The minimum number of qualified nurse hours needed to care for these service users is 253hours per week the home provided 196.5 week commencing 11/07/05 and the minimum number of care assistant hours needed is 704 the home provided 841 week commencing 11/07/05. There is a shortfall of 56 qualified nurse hours per week, though the care assistant hours provided exceed the minimum number therefore making up the physical numbers as described above service users at the home have complex health and mental health needs and have been assessed as requiring a certain amount of nurse supervision. The majority of the time there is only one qualified nurse available in the home and none of the nurses currently working in the home have a specialist qualification in dealing with older people with mental health problems. The qualified nurse on duty felt they were very busy and observation bore this out, also the shortfall in some of the care plans inspected illustrated the need for more qualified nurse hours being provided.
Somerset Nursing Home J53 J04 S45154 Somerset NH V239314 130705 Stage 4.doc Version 1.40 Page 16 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) 38 The home provides a safe place for service users to live and staff to work EVIDENCE: All new staff receive fire training as part of their induction and this is then updated on a six monthly basis to ensure staff know what to do in the event of a fire. Fire fighting equipment such as extinguishers and the alarm system is checked on a regular basis as the emergency lighting to ensure it is working properly. All the necessary insurances to protect service users, visitors to the home and staff were in place and up to date Somerset Nursing Home J53 J04 S45154 Somerset NH V239314 130705 Stage 4.doc Version 1.40 Page 17 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 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 3 x 3 x x x x 3 STAFFING Standard No Score 27 1 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x x x x x x 3 Somerset Nursing Home J53 J04 S45154 Somerset NH V239314 130705 Stage 4.doc Version 1.40 Page 18 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 OP7&8 Regulation 15 Timescale for action Service users care plans must be On recept clear,old out of date information of this removed and enteries signed and report ans maintained dated. Also where service users develop an acute problem such thereafter as an infection a care plan must be wriiten detailing the care,treatment and progress. Where service users have a problem asscoiated with dementia a care and management plan of any difficult behavior must be written The registered provider must On recept ensure enough suitably qualified of this nurses are deployed in the home report ans at all times. maintained thereafter Requirement 2. OP27 18 1 a 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 Good Practice Recommendations Somerset Nursing Home J53 J04 S45154 Somerset NH V239314 130705 Stage 4.doc Version 1.40 Page 19 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
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