CARE HOMES FOR OLDER PEOPLE
Sonesta Nursing Home 797 Finchley Road Golders Green London NW11 8DP Lead Inspector
Tony Brennan Key Unannounced Inspection 16th May 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 Sonesta Nursing Home DS0000010547.V289950.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. Sonesta Nursing Home DS0000010547.V289950.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Sonesta Nursing Home Address 797 Finchley Road Golders Green London NW11 8DP 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) 020 8458 3459 020 8905 5235 Sonesta Nursing Home Limited Mrs Farzana Kauser Chowdhury Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Sonesta Nursing Home DS0000010547.V289950.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Specific service user One specific service user who currently resides in the home and is under 65 years of age can reside in this home. This condition will need to be reviewed when s/he vacates the home. 3rd November 2005 Date of last inspection Brief Description of the Service: Sonesta is a privately owned registered care home with nursing for up to thirty-two older people. It is situated on the Finchley Road in Golders Green, close to local shops and public transport. Accommodation in the home is provided in eighteen single and seven double rooms. The home has a large ground floor lounge and dining area, central kitchen and a smaller first floor lounge. There is a large garden to the rear of the home. The stated aims of the home are to provide a comfortable and safe environment, and the specialist care that service users in the home need. The current fees range from £575 to £680. This report is available through the internet. Copies may also be obtained from the provider of this service. Sonesta Nursing Home DS0000010547.V289950.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken as part of the annual inspection programme. The inspector also sought to confirm that the eight areas for improvement identified at the last inspection were addressed. The inspection took place over one day. The registered manager, Mrs Chowdhury, assisted the inspector with the inspection. The inspector spoke with six people who live at Sonesta Nursing Home and five staff. The inspector observed care practice and interaction between service users and staff. The inspector toured the building and examined a number of records relating to the care, health and safety and management of the home. The inspector would like to thank the registered manager and staff who assisted him by answering questions about the running of the home. The inspector would also like to thank those people who live at the home who discussed their views of the service they receive. What the service does well: What has improved since the last inspection?
Eight areas for improvement were identified at the last inspection; seven of these had been met. A full history of the medication prescribed to each person living at the home is now available. A list of medication is prepared and signed by the person or their representative. Controlled drugs are stored safely and the required records are maintained. These improvements have ensured that people living at the home are protected by safe procedures for handling medication. The flooring in the food storage area and the laundry have been replaced. The fire emergency plan has been reviewed and now includes a floor
Sonesta Nursing Home DS0000010547.V289950.R01.S.doc Version 5.1 Page 6 plan for the home. These improvements to the environment and fire safety measures mean that people living at Sonesta are safe. There had been one complaint in the last inspection year that had been investigated by the Commission and had been responded to appropriately. Areas for improvement identified regarding this complaint had been addressed. 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. Sonesta Nursing Home DS0000010547.V289950.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 Sonesta Nursing Home DS0000010547.V289950.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 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users needs are assessed prior to admission to the home to ensure they receive the care and support they require. EVIDENCE: A service user who recently came to live at the home said, “staff are very helpful” and that staff were “well informed and I am sure they know what they are doing”. The inspector observed staff supporting this service user and found that they understood the needs of this service user. A member of staff explained to a service user what was for lunch and offered assistance with personal care in a sensitive manner. The inspector found that there were assessments made prior to the service users admission to the home. These included assessments from social workers and health professionals dealing with the nursing needs of service users. The needs identified in assessments were used as the basis for planning care and support for service users. Sonesta Nursing Home DS0000010547.V289950.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 9 10 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users personal, social and medical care needs are planned for and met. Service users are protected by safe procedures for handling medication. Service users’ right to privacy is respected. EVIDENCE: A service user said, “they do ask what I like and want”. Care plans were detailed and gave information on how the needs of service users would be met. The care plans also detailed how service users choices could be supported. A service user said, “staff don’t force me to do anything”. Service users had specified their preferred times to go to bed and get up. Care plans had been reviewed monthly. Risk assessments had been carried out of service users risks of falls, manual handling and tissue viability. The inspector saw an example of detailed planning around the pressure care for one service user and this had been reviewed regularly and the support needed had been identified. Records showed that service users had received on-going medical care (e g visits from the chiropodist, dentist and optician). Service users are fully supported to live in a manor they choose and their needs are met. Sonesta Nursing Home DS0000010547.V289950.R01.S.doc Version 5.1 Page 10 Records for medication received, administered and returned were all complete. The medication policy covered all the areas necessary to ensure detailed guidance on the handling of medication was provided to staff. There were medication profiles for service users that provided details of what medication each servcie user was on and any planned reviews. Changes in medication had been signed by the GP. A list of medication returned to a service user was available. The inspector spoke with staff and examined training records that showed that staff training had been received on this system. Training records showed that further advanced training on medication administration was planned. There is now a record of controlled medication for the two service users on controlled medication. There is now a record of this. These were checked by the inspector and found to correspond with the Controlled Drugs book. Medication is administered safely so that service users receive their medicines which contributes to their continues health and well being. Sonesta Nursing Home DS0000010547.V289950.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 14 15 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are provided with sufficient and varied activities to meet their needs. Service users are supported to maintain contact with relatives and other representatives of their choice. Service users are able to make choices about how they live in the home. Service users are provided with varied and balanced meals. EVIDENCE: The inspector observed service users taking part in activities on the day of the inspection. Light exercise and listening to music were provided and staff were observed encouraging and supporting servcie users to take part. Service users enjoyed both these activities. One service user commented, “staff do this kind of thing everyday”. The inspector saw that there was an activities plan on display in the sitting room. Another service user said, “we do play bingo and have music shows”. Records showed that a service user who is Muslim is supported to practice his religion. Service users and two relatives spoken to confirmed that there was no restriction on times of visits. A service user said, “people come and go as they like”. The chef explained that service users were asked what they would like to eat each day. A service user said that staff “ask me what I like to eat”. The menu showed that a range of meals was offered. Another service user
Sonesta Nursing Home DS0000010547.V289950.R01.S.doc Version 5.1 Page 12 commented that the food was “very good” and “I would be fat if I eat everything”. The registered manager explained that servcie users are consulted every six weeks about the menu. The inspector saw that meals were well presented and they were provided in a relaxed environment. Sufficient staff were available and when necessary service users were observed being assisted to eat. Sonesta Nursing Home DS0000010547.V289950.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 18 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are confident that their complaints will be listened to, taken seriously and acted upon. Service users are protected from abuse. EVIDENCE: The complaints policy explained how to make a complaint and how it would be dealt with. This was displayed around the home. A service user said, “if I don’t like anything I know what to do”. The complaints record showed actions taken to resolve complaints. There had been one complaint in the last inspection year that had been investigated by the Commission and had been responded to appropriately. Service users said that they felt safe and could approach staff if they had any concerns regarding how they are treated. A service user said, “if I’m unhappy I can go to the office to tell them”. There were comprehensive policies on handling abuse and protection. Staff spoken to were clear about the signs of abuse and how suspected abuse should be handled. Sonesta Nursing Home DS0000010547.V289950.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): 19 26 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service users live in a safe and comfortable environment. The home is a clean and hygienic environment for service users to live in. EVIDENCE: The inspector toured the building and found that the home was decorated and furnished to meet the needs of service users. Since the last inspection the flooring in the laundry has been replaced. The floor in the food storage area had also been replaced. The radiators in service users en suite bathrooms are still not fitted with guards. The registered manager explained that there was an on-going maintenance programme for the home and the top floor is in the process of being redecorated. Bedrooms were personalised with service users effects. A service user said, “my bedroom’s got everything I want”. The inspector found that the home was clean and hygienic. Guidance and procedures were in place to prevent cross infection. Protective clothing and hand washing facilities are available to staff throughout the home. The sluice rooms were tidy and in working order.
Sonesta Nursing Home DS0000010547.V289950.R01.S.doc Version 5.1 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 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): 27 28 29 30 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Sufficient staff are available at all times to meet service users needs. Service users are protected by the home’s recruitment practices. Staff do not have the skills to meet all the assessed needs of service users. EVIDENCE: A servcie user said, “staff are very helpful”. The rota showed that a consistent level of staffing is maintained. Service users and staff spoken to felt that there were sufficient staff available. A service user spoken to said, “staff are well informed and I am sure they know what they are doing”. Staff spoken to and training records confirmed that staff had achieved National Vocational Qualification at level 2 in care. A number of staff have commenced the National Vocational Qualification at level 3. Training records also showed that staff did not have all the statutory required training. Training is required in the areas of fire safety, manual handling and food hygiene. Nursing staff spoken to confirmed that they had training on tissue viability, PEG feeding and stoma care. The inspector examined staff records, which contained all the required information. Sonesta Nursing Home DS0000010547.V289950.R01.S.doc Version 5.1 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 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): 31 33 35 38 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The manager has the necessary qualifications to manage the home effectively and in the best interests of service users. Service users have been consulted about the quality of the service provided and encouraged in making suggestions for improvement. Service users financial interests are protected by the home’s procedures. Service users and staff are protected by the home’s health and safety procedures. EVIDENCE: A service user said “the manager listens to me”. The registered manager explained that she has completed the Registered Manager’s Award. The registered manager explained that she would be applying for the dementia category. As part of this, all care staff have already received training in dementia. The registered manager explained that surveys are carried out twice a year as part of on-going monitoring of the quality of service provided.
Sonesta Nursing Home DS0000010547.V289950.R01.S.doc Version 5.1 Page 17 This process had started. Ongoing meetings are held to consult service users and representatives about the quality of the servcie provided. Either relatives or social service departments manage most service users money. Two service users money is managed by the home. Each service user has a separate account and any expenditure is recorded. The home does not hold cash, paying any bills by cheque drawn on the service users account. Records showed that fire equipment was tested regularly and maintained. Drills were taking place. Since the last inspection the fire emergency plan has been reviewed and now includes a floor plan of the home. The inspector questioned staff on the fire safety procedures and found that they understood fire safety issues. All health and safety policies were available. Certificates for gas, legionella and electrical testing were in date. COSHH guidance was in place and chemicals were stored safely. Records showed that staff had received training on health and safety topics that ensured that they followed safe working practices. The inspector discussed health and safety issues with staff and they demonstrated their understanding. The home has an effective system for monitoring accidents. Sonesta Nursing Home DS0000010547.V289950.R01.S.doc Version 5.1 Page 18 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 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Sonesta Nursing Home DS0000010547.V289950.R01.S.doc Version 5.1 Page 19 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 OP19 Regulation 13(4)(a) Requirement The registered provider must ensure that any radiators in service users en suite bathrooms are fitted with a guard. (Timescale 01/01/06 not met) This requirement has been restated. The registered provider must ensure that training is provided on fire safety, manual handling and food hygiene. Timescale for action 01/08/06 2 OP30 18(1) 01/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Sonesta Nursing Home DS0000010547.V289950.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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