Inspection on 19/05/05 for Sonesta Nursing Home

This inspection was carried out on 19th May 2005.

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

Sonesta Nursing Home 24/11/08

Sonesta Nursing Home 16/05/06

Sonesta Nursing Home 03/11/05

Sonesta Nursing Home 02/12/04

Sonesta Nursing Home 27/05/04

Sonesta Nursing Home 10/03/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Sonesta Nursing Home 797 Finchley Road Golders Green London NW11 8DP Lead Inspector David Hastings Announced 19 May 2005 at 9.30am 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. Sonesta Nursing Home Version 1.10 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 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 Mr Ejaz Chowdhury & Mrs Farzana Chowdhury Vacant Post N Care Home with Nursing 32 Category(ies) of OP Old Age registration, with number of places Sonesta Nursing Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1 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. Date of last inspection 2 December 2004 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, and 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.’ Sonesta Nursing Home Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on Thursday 19th May 2005 and lasted six hours. Six staff and ten residents were spoken to. A partial tour of the premises took place and care records were inspected. Seven comment cards were received by the CSCI from relatives, six comment cards were received from service users and one comment card was received from a care professional. These were generally positive regarding the care provided by the staff at the home. The inspector was assisted throughout the inspection by the registered providers and acting manager. What the service does well: What has improved since the last inspection? What they could do better: Residents’ social, emotional and recreational needs are not being either assessed or addressed by the home. One service user said, “there’s not much to do”. Residents with dementia are being admitted to the home but staff do not have the appropriate training or management support to look after all the needs of these residents. Residents’ privacy is sometimes not respected by staff and the wishes of residents with dementia are sometimes not being acknowledged. The management structure of the home is unclear and the acting manager needs to be appropriately trained and registered with the CSCI. Two requirements from the last inspection relating to keeping residents suitably occupied with appropriate activities and meeting the emotional needs Sonesta Nursing Home Version 1.10 Page 6 of residents have been restated. Thirteen new requirements and two recommendations have been issued as a result of this inspection. The requirements relate to obtaining a variation for residents with dementia, proper assessments for residents with dementia and written confirmation to all potential residents that the home can meet their needs, ongoing dementia training for all staff, the assessment of all exiting residents with dementia, the need to maintain residents privacy at all times, recording residents likes and dislikes, ensuring all residents receive the appropriate diet and three requirements relating to minor repair issues. The two recommendations relate to improving quality assurance systems in the home. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Sonesta Nursing Home Version 1.10 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 Sonesta Nursing Home Version 1.10 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) 2, 3 and 4 Service users moving into the home are not being satisfactorily assessed and some of their emotional, social and recreational needs are not being met. Service users at the home with dementia are not being sufficiently supported. EVIDENCE: A requirement was issued at the last inspection that all statements of terms and conditions are signed by the service user or their representative. All terms and conditions seen were either signed or identified that the service user or their representative have refused to sign these statements. The registered provider informed the inspector that some relatives have refused to sign because they say the contracts are with the local authority. The pre assessments for two service users were examined. There was information regarding the physical needs of service users but little or no information regarding the social, emotional and recreational needs. A requirement has been made that the registered provider ensure that all the needs of potential service users, as outlined in Standard three of the National Minimum Standards, must be assessed before the service user moves in to the home on a trial basis. The registered provider must also write to the service Sonesta Nursing Home Version 1.10 Page 9 user or their representative specifying how the home will meet all their assessed needs. Both these service users will be sharing a room together. The registered provider informed the manager that the service users and their relatives were aware of this and had agreed to share. It was noted that on one assessment the service users had been diagnosed with dementia. The home is not registered to take people with dementia, however a large number of service users living at the home have some form of dementia. The registered provider must either apply for a variation for the existing service users with dementia or apply for a major variation to enable the home to take people with a diagnosis of dementia. Either way the home must improve it’s services for people with dementia. Taking into account the number of service users with dementia, no adequate dementia training programme or staff support system has been implemented. A requirement relating to dementia training for all staff has been issued in the relevant section of this report. Until these issues are resolved the home cannot accept service users with a diagnosis of dementia. Sonesta Nursing Home Version 1.10 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, 9, 10 and 11. Although the health needs of service users are set out in their plan of care, the home is still not addressing the emotional, social or recreational needs of service users. The home is good at meeting service users’ physical health care needs. Service users receive the medication that is prescribed for them at the right times by suitably qualified staff. Service users’ privacy is not being adequately respected. EVIDENCE: Sonesta Nursing Home Version 1.10 Page 11 Nine care plans were examined. These plans contained good information regarding the physical care needs of service users. However the plans still did not sufficiently address the social, recreational and emotional needs of service users. Although some information was recorded relating to service users’ interests and hobbies it was not detailed and no plan had been generated as to how these needs would be met. The daily report concentrated on the monitoring of physical needs and did not address the emotional needs of individuals. The requirement relating to this, restated at the last inspection, has been restated again. Failure to comply with this requirement will lead to enforcement action being taken by the CSCI. The inspector was disappointed that the acting manager has not addressed this issue. There was evidence that care plans are being reviewed monthly. Care plans also contained extensive risk assessments. Examination of service user records, and discussion with service users and staff demonstrated that there is access to appropriate medical practitioners, including a GP, dentist and optician. The home has clear guidance on the prevention and treatment of pressure sores, which staff were aware of and implementing. Records examined showed that pressure care and nutritional assessments are being carried out on service users and regularly reviewed. Two requirements, issued at the last inspection, relating to continence management and pressure care have both been complied with. During the inspection a number of staff, including the acting manager were observed walking into service users’ rooms without knocking. When asked if staff usually knock on bedroom doors before entering one service user said, “No, they don’t do anything like that”. It was particularly worrying that the acting manager was not modelling this good practice. This issue needs to be addressed and a requirement has been issued in the relevant section of this report that all care plans detail how service users privacy is to be maintained. Two service users with advanced dementia share a room. The review notes seen for one of these service users indicated that the service user would only stay in her room if she became very disruptive. Records examined however indicated that she, and the other service user, have remained in their room for months. This does not indicate that service users with dementia are being properly supported. Although staff said they visit the two service users regularly there was no evidence that other behaviour management strategies had been attempted. A requirement has been issued that all service users with dementia undertake an appropriate assessment, by professionals trained to do so, in order to identify needs and ensure that the home meets these needs. The records in relation to the receipt, administration and disposal of medication were detailed and accurate. A requirement issued at the last inspection that service users wishes in the event of their death are recorded has now been complied with. Care plans also indicated where a service user has not wanted to discuss this issue. Sonesta Nursing Home Version 1.10 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) 12 and 15 Little effort has been made to find out what individual service users enjoy doing and how staff are to support them to carry out meaningful activities. The home provides a wholesome, appealing and balanced diet. however service users’ wishes in relation to what they want to eat must be recorded and respected. EVIDENCE: A requirement was issued at the last inspection that daily records include how the social and emotional goals (as identified in care plans) are to be met. This has still not been complied with and is again restated. A recommendation was also issued that the activities coordinator undertakes training in activities particularly for people with dementia. The registered provider informed the inspector that she had personally provided this training. However it was impossible to assess the effectiveness of this training as the vast majority of daily reports indicated that service users spent the day “watching television and listening to music”. During the inspection the staff were seen playing bingo with service users. One service user commented that there is, “not much to do”. Lunch was relaxed and enjoyable. Staff were sitting with service users providing discreet assistance as needed. Service users were generally positive regarding the quality of food. Some service users were not sure if a choice was Sonesta Nursing Home Version 1.10 Page 13 offered at lunch time, however the cook and registered provider informed the inspector that two different hot meals were provided each day. Service users’ individual likes and dislikes were not being recorded and one service user, when asked what happens if they don’t like the meal said “you just get on with it”. This could be avoided if staff were aware of what service users’ like and dislike to eat. A requirement relating to this has been made in this report. One service user’s plan clearly identified that they were vegetarian. The cook and the acting manager appeared to be unaware of this and the service user had been receiving pureed meat. The fact that the service user has dementia indicates that staff are unaware of the needs and rights of service users with dementia. The registered provider informed the inspector that she would make sure that the service user was given a vegetarian meal from now on. A requirement that all service users, including those with dementia, are provided with the diet appropriate to their needs and wishes has been issued. Sonesta Nursing Home Version 1.10 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 Generally the home deals with complaints well but the manager or registered provider must ensure that written responses are given to complainants so they have a record of how the home is addressing the complaint. EVIDENCE: The record of complaints was examined. There have been five complaints since the last inspection. Four of these complaints have been dealt with according to the home’s policy. However there was no written outcome for one complaint received by the home. The registered provider must ensure that all complainants receive a written response to their complaints. A requirement relating to this has been issued in the relevant section of this report. Sonesta Nursing Home Version 1.10 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 Sonesta Nursing Home has a warm, friendly and comfortable atmosphere. There are some minor repair issues but the home is generally accessible, safe and maintained to a satisfactory standard. EVIDENCE: Two requirements were issued at the last inspection. The requirement that the flooring in the ground floor bathroom is cleaned has been complied with as all bathrooms in the home have new flooring. The second requirement that all bedrooms have a lockable cupboard has not been complied with. However the registered provider informed the inspector that all service users could have a lockable, metal box in their room. Two of these were seen during the inspection. The premises were found to be clean, tidy and free of offensive odours. The laundry facilities were seen, and the equipment appeared to be satisfactory with the appropriate sluice specification. However the laundry floor is in need of repair. The flooring in the food store also needs repairing. Some radiators in service users’ en suite bathrooms were not covered and could present a risk of injury. Sonesta Nursing Home Version 1.10 Page 16 Three requirements relating to these issues have been made in the relevant section of this report. Sonesta Nursing Home Version 1.10 Page 17 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 staff working at the home are kind, caring and supportive. Service users are protected by good staff recruitment policies and procedures. EVIDENCE: The registered provider informed the inspector that the staffing ratio has not changed since the last inspection and is inline with the Department of Health’s “No regression” policy. There appeared to be sufficient staff on duty at the time of the inspection and service users confirmed that staffing levels were satisfactory. Service users that the inspector spoke with were positive about the staff and one service user commented that the staff are, “very good”. Care staff interviewed said there were good working relationships between the care staff and nursing staff. All staffing files examined contained the required information including CRB checks, two references and proof of identity. Sonesta Nursing Home Version 1.10 Page 18 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, 33, 37 and 38. The acting manager does not have a clearly defined role in the home and this is leading to confusion among some staff and outside professionals. Quality monitoring systems could be improved so that the registered providers can better measure their success in meeting the aims and objectives of the home. There are good systems in place to monitor health and safety compliance and protect the safety and welfare of service users and staff. EVIDENCE: The home now has an acting manager. The acting manager has not yet registered with the CSCI nor has he started the required management training. Staff appeared confused as to who was the manager and it appears that the majority of the roles and responsibilities of the manager are being taken on by the registered provider. The registered provider also informed the inspector that the home was still in the process of recruiting a manager. This uncertainty presents problems with the overall management of the home. Comments Sonesta Nursing Home Version 1.10 Page 19 received by the CSCI by social workers indicated that it was not always clear who was the manager of the home. A requirement that the manager must apply to be registered and undertake the appropriate training has been issued in the relevant section of this report. A questionnaire is produced twice a year to monitor quality issues however these are not given to outside professionals who liase with the home. It was suggested that this take place. Discussion also took place about quality monitoring taking place with service users during their monthly care pan review. A recommendation relating to this has been issued. The registered provider informed the inspector that there were no concerns as to the financial viability of the home and a satisfactory business plan was examined. The registered provider is appointee for three service users but indicated that she was in the process of transferring this responsibility to the relevant local authorities. Examination of records within the home indicated that the health, safety and welfare of service users and staff were being safeguarded. The accident book indicated that falls by service users were being recorded with appropriate action taken and service users risk assessments updated where necessary. Fire records were found to be up to date including weekly alarm tests and fire drills for day and night staff. Sonesta Nursing Home Version 1.10 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x 1 x 3 x x x 3 3 Sonesta Nursing Home Version 1.10 Page 21 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 12 Regulation 16(2)(m) (n) Requirement The registered person is required to ensure that daily records include progress on goals identified in the care plans including social and emotional aspects. (Timescale of 01/08/04 and 01/02/05 not met) 2. 7 15(1) This requirement is restated. The registered provider must 01/08/05 ensure that all care plans clearly identify how the social, recreational and emotional needs of service users are to be met by staff at the home. (Timescale of 01/08/04 and 01/02/05 not met) 3. 3 14(1) This requirement is restated. The registered provider must ensure that all potential service users have a full assessment before moving into the home. This assessment must include all the requirements of standard three of the National Minimum Standards for Older People. 01/08/05 Timescale for action 01/08/05 Sonesta Nursing Home Version 1.10 Page 22 4. 3 14(1)(d) 5. 4 10(1) 6. 4 12(1)(a) 7. 7 14(2) 8. 10 12(4)(a) 9. 15 12(4)(b) 10. 15 12(4)(b) 11. 12. 19 19 23(2)(b) 23(2)(b) The registered provider must ensure that all potential service users are given written confirmation that the home can meet all of thier assessed needs before they move in to the home. The registered provider must apply to the CSCI for either a minor variation for the existing service users who have dementia or for a major variation to enable service users with dementia to be admitted to the home. The registered provider must ensure that all staff undertake dementia training and are provided with ongoing support to ensure that service users with dementia are appropriately cared for. The registered provider must ensure that all service users with dementia are appropriatley assessed in order to ensure that all their needs are being met by the staff at the home. The registered provider must ensure that all staff are aware of the need to maintain service users privacy at all times. The registered provider must ensure that all service users likes and dislikes are recorded on plan of care. The registered provider must ensure that all service users, including those with dementia recieve the appropriate diet as per their wishes. The registered provider must ensure that the flooring in the laundry is replaced. The registered provider must ensure that the flooring in the food storage area is either repaired or replaced. Version 1.10 01/08/05 01/09/05 01/11/05 01/09/05 01/08/05 01/08/05 01/08/05 01/10/05 01/10/05 Sonesta Nursing Home Page 23 13. 19 13(4)(a) 14. 31 8(1) 15. 31 9(2) The registered provider must ensure that any radiators in service users en suite bathrooms are fitted with a guard. The registered provider must ensure that the acting manager applies to the CSCI for registration. The registered provider must ensure that the acting manager undertakes the appropriate management training. 01/09/05 01/09/05 01/09/05 16. 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. 2. Refer to Standard 33 33 Good Practice Recommendations The registered provider should try and obtain regular feedback from outside proffessionals in order to monitor quality issues at the home. The registered provider should incorporate quality assurance monitoring as part of the monthly care plan review with service users. Sonesta Nursing Home Version 1.10 Page 24 Commission for Social Care Inspection 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 © 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 Sonesta Nursing Home Version 1.10 Page 25 - 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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