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Inspection on 16/11/06 for Southbank Nursing Home

Also see our care home review for Southbank Nursing Home for more information

This inspection was carried out on 16th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The relationships between the residents and the staff were generally friendly. The home made sure that prospective residents were assessed before the offer of a place was confirmed. The residents and relatives were pleased with the care their relative received. One relative said, "The staff are kind, friendly and willing to assist". The staff showed a knowledge and understanding of the needs of the residents. The home showed a commitment to staff development and training. The home provided a relaxed and friendly environment. A choice of menu was available and staff did make an effort to make the mealtimes into a sociable occasion. The kitchen was well stocked with food.

What has improved since the last inspection?

A requirement made at the last inspection to review the care plans and the risk assessments had been acted upon. However, some further improvements were required. Since the last inspection it was noted that the environment had generally improved including that of a number of bedrooms and the lounge areas. A programme of upgrading and redecoration was on-going. The medication systems in place had improved since the last inspection.

What the care home could do better:

Although plans of care were available for each resident and there was evidence of improvement since the last inspection, shortfalls identified had the potential to put residents at risk and the care plans and documentation must accurately reflect the needs of the residents. Care plans must include support with oral hygiene and attention to finger nails. The home must put the necessary arrangements in place to keep the home free from offensive odours. This would help to maintain a pleasant environment. The manager must ensure that all staff are fully aware of the potential signs of abuse and record and report any concerns appropriately. The staffing levels/deployment of staff must be reviewed in line with the dependency needs of the residents to ensure the appropriate number and skill mix of staff are on duty to meet the residents` assessed needs at any one time. The home must ensure the social/recreational needs of all residents accommodated are met and appropriate levels of stimulation are provided.

CARE HOMES FOR OLDER PEOPLE Southbank Nursing Home 1-2 Cavendish Road Bowdon Altrincham Cheshire WA14 2NJ Lead Inspector Elizabeth Holt Unannounced Inspection 16th November 2006 10:30 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 Southbank Nursing Home DS0000006722.V298266.R01.S.doc Version 5.2 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. Southbank Nursing Home DS0000006722.V298266.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Southbank Nursing Home Address 1-2 Cavendish Road Bowdon Altrincham Cheshire WA14 2NJ 0161 927 7200 0161 929 0042 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) www.craegmoor.co.uk Parkcare Homes (No. 2) Limited Ms Dawn Adey Care Home 58 Category(ies) of Old age, not falling within any other category registration, with number (48), Physical disability (10) of places Southbank Nursing Home DS0000006722.V298266.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. All service users require general nursing care. The overall number of service users for whom accommodation is provided at any one time shall not exceed 58 (a maximum of 48 older people and 10 younger adults with a physical disability). Service users requiring care by reason of old age shall be aged over 60 years. Service users requiring care by reason of physical disability shall be aged over 18 years and shall be accommodated on the first floor of the building Minimum staffing levels as specified in the Notice issued under Section 25(3) of the Registered Homes Act and dated 12 July 2000 shall be maintained. 2nd February 2006 Date of last inspection Brief Description of the Service: Southbank Nursing Home provides 24 hour nursing care and accommodation for 48 older people and 10 young adults with a physical disability. The home consists of two large detached Victorian buildings where an indoor link corridor connects them. Southbank is the first building which contains the Young Disabled Unit and Delamere is the name of the second building. In the Southbank building there are 19 bedrooms (4 were not occupied due to difficult access). Five of these bedrooms were double rooms. Bedroom accommodation in Delamere consisted of 16 bedrooms, 7 of which are double. One is currently used as a single room. Passenger lifts were available in both buildings. The home is within easy reach of Altrincham town centre. Southbank Nursing Home DS0000006722.V298266.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on 16th November 2006. All the key National Minimum Standards (NMS) were reviewed during this inspection. The pre inspection questionnaire sent to the home was not received by the Commission for Social Care Inspection (CSCI) before the visit took place. Time was spent talking to the residents, their relatives, the manager and the staff team about the day to day life in the home and to establish what the home was like for the residents living there. A tour of the premises was undertaken and examination of documents and care files for individual residents also took place. As part of the inspection process, ten questionnaires were left with the manager to be given to residents/relatives in order to give them an opportunity to say how they found the service provided by the home. Two completed questionnaires were returned to the CSCI. What the service does well: What has improved since the last inspection? A requirement made at the last inspection to review the care plans and the risk assessments had been acted upon. However, some further improvements were required. Since the last inspection it was noted that the environment had generally improved including that of a number of bedrooms and the lounge areas. A programme of upgrading and redecoration was on-going. The medication systems in place had improved since the last inspection. Southbank Nursing Home DS0000006722.V298266.R01.S.doc Version 5.2 Page 6 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. Southbank Nursing Home DS0000006722.V298266.R01.S.doc Version 5.2 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 Southbank Nursing Home DS0000006722.V298266.R01.S.doc Version 5.2 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 and 6 Quality in this outcome area is good. This judgement has been made using available evidence and a visit to the home. Care needs of prospective residents were assessed before they are admitted to the home. EVIDENCE: Since the last inspection the Statement of Purpose had been reviewed and updated. However, this required some further updating following changes in the staffing of the home. For residents who were referred through Care Management arrangements the home obtained a summary of the Care Management Assessment prior to admission. The pre admission assessment involved the prospective resident wherever possible and his/her representative and any relevant professionals. The home did not provide an intermediate care service. Southbank Nursing Home DS0000006722.V298266.R01.S.doc Version 5.2 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans were available for each resident but some areas of the care plans had shortfalls which had the potential to put residents at risk. Medication procedures were being adhered to. EVIDENCE: A requirement made at the last inspection visit involved the need for care plans to accurately reflect the residents’ assessed needs and to provide accurate information for the staff to be able to meet in full the resident’s health and welfare needs. The manager had held a workshop with staff to inform them of the detail required in the documentation and those care plans examined did show some improvements including recordings of recent reviews. The evaluations in the documents were detailed. The daily statements in the care plans were generally detailed and showed the care given. It was noted that when residents had been assessed as having a high Waterlow score, a pressure-relieving mattress was provided. Southbank Nursing Home DS0000006722.V298266.R01.S.doc Version 5.2 Page 10 The serious shortfalls noted included the following; a) The risk assessment had not been updated to reflect a recent review and assessment by the speech therapist. This review included that medication administered to the individual must be of a ‘custard’ consistency. Lack of including such important information in the risk assessment could place the resident at significant risk. b) It was of concern that one of the residents had evidence of bruising to her left eye. None of the staff on duty could offer any explanation regarding this. One entry in the daily statement stated, ‘bruising to left eye’ and commented that a photograph was taken. There was no follow up to this recording. The manager was unaware of this and it appeared that the appropriate course of action was not put into practice. c) The fluid balance records or the pressure relief charts on the Younger Physically Disabled unit had not been completed when these were reviewed at 12.00 noon. A discussion with the staff highlighted that they found this difficult to carry out, however it was clear that the care and the fluids had been provided. It is required that staff review the need to complete these records and if required they must be completed following the care/treatment delivered and not retrospectively. The manager appeared to be more aware of the health care needs of the residents accommodated and was up to date with information regarding any wounds present in the home and their management. Residents were registered with local General Practitioners and had access to visiting healthcare professionals. In response to a requirement made following concerns raised in May 2006 the home had provided medication training for the nursing staff responsible for its administration. The medication administration record charts (MARs) were clearly recorded and the prescriber’s directions were followed. From observations made during the inspection and discussions with members of staff, visitors and residents it appeared that the nurses and care staff treated the residents with respect and dignity. Residents and relatives spoken to during the inspection were very pleased with the care they received. Southbank Nursing Home DS0000006722.V298266.R01.S.doc Version 5.2 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities were provided and residents were encouraged to maintain contact with family and friends. Residents could exercise some choice over their daily lives and received a balanced and nutritious diet. EVIDENCE: The home provided a programme of activities for the month ahead which includes a variety of events including; visiting entertainers, bingo and in house celebrations. There was some evidence of staff promoting activities on a one to one basis during the inspection on one of the units, however on Delamere there was no evidence of any activities/stimulation being provided. It is recommended that social activities carried out are included in the recording in the individual’s care plan. The home had an open visiting policy and visitors could be received in the resident’s own room or any of the communal areas of the home. Southbank Nursing Home DS0000006722.V298266.R01.S.doc Version 5.2 Page 12 From speaking to residents and staff it appeared that residents were able to exercise some choice and control over their lives. One resident said, “The staff are very kind and come and chat to me”. One service user commented that he had to wait a lengthy period of time to be taken to the bathroom. This was raised with the manager and the staff acted upon the resident’s wishes. Evidence was seen that residents could bring personal possessions into the home. The menus offered a varied, wholesome and nutritious diet. The chef said he would prepare an alternative if a resident did not want the particular choice available. Southbank Nursing Home DS0000006722.V298266.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had the systems and procedures in place that allowed people to express their complaints/concerns. People were not fully protected from abuse. EVIDENCE: The home had a complaints procedure and residents/relatives spoken to were aware of how to make a complaint. There were a number of concerns noted in a service user’s plan of care that had been raised by a relative. A discussion with the manager showed she had spoken with this relative at length but there was no record held on file. It is strongly recommended that the manager records the outcomes of discussions held to show she has acted upon the information provided. One complaint had been investigated by social services since the last inspection and it appeared the concerns had been addressed following a review of the service user’s needs, however, the relatives were concerned that the homes’ response was reactive rather than pro active. Policies and procedures were in place to help the staff protect the residents from harm or abuse. Staff training records showed staff had received training in the Protection of Vulnerable Adults. The home must ensure staff clearly understand the potential indicators of abuse and record appropriately in the Southbank Nursing Home DS0000006722.V298266.R01.S.doc Version 5.2 Page 14 care plans any evidence of bruising. Staff may require further training to ensure they record the necessary information and report this appropriately. Southbank Nursing Home DS0000006722.V298266.R01.S.doc Version 5.2 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 the following standard(s): 19 and 26 Quality in this area outcome is good. This judgement has been made using available evidence including a visit to this service. The environment was not safe and the staff’s safety could be compromised due to poor health and safety practice. The home was generally well maintained however there were some unpleasant odours. EVIDENCE: Facilities were available to ensure the home was accessible to all. An internal passenger lift was available between floors. There was an on going programme in place to redecorate and refurbish the home and it was noted that since the previous inspection a number of bedrooms and the lounge on Delamere had been redecorated. Communal rooms contained comfortable furniture which met the resident’s needs. During a tour of some of the rooms it was noted that staff could not access both sides of the bed when residents were being nursed in bed. This could compromise staff’s health and safety. Southbank Nursing Home DS0000006722.V298266.R01.S.doc Version 5.2 Page 16 Some areas of the home had an unpleasant odour and responses in the service users questionnaires indicated that at times unpleasant odours were present in the home. Southbank Nursing Home DS0000006722.V298266.R01.S.doc Version 5.2 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 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Policies and procedures were in place to ensure that suitable people were employed to care for vulnerable people. The number of staff on duty did not appear to fully meet the needs of all the residents. EVIDENCE: Forty three residents were accommodated in the home at the time of the inspection. During the visit staff were observed to be busy and the dependency needs of the residents was high. There were a number of residents being nursed in bed due to their poor health status and following a visit to a number of these residents it appeared their needs were not always fully met. A number of residents’ finger nails were lengthy and required cleaning. Three residents appeared to be lay in positions that were uncomfortable and required attention, two residents required oral hygiene needs meeting and other residents did not appear to have received attention from staff members for a period of time. Documentation available did not support the time of the nursing care interventions. One resident said the staff were great but another resident said they were always busy and did not have the time often to “sit and chat”. The manager must ensure the deployment and number of staff are sufficient to meet the assessed needs of the residents’. Southbank Nursing Home DS0000006722.V298266.R01.S.doc Version 5.2 Page 18 Discussions between residents and staff were observed to be positive and it was evident the staff knew the residents well. The home had a recruitment policy. The contents of several staff files were assessed and it was pleasing to see these contained the appropriate information in line with the regulations. One staff members file held a copy of a serious incident letter. A discussion with the manager highlighted the need to record the incident/copies of statements, training needs identified and the outcome on the individual members file. A recommendation was made to include interview notes as part of the recruitment process. A system was in place to identify staff training and development needs. Not all staff had received the required mandatory training but plans were in place to address this. Staff stated they found study days interesting and relevant to their daily work. Southbank Nursing Home DS0000006722.V298266.R01.S.doc Version 5.2 Page 19 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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had the systems in place to monitor the service based on the people’s views. Improvements in the leadership of the home have led to the health, safety and welfare of service users and staff being promoted and protected. EVIDENCE: On the days of the inspection the home’s manager was on duty. The manager was aware of the health status of the residents accommodated and had made considerable improvements in overseeing the needs of these residents. A new area manager had been appointed since the last inspection and the manager was finding her encouraging and supportive in her role. Southbank Nursing Home DS0000006722.V298266.R01.S.doc Version 5.2 Page 20 The home had a quality audit questionnaire to seek the views of residents/relatives. A residents/relatives evening had been held in October 2006 and minutes from this evening were made available. Changes had been made to the way in which residents’ personal allowance was managed and was now on a computerised system. The administrator had just received training in this system and was not able to access the required information at the time of the inspection. The system was explained and will be reviewed at the next inspection. The home were due to have a new fire risk assessment the day following this inspection and a new system was to be implemented for the recording of the monitoring and testing of the fire equipment, safety checks. The last fire drill was recorded on the 1.08.06. An action plan was available following the fire officers’ inspection report of 2 October 2006. Southbank Nursing Home DS0000006722.V298266.R01.S.doc Version 5.2 Page 21 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Southbank Nursing Home DS0000006722.V298266.R01.S.doc Version 5.2 Page 22 No 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 Regulation 15 Requirement 1.Residents care plans must contain sufficient and accurate information to provide staff of the actions to be taken to meet in full the residents’ health and welfare needs. Staffing levels must be reviewed in line with the dependency needs of the residents accommodated to ensure that people’s needs are appropriately met. Timescale for action 31/01/07 2. OP27 18 31/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP18 Good Practice Recommendations It is strongly recommended that the manager ensures staff are familiar with the Vulnerable Adults Policy and that a rolling programme of training be maintained in this subject. DS0000006722.V298266.R01.S.doc Version 5.2 Page 23 Southbank Nursing Home 2 OP18 It is strongly recommended that all information relating to a complaint be appropriately recorded and maintained for future reference. Southbank Nursing Home DS0000006722.V298266.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ 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 Southbank Nursing Home DS0000006722.V298266.R01.S.doc Version 5.2 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!