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Inspection on 02/02/06 for Southbank Nursing Home

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

This inspection was carried out on 2nd February 2006.

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

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

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

During the inspection there was evidence of positive interaction between staff and residents.

What has improved since the last inspection?

Since the last inspection the home had started a programme of decoration, repair and maintenance throughout the home. Progress had started on the purchase of new chairs and furniture however some areas remained in urgent need of redecoration. This programme of repainting, decorating, carpeting and the provision of new profiling beds, pressure relieving mattresses and furniture has improved considerably over the last 7 weeks. The trolley shower room on the Young Physically Disabled Unit had been decorated. Extra lights had been fitted on the corridor in Delamere and plans to review and replace the lighting had been made. Some improvements were noted in the medication administration records in relation to the recording of the date the drugs were administered. All staff had received training in the Protection of Vulnerable Adults since the last inspection.

What the care home could do better:

The information provided for prospective service users and their relatives/advocates must be reviewed and updated. The standard of recording in the care plans to ensure they cover all the health, personal and social care needs of the residents require improving. The care plans must contain detailed information including risk assessments so the staff caring for the residents have all the information needed to meet resident`s needs. Staff training must be provided to ensure the staff have the necessary skills to make sure that the residents needs are being correctly met. The homes staff recruitment must ensure that the necessary Criminal Records Bureau Disclosures checks are done to protect the residents.

CARE HOMES FOR OLDER PEOPLE Southbank Nursing Home 1-2 Cavendish Road Bowdon Altrincham Cheshire WA14 2NJ Lead Inspector Elizabeth Holt Unannounced Inspection 2nd February 2006 12:00 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 Southbank Nursing Home DS0000006722.V278648.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. Southbank Nursing Home DS0000006722.V278648.R01.S.doc Version 5.1 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.V278648.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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. 28th September 2005 3. 4. 5. 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 are not occupied due to difficult access). Five of these bedrooms are double rooms. Bedroom accommodation in Delamere consists of 16 bedrooms, 7 of which are double. One is currently used as a single room. Passenger lifts are available in both buildings. The home is within easy reach of Altrincham town centre Southbank Nursing Home DS0000006722.V278648.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 carried out on Thursday 2 February 2006, starting at 12.00pm. During the course of the inspection time was spent talking to the Registered Manager, some residents and staff members to find out their views of the home. Time was spent examining records, documents, residents and staff files and a tour of the home was carried out. On the day following this inspection a visit was made by the Commissioning Service Manager who identified a number of concerns particularly in relation to the poor standard of furniture, furnishings, equipment, and décor which confirmed the requirements of the report by the Commission for Social Care Inspection carried out in September 2005. Concerns were also raised about a lack of activities and little interaction between residents and staff was observed. Following these concerns an action plan was developed by the home and 3 further joint visits to the home in February, March and April 2006 has shown a commitment to the home making improvements both environmentally and in relation to staff training.. During this inspection only a selection of key National Minimum Standards were assessed, therefore to gain a full picture of how the home meets the needs of residents, this report should be read in conjunction with previous reports. What the service does well: What has improved since the last inspection? Since the last inspection the home had started a programme of decoration, repair and maintenance throughout the home. Progress had started on the purchase of new chairs and furniture however some areas remained in urgent need of redecoration. This programme of repainting, decorating, carpeting and the provision of new profiling beds, pressure relieving mattresses and furniture has improved considerably over the last 7 weeks. The trolley shower room on the Young Physically Disabled Unit had been decorated. Extra lights had been fitted on the corridor in Delamere and plans to review and replace the lighting had been made. Southbank Nursing Home DS0000006722.V278648.R01.S.doc Version 5.1 Page 6 Some improvements were noted in the medication administration records in relation to the recording of the date the drugs were administered. All staff had received training in the Protection of Vulnerable Adults since the last inspection. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Southbank Nursing Home DS0000006722.V278648.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 Southbank Nursing Home DS0000006722.V278648.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): 1 and 6 Information was not up to date to allow residents and their advocates to make choices. EVIDENCE: The Statement of Purpose was reviewed and requires updating.. The Service User’s Guide was not readily available at the time of the inspection. The home did not provide an intermediate care service. Southbank Nursing Home DS0000006722.V278648.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, 9 and 10 Although each resident had an individual plan of care, limited progress has been made on improving the documentation to ensure that the healthcare needs of residents are met. Some shortfalls re medication practice and the documentation have a potential to place residents at risk. EVIDENCE: A sample of care plans were seen and little progress has been made on the requirement made at the last inspection to ensure that these identify all aspects of health, personal and social care and involve the resident or their representative where possible. The manager informed the inspector that they had discussed care plans at a staff meeting and have discussed starting a communications file with some relatives. The requirement made at the last inspection to include detailed risk assessments in the care plans had not been addressed. The manager advised the inspector that she was planning to provide a course on the risk assessment process. Some of the shortfalls identified during this inspection are detailed below: Southbank Nursing Home DS0000006722.V278648.R01.S.doc Version 5.1 Page 10 a) The care plan contained detailed daily statements in relation to the health and well being of the resident which led to his hospital admission, however the standard of wording was variable and requires some attention to detail. A discussion with the manager highlighted this was possibly due to English being a second language for a number of the nursing staff. It was pleasing to see that training was in place for the staff. b) There was a risk assessment in place however this lacked detail in the risks associated with the management of epilepsy. c) A care plan stated that oxygen had been administered to a resident in the event of an acute episode. A discussion with a staff member showed he lacked knowledge regarding the administration of oxygen therapy. This must be prescribed and be in line with a care plan and risk assessment for this resident. The policy requires updating and nursing staff require guidance and training regarding the administration of oxygen therapy. The medication administration record for this resident was poorly recorded and must be addressed as a matter of urgency. d) The care plans for residents who required their blood glucose levels monitoring were inadequately detailed and did not reflect that each resident had their own lancing device. The infection control policy must be reviewed to include this and staff advised appropriately. The storage of both oxygen cylinders and equipment for residents who no longer resided at the home must be disposed of appropriately. e) The letters from the General Practitioners in relation to the administration of homely remedies require reviewing to include the particular homely remedies each individual resident is able to be given. f) Examination of one of the medication administration records showed that the time for the administration of the antibiotic prescribed was 10.00, 18.00 and 22.00 hours. The registered nurse must be confident/competent to question the GP to ensure the administering times are appropriate. It was pleasing to see that following a requirement made at the last inspection an updated staff specimen signatures list was available for all registered nurses who administer medication. At the time of this inspection, approximately 8 residents had cold/flu like symptoms. A discussion with the manager highlighted the need to revise the home’s infection control policy and to remind staff of the importance of appropriate hand washing and personal hygiene techniques. At the time of this inspection the home had 6 residents with pressure sores. Some of these were acquired prior to their admission to Southbank Nursing Home. Specialist input/advice was being sought from the Tissue Viability Nurse. Southbank Nursing Home DS0000006722.V278648.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): 13 and 14 Relatives were encouraged to visit the home and residents who could express a view felt they had some variation and control over their lives. EVIDENCE: The lunchtime meal of a choice of fresh fish and a choice of desert was seen and residents spoken to were complimentary about the food provided. There was evidence that the staff were keen to discover the individual likes and dislikes of residents food preferences and provided this where possible. Mealtime was a sociable occasion for some of the residents and some residents chose to eat in the privacy of their bedroom. A discussion with the manager focused on residents on the Southbank unit, who received their meals on small tables in front of them and how this could be made into a more sociable time. It was pleasing to see that the furniture in the large lounge had been rearranged to create two more homely sociable areas within this room for residents to sit. Some of the televisions were seen to be on a programme that none of the residents were engaged in watching. Following a further visit to the home the manager has proposed to discuss programmes with residents and purchase a weekly television guide to assist them in this decision making process. One relative said “the staff are brilliant”, “she is well fed” and “I am rung at home if she has a fall or if there are any Southbank Nursing Home DS0000006722.V278648.R01.S.doc Version 5.1 Page 12 changes in her health.” Residents who could express a view said they were able to get up and go to bed at a time suitable to themselves. In residents’ bedrooms there were a number of personal belongings ranging from photographs to small pieces of furniture that residents or family members had brought into the home. Southbank Nursing Home DS0000006722.V278648.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 Residents/relatives are aware of the home’s complaints procedure EVIDENCE: Following a requirement made at the last inspection for staff to receive training in Adult Protection, it was pleasing to see this had been addressed. Staff spoken to were positive about what they had learnt and were clear on the action they would take in the event of an allegation of abuse. One complaint has been received by the Commission for Social Care Inspection in the last year alleging poor care practice ,this was partially upheld. Southbank Nursing Home DS0000006722.V278648.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): 25 Upgrading of the home is required to make the living areas for residents safe and comfortable. EVIDENCE: Following a number of requirements made at the previous inspection it was noted that some improvements to the décor had been started. A programme of decoration was in place and the full audit required of bedroom furniture and furnishings had not yet been fully addressed. The timescales for some of the requirements made had not been reached at the time of this inspection and a meeting was planned with the area manager to action plan this. Some attention had been paid to the dim lighting in the corridor and plans were being made to provide additional lighting in other bedrooms requiring this. Southbank Nursing Home DS0000006722.V278648.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): 28, 29 and 30 The home was not able to clarify the specific training that each staff member had undertaken. The recruitment process does not fully ensure that staff are safe to work with vulnerable adults. EVIDENCE: Although there appeared to be a commitment to staff training and one staff member had just completed an assessors course for Moving and Handling, the staff training records were not available at the time of this inspection. A requirement was made that all staff have an individual training and development plan that highlights the mandatory training undertaken and any refresher training. Whilst the inspection was being carried out a number of staff were attending a course in English as a second language for overseas students. Staff informed the inspector that they had undertaken study days but were not specific about these courses, saying that they could not remember them. There were no staff vacancies at the time of the inspection. The home’s system for the recruitment of staff is held at the Head Office. Copies of the required information for example, an application form, 2 written references, were held on file in the home. Southbank Nursing Home DS0000006722.V278648.R01.S.doc Version 5.1 Page 16 Criminal Records Bureau disclosures for staff employed were available, however some of these were “standard” rather than “enhanced” checks and others required updating from the current place of employment. Southbank Nursing Home DS0000006722.V278648.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 ,35 and 36 There is a lack of leadership and guidance to the staff to ensure the residents are receiving a consistent quality of care. This results in some care practices that do not always promote and safeguard the health, safety and welfare of residents. EVIDENCE: The home’s manager was on duty on the day of the inspection. While three visitors to the home were positive about the staff team generally, the manager when questioned was not clearly aware of the health status of the residents accommodated. The recording in the care plans and conversations with staff members gave some examples of poor practice and staff not always being fully aware of what was expected of them. A discussion with the manager focused on the possibility of a senior nurse taking a more clinical lead within the home to ensure that standards of nursing care and attention to detail are provided and maintained. Southbank Nursing Home DS0000006722.V278648.R01.S.doc Version 5.1 Page 18 The home carries out a quality assurance self audit questionnaire which seeks the views of residents and relatives. Relatives meetings were advertised 6 monthly however the attendance was zero at the recent one. At the time of this inspection the home did not have a list of personal allowances for any residents accommodated. This information was held at the Head office and will be followed up on the next inspection. It was pleasing to see that the manager had developed a new format for the supervision of staff to include their personal performance and review. This had not commenced at the time of the inspection. All care staff are required to receive formal supervision at least 6 times a year. Southbank Nursing Home DS0000006722.V278648.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X X X X 2 X STAFFING Standard No Score 27 X 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 2 X x Southbank Nursing Home DS0000006722.V278648.R01.S.doc Version 5.1 Page 20 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 OP1 Regulation 4 Requirement The Responsible Individual must ensure that an up to date Statement of Purpose and Service User Guide is available. 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. 2.The plans of care must include detailed risk assessments to ensure unnecessary risks to the health or safety of residents are so far as possible eliminated. (Previous timescale of 05/01/06 had not been met). The Responsible Individual must ensure that staff administering medication adhere to the guidance issued by the Royal Pharmaceutical Society and the Nursing and Midwifery Council in respect of the safe receipt, and administration and disposal of medication. DS0000006722.V278648.R01.S.doc Timescale for action 12/06/06 2 OP7 15 31/05/06 3 OP9 13 30/04/06 Southbank Nursing Home Version 5.1 Page 21 The Responsible Individual must ensure medication is administered in strict accordance with the prescriber’s directions. Staff administering medication must be up to date with current practice and have their competency assessed. 4 OP7 18(1)a Staff must receive training in Infection Control and in the administration of oxygen therapy. A full audit of the home in particular the bedrooms and furnishings is required to ensure that all parts of the home are kept clean, reasonably decorated and furniture is adequate. (Previous timescale of 30/01/06 had not been met). Evidence must be available of staff training. The Responsible Individual must ensure that Enhanced Criminal Records Bureau disclosures are obtained for each staff member employed in the home who is in direct contact with the residents. 15/05/06 5 OP19 16 & 23 30/05/06 6 7 OP30 OP29 18(1) 19 12/06/06 24/04/06 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 Southbank Nursing Home DS0000006722.V278648.R01.S.doc Version 5.1 Page 22 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.V278648.R01.S.doc Version 5.1 Page 23 - 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!