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Inspection on 28/09/05 for Southbank Nursing Home

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

This inspection was carried out on 28th September 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.

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 home assessed prospective residents care needs before their admission to the home. It was evident that residents had a good rapport with the staff. One resident said, "the staff are kind and the food is excellent. It`s always hot". Residents and relatives spoken to were positive about the staff in the home. Mealtimes appeared to be a relaxing, social occasion and comments regarding the quality and quantity of food were positive.

What has improved since the last inspection?

Care planning had improved since the last inspection however some improvements were required to personalise these and involve residents/relatives in the drawing up of their relatives care plan. Since the last inspection new furniture had been purchased for ten residents bedrooms which included a lockable drawer. Four bedrooms had been redecorated since the last inspection. The lounge in Southbank had been re-carpeted since the last inspection and some building work was being undertaken to create a new shower room and toilet. Other improvements since the last inspection included a replacement of a number of `failed` double glazed window units.

What the care home could do better:

Risk assessments require development and the staff may require some training in the development of these. Involvement of relatives/residents in the development of individual care plans requires recording in the care plan. Accurate recording for medication administered must be carried out. There was limited evidence to show that activities in all areas of the home had been planned and/or recorded in the individual plan of care. Staff were required to undertake training in Adult Protection immediately following the inspection. An action plan has been received by the Commission to indicate that all staff are booked for a training session to include local policy application and the referral system. An immediate requirement was made during the inspection for all staff to receive up to date Moving and Handling training by an appropriately trained person and to ensure this is borne out in practice. A full audit was required of a number of bedrooms fixtures, light fittings furnishings and floor coverings. Some of these required addressing as a matter of urgency.

CARE HOMES FOR OLDER PEOPLE Southbank Nursing Home 1-2 Cavendish Road Bowdon Altrincham Cheshire WA14 2NJ Lead Inspector Elizabeth Holt Unannounced Inspection 28th September 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Southbank Nursing Home DS0000006722.V254539.R01.S.doc Version 5.0 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.V254539.R01.S.doc Version 5.0 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) 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.V254539.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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. 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. All service users require general nursing care. 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 23 January 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 with ease of access to public transport, local shops, parks and the motorway system. Southbank Nursing Home DS0000006722.V254539.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the home’s first annual unannounced inspection visit for the year, which took place over two days over ten and a half hours. This inspection looked at a selection of the key National Minimum Standards therefore this report should be read together with the earlier report and any future reports to get a full picture of how the home is meeting the needs of residents living there. During this inspection not all the requirements from the previous inspection had been addressed and these have been included in this report. Since the last inspection the Commission for Social Care Inspection have received two complaints. One was up-held in part and the other is still under investigation. What the service does well: What has improved since the last inspection? Care planning had improved since the last inspection however some improvements were required to personalise these and involve residents/relatives in the drawing up of their relatives care plan. Since the last inspection new furniture had been purchased for ten residents bedrooms which included a lockable drawer. Southbank Nursing Home DS0000006722.V254539.R01.S.doc Version 5.0 Page 6 Four bedrooms had been redecorated since the last inspection. The lounge in Southbank had been re-carpeted since the last inspection and some building work was being undertaken to create a new shower room and toilet. Other improvements since the last inspection included a replacement of a number of ‘failed’ double glazed window units. 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.V254539.R01.S.doc Version 5.0 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.V254539.R01.S.doc Version 5.0 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 5 Residents’ needs were assessed before they were admitted to the home. Relatives are able to visit the home before making the decision to stay. EVIDENCE: Residents’ needs were assessed before they moved into the home. Examples of pre admission assessments and of the Multi Disciplinary Assessments were held within the care plans. Information gathered was used to create the care plans. Where possible prospective residents and their family/representatives were encouraged to view the home before making a decision about admission. Southbank Nursing Home DS0000006722.V254539.R01.S.doc Version 5.0 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 and 9. Plans of care were available for each individual however some shortfalls in risk assessments have the potential to place the residents at risk. Some medication recording practice potentially put residents at risk. EVIDENCE: A sample of care plans was examined. Evidence was seen that care plans were detailed and reviewed on a monthly basis. Risk assessments were included within the individual care plans however they were limited and lacked detail in some instances. Risk assessments regularly stated, “refer to care plan”. Staff spoken to were not clear that the plan of care and risk assessment should be two separate documents. A number of care plans included core care plans, which were not personalised to the needs of the individual. One care plan stated “catheter fallen out” and there was no further information included. Limited evidence was seen of the involvement of the relative/representatives in the drawing up of the care plan. Southbank Nursing Home DS0000006722.V254539.R01.S.doc Version 5.0 Page 10 Equipment used for the prevention of pressure sores was not clearly recorded in the care plans, however a full list of all equipment in use was available. Medication administration record charts (MAR) were not always completed accurately. There was evidence of gaps on the mar charts for drugs prescribed. Controlled drugs were accurate. An updated staff specimen signatures list was not available for each staff member. Each resident was registered with a General Practitioner and there was evidence of referral to other specialist health professionals. One relative spoken to felt the staff provided “good” care to her relative and she felt she could express dissatisfaction with any aspect of her relatives care to the staff. Southbank Nursing Home DS0000006722.V254539.R01.S.doc Version 5.0 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 and 15 Resident’s social activities were limited at the time of the inspection. Residents were offered a nutritious, healthy diet. EVIDENCE: The activities organiser had been absent from the home for a period of time however she was due to return the week after the inspection. When activities did take place these were not consistently recorded. A limited social history was recorded on admission. Two residents on the Young Physically Disabled unit and four older people had been on a recent trip to Blackpool, which they had thoroughly enjoyed. One resident expressed pleasure that his daughter took him out for lunch on occasions. Residents on Delamere unit were encouraged to join the other residents for musical entertainment and/or videos. During the inspection there was no evidence of any activities/stimulation being provided. Menus were in place, which gave residents choices. Residents spoke highly of the meals provided. “The meals are always hot and the food is excellent.” Homemade soup was being prepared at the time of the inspection. The resident’s nutritional needs were recorded and monitored. Southbank Nursing Home DS0000006722.V254539.R01.S.doc Version 5.0 Page 12 Tables were pleasantly laid in the dining room and this room had been recarpeted since the last inspection. Staff was observed to assist residents in a sensitive and appropriate manner that required help at mealtime. Two residents said they had not had their hair done for a lengthy period of time and some other residents looked like they required a trim. It is pleasing that the administrator carries out hairdressing at the weekend but maybe this service requires increasing in order to meet the needs of all residents accommodated. Southbank Nursing Home DS0000006722.V254539.R01.S.doc Version 5.0 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 Residents knew about the complaints procedure and the procedure to make a complaint was available. Staff were not clear about how to put the policy for the protection of vulnerable adults into practice and therefore residents were not fully protected from abuse. EVIDENCE: The home had a detailed complaints procedure in place and following a discussion with some of the residents it was clear they were aware of this procedure. Following discussions with a number of staff it was not evident they had received training on adult protection. Staff could not make reference to the policy and were not clear on the action they would take in the event of an allegation of abuse. These concerns were included in a letter of serious concern for immediate action. An action plan has been received from the home which includes training for all staff, local policy application and the referral system. Southbank Nursing Home DS0000006722.V254539.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,23,24,25 and 26 Improvements in the décor were required in some areas of the home which was generally clean. Some areas of the home did not provide comfortable surroundings for the residents and required urgent attention. EVIDENCE: Since the last inspection some areas of the home had undergone maintenance and renewal and following a requirement made at the previous inspection 4 bedrooms had been redecorated and ten new sets of bedroom furniture had been provided. The carpet and décor in Southbank’s main dining room had been replaced. Some areas of the home were pleasantly decorated The trolley shower room required to be decorated at the last two inspections has not yet been completed, this requirement has been reiterated. A passenger lift offered access to all the home’s floors. Since the last inspection there was evidence that building work had been commenced in the home however a number of areas in the home were Southbank Nursing Home DS0000006722.V254539.R01.S.doc Version 5.0 Page 15 identified to be in need of attention. A former double toilet was being converted into a shower room and single toilet. This work was still ongoing. Some areas of serious concern were raised immediately following the inspection. These included renewal of curtains and carpets in some bedrooms on Delamere unit, bedding and bedheads required replacement, lampshades and the main lighting plus overbed lighting for some bedrooms required renewing/replacing with more appropriate lighting. Some of the bedroom furniture was substandard. A hole was noted in the ceiling by the nurses station on Delamere unit, this must be repaired. One bedroom contained ‘clutter’ which did not belong to the resident who was currently residing in this bedroom. Commodes in bedrooms must be reviewed as one was noted to have a loose arm, others were not clean. It was pleasing that action was taken during the inspection to repair window restrainers which were not working appropriately. The small kitchen on Delamere unit was “dirty” and required redecorating. A number of the beds for nursing residents were not adjustable height beds. A review of these beds for residents in receipt of nursing care must be made and a programme of replacement commenced. A number of chairs were dirty and encrusted with food. All the above issues were discussed with the manager during the inspection. A full audit of the home must be carried out to identify the areas in most need of attention. Southbank Nursing Home DS0000006722.V254539.R01.S.doc Version 5.0 Page 16 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 The number of staff was sufficient to meet the needs of the residents accommodated. EVIDENCE: At the time of the inspection the home accommodated 52 residents, 43 older people assessed as requiring nursing care and 9 younger adults on the physically disabled unit in receipt of nursing care. At the time of the inspection 2 residents were in hospital. Examination of the duty records indicated that staffing levels were sufficient to meet the needs of the residents accommodated. A high number of the care staff are overseas nurses awaiting to commence an adaptation nursing programme and are not required therefore to undertake NVQ level 2 course. Southbank Nursing Home DS0000006722.V254539.R01.S.doc Version 5.0 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): 31 38 Some areas of practise did not promote the health safety and welfare of the residents. EVIDENCE: The manager was approachable by the staff It was of concern to the inspector that an immediate requirement letter was left in relation to poor moving and handling practice observed during the inspection. The use of the under arm drag lift is banned from current safe moving and handling practice. Southbank Nursing Home DS0000006722.V254539.R01.S.doc Version 5.0 Page 18 Serious concerns were raised in relation to poor moving and handling in June 2004 December 2004 and January 2005. The manager informed the inspector that she was the home’s trainer for moving and handling. If this practice has not improved the Commission For Social Care Inspection may be minded to take enforcement action. Staff spoken to informed the inspector they were in receipt of supervision. Fire safety checks were carried out on a regular basis however the zones from which the alarm is tested were not being accurately recorded. Southbank Nursing Home DS0000006722.V254539.R01.S.doc Version 5.0 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 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 X 3 X 2 2 2 2 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x x x x 2 Southbank Nursing Home DS0000006722.V254539.R01.S.doc Version 5.0 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 OP7 Regulation 15 Requirement All residents must have an individual plan of care that details the action which needs to be taken to ensure all aspects of health, personal and care needs are met. The residents care plans must, where possible be drawn up with the involvement of the resident. Once agreed it must be signed for by the resident whenever possible and /or their representative. The record of medicines must be kept and include the date on which they were administered to the resident. 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. All staff must receive training in the action to be taken in the event of an allegation of abuse. A full audit of the home and in particular the bedrooms and furnishings is required to ensure DS0000006722.V254539.R01.S.doc Timescale for action 20/01/06 2 OP9 17 24/12/05 3 OP7 13 05/01/06 4 5 OP18 OP19 13 23 30/01/06 30/01/06 Southbank Nursing Home Version 5.0 Page 21 6 7 OP21 OP24 23 23 8 OP24 16 9 10 OP26 OP38 16 13 that all parts of the home are kept clean and reasonably decorated. The trolley shower room must be decorated .(Timescales of 1.12.04 and 31.03.05 not met.) The lighting in a number of the residents bedrooms must be reviewed/ replaced with appropriate lighting. A programme to provide adjustable height beds for residents receiving nursing care must be commenced. A sluicing disinfector must be installed. (Timescales of 1.12.04 and 31.03.05 not met) The tray carriers in the kitchen must be replaced. 10/01/06 30/03/06 30/03/06 30/03/06 30/03/06 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.V254539.R01.S.doc Version 5.0 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. 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