CARE HOMES FOR OLDER PEOPLE
Southborough Nursing Home 12-14 Langley Avenue Surbiton Surrey KT6 6QL Lead Inspector
Diane Thackrah Unannounced Inspection 7th February 2006 10:10 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 Southborough Nursing Home DS0000026258.V265752.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. Southborough Nursing Home DS0000026258.V265752.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Southborough Nursing Home Address 12-14 Langley Avenue Surbiton Surrey KT6 6QL 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) 0208 390 3366 0208 390 9394 info@lrh_homes.com London Residential Healthcare Limited Mrs Katherine Mary Litster Care Home 56 Category(ies) of Old age, not falling within any other category registration, with number (56), Physical disability (56), Physical disability of places over 65 years of age (56) Southborough Nursing Home DS0000026258.V265752.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25th May 2005 Brief Description of the Service: Southborough Nursing Home is a registered care home with nursing for up to fifty-six service users over the age of sixty-five who require general nursing care and who may have a physical disability. The home is situated in a residential area of Surbiton, close to public transport, local shopping and leisure facilities. The home is owned and managed by London Residential Healthcare Limited (LRH). Bedrooms are situated on the ground and first floors of the home. Passenger lifts provide access to the first floor of the home. The main communal areas of the home are situated in the ground floor and consist of two large lounges, one small sitting room, a dining room and a large conservatory. A small sitting room is available on the first floor. To the rear of the property there is a large garden. Ample parking is available to the front of the property. Southborough Nursing Home DS0000026258.V265752.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place between the hours of 10.10 – 14.00 on 7th February 2006. A partial tour of the premises took place and care records were examined. The Registered Manager, care and nursing staff and service users were available for discussion. All service users spoken with during the inspection expressed their satisfaction with the service. What the service does well: What has improved since the last inspection?
Some of the Requirements set at the last inspection of the home have been met. There have been improvements in the way in which medication is
Southborough Nursing Home DS0000026258.V265752.R01.S.doc Version 5.0 Page 6 handled and the storage of dried food in the kitchen is now in line with good practice. Records indicate that staff members are provided with formal supervision on a regular basis. The Registered Manager said that there has been ongoing staff training since the last inspection of the home. Some staff members have received training in Tissue Viability, Pressure Sores, Moving and Handling and Infection Control. 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. Southborough Nursing Home DS0000026258.V265752.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 Southborough Nursing Home DS0000026258.V265752.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): None of these Standards were assessed during this inspection. All key Standards were assessed as being met at the last inspection of the home. EVIDENCE: Southborough Nursing Home DS0000026258.V265752.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. There continues to be good arrangements for addressing the health, personal and social care needs of the service users. However, some improvements must be made to the care planning process, and to the way in which medication is handled, to ensure that the well being of service users is fully protected. EVIDENCE: There were detailed care plans, which gave staff members’ clear instructions about how service user’s needs should be addressed. One care plan examined had been signed by the relative of the service user, indicating that they had been involved in the care planning process. There were also records detailing that this care plan had been reviewed on a regular basis and changed in line with the service user’s changing needs. The care plan contained risk assessments in relation to moving and handling, the risk of falls and nutrition. Two staff members spoken with were clear about information written in care plans, and their responsibilities for meeting service user’s needs. All service users spoken with during the course of this inspection indicated that they were happy in the home and that their needs were met.
Southborough Nursing Home DS0000026258.V265752.R01.S.doc Version 5.0 Page 10 Care records for a service user who has a pressure sore were examined. There was a waterlow score, risk assessment and detailed instructions about how the pressure sores should been treated. There were records that detailed that the home had been in consultation with the Tissue Viability Nurse in relation to this service user’s pressure sores. There were records detailing that this service user required a pressure relieving mattress, and this had been provided by the home. There was a care plan for this service user that said that dressings should be changed every third day. However, care records detailed that the dressings had been changed less frequently than this. The Registered Manager said that this was because dressings were now required to be changed less often. Whist it is acknowledged that this service user was observed to have fresh dressings, it is necessary that the care plan accurately reflects the care that is being provided. A Requirement is made in relation to this issue. Some staff members have attended refresher training in the safe handling of medication since the last inspection of the home. There were records detailing that senior staff members carry out regular audits on medication. Medication was stored securely. Medication Administration Records for five service users were examined and these were generally up to date and in good order. Medication for two service users was examined. There was one item of medication on each service user’s Medication Administration Record that was not available in the home. The Registered Manager said that both items of medication had been discontinued. It is necessary that Medication Administration Records clearly indicate when short-term medication is to be discontinued. Southborough Nursing Home DS0000026258.V265752.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, 14 and 15. Service users continue to be consulted with about meals and activities and therefore differing expectations and lifestyles are well catered for. EVIDENCE: Service users spoken with said that they were happy with the arrangements for social and recreational activities. One service user said that they had had a good Christmas at the home and another service user said “I enjoy the singing” One service user said that they enjoyed going out with their family. An activities programme was displayed and there was a notice detailing that regular church services are held in the home. There was an activities coordinator who was spending time in one to one discussions with some service users during this inspection. There are two large communal lounges. Some service users were reading newspapers in one lounge and others were listening to music in the second lounge. There is a television in one lounge; a service user said that this was sometimes switched on. There were photographs displayed of trips that had occurred in the summer time including a trip to Richmond Park. The activities coordinator complies written social ‘reviews’ for each service user. These are then made available at each review of care. Southborough Nursing Home DS0000026258.V265752.R01.S.doc Version 5.0 Page 12 Two service users spoken with said that they were able to make choices about daily living and that staff members respected their wishes. Formal meetings occur on a regular basis were service users are invited to discuss daily living issues. There were menus on each table in the dining room. Menus detailed that a choice was always available. Most service users had cottage pie and fresh vegetable for lunch during this inspection, some service users had sandwiches. A number of service users had wine or beer with their meal. Purred meals were proved to some service users and there was good support from staff members for those service users who required to be fed. Positive comments were received from some service users about food in the home. One service user said, “The food is very good” another service user said “I had a good cooked breakfast this morning”. Most service users had a soft drink close to hand at the time of inspection and hot drinks were provided at midmorning. A Requirement was made at the last inspection of the home regarding the need for dry food to be stored in line with good health and safety procedures. This Requirement has been met. All food was stored appropriately and the kitchen was clean and well organised. Southborough Nursing Home DS0000026258.V265752.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. There is a system in place for the effective handling of complaints and service users and their relatives are encouraged to raise any concerns they have. Service users therefore know that their concerns will be acted upon. Arrangements are in place for handling allegations and instances of abuse. This ensures that service users will be protected from harm. EVIDENCE: There are policies and procedures in place for dealing with complaints. Information is made available in the Service User Guide about how a compliant, concern or suggestion should be made, and how this will be handled. This information also includes details about how a complaint may be made to the Commission for Social Care Inspection. The Registered Manager said that service users and their relatives are encouraged to raise any concerns with staff members before they become problematic. She also said that no complaints have been received by the home since the last inspection. The home has a copy of the Royal Borough of Kingston Upon Thames vulnerable adult protection procedures. The Registered Manager assured the inspector that there have been no allegations of abuse made within the home in the past year. Records examined detailed that staff members receive training in the protection of vulnerable adults as part of the induction programme. Southborough Nursing Home DS0000026258.V265752.R01.S.doc Version 5.0 Page 14 Southborough Nursing Home DS0000026258.V265752.R01.S.doc Version 5.0 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, 22, 25 and 26. The home is decorated and furnished to a good standard and facilities are accessible and clean. This ensures that service users live in a pleasant, homely and comfortable environment. However, there is a need to improve some health and safety practices in order to ensure that the well being of service users is fully protected. EVIDENCE: Communal areas and some service users bedrooms were viewed and these were in good decorative order. The Registered Manager said that there are no outstanding Requirements following environmental health and fire inspections. A London Fire and Emergency Planning Authority inspection of the home is scheduled to take place in February 2006. Close circuit television cameras are used in some areas of the home, but not areas used by service users. The home has been assessed by an Occupational Therapist and there are a number of environmental aids and adaptation that are designed to promote the
Southborough Nursing Home DS0000026258.V265752.R01.S.doc Version 5.0 Page 16 independence of service users. Hoists and assisted baths are available throughout the home and there were certificates detailing that these had been serviced on a regular basis. Staff members receive training in moving and handling and in the use of hoists. There are grab rails in toilets and bathrooms and in corridors. There is a passenger lift to all floors, this has been safety tested recently. Call bells were available in bedrooms and bathrooms viewed. There was good lighting and the home was warm and well ventilated. One service user said that they found the temperature of the home comfortable. Windows on the first floor had restrictors and the Registered Manager said that all radiators in the home have recently been safety checked by the home’s maintenance worker. There is emergency lighting throughout the home and records detailing that this has been checked for safety. All sinks in communal toilets, bathrooms and service users’ bedrooms are fitted with a thermostatic value to prevent the risk of scalding. Water temperatures checked were at a safe temperature. The home has a risk assessment in place in relation to the risk of legionella. This details that water temperatures will be checked on a weekly basis. Records indicated that water temperatures have not been checked since November 2005. There must be weekly tests on water temperatures throughout the home for the purpose ensuring that water temperatures remain at a safe temperature, and as a precaution against the risk of legionella. A Requirement is made in relation to this issue. The home was clean and hygienic and cleaning staff members were on duty. Southborough Nursing Home DS0000026258.V265752.R01.S.doc Version 5.0 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): 29. There have been some improvements in relation to the safe recruitment of staff members. However, procedures are not robust and do not fully provide the safeguards to offer protection to people living in the home. EVIDENCE: A staff member reported that since the last inspection of the home, Criminal Records Bureau and Protection of Vulnerable Adults checks have been obtained in relation to all staff members. Four staff files were examined. Three files contained all information and documentation required by Regulation. However, it is of concern that one new staff member has been employed to work in the home prior to a satisfactory Criminal Records Bureau check being obtained. A repeat Requirement is made in relation to this. In order to offer protection to the people living in the home, a satisfactory Criminal Records Bureau check must be in place for each staff member prior to them commencing work. Any exceptions to this rule must be agreed by the Commission for Social Care Inspection. Southborough Nursing Home DS0000026258.V265752.R01.S.doc Version 5.0 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 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): 35, 36 and 38. Staff members receive good guidance and leadership and, in general, there are safe working practices. Some improvements must be made in relation to health and safety to ensure that the welfare of service users is fully promoted and protected. EVIDENCE: Staff members spoken with confirmed that they received formal supervision on a regular basis and there were records to back this up. The home keeps small amounts of money for some service users. There are records of any money held. All staff members undergo induction training in safe working practices. There are environmental risk assessments in place, including a risk assessment in relation to fire. Records indicate that the fire alarm and emergency lighting is tested on a regular basis. Fire fighting equipment is situated throughout the
Southborough Nursing Home DS0000026258.V265752.R01.S.doc Version 5.0 Page 19 home and emergency exits were clear. There was a landlord’s gas safety certificate and records detailing that the electrical system in the home has recently been serviced. Regular health and safety audits occur. Certificates were available detailing that regular safety checks are made on hoists, assisted baths and the lift. There was a risk assessment in place for reducing the risk of legionella, however, good practice has not been followed for ensuring that risk is reduced. A Requirement has been made in relation to this issue. (Refer to Standard 25 of this report) Southborough Nursing Home DS0000026258.V265752.R01.S.doc Version 5.0 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. 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 X X X 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 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X 2 3 STAFFING Standard No Score 27 X 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 3 X 2 Southborough Nursing Home DS0000026258.V265752.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes. 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 (1) Requirement Timescale for action 01/04/06 2. OP9 13 (2) 3. OP25 13 (4)(c) 4. OP29 19 (1) Schedule 2 The Registered Provider must ensure that care plans accurately reflect the care that is to needed by a service user. The Registered Provider must 01/04/06 ensure that Medication Administration Records detail when short-term medication is to be discontinued. The Registered Provider must 01/04/06 ensure that weekly tests on water temperatures throughout the home occur for the purpose ensuring that water temperatures remain at a safe temperature, and as a precaution against the risk of legionella. The Registered Provider must 07/02/06 ensure that a satisfactory Criminal Records Bureau check is obtained prior to any staff member commencing work in the home. Repeat Requirement. Timescale of 01/08/05 unmet. Southborough Nursing Home DS0000026258.V265752.R01.S.doc Version 5.0 Page 22 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 Southborough Nursing Home DS0000026258.V265752.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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