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Inspection on 14/09/05 for Southcrest Nursing Home

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

This inspection was carried out on 14th 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 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 home is being effectively and competently managed, and staff were very caring and considerate to residents, who were very complimentary about the staff team. The rights and interests of residents is clearly promoted by staff. Meals are varied, well-balanced and nicely presented offering choice and variety.

What has improved since the last inspection?

Decoration and furnishings are being gradually improved and those areas are starting to look more welcoming and homely. Action has been taken to improve the home`s fire protection system, and to safeguard the health and safety of residents should a fire occur within the home.

What the care home could do better:

Medication records need to be more accurately completed by registered nurses, and care plans need further development to ensure that risks identified through assessment generate a plan of care to minimise or reduce the risk identified. Staff were not being formally supervised to ensure that they understood and implemented the home`s philosophy of care. This is important to ensure that the home is delivering the service that it claims to provide.

CARE HOMES FOR OLDER PEOPLE Southcrest Nursing Home 215 Mount Pleasant Southcrest, Redditch Worcester B97 4JG Lead Inspector Nick Richards Unannounced 14 September 2005 10:15 hours The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Southcrest Nursing Home E52 S4103 SOUTHCREST NH V248590 140905.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Southcrest Nursing Home Address 215 Mount Pleasant, Southcrest, Redditch, Worcestershire B97 4JG Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01527 550720 01527 550720 Dr Sabarathnam Ananthram Mrs Kalpana Ananthram Gail Elizabeth Gilbert Care Home with Nursing 40 Category(ies) of OP Old age (40) registration, with number PD Physical disability (3) of places PD(E) Physical disability over 65 (40) Southcrest Nursing Home E52 S4103 SOUTHCREST NH V248590 140905.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. All persons admitted within category PD must be at least 55 years of age and on a named basis, with prior agreement of the registration authority. Date of last inspection 18 April 2005 Brief Description of the Service: Southcrest Nursing home is a forty-bedded care home providing nursing care for people over the age of 65 years. Accommodation is provided on three levels/floors (in single or double occupancy bedrooms), and there is a passenger lift and two staircases to all levels. There is a variety of aids and adaptations around the building to allow people to move about more independently. There are communal toilets, bathrooms and lounges on each floor. The home is situated on the perimeter of central Redditch, and local services and resources can be easily and readily accessed. Southcrest Nursing Home E52 S4103 SOUTHCREST NH V248590 140905.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 3 hours and was carried out to assess how the home was addressing the requirements from the previous inspection, and to establish how effective care was during the morning and early afternoon period. A tour of the premises took place and staff and care records were inspected. Four of the nine staff on duty and five of the thirty-seven residents were spoken to. What the service does well: What has improved 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. Southcrest Nursing Home E52 S4103 SOUTHCREST NH V248590 140905.doc Version 1.40 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Southcrest Nursing Home E52 S4103 SOUTHCREST NH V248590 140905.doc Version 1.40 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3 and 4. The admission procedure remains comprehensive to ensure that there is a proper assessment prior to people moving into the home. This helps to ensure that care needs can be met. Residents and their representatives are provided with suitable information prior to admission to ensure that an informed choice can be made. EVIDENCE: The admission procedure was effective to guide staff on the actions to be taken to ensure that new residents’ needs are properly assessed and planned for. Individual records are kept for each of the residents, and inspection of the records for five residents had full assessment information recorded. Staff members on duty were spoken to, and knew about the care needs of the residents. Residents who were interviewed (people who had been resident within the home for a long period and people who had only been resident for a short period of time) all said that they felt that the home was effectively meeting their care needs, and were very pleased and content with the range of services being provided for them. Southcrest Nursing Home E52 S4103 SOUTHCREST NH V248590 140905.doc Version 1.40 Page 8 The homes Statement of Purpose and Service User Guide are satisfactory and readily available to people – providing residents and prospective residents with details of the services the home provides, and enabling an informed decision about admission to be made. It was noted that a copy of the Service User Guide and a contract was available in residents’ rooms. There was some contradictory information in both documents. For example, meal times were recorded differently in both documents. Clarity needs to be provided to ensure that residents have accurate information available to them. The home does not contract to provide Intermediate Care, therefore Standard 6 is not applicable to the home. Southcrest Nursing Home E52 S4103 SOUTHCREST NH V248590 140905.doc Version 1.40 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 standard(s) 7, 8, 9 and 10. The health care needs of residents are identified and met. However, care records require development to ensure care practice is undertaken in a consistent manner. EVIDENCE: Each resident has a care plan in place, but the quality and content of care plans vary considerably. While some care documents effectively specify how care is to be delivered, some care plans failed to effectively specify how care is to be delivered. A range of health care risk assessments had been undertaken (such as fall risk assessments and pressure ulcer development risk assessments), but when risks had been identified through assessment, plans of care necessary to reduce or eliminate the identified risk had not been completed. It was noted, however, that care practice appeared to respond to identified risk as one resident had been identified as being at risk of pressure ulcer development, and a pressure-relieving mattress was in place on her bed. A care plan would effectively specify the total care required to address the potential need. Southcrest Nursing Home E52 S4103 SOUTHCREST NH V248590 140905.doc Version 1.40 Page 10 A member of the nursing team was observed administering medication to residents. Medication was administered safely, sensitively and diligently to ensure that the right medication was administered to the right person, at the right time and in the right dose – thereby promoting the safety and well-being of residents. However, it was noted that some medication administration record (MAR) charts had not been accurately completed by nursing staff within the home, resulting in no entries having been made against some administration times, and some variable dose medication (such as painkillers) being given without nursing staff recording the actual dose administered. This lapse in record keeping poses a potential risk to the health and safety of residents. One person had been regularly given an antipsychotic medicine, which had been prescribed on an “as and when” basis. An examination of the resident’s care file failed to identify the reason for the administration of the medicine. A care plan had not been developed. Nursing documentation confirmed that the home’s manager was undertaking some quality audits of the MAR charts, but the frequency of audit needs to be increased to ensure that the issues identified by this inspection are identified and addressed at an early stage. Residents spoken to were happy to confirm that their care needs were being met by staff within the home in a dignified and respectful way. Staff were seen providing care sensitively and discretely to residents, and discussions with staff confirmed that they were aware of residents’ care needs, and how the care was to be provided. Care records clearly evidenced the accessing of multidisciplinary healthcare professionals such as general practitioners (GPs), speech and language therapists, chiropodists, dentists and opticians, in response to changes in healthcare need (reactive care), and as a preventative measure (proactive care). Southcrest Nursing Home E52 S4103 SOUTHCREST NH V248590 140905.doc Version 1.40 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 standard(s) 13 and 15. Meals are well managed, creative and provide daily variety and flexibility for people living in the home. Contact with family and friends was openly maintained. EVIDENCE: A number of people living in the home were spoken to and everyone who commented on the food said how good it was and that they welcomed the daily choices offered. Menus were inspected and found to be balanced and interesting and meal time arrangements are also flexible enough to accommodate individual preferences. Menus were based on a four-week rotational basis, and the inspection was part of week one of the four-week menu cycle. The main meal served on the day of inspection comprised of roast chicken and stuffing, roast and mashed potatoes and vegetables. An alternative choice of chicken and salad was available, and people with swallowing difficulties were provided with a soft-textured diet. Dessert consisted of trifle, and residents could partake of up to three cooked meals a day if they so desired. Catering staff demonstrated a detailed knowledge and understanding of individual residents’ dietary preferences and requirements. Several residents interviewed explained how they had been provided with breakfast of their own choice (one person said that she had weetabix and toast Southcrest Nursing Home E52 S4103 SOUTHCREST NH V248590 140905.doc Version 1.40 Page 12 and marmalade, while another resident said that she had rice crispies, but could not remember what else she had eaten). The chef keeps a record of each resident’s meal selection on file for reference purposes. The only concern expressed by residents about the meals provided related to the criticism that too much food is provided! Residents’ weight charts confirmed that residents were not losing weight unexpectedly, and that weights were stable. During the morning period, care staff were seen providing residents with squash and a selection of fresh fruit. Care staff were seen providing direct assistance to people with their breakfast in a sensitive and relaxed manner. Residents spoken to said that they could receive visitors at any time of the day, thereby maintaining links with family members. Southcrest Nursing Home E52 S4103 SOUTHCREST NH V248590 140905.doc Version 1.40 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 standard(s) These Standards were not inspected. EVIDENCE: These Standards were not inspected. Southcrest Nursing Home E52 S4103 SOUTHCREST NH V248590 140905.doc Version 1.40 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 standard(s) 19, 20, 21, 22, 23, 24, 25 and 26. Improvements to the décor continue to be made on a planned rolling programme of improvement. Improvements within the physical environment have helped to provide people with safe, comfortable surroundings. EVIDENCE: Since the last inspection, the home have continued with their redecoration programme. Many bedrooms are nicely decorated and furnished with people’s own possessions, and many residents spoken to expressed their happiness with their rooms. The home was both clean and tidy. The home has completed a large programme of fire safety measures that enables residents to sit in their bedrooms with their doors open, knowing that, in the unlikely event of a fire occurring, the doors will automatically close and help to protect against and delay the spread of fire and smoke. Hot water temperatures have been risk assessed and had been regulated to prevent people being accidentally scalded when they have a bath. Southcrest Nursing Home E52 S4103 SOUTHCREST NH V248590 140905.doc Version 1.40 Page 15 As raised within the previous inspection report, carpets in some bedrooms were worn. This not only looks unsightly, but will become a trip hazard in the near future. This carpeting must be repaired or ideally replaced. Opportunity was taken to talk with the home’s financial/general manager regarding environmental upgrade. He confirmed that replacement carpets had been identified and the home was planning to replace fatigued items of carpet. However, because of the complexity of the process, rooms would need to be vacant for several days to enable fitters to remove and replace carpets, and the home was reluctant to disturb residents unnecessarily. The financial/general manager also discussed the homes intention to transform some rooms’ usage to increase the ratio of single to double-occupancy bedrooms by undertaking some internal environmental changes, and transforming the staff room and adjacent areas into two single-occupancy bedrooms, and reducing some bedrooms from double to single-occupancy. The intention is not to increase occupancy levels. The home aims to relocate the staff room (currently situated on the second floor) to the basement area. At the time of inspection, all areas within the home were clean, tidy and free from offensive odours. Residents confirmed that domestic staff had been into their rooms that morning to clean. Southcrest Nursing Home E52 S4103 SOUTHCREST NH V248590 140905.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30. Staffing levels and competencies are generally suitable to ensure that residents’ needs are identified and effectively met. However, further staff training is necessary to ensure that all care staff can meet the needs of people with memory loss problems. EVIDENCE: There were suitable nursing and care staff on duty to provide care and support for the 37 people who were resident in the home at the time of inspection. In addition to nursing and care staff, there were also ancillary staff on duty to support service provision. During the visit, call bells were activated, and staff responded speedily to them. The duty rotas confirmed that the staffing levels were stable, with little evidence of staff being absent through short-term sickness. Training has been provided to staff, and includes first aid and moving and handling. Training was identified as a result of the needs of residents, to ensure that care delivered was appropriate to and in response to the needs of residents. Staff did say that they had not received any training relating to the care and management of people with memory loss problems. This is vital given the large numbers of people who are resident within the home and who possess memory loss problems alongside their physical care needs. Southcrest Nursing Home E52 S4103 SOUTHCREST NH V248590 140905.doc Version 1.40 Page 17 Opportunity was taken to examine three staff files. All files contained an application form, but two files had not been fully completed (dates relating to the individual’s education had not been completed, and one application form did not contain details of the person’s employment history). All files contained at least two written references, but the information on one reference was scant (for example, it failed to confirm the individual’s dates of employment and did not contain any supportive information for the individual). It is acknowledged that the individual concerned had been appointed two years ago, but this was when the specifications of the National Minimum Standards had already been put in place. One staff file contained a detailed “Personal Development Record”, but this was last completed in January 2004. The same staff file only specified first aid and moving and handling training having been provided for the individual in the course of 20 months. Southcrest Nursing Home E52 S4103 SOUTHCREST NH V248590 140905.doc Version 1.40 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33 and 36. There is clear leadership, guidance and direction to staff to ensure residents receive consistent care, resulting in practices that promote and safeguard the health, safety and welfare of the people using the service. EVIDENCE: There is a registered manager, and she is competent and appropriately qualified and experienced to manage the service. Staff and residents spoke very highly of her, and significant diligence and action has been undertaken to maintain the quality of the service provided by the home since the time of the previous inspection. Residents clearly expressed their opinion that the home was being run in their best interests. Staff were not being formally supervised to ensure that they understood and delivered the philosophy of the home. One staff member stated that she had been subject to on-going supervision, but was unclear about the nature of the Southcrest Nursing Home E52 S4103 SOUTHCREST NH V248590 140905.doc Version 1.40 Page 19 supervision in question. The member of staff did not clearly understand the principles of supervision. Southcrest Nursing Home E52 S4103 SOUTHCREST NH V248590 140905.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 3 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 3 3 x x 1 x x Southcrest Nursing Home E52 S4103 SOUTHCREST NH V248590 140905.doc Version 1.40 Page 21 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 1 Regulation 5 Requirement All information presented to residents in the Service User Guide and contract must be accurate and non-contradictory. Care plans must be comprehensive in content to ensure that care is delivered consistently. Risks identified through assessment must generate an effective plan of care to ensure the risk is reduced or eliminated. The administration of all prescribed medication to residents must be accurately recorded on the MAR charts. When medication prescribed on a variable dose basis is administered to residents, the actual dose administered must be recorded onto the MAR chart. The worn carpetting in bedrooms must be replaced. All care staff must receive accredited training in the care and management of people with memory loss problems. All application forms must be scrutinised to ensure that all relevant data is provided. Al staff must receive three days E52 S4103 SOUTHCREST NH V248590 140905.doc Timescale for action Immediate and ongoing. Immediate and ongoing. Immediate and ongoing. Immediate and ongoing. Immediate and ongoing. 30/10/05 30/11/05 2. 7 15 3. 7 15 4. 9 13 5. 9 13 6. 7. 19 30 23 18 8. 9. 29 30 18 18 Immediate and ongoing. Immediate Page 22 Southcrest Nursing Home Version 1.40 paid training each day. 10. 36 18 All care staff must be formally supervised in accordance with the specifications of Standard 36. and ongoing. Immediate and ongoing. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 9 19 Good Practice Recommendations Opportunity should be taken to increase the frequency of medication audits within the home. An assessment of all bedroom carpets should be undertaken to identify those carpets that need replacing, and an action plan developed, implemented and forwarded to the Commission. Southcrest Nursing Home E52 S4103 SOUTHCREST NH V248590 140905.doc Version 1.40 Page 23 Commission for Social Care Inspection The Coach House, John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Southcrest Nursing Home E52 S4103 SOUTHCREST NH V248590 140905.doc Version 1.40 Page 24 - 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!