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Inspection on 18/04/05 for Southcrest Nursing Home

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

This inspection was carried out on 18th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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. The proprietor, manager and staff work hard to improve standards within the home whilst being constrained by restrictive financial income. Although the home was operating at a loss, the proprietor was supporting the home and investing revenue within the home. 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:

CARE HOMES FOR OLDER PEOPLE Southcrest Nursing Home 215 Mount Pleasant Southcrest Redditch B97 4JG Lead Inspector Nick Richards FINAL - Unannounced 18 April 2005 07:40 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 V221635 180405.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Southcrest Nursing Home Address 215 Mount Pleasant Southcrest Redditch Worcestershire B97 4JG 01527 550720 01527 550720 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) Dr Sabarathnam Ananthram Mrs Kalpana Ananthram Mrs Gail Elizabeth Gilbert CRH 40 40 3 40 Category(ies) of OP Old Age registration, with number PD Physical Disability of places PD(E) Physical Disability - over 65 Southcrest Nursing Home E52 S4103 Southcrest V221635 180405.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 3 November 2004 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 V221635 180405.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 5 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 early morning period. A tour of the premises took place and staff and care records were inspected. Eight of the thirteen staff on duty and seven of the thirty-three residents were spoken to. What the service does well: What has improved since the last inspection? What they could do better: Although the home relies heavily on adaptation nurses, this appears to be causing concerns with some service users and staff – particularly in relation to continuity of staffing, communication and training. The home needs to improve it’s staff training to increase the numbers and ratios of staff with a National Vocational Qualification (Level 2) in Care. Action Southcrest Nursing Home E52 S4103 Southcrest V221635 180405.doc Version 1.30 Page 6 is being taken to attempt to improve the retention of adaptation staff once they have completed their training. There also appears to be a problem in relation to the numbers and/or deployment of staff for social, occupational and recreational purposes. Whilst staff were clearly responsive to the direct care needs of residents, some residents felt that staff did not have the time to “sit and talk” with them - particularly as many residents liked to make use of their bedroom during the daytime. 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. 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 V221635 180405.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Southcrest Nursing Home E52 S4103 Southcrest V221635 180405.doc Version 1.30 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 standard(s) 1,2,3 and 4. Progress had been made to improve the admission procedure 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. EVIDENCE: The admission procedure was satisfactory 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 three residents had full assessment information recorded. Staff members on duty were spoken to, and knew about the care needs of the three residents. The homes Statement of Purpose and Service User Guide are satisfactory – providing residents and prospective residents with details of the services the home provides, enabling an informed decision about admission to be made. Both documents would benefit from having bigger lettering to help people with limited or failing eyesight to read the documents. Southcrest Nursing Home E52 S4103 Southcrest V221635 180405.doc Version 1.30 Page 9 Southcrest Nursing Home E52 S4103 Southcrest V221635 180405.doc Version 1.30 Page 10 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. Significant progress has been made on improving arrangements to ensure that the health care needs of residents are identified and met. These improvements help to safeguard the health care needs of residents. EVIDENCE: Individual plans of care are available, and progress has been made to ensure that all aspects of health, personal and social care needs are identified and planned for. Plans were detailed, up to date and had been regularly reviewed. Significant events in the home had been recorded, daily entries into case records had been made and entries available gave an indication of the actual care given. 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. Nursing staff were observed administering medication to residents. Medication was administered safely and sensitively 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. Southcrest Nursing Home E52 S4103 Southcrest V221635 180405.doc Version 1.30 Page 11 Southcrest Nursing Home E52 S4103 Southcrest V221635 180405.doc Version 1.30 Page 12 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. Catering staff demonstrated a detailed knowledge and understanding of individual residents’ dietary preferences and requirements. Care staff were seen providing direct assistance to people with their breakfast in a sensitive and relaxed manner. During the inspection, some relatives were seen visiting people, and staff greeted visitors politely. Residents spoken to said that they could receive visitors at any time of the day, thereby maintaining links with family members. One resident confirmed that there were “no restrictions” on visiting. Southcrest Nursing Home E52 S4103 Southcrest V221635 180405.doc Version 1.30 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) 16 and 18 Complaints are handled objectively and residents are confident that their concerns will be listened to, taken seriously and acted upon. A vulnerable adults procedure has been developed to ensure a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has a simple and clear complaints procedure, and the complaint records indicated that this is followed. A copy of the complaints procedure had been given to all residents, and was available to visitors and relatives. Residents spoken to were confident that concerns could be raised with the home. One person said, “If there’s anything that needs to be said, my son will do that”. A procedure for responding to allegations of abuse is available. Southcrest Nursing Home E52 S4103 Southcrest V221635 180405.doc Version 1.30 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 nearly completed a large programme of fire safety measures, which had been identified within the previous inspection. This 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. Southcrest Nursing Home E52 S4103 Southcrest V221635 180405.doc Version 1.30 Page 15 Hot water temperatures have been risk assessed and had been regulated to prevent people being accidentally scalded when they have a bath. Baths had been identified within the previous inspection report as items that required replacing to ensure that (1) residents could easily get in and out of baths and (2) staff could assist residents with personal care (when necessary) without injuring themselves. Carpeting 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. Southcrest Nursing Home E52 S4103 Southcrest V221635 180405.doc Version 1.30 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, 30 The deployment and number of staff available in the early morning is generally sufficient to meet the direct care needs of the residents, but attention is needed to ensure that social, occupational and recreational care needs are suitably addressed. EVIDENCE: Staffing levels have stabilised within the previous 12-month period, and there were a total of nine nursing and care staff on duty to provide care and support for 33 residents. The duty rotas confirmed that the staffing levels were stable, with little evidence of staff being absent through short-term sickness. Some residents spoken to expressed a concern about the adaptation nurses who were working within the home. Residents’ concerns related to the turnover of staff and how this affected peoples’ ability to develop and maintain relationships with staff on a longer-term basis. The manager has identified this as a concern, and is looking to encourage adaptation nurses to stay employed within the home for a 12-month period after gaining their qualification to further promote stability. Residents said that staff were “very good, they look after us well” and were “very attentive”. Residents generally believed that there were sufficient staff available to meet their needs (“Whenever I ring the bell, someone comes …anything you want done they do”), although comments were made that “They (staff) don’t have the time to spend talking”, and some residents and staff expressed concerns about the communication abilities of some adaptation nurses. The home has identified these concerns, and was taking action to Southcrest Nursing Home E52 S4103 Southcrest V221635 180405.doc Version 1.30 Page 17 provide English language tuition to staff. Staff discussed the care requirements and needs of residents, and could clearly demonstrate their understanding of each person’s care plan. During the visit, call bells were activated, and staff responded speedily to them. It was, however, noted that the predominant form of care being provided during the morning period was direct care rather than occupational, recreational or social care. Very few staff had completed NVQ level 2. This was directly influenced by the numbers of foreign nationals working within the home (a total of 13 staff – many of whom were adaptation nurses whose qualification is not recognised within the United Kingdom, and therefore need to undertake additional training within the UK to gain professional recognition and competence). In addition to nursing and care staff, there was also catering, domestic, laundry and maintenance staff working in the home. Southcrest Nursing Home E52 S4103 Southcrest V221635 180405.doc Version 1.30 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, 34, 35, 36, 38 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 improve 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. Recruitment procedures had been developed and enhanced since the previous inspection, but staff were not being formally supervised to ensure that they understood and delivered the philosophy of the home. The opinions of Southcrest Nursing Home E52 S4103 Southcrest V221635 180405.doc Version 1.30 Page 19 residents had been sought in the form of quality assurance questionnaires, and these had been collated and incorporated within the service users’ guide. The registered manager agreed that the questionnaire needed further development to demonstrate what action was being taken to address any dissatisfaction expressed by residents with the service. The proprietor was financially supporting the home. Current occupancy was set at 33, while “break-even” (no profit, but no loss) was cited as being 35 residents, and an occupancy of 37 or more residents resulted in profit. Since the time of the previous inspection, the proprietor has invested £3500 for the provision of fire safety devices within the home – while operating the home at a financial loss. The home was not in financial difficulty and was attempting to improve standards whilst carefully and effectively counter-balancing income with expenditure. Southcrest Nursing Home E52 S4103 Southcrest V221635 180405.doc Version 1.30 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 3 3 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 2 2 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 3 x 1 x 3 Southcrest Nursing Home E52 S4103 Southcrest V221635 180405.doc Version 1.30 Page 21 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. 2. 3. Standard 19 21, 22 28 Regulation 23 23 18 Requirement The worn carpetting in bedrooms must be repaired or replaced. Suitable baths must be provided to ensure that residents can be bathed appropriately. Training must be provided to ensure that at least 50 of carers are trained to NVQ level 2 (or equivalent) by the end of 2005. The deployment and number of staff must be sufficient to ensure that social,recreational and leisure needs are met. Staff must be formally supervised. Timescale for action 30/08/05 30/08/05 31/12/05 4. 27 18 30/06/05 5. 36 18 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. Refer to Standard 1 Good Practice Recommendations Improve the typesetting on the Service User Guide and the Statement of Purpose to help people with poor eyesight to read and understand both documents. Southcrest Nursing Home E52 S4103 Southcrest V221635 180405.doc Version 1.30 Page 22 Commission for Social Care Inspection The Coach House John Comyn Drive 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. 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