CARE HOMES FOR OLDER PEOPLE
Southdown Nursing Home 5 Dorset Road Cheam Surrey SM2 6JA Lead Inspector
Alison Ford Unannounced Inspection 1st December 2005 10:50 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 Southdown Nursing Home DS0000019123.V267843.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. Southdown Nursing Home DS0000019123.V267843.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Southdown Nursing Home Address 5 Dorset Road Cheam Surrey SM2 6JA 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) 020 8643 1639 020 8642 1369 Mr Wijayarathna Mrs M Wijayarathna Mrs Dona Konthasinghe Care Home 25 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (0) of places Southdown Nursing Home DS0000019123.V267843.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The maximum number of service users admitted with a diagnosis of dementia does not exceed 10. A Registered Mental Health Nurse or Registered General Nurse who holds a recognised Dementia training certificate is always on duty. All staff must have dementia awareness training. Date of last inspection 14th June 2005 Brief Description of the Service: Southdown is a converted and extended house, providing nursing care for up to 25 elderly people, including up to ten who may suffer from dementia. The home is situated in a residential area of Cheam and is close to public transport links. There are fifteen single and five double rooms arranged over two floors. Nine of the single rooms have en-suite facilities. A shaft lift provides access to the lower first floor with a stair lift serving those few bedrooms on the upper first floor. In addition to the dining room there are two communal lounges. There is pleasant back garden, which can be used by residents, and car parking is available at the front. Southdown Nursing Home DS0000019123.V267843.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 homes second one for the year 2005/2006 and was an unannounced visit, taking place over two and a half hours. During this time a partial tour of the premises was undertaken, a sample of care plans were assessed, and many of the residents were spoken with. During the course of the inspection year all of those standards considered by The Commission to be key to the inspection process have been assessed and this report should be read in conjunction with the one following the inspection of 14th June 2005. What the service does well: What has improved since the last inspection?
Southdown Nursing Home DS0000019123.V267843.R01.S.doc Version 5.0 Page 6 Since the last inspection the staff in the home have been encouraging the families and friends of residents to contribute to compiling “ life stories “. This has lead to a greater understanding of resident’s behaviour patterns and enabled staff to appreciate their achievements and individuality. Some areas of the home have benefited from redecoration although an ongoing programme is still required to ensure that the home remains a pleasant place for residents to live. 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. Southdown Nursing Home DS0000019123.V267843.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 Southdown Nursing Home DS0000019123.V267843.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): 2,3,6 A comprehensive pre-admission assessment ensures that residents healthcare needs can be met by the home, and a contract ensures that they are certain exactly what is being supplied. This home does not offer intermediate care: this standard does not apply. EVIDENCE: A sample of four care plans were seen and these all contained a copy of the pre -admission assessment undertaken by the manager of the home. This covered all aspects of the resident’s physical and psychosocial needs, and formed the basis for subsequent care planning. The plans contain evidence that the staff are able to meet the needs of the residents. This includes examples of remobilising residents and promoting healing of pressure sores and ulcers. The home is currently registered to provide care for ten older people with dementia and several of the staff have undertaken courses in dementia awareness. In response to a previous requirement the contract supplied to residents now includes the details of the bedroom that is to be occupied by the resident.
Southdown Nursing Home DS0000019123.V267843.R01.S.doc Version 5.0 Page 9 Southdown Nursing Home DS0000019123.V267843.R01.S.doc Version 5.0 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 the following standard(s): 7,8,9,10 Residents in this home consider that they are always treated with respect and dignity and their care plans accurately reflect their assessed healthcare needs ensuring that appropriate interventions and care are given. Medication procedures have not been updated in line with current legislation to ensure the protection of residents. EVIDENCE: A sample of four care plans was inspected and they illustrated that they are designed to meet all aspects of health, personal and social care. Plans are reviewed monthly to ensure that they reflect the care that is currently being provided and input is gained from other healthcare professionals as required. In response to a previous requirement, relatives and friends have been encouraged to supply “life stories “. The Registered Manager agreed how interesting it had been collecting this information and how it was allowing staff to appreciate the residents as individuals.
Southdown Nursing Home DS0000019123.V267843.R01.S.doc Version 5.0 Page 11 Regular monitoring of residents considered to be at risk of developing pressure sores, is evident in care plans and pressure-relieving devices were in use throughout the home. Staff were observed treating residents with respect and all the residents spoken with agreed that they were always kind. Personal care is delivered in resident’s own rooms and screening is provided in shared rooms. The medication policy has not yet been updated in line with current legislation and medicines awaiting disposal are in the drug cupboard. The Registered Provider must ensure that appropriate arrangements are made to ensure the safe disposal of these drugs, by a company with a licence to do so. Southdown Nursing Home DS0000019123.V267843.R01.S.doc Version 5.0 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 the following standard(s): 15 Residents receive a balanced diet however, a lack of choice of menu means that they are not able to exercise any control over the food that they eat. EVIDENCE: The lunchtime meal was served during the inspection and was well presented with large servings. One resident complained, “ the amount of food served was too daunting” and staff must ensure that portions are tailored to meet individual appetites. On admission, resident’s particular food dislikes are noted however, other than that the meal served is a set menu. Some way of offering residents an element of choice must be introduced into the home. Despite a previous recommendation, drinks are still being served in metal cups, giving an institutional feel to the home. This practice must now stop and alternative crockery introduced. It was noted that all the bread and milk in the kitchen was frozen, having been removed from the freezer earlier that morning. The Registered Provider must ensure that there is always bread and milk available to be used in the home. Southdown Nursing Home DS0000019123.V267843.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 Residents and their relatives in this home are confident that any concerns that they may have would be dealt with promptly and sensitively. EVIDENCE: The complaints book was seen and the five minor complaints had all been resolved in a timely and satisfactory manner. The Commission has received no complaints about this service since the last inspection. Southdown Nursing Home DS0000019123.V267843.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): 19,26 Residents live in a safe environment, which appears to suit their needs however a limited programme of refurbishment and redecoration has resulted in some areas now becoming shabby. Some areas of the home have offensive odours, which are unpleasant for both residents and their relatives. EVIDENCE: The home is situated in a residential area close to public transport links and off street parking is provided. Shaft and stair lifts ensure that all areas of the home are accessible to residents and there is a rear garden for their use. Some areas of the home have been redecorated since the last inspection however in order to maintain a pleasant environment for residents to live in, further redecoration is needed. A planned programme of refurbishment must forward to the Commission for Social Care Inspection. Southdown Nursing Home DS0000019123.V267843.R01.S.doc Version 5.0 Page 15 Despite previous requirements there was evidence that residents safety, in the event of a fire, is still being compromised due to bedroom doors being held open. Magnetic door catches, which operate in the event of a fire, must now be fitted to bedroom doors that residents wish to keep open. One fire door in the lounge was also not working properly and was held open by a resident’s chair. The Registered Manager agreed to deal with this on the day of the inspection It was noted that some areas of the home were malodorous; the Registered Provider must take measures to rectify this problem. Southdown Nursing Home DS0000019123.V267843.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): 27,29 Staff in this home are employed in sufficient numbers so that the needs of the residents will be met however, the homes recruitment procedures are not sufficient to protect them. EVIDENCE: Staffing rotas were seen and complied with previously agreed levels. There are always qualified nurses on duty as well as care staff and the registered manager is a nurse. On the day of the inspection a trained nurse was working in a supernumery capacity prior to joining the nurse bank. Since the last inspection a new cook has been appointed however clearance from the Criminal Records Bureau was not obtained by the home, prior to her appointment and has still not been applied for. An immediate requirement was issued that no staff are to be employed without all of the information required by The Care Homes Regulations and there is evidence that clearance from The Criminal Records Bureau has been applied for on all staff members. Southdown Nursing Home DS0000019123.V267843.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): 35 This home does not take any responsibility for any of the financial affairs of any of its residents. The remaining standards were not assessed at this visit. EVIDENCE: Although these standards were not assessed at this visit it was recommended that a visit should be requested from the fire safety officer, as it appeared that the last one was over two years ago. Southdown Nursing Home DS0000019123.V267843.R01.S.doc Version 5.0 Page 18 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 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Southdown Nursing Home DS0000019123.V267843.R01.S.doc Version 5.0 Page 19 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 OP9 Regulation 13(2) Requirement The Registered Provider must ensure that arrangements are made, in line with current legislation, to dispose of unwanted medication. The Registered Provider must ensure that metal teacups are replaced by alternative crockery. The Registered Provider must ensure that residents are able to exercise some choice over the meals that they are served. The Registered Manager must ensure that the portions of food are suitable for the individual appetites of residents The Registered Provider must ensure there is always bread and milk, that is ready to use, available in the home The Registered Provider must ensure that there is a planned programme of redecoration and refurbishment and a copy is sent to The Commission for Social Care Inspection office. (Previous timescale 1/10/05 not met)
Southdown Nursing Home DS0000019123.V267843.R01.S.doc Version 5.0 Page 20 Timescale for action 31/12/05 2 3 OP15 OP15 16(2)(g) 16(2)(i) 31/12/05 30/01/06 4 OP15 16(2)(i) 01/12/05 5 OP15 16(2)(i) 01/12/05 6 OP19 23(2)(d) 30/01/06 7 OP19 13(4)(c) The Registered Provider must ensure that automatic door catches, which operate in the event of a fire, are fitted to bedroom doors where residents wish them to remain open. 30/01/06 8 9 OP19 OP26 13(4)(c) 16(2)(k) (Previous timescale 1/10/05 not met) The Registered Provider must 01/12/05 ensure that all fire doors are fully operational at all times. The Registered Provider must 30/01/06 ensure that all areas of the home remain free from unpleasant odours (Previous timescale 1/10/05 not met) The Registered Provider must provide evidence that Criminal Records Bureau clearance has been applied for on all employees prior to their starting work. Immediate requirement issued. (Previous timescale not met) 10 OP29 19 28/12/05 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 OP38 Good Practice Recommendations It is recommended that The Registered Manager should request a visit from the Fire Safety Officer. Southdown Nursing Home DS0000019123.V267843.R01.S.doc Version 5.0 Page 21 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
© 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 Southdown Nursing Home DS0000019123.V267843.R01.S.doc Version 5.0 Page 22 - 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!
