Inspection on 14/06/05 for Southdown Nursing Home

This inspection was carried out on 14th June 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.

Other inspections for this house

Southdown Nursing Home 31/05/07

Southdown Nursing Home 06/02/07

Southdown Nursing Home 07/06/06

Southdown Nursing Home 01/12/05

Southdown Nursing Home 01/11/04

Southdown Nursing Home 11/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Southdown Nursing Home 5 Dorset Road Cheam Surrey SM2 6JA Lead Inspector Alison Ford Announced 14 June 2005 09:30 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. Southdown Nursing Home Version 1.10 Page 3 SERVICE INFORMATION Name of service Southdown Nursing Home Address 5 Dorset Road, Cheam, Surrey, SM2 6JA 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) 020 8643 1639 020 8642 1369 wij@ceylonsapphires.co.uk Mr Wijayarathna Mrs Dona Konthasinghe CRH 25 Category(ies) of N Care home with nursing registration, with number of places Southdown Nursing Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st November 2004 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 accommodated on 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 Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was the homes first one for the year 2005/2006 and took place over six hours. During this time a partial tour of the premises was undertaken, a sample of care plans were assessed, and various certificates required to ensure the safety of residents were seen. Much of the visit was spent talking to the residents and eight relatives who were in the home during the day. All of the feedback from them was positive. Prior to the inspection, questionnaires had been sent to residents, their relatives care managers and healthcare professionals. On this occasion fourteen replies were received including one from the general practioner for the home, and they all reflected a high level of satisfaction with the standard of care that was being provided by the staff within the home. What the service does well: The residents in this home consider that they live in a safe well-managed environment and all of those that were spoken to were appreciative of the care that they receive. Several relatives took the trouble to visit on the day of the inspection to confirm their satisfaction with the standard of care, the homes manager and her staff team. Some of the residents have advanced stages of dementia however their relatives felt that they benefited from the individual care that was given and praised the patience and tolerance of the staff many of whom have been there for some while. Comments were made that “staff were very friendly” “treat the residents well ”and that “residents always look well cared for.” A comprehensive pre-admission assessment ensures that the healthcare needs of residents will be met and care plans accurately reflect the care that is currently being delivered. There were several examples of how much the health of residents had improved since they had been living in the home. Activities suitable for the needs of the residents are provided and a birthday was being celebrated on the day of the inspection. Residents expressed their satisfaction with the meals served in the home and alternative choices would always be made available. All of those spoken to were confident that the management team would deal with any concerns that they might have promptly and appropriately. Staff training has a high priority in the home and more than 50 of the care staff have undertaken an NVQ qualification and safety practices were generally of a good standard. Southdown Nursing Home Version 1.10 Page 6 What has improved since the last inspection? What they could do better: Although those spoken to appreciated the homely environment it was felt that the home would benefit from further refurbishment and redecoration. Some bedroom furniture has now become shabby, much of the paintwork is chipped and some areas were malodorous. One of the upstairs carpets must be replaced without delay as it poses a serious hazard to the staff. Despite previous requirements, automatic door closers still need to be fitted to resident’s bedroom doors, where they wish them to be kept open, to ensure their safety in the event of a fire. Window restrictors need to be fitted to the new front windows and the first floor French windows leading to a balcony were unlocked. Some issues were raised about the provision of specialist equipment although this was dealt with during the course of the inspection. It was felt, that to better understand the current healthcare needs of the residents, especially those with dementia, it would be beneficial to understand their previous lives, prior to their needing nursing care and recommendations to involve families and relatives in this process were made. Recruitment procedures must be made more robust in order to ensure that all potential staff have the required documentation to safeguard the health safety and welfare of the residents. Please contact the provider for advice of actions taken in response to this Southdown Nursing Home Version 1.10 Page 7 inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Southdown Nursing Home Version 1.10 Page 8 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 Southdown Nursing Home Version 1.10 Page 9 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) 3,2,5 Residents or their relatives do not always visit the home prior to admission, it is sometimes chosen by a care manager, on their behalf, however, a comprehensive pre-admission assessment is undertaken so that they can be confident that their healthcare needs will be met. EVIDENCE: A sample of 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. There was evidence from conversations with residents, relatives and from examining care plans, that the home was able to meet the needs of the residents. This included examples of remobilising residents and promoting healing of pressure sores and ulcers. Comments were received from relatives about how the health of residents had improved since their admission. The home is currently registered to provide for ten older people with dementia and several of the staff have undertaken courses in dementia awareness During the inspection it became apparent that residents and their relatives may not always be involved in the choice of the home and it may be selected, by a care manager, on their behalf. Although each placement is subject to a review after a month, and residents may often be too frail to visit, it is Southdown Nursing Home Version 1.10 Page 10 recommended that the management team should encourage more involvement from relatives in this process. It was noted that resident’s contracts still need to be amended to specify which room will be occupied. This home does not offer intermediate care therefore standard 6 is not applicable. Southdown Nursing Home Version 1.10 Page 11 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) 7,8,10 Residents in this home are treated with respect so that their dignity is maintained. Their care plans accurately reflect their assessed healthcare needs ensuring that appropriate interventions and care are given. EVIDENCE: Southdown Nursing Home Version 1.10 Page 12 A sample of care plans was inspected and they illustrated that they are designed to meet all aspects of health, personal and social care. Risk assessments include those related to falls as well as manual handling and skin integrity and body weight was regularly monitored. Each file seen included a body map where any blemish or bruise was noted. Plans are reviewed monthly and in some cases there is involvement of residents or their representative however, relatives that were spoken to, said that they were not particularly interested in contributing to this process. It was felt that care would be improved if there was more understanding of the past lives of residents especially those with dementia and a recommendation was made to involve relatives in producing a “life story “ of them. Staff would then be able to relate present behaviour patterns to resident’s lives. Pressure relieving devices were in use throughout the home and some nursing beds have been purchased. It was felt that one resident, who was particularly unwell, would have benefited from being nursed in such a bed and risks to staff when lifting and turning him, would also be minimised. A requirement was made to ensure that suitable equipment is provided for those residents who require it. Residents were observed to be well groomed and appropriately dressed during the inspection and relatives who contributed to the inspection confirmed this was usually the case. Several relatives commented favourably upon the way that staff treated the residents. Screening has been provided in shared rooms. Southdown Nursing Home Version 1.10 Page 13 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) 12,13,14,15 Residents in this home would be supported to exercise choices in their lives, as far as they are able, so that they can maintain their independence and they would be encouraged to maintain contact with their families and friends so that they have interest and variation in their day. Meals are well prepared and varied to ensure that nutritional needs are met. EVIDENCE: Southdown Nursing Home Version 1.10 Page 14 Residents and relatives indicated that the routines of the home offer choice and flexibility. For example residents may choose when to have a bath and when to get up. However some with advanced dementia benefit from having a more structured routine. There is an open visitors’ policy and several visited on the day of the inspection and said they were always made welcome and offered tea or coffee. All of the residents spoken to confirmed their satisfaction with the food. Menus were seen and appeared varied; they are on a three week rota and changed twice a year. A list of all service users dislikes is kept in the kitchen and an alternative meal would be available if it were asked for. Care staff were seen assisting service users appropriately at lunchtime and special diets are catered for. Afternoon tea was served in metal cups and it was felt that this portrayed an institutional rather than homely appearance. Prior to the introduction of these there had been a lot of breakages however the registered provider must explore alternative possibilities and replace them. Activities, suitable for this client group, are offered on a daily basis and include chair based exercise and musical entertainment. A birthday was being celebrated on the afternoon of the inspection. Southdown Nursing Home Version 1.10 Page 15 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) 16,18 Any concerns that residents may have may have are dealt with promptly and sensitively so that they can feel confident that their complaints will be listened to and that procedures are in place to ensure that they are protected from abuse. EVIDENCE: The complaints book showed that seven complaints had been made directly to the home since the last inspection and that they had all been resolved appropriately. One complaint had been received by the Commission for Social Care Inspection however this was not upheld. The registered manager is always available if there are any concerns and several relatives commented on how well she supervised the staff in the home and that they were confident that any problems would be dealt with promptly. All the staff have undertaken training in adult protection issues and the protection of vulnerable adults. One new member of staff had been appointed without satisfactory Criminal Records Bureau and POVA clearance and an assurance was made that she would not work again until this had been obtained. A requirement was issued that these checks must be obtained prior to commencement of employment in future. The home does not take responsibility for the finances of any of the residents. Southdown Nursing Home Version 1.10 Page 16 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,,25,26 Residents live in an environment, which appears to suit their needs however their safety is compromised as not all windows in their rooms have been fitted with window restrictor and the magnetic locks on their bedroom doors do not operate with the fire alarm. A limited programme of refurbishment and redecoration has resulted in some areas now becoming shabby. Some resident’s bedrooms have offensive odours, which are unpleasant for them 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. The registered provider must ensure that this is kept well maintained so that residents can enjoy using it. The cupboard in the garden housing the gas meter is also broken and must be repaired. In order to maintain a pleasant environment for residents to live in, some areas of the home now require redecoration and some bedroom furniture requires replacement. A planned programme of refurbishment must now be implemented and a copy forwarded to the Commission for Social Care Inspection. In addition the carpet leading to the staff room is very worn and Southdown Nursing Home Version 1.10 Page 17 torn and poses a considerable risk to staff members. The registered provider gave an assurance that this would be repaired temporarily and replaced at the earliest opportunity. There was evidence that residents safety, in the event of a fire, is still being compromised due to bedroom doors being held open despite a previous requirement to fit magnetic catches where residents wished to leave them open. This requirement is therefore repeated. New windows have been fitted to the front of the house however one on the first floor was seen to be without any form of restrictor: this must be fitted as soon as possible. One bedroom has doors leading to a veranda and this was unlocked with the keys in the lock. The registered manager must ensure that this door is locked and the keys removed when the resident is in her room. It was noted that some bedrooms were malodorous the registered provider must take measures to rectify this problem. Southdown Nursing Home Version 1.10 Page 18 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) 27,29,30 Residents cannot always be confident that they are protected by the homes recruitment policies which is in place, as Criminal Record Bureau checks have not always been carried out on staff prior to appointment. Staff are employed in sufficient numbers and are appropriately trained to meet the needs of the residents 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. Staff turnover within the home is very low and this was commented on by the relatives that were spoken to who appreciated seeing the same staff when they visited and felt that they got to know them well. Several commented on how tolerant the staff were. More than 50 of the care staff are qualified to NVQ level 2 standard, thus exceeding the National Minimum Standard requirement. Communication between staff for whom English was not their first language and residents had previously posed a problem however both staff and relatives agreed that this was now much improved. Two new members of staff, one nurse and one laundry assistant have been employed since the last inspection; neither had received Criminal Records Bureau clearance prior to beginning work. The registered provider was reminded of her responsibilities in this and agreed to obtain checks against the POVA register and apply for clearance before they undertook any more duties. A requirement was issued to ensure that this did not occur again and a further visit will be undertaken to check compliance. Southdown Nursing Home Version 1.10 Page 19 Staff training is ongoing in the home and recent updates have included moving and handling, feeding, management of confused people, cross infection, food hygiene and the treatment of scabies. Southdown Nursing Home Version 1.10 Page 20 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) 33,38 Residents in this home can be confident that the home is run in their best interests and appropriate safety practices are in place so that their welfare is protected. EVIDENCE: Residents meetings are held in the home every two months, chaired by the registered provider and staff meetings occur every month. Times of these are now varied and attendance has improved and minutes are available, which were seen, for those unable to attend. All of the residents and relatives that were spoken to felt able to approach the registered manager at any time with suggestions and her presence is very evident within the home. They had been made aware of the inspection and some had made a special effort to come in to express their views. The registered provider undertakes visits in accordance with regulation 26 however no records were available to support this. These must be made available for inspections. Southdown Nursing Home Version 1.10 Page 21 Maintenance records were in good order and certificates of worthiness for equipment and services used in the home were all up to date. No accidents had occurred since the last inspection, which had necessitated hospital admission and all incidents had been reported in line with current legislation. Southdown Nursing Home Version 1.10 Page 22 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x 2 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 2 x x x x x 2 2 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 2 x x x x 3 Southdown Nursing Home Version 1.10 Page 23 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 2 Regulation 5 (b) Requirement The registered proprietor must ensure that residents contracts state which room that they will occupy. (Previous timescale 25/2/05 not met ) The registered manager must ensure that all residents have acess to specialist nursing equipment when it is required Timescale for action 1/10/05 2. 8 16(2)(c ) 3. 4. 19 19 23(2)(d) 23(2)(d) 5. 19 23(2)(b) 6. 19 13(4)(a) The registered proprietor must ensure that the carpet leading to the staff room is replaced The registered proprietor must 1/10/05 ensure that there is a planned programme of refurbishment and redecoration and a copy of it is sent to the Commission for Social Care Inspection office. The registered proprietor must 1/10/05 ensure that the cupboard housing the gas meter is repaired. The registered proprietor must 1/10/05 ensure that magnetic door catches, which operate automatically in the event of a fire, are fitted to bedroom doors where residents wish to leave Version 1.10 Page 24 From the day of the inspection 14/6/05 and henceforth 30/7/05 Southdown Nursing Home 7. 8. 25 25 13(4)(a) 13(4)(a) 9. 26 16(2)(k) 10. 29 19 11. 33 26 them open. ( Previous timescale 25/2/05 not met) The registered proprietor must ensure that restrictors are fitted to residents bedroom windows. The registered manager must ensure that the french doors leading from the first floor bedroom remain locked when the resident is in the room. The registered provider must ensure that all areas of the home remain free from unpleasnt odour. The registered provider must ensure that Criminal Records Bureau clearance is received for all staff prior to the comencement of their employment. The registered provider must ensure that reords of visits made under regulation 26 are available for inspection. 1/10/05 14/6/05 and henceforth 1/10/05 From the date of inspection 14/6/05 and henceforth 1/10/05 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. 2. 3. Refer to Standard 2 8 15 Good Practice Recommendations It is recommended that the registered manager should encourage residents families to be involved in the process of choosing the home. It is recommended that the registered manager should encourage relatives and friends of residents to become involved in providing details about their past lives. It is recommended that the metal cups used be repalced with something that appears less institutional. Southdown Nursing Home Version 1.10 Page 25 Commission for Social Care Inspection 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 Version 1.10 Page 26 - 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. 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