CARE HOMES FOR OLDER PEOPLE
Southdown Nursing Home 5 Dorset Road Cheam Surrey SM2 6JA Lead Inspector
Alison Ford Key Unannounced Inspection 6th February 2007 10:30 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.V329047.R01.S.doc Version 5.2 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.V329047.R01.S.doc Version 5.2 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 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.V329047.R01.S.doc Version 5.2 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 7th June 2006 Brief Description of the Service: Southdown is a converted and extended house, registered with The Comission For Social Care Inspection to provide nursing care for up to 25 elderly people, including up to ten that 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. At the time of this inspection fees range from £450 - £520 per week. Any additional charges that might be payable for personal items or services such as hairdressing would be discussed prior to admission. Copies of the homes Statement of Purpose and the latest inspection report can be obtained directly from the home or, in the case of the latter, from the Commission for Social Care Inspection via the internet. Southdown Nursing Home DS0000019123.V329047.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes second key inspection for the year 2006/2007 and was an unannounced visit. In August 2006 the home also received a random unannounced inspection, which resulted in a statutory notice being issued because of concerns about the safety of residents in the event of a fire. These issues have now been satisfactorily resolved. At this visit a partial tour of the premises was undertaken and a sample of care plans, records and documentation relating to the health and safety of residents was seen. There were seventeen residents living in the home and several were spoken with and also all of the members of staff on duty at the time. Since the last inspection the Registered Manager has resigned from her position and the inspection process was conducted with help from one of the trained nurses however, the homes Registered Provider arrived during the morning. During the visit it was noticed that one resident had suffered extensive bruising to the side of her face. No explanation was available for this incident and a referral was made to Sutton Social Services Team under their Protection of Vulnerable Adults Procedures.The Registered Provider made an assurance that an internal investigation would take place. No complaints have been received about this service since the last inspection. What the service does well:
The residents in this home and their families consider that they live in a pleasant environment, which suits their needs, and all of those that were able to express an opinion, were appreciative of the care that they receive. Residents looked well cared for and comfortable and comments were made that “staff were very nice” “treat us well ” and that “there is always plenty of food” Menus were varied and particular preferences and dietary needs are catered for. Staffing levels appear to be sufficient to meet the care needs of residents and many of the staff have received some training in caring for residents with dementia. Staff turnover is very low, enabling continuity of care to be provided and more than 50 of carers are educated to NVQ level 2 and above. A comprehensive pre-admission assessment in addition to the one from the care manager ensures that the healthcare needs of residents will be met and care plans accurately reflect the care that is currently being delivered. These
Southdown Nursing Home DS0000019123.V329047.R01.S.doc Version 5.2 Page 6 plans are regularly reviewed and advice is gained from other healthcare professionals as required. Their frailty means that residents are often not able to contribute to these plans however input is encouraged from their relatives who sign to say that they agree with them. Some activities, suitable for the needs of the residents, are provided although recognising the importance of any form of interaction and communication with residents it is recommended that consideration should be given to increasing them. What has improved since the last inspection? What they could do better:
In order that potential residents can make an informed choice about the place where they are going to live they must be able to access all of the relevant information. Currently information is given to their representatives when they receive their contract. Some work must now be undertaken to ensure that there is a clear Statement of Purpose for the home setting out its aims and objectives and in accordance with the regulations. In addition there must be a Service User Guide available for residents and their families. This should be a “Guide Book “ to the home so that residents are aware of the services that will be provided and what it will be like for them living there. Some concerns were raised about a resident not being moved according to their current manual handling plan. It was suggested that advice should be taken about the suitability of the equipment provided by the home and whether it was the most appropriate for the current residents in addition to ensuring that it all equipment is in working order. The home is currently without a Registered Manager although the Registered Provider sometimes works there. In order to provide continuity of care for residents and sound leadership for staff an appropriately qualified and
Southdown Nursing Home DS0000019123.V329047.R01.S.doc Version 5.2 Page 7 experienced person must be put forward to The Commission for Social Care Inspection for registration. Since the previous manager left the home not all care staff have had access to formal supervision sessions. These must be provided to ensure that there is continual monitoring of practices within the home and any future training needs can be identified. There is currently no formal way available for residents or their representatives to air their views of how the home is run or to influence the services that are provided. A quality assurance monitoring tool must be introduced so that they are given the opportunity to contribute to this process. Some issues were raised in conjunction with some unexplained bruising seen on a resident. Appropriate action had not been taken at the time and in order to safeguard both residents and staff, requirements were made to ensure that all staff had received up to date training, and records were kept appropriately in future. 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. The summary of this inspection report can be made available in other formats on request. Southdown Nursing Home DS0000019123.V329047.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Southdown Nursing Home DS0000019123.V329047.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,3,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a pre admission assessment process in place to ensure that the home and the services that it provides will meet residents assessed needs however, written information that is given to them needs to be updated so that they can be sure that the placement will suit them. This home does not offer intermediate care. EVIDENCE: The local authority funds the majority of the current residents and the care manager’s assessments, determining the level of support that is required were seen in care plans that were assessed. In addition a senior member of the homes staff will visit a potential resident to make certain that their needs can be met.
Southdown Nursing Home DS0000019123.V329047.R01.S.doc Version 5.2 Page 10 A combined Statement of Purpose / Service User Guide is given to the representatives of residents, along with a written contract, at the time of admission. This now needs to be amended so that there are two distinct documents in place. A clear Statement of Purpose must be available for the home, which complies with Regulation 4 of The Care Homes Regulations and identifies the objectives and philosophy of the home. In addition, a written guide to the home, which will include a summary of The Statement of Purpose and a description of the services being offered, must support this and be made available to residents. Information relating to fees must also be included in this in line with Regulation 5 and it must reflect the current situation in the home with regard to staffing. Southdown Nursing Home DS0000019123.V329047.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents in this home consider that they are always treated with respect and dignity however, although their care plans accurately reflect their assessed healthcare needs, the appropriate interventions and support are not always given which would ensure their comfort and safety. Medication policies and procedures are in place to ensure the protection of residents. EVIDENCE: A sample of four care plans was inspected at this inspection. These are usually reviewed monthly to ensure that they reflect the care that is currently being provided although care must be taken to ensure that this always happens. Input is gained from other healthcare professionals as required.
Southdown Nursing Home DS0000019123.V329047.R01.S.doc Version 5.2 Page 12 It was noted at previous inspections that some relatives have supplied life stories to help staff gain a greater understanding of their residents although this does not appear to have been developed any further. This information would help staff to understand the behaviour of their residents and is fundamental to providing good quality care to those with dementia. The recommendation to undertake this work is therefore repeated. During the inspection it was noted that one resident had extensive bruising to their face. No explanation was available, the incident had not been recorded, appropriate medical advice had not been sought and the resident’s representatives had not been informed. A referral was made to the local authority in accordance with their adult protection procedure. Requirements are issued in relation to this issue under standards 18 and 38 and the Registered Provider agreed to hold an internal investigation. During the inspection it was also noted that one resident was not transferred between a chair and wheelchair in accordance with her moving and handling assessment. Apparently not all of the hoists in the home were in working order at the time,and an alternative lifting aid was used. A lack of appropriate equipment could lead to serious injuries to both residents and staff. Requirements are issued in relation to this under standard 38 and in addition a recommendation is made that professional advice should be gained as to which type of equipment would be the most suitable for the current residents in 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 Southdown Nursing Home DS0000019123.V329047.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14,15 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. In order to preserve their independence, residents would be encouraged to make choices within their limitations and abilities and visitors are encouraged to allow them to maintain relationships with families and friends. Meals that are served in the home are nutritious and suited to resident’s preferences, and a limited range of activities in the home offer them stimulation and interest. EVIDENCE: The majority of residents in this home are very frail and have limited capabilities although they are encouraged to make choices in their lives as much as they are able. Visitors are always made welcome and one who was visiting at the time commented on the friendliness of the staff. The lunchtime meal was served during the inspection and looked well cooked and presented. Those who were able to express an opinion confirmed their satisfaction with the food served in the home, menus were varied and choices
Southdown Nursing Home DS0000019123.V329047.R01.S.doc Version 5.2 Page 14 are available. One resident has a vegetarian menu and previously the home has been able to provide ethnically diverse meals. A range of activities is offered in the home and although it is again suggested that this could be expanded it is acknowledged that resident’s capabilities are generally very limited. Southdown Nursing Home DS0000019123.V329047.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16,18 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. An appropriate complaints procedure is in place, which should ensure that residents concerns will be listened to and acted upon promptly however, they cannot be confident that measures are in place to protect them from abuse. EVIDENCE: There is a complaints procedure, which is displayed in the hall. This provides information about the process although a visiting relative commented that in their opinion the management team would always deal with any concerns promptly. The complaints book was seen and there was one documented concern, regarding issues that had occurred at night, that had now been dealt with. In order to help to protect residents no new members of staff are employed without appropriate clearance from the Criminal Records Bureau and there has been some training in the recognition of adult abuse within the last year. A carer, who was spoken with, displayed a thorough understanding of the relevant issues. As detailed in standard 8, concerns were raised about unexplained bruising to the face of one resident, noted when they had been helped up in the morning. The Registered Provider agreed to investigate this promptly when informed
Southdown Nursing Home DS0000019123.V329047.R01.S.doc Version 5.2 Page 16 however, no action had been taken prior to this time and a requirement is made to ensure that all staff who work in the home have had the necessary training to help the recognise and report possible abuse and that their knowledge is updated on a regular basis. Southdown Nursing Home DS0000019123.V329047.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents live in a home, which suits their needs and expectations and provides them with a clean and pleasant environment. EVIDENCE: Since the last key inspection communal areas and the majority of bedrooms have been redecorated and the home appears much brighter and fresher. On the day of this visit it was clean and free from odour. Adaptations are in place to meet resident’s needs and the building now complies with fire safety regulations. Southdown Nursing Home DS0000019123.V329047.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29,30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Staff in this home are employed in sufficient numbers so that the healthcare needs of the residents will be met and robust recruitment procedures are in place to protect them Training is in place to help staff to fulfil the aims of the home and meet the needs of the residents. EVIDENCE: On the day of the inspection there were sufficient numbers of staff on duty to care for the seventeen residents currently living there. Off duty records confirmed this to always be the case. All of the care staff have completed an NVQ level 2 qualification and one is currently undertaking level 3. In addition to mandatory training, all of the staff have undertaken training in dementia awareness. Other recent topics have included diabetes and first aid. These are undertaken by the homes “in-house“ trainer. As noted under standard 18 the Registered Provider must ensure that all staff are fully aware of the procedures to be followed with regard to possible adult abuse.
Southdown Nursing Home DS0000019123.V329047.R01.S.doc Version 5.2 Page 19 Staff turnover is very low which promotes continuity of care and allows residents to get to know those who are caring for and supporting them. No new members of staff have been employed since the last inspection. Southdown Nursing Home DS0000019123.V329047.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,36,38 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Residents do not currently benefit from the skills and leadership of a registered manager. There is no evidence that residents or their relatives are able to influence the services that they receive or contribute to the running of the home and some working practices do not ensure that resident’s health and safety are fully protected. EVIDENCE: The home is currently without a registered manager, the previous manager having recently left. Staff confirmed that The Registered Provider is often in
Southdown Nursing Home DS0000019123.V329047.R01.S.doc Version 5.2 Page 21 the home however; in order to maintain continuity and leadership a suitable person must be put forward for registration without delay. Despite a previous requirement there is still no quality assurance monitoring tool in use in the home. Without this there is no evidence that residents or their representatives are asked about their views of the home or that they are able to influence the care or services that they receive. Since the departure of the homes manager not all care staff have been receiving supervision. This must be put in place in order to monitor their practice and identify any future training needs that they may have. As previously noted under standard 8 concerns were raised about an injury to a resident that had not been recorded in the appropriate book. All injuries and incidents must be appropriately recorded. As noted under standard 7 it was observed that a resident was not moved in accordance with her moving and handling care plan. In order to protect the health and safety of both residents and staff members these plans must be adhered to. Regular review will ensure that they remain up to date. The Registered Provider must ensure that staff have access to the most appropriate equipment and that it is in working order. Southdown Nursing Home DS0000019123.V329047.R01.S.doc Version 5.2 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. 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 X 1 Southdown Nursing Home DS0000019123.V329047.R01.S.doc Version 5.2 Page 23 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 OP1 Regulation 4 and 5 Schedule 1 Requirement The Responsible Person must ensure that there is a clear Statement of Purpose available and that this is supported by a Service User Guide so that residents are made aware of the services that are provided and can measure the homes success in meeting its objectives. The Responsible Person must ensure that there is evidence that all staff have received training in procedures concerned with recognising and reporting suspected or possible adult abuse. The Responsible Person must ensure that a suitable person is put forward for registration to ensure continuity and leadership within the home. The Registered Provider must provide evidence that a quality assurance tool has been introduced into the home. Previous timescale 08/11/06 not achieved Timescale for action 30/05/07 2 OP18 13 (6) 30/05/07 3 OP31 8 30/05/07 4 OP33 12(2) 30/05/07 Southdown Nursing Home DS0000019123.V329047.R01.S.doc Version 5.2 Page 24 5 OP36 18(2) The Registered Provider must provide evidence that all care staff have formal supervision sessions at least six times a year. Previous timescale 08/11/06 not achieved The Responsible Person must ensure that all accidents within the home are appropriately recorded. The Responsible Person must ensure that for any resident requiring support to be moved it is undertaken according to their current moving and handling assessment The Responsible Person must ensure that staff have access to the most appropriate moving and handling equipment in order to maintain the safety of both them and the homes residents. The Responsible Person must ensure that all equipment required to move residents is in working order. 30/05/07 6 OP38 Schedule 4 12 13(5) 06/02/07 7 OP38 06/02/07 8 OP38 13(5) 06/03/07 9 OP38 13(4)( c) 06/03/07 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 OP7 Good Practice Recommendations It is recommended that professional advice should be sought as to the suitability of hoists and other moving and handling adaptations and equipment. This will ensure that they are the most appropriate for the current residents and maintain the health and safety of both them and the
DS0000019123.V329047.R01.S.doc Version 5.2 Page 25 Southdown Nursing Home 2 OP7 3 OP12 staff. . It is recommended that staff engage with residents and their representatives to undertake some life history work and gain a deeper understanding of resident’s previous lifestyle. It is recommended that the range of activities should be introduced into the home for residents to provide more interest and stimulation to their daily lives. Southdown Nursing Home DS0000019123.V329047.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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