Inspection on 13/03/07 for Southdown Nursing & Residential Home

This inspection was carried out on 13th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Southdown Nursing & Residential Home The Old Vicarage 17 Church Road Wanborough Swindon Wiltshire SN4 0BZ Lead Inspector Steve Cousins Key Unannounced Inspection 09:00 13 – 14th March 2007 th 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 & Residential Home DS0000068647.V330416.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 & Residential Home DS0000068647.V330416.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Southdown Nursing & Residential Home Address The Old Vicarage 17 Church Road Wanborough Swindon Wiltshire SN4 0BZ 01793 790727 01793 790727 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) Southdown Care Limited Miss Deborah McHugh Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Southdown Nursing & Residential Home DS0000068647.V330416.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. From time to time service users aged between 60 and 65 years may be accommodated. No more than 24 persons in receipt of nursing care at any one time. Date of last inspection 23rd January 2007 Brief Description of the Service: Southdown Care Home is registered to provide nursing and residential care for up to 30 service users. The home is located within the village of Wanborough with local pubs, post office and bus stop nearby. It is approximately four miles from Swindon and the M4 motorway. The home is a converted listed building with a purpose built annexe. Accommodation is provided on three floors and there is access to a secluded courtyard and gardens. Carevale Ltd owns the home and Deborah McHugh is the registered manager. A registered nurse is on duty at all times, supported by care assistants. Catering, laundry, housekeeping and maintenance services are also provided. Southdown Nursing & Residential Home DS0000068647.V330416.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days on the 13th and 14th March 2007 in order to inspect all of the key minimum standards relating to care homes for elderly people. Two inspectors visited the home between 9.00 a.m. and 5.00 p.m. on the first day, and one inspector between 9.30am and 3.00pm on the second day, making a total of 21.5 inspection hours. The lead inspector then met with Mrs McHugh, the registered manager, and Mr Weissbraun, the home’s new owner, in order to discuss the outcome of the visit. The findings from this inspection are based on a tour of the premises, speaking to residents, relatives, the manager and staff, and visiting frail residents. A number of records were inspected, including care plans, medication records and staff records. Comment cards were received from five residents’ relatives following the inspection and their views are incorporated in this report. The judgements contained in this report have been made from evidence gathered during the inspection and take into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? The Commission had serious concerns about the home following the last key inspection held in September 2006 when thirty statutory requirements and eleven good practice recommendations were issued. Due to some of the statutory requirements recurring over many previous inspections, enforcement notices were issued relating to the cleanliness of the home, the provision of pressure relief to residents, staff training and the lack Southdown Nursing & Residential Home DS0000068647.V330416.R01.S.doc Version 5.2 Page 6 of monthly visit reports by the owners. Two further unannounced inspections were held on the 4th December 2006 and the 23rd January 2007 in order to monitor progress. Southdown changed ownership in January 2007 and it is evident that the new owners have made genuine efforts to improve the home. The manager and staff have a more positive outlook and there has been an investment in the environment. There have been improvements in all areas relating to the statutory notices and further improvements in assessment procedures, the recording of care given to residents, medication procedures and complaint recording were evident. Improvements to the environment have included some redecoration, purchasing new furniture, refurbishment of a bathroom and the installation of a stair lift to the top floor. It is notable that twenty-six of the thirty requirements set at the previous inspection have been met and six of the eleven recommendations acted upon. What they could do better: Care planning still needs to improve as plans do not accurately reflect residents care needs and they are not all being regularly reviewed or agreed with by residents and relatives. Care assistants were not all aware of how to refer to care plans to ensure the care and support they give is correct. Residents who have problems taking in adequate nutrition need to be regularly weighed and assessed. Nurses need to follow recommended procedures when recording medication received in the home and administered to residents. Although there has been some improvement in providing social activity, more dedicated staff hours may further enhance this. Some evidence suggests that residents’ privacy and dignity is not always fully respected. More quality assurance systems need to be introduced to ensure that views of the residents and relatives are heard and care practice is monitored. A formal staff supervision system needs to be fully introduced and staff awareness of health and safety improved. Staff induction training needs to be more structured and staff training needs should be assessed and recorded. Further improvements to the decoration of the home and the provision of suitable bedside lighting, locks on their doors, comfortable seating and sufficient electrical sockets would further enhance the environment for the residents. The manager and registered provider must now focus on meeting the four unmet requirements from the previous inspection to avoid any further enforcement action by the Commission and to addressing the remaining good practice recommendations. A further eight statutory requirements were set at this inspection and a further six good practice recommendations. Southdown Nursing & Residential Home DS0000068647.V330416.R01.S.doc Version 5.2 Page 7 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 & Residential Home DS0000068647.V330416.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 & Residential Home DS0000068647.V330416.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 and 3. Standard 6 does not apply to this home. Quality in this outcome area is good. The home has a clear statement of purpose and a new service users guide is available. Prospective residents needs are assessed before moving into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is now under new ownership and revised copies of the statement of purpose and service users guide have been produced and are to be distributed to residents and relatives. A copy of the previous key inspection report was kept in the entrance lobby, however two of the five relatives who returned comment cards indicated that they were unaware of how to access the inspection reports on the home. The records of two new residents contained pre admission assessment forms that had been completed by the manager and there had been an improvement Southdown Nursing & Residential Home DS0000068647.V330416.R01.S.doc Version 5.2 Page 10 in the standard of assessment since the previous key inspection. The two records contained other supporting documents including assessments from a care manager and hospital discharge summaries. One resident confirmed that the manager had come to see her in hospital prior to moving in but the other was unable to confirm this due to their condition. Southdown Nursing & Residential Home DS0000068647.V330416.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): Standards 7,8,9 and 10. Residents’ have care plans, but these do not always accurately reflect individual needs and care staff do not always refer to them to direct the care they give. Residents’ health care needs appear to be addressed and there has been an improvement in the provision of pressure relief equipment, but those nutritionally at risk need to be weighed more frequently. Residents appear to be treated with dignity and respect, however some residents’ comments indicate that further improvement is required in this area. Staff responsible for administering medication need to improve recording procedures to ensure records are accurate. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector reviewed the care of four residents in detail, three females and one male between the ages of 84 and 95. They had varying physical, social Southdown Nursing & Residential Home DS0000068647.V330416.R01.S.doc Version 5.2 Page 12 and mental health needs. Some were new to the home and others had been at Southdown for some time. The care of other residents was reviewed in less detail. The residents care plans were reviewed. A requirement relating to care planning was set at the previous inspection. Some improvement was noted however further development is required. Plans were in place for all residents but these were not always an accurate reflection of assessed needs. Plans lacked clarity and some contained contradictory information. For example, one resident’s plan stated that they had a wound that required dressing, however this was not the case. Another resident had a different pressure relief mattress on their bed than stated in the care plan. Where a resident required regular analgesia, a care plan was not in place to review the efficacy of pain control. A resident who had a skin break recorded, did have a wound assessment carried out and a record of the initial dressing, however no further action or review had been recorded. Plans were not always in place for those residents who were terminally ill in order to ensure that the care they receive is what they would wish. All plans had included a section headed ‘Religion/Death’ and it is possibly inappropriate that these diverse subjects are assessed in one plan. Some care plans had not been reviewed monthly and many had not been signed by the resident or their representative in order to record agreement. Care assistants were not all sure about how to use a care plan to direct the care that they gave. One said that they had not read any of the care plans and that they were not sure what a care plan is. When asked about care plans another staff member said she had not personally gone through any of them as the nurse in charge tells them what needs to be done. The inspector visited the residents and found that interventions were generally in place to meet their assessed needs, such as pressure relief equipment, continence aids and manual handling equipment. Positional changes were being recorded where required. Good practice was evident in the care of two very frail residents in regard to maintaining their skin integrity. As detailed at the previous inspection, further improvement is required relating to those residents who are assessed as nutritionally at risk. Records indicated that they had not all been regularly weighed in order to ascertain if there had been any weight loss and plans were not always in place to direct care in relation to issues such as the provision of dietary supplements. Daily records indicated that staff are prompt in referring residents to their General Practitioner (GP) when required and to other health care professionals, such as the tissue viability nurse. A GP visits the home weekly to see any residents with health care problems and comments received from the GP Southdown Nursing & Residential Home DS0000068647.V330416.R01.S.doc Version 5.2 Page 13 during the inspection indicated that they were satisfied with the overall care provided by the home, saying the staff were “caring” and that they “do a good job”. GP’s visits are recorded along with any action required. The residents’ appeared to be having their personal hygiene needs met and those who were able to communicate indicated some satisfaction with the care given. Residents comments included “Staff are ok they help you” and another said they were “treated very well”. One resident felt that “Older staff are ok, but younger ones hurry through” and felt some carers were “ a little bit rough” when handling her. Of the five comment cards received from relatives, all answered yes to the question ‘Are you satisfied with the overall care provided?’ Comments added included ‘We are very happy with the care my mother is receiving’ and ‘Staff at this home are very good. We are very happy with them’. There was some evidence to suggest that residents’ privacy and dignity was respected. It was observed that personal care was being given behind closed doors and staff knocked on doors before entering a room. Indirect observation indicated that staff spoke in a friendly and respectful way to residents. One resident stated: “Staff are very nice and friendly” but another said, “Some staff are very nice but some are difficult to get on with”. Observations made during the inspection found staff having to use screens to ensure residents privacy when using the ground floor bathroom. Discussion with the staff confirmed this was due to having to use the hoist. Discussion with the resident involved confirmed they felt their dignity was respected and they had no concerns over this practice. However the screens were not sufficient to fully ensure people walking past the bathroom could not see into the room. This was brought to the attention of the manager and it was unclear whether this is a training issue for staff in the use of the hoist or whether the bathroom facilities are unsuitable. It is recommend this practice is reviewed. The arrangements regarding administration of medication were reviewed. Registered nurses are responsible for the administration of medicines in the home. Medications were safely and securely stored and records of receipts, administration and disposals are maintained. In two cases relating to the receipt of a controlled medicine and the administration of night sedation, records were inaccurate, indicating that the staff responsible were not following recommended procedures. One resident also felt that they were not receiving their medication promptly. The registered manager has subsequently investigated these issues and has taken action in order to improve practice. Due to their needs, no residents currently self-administer their medication. Southdown Nursing & Residential Home DS0000068647.V330416.R01.S.doc Version 5.2 Page 14 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 and 15. Quality in this outcome area is good. The provision of social activities continues to improve but inconsistencies in how and when activities are delivered remains. Visitors are made to feel welcome. The standard of meals remains satisfactory but the choice and variety has improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Improvements have been made to the number of hours allocated to activities in the home. The home has a designated activities coordinator who now works Monday, Tuesday and Thursday between the hours of 9.00am and 3.00pm, an increase of six hours. Discussion with residents about their involvement in the leisure and social activities was varied. For example one resident commented, “There’s lots to do” another resident commented, “I think there are activities but I don’t go”, while another resident said “I am bored and there is nothing to do”. Discussion with the activities coordinator and examination of records demonstrated activities are taking place. A record is kept of the activities provided including the resident’s involvement. Southdown Nursing & Residential Home DS0000068647.V330416.R01.S.doc Version 5.2 Page 15 There is evidence to demonstrate that opportunities are being provided to enable residents’ to access their community. For example trips out have been arranged for residents to visit the local garden centre and an Easter bingo and raffle is planned in the village hall. However on the day of our site visit the activities coordinator was covering for the cook and no activities were planned for the week. This needs to be addressed to ensure resident’s opportunities are not restricted. Observations made during the site visit found residents being left watching the television and for a period of over twenty minutes whilst the picture had been lost. Staff were walking through the lounge but no one tuned in the picture or interacted with residents. One lounge on the first floor had music playing loudly. When the residents were asked if they wanted the music turned down two residents replied “yes”. Discussion with the registered provider confirmed there are plans to provide further additional hours and recruit another member of staff to ensure activities for residents are not compromised and improve the variety and opportunity for residents. There was opportunity to meet with the relatives of three residents. They confirmed they could visit the home at anytime. One relative confirmed they are able to share a meal with their relative if they wish and commented the food is “very good”. Discussion with the relative of one resident confirmed they could choose whether to meet in one of the communal areas or their relative’s room. The five comment cards received from friends and relatives all indicated that they were able to visit in private and were welcomed at any time. They also indicated that they were kept informed of important matters concerning the resident and, where applicable, consulted about their care. Residents were generally complimentary about the meals available. The home operates a four-week rotating menu. The cook commented that since changing food suppliers more choice and variety is being offered to residents. The menu offers a choice at breakfast, which includes a full cooked breakfast. The lunchtime meal is the main meal of the day and is a set menu. The cook confirmed that she speaks to residents each day to inform them of the lunch menu and if a resident does not like the choice then an alternative is offered. Discussion with residents confirmed this practice. One resident commented, “If I don’t like it [the meal] I get something else”. These alternatives should be clearly recorded to ensure residents are getting a balanced and nutritious diet. Southdown Nursing & Residential Home DS0000068647.V330416.R01.S.doc Version 5.2 Page 16 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 and 18. Procedures for dealing with complaints are improving and as far as possible, residents are protected from abuse, although some staff members’ awareness of reporting procedures needs to be enhanced. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaint procedure, which is contained in the service users guide. Three of the five comment cards received from relatives and friends indicated that they were not aware of the complaint procedure. One resident stated, “ I would talk to Debbie (manager) if I wanted to complain” but one said: “I don’t know who I would complain to.” Previous inspections and a recent complaint indicated that complaints had not always been recorded or dealt with promptly. Discussion with the manager and provider indicated that there was a greater awareness of the need to record all complaints and take prompt action to resolve them. They were intending to provide a book in each resident’s room for the purpose of improving communication with relatives; it was suggested that a copy of the complaint procedure be attached. A complaints record book had since been started in February 2007. Four complaints had been logged and the action taken to resolve them had been Southdown Nursing & Residential Home DS0000068647.V330416.R01.S.doc Version 5.2 Page 17 recorded, although the date of resolution had not been added. The complaints procedure also states that the complainant will be asked to read and sign the book in order to confirm that it is a an accurate record of the complaint. This was not evident during this inspection. The CSCI had received one complaint about the home, which was currently being investigated by the owner. A ‘whistle blowing’ policy is in place along with a protection of vulnerable adults policy that also relates to the local ‘no secrets’ guidelines for reporting suspected abuse. Staff training relating to protection of vulnerable adults is available and records indicated that the majority of staff had received this during 2006 and that new staff would receive training during the coming year. Staff awareness of the reporting procedure varied. One staff member stated that they had “watched a video about abuse” but had not seen the ‘no secrets’ booklet but would report any concerns to the manager. Another was unable to tell the inspector the procedure for reporting alleged abuse due to communication difficulties. Southdown Nursing & Residential Home DS0000068647.V330416.R01.S.doc Version 5.2 Page 18 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 19,20,21,22,23,24,25 and 26 The overall standard of accommodation is improving however there are still some deficits in the decoration and facilities and furnishing provided in residents rooms. As a priority, attention needs to be given to ensuring electrical safety in the home. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the building was made and all resident bedrooms and communal living areas were seen. Parts of the home are in need of decorating where paintwork is chipped or flaking and some skirting boards and the bottom of doors have gouges in the woodwork. However since the last site visit improvements have been made and work is continuing on redecorating the home. One relative commented ‘There are good signs that Southdown is improving its’ amenities under it’s new ownership’. Southdown Nursing & Residential Home DS0000068647.V330416.R01.S.doc Version 5.2 Page 19 The majority of resident’s bedrooms offer single occupancy and some en suite facilities. Where residents shared a bedroom, screens to respect their privacy were not always provided. Discussion with resident’s confirmed they were able to bring small personal items to the home. One resident commented they had “everything they needed”. However, not all bedrooms had suitable bedside lighting, locks on their doors, comfortable seating and sufficient electrical sockets and many bedrooms had extension leads or double plugs with electrical appliances plugged in such as televisions and air flow mattresses. In one bedroom the extension lead was across the carpet, a clear risk to the resident. This was brought to the attention of the manager who removed the extension lead. In addition, one plug socket in a resident’s bedroom was broken and another socket had exposed leads by the side of the resident’s bed. Due to the significant risk to the resident these electrical sockets were immediately repaired. There were no records to indicate that portable appliance testing had been carried out and a current electrical wiring certificate was not available. There are three separate communal lounges and new comfortable seating has been provided. In one communal lounge there is a small dining area where a maximum of eight residents can eat their meals. This is the only dining area in the home and means other residents have to eat their meal either in their room or in one of the communal lounges. While this currently meets the requirements for care homes registered before the 31st March 2002 consideration should be given to providing additional dining facilities. Three service users did comment that they enjoyed having their meal in their room. Not all service users could express a view on where they wish to eat their meal and observations made during the inspection found they remained in the same room throughout the day. If additional dining facilities were to be provided this would offer residents more choice and provide an area where all residents could enjoy a meal together. Toilet and bathing facilities are situated on all three floors of the home close to communal living areas and resident’s bedrooms. One of the downstairs toilets requires a suitable lock that will ensure service users privacy and allow access to staff in the event of an emergency. The accommodation is split over three floors, which can be accessed by two passenger lifts. In addition, a chair lift has been fitted to ensure residents can access the top floor area should the passenger lift fail. The registered provider confirmed that plans are in place to replace one lift, which had persistently broken down. Aids and adaptations are in place at the home however the hoists in the bathrooms had not been serviced since February 2006. The manager was not clear on the frequency of the service they require and it is recommended that the home ensure all adaptations are serviced in line with the manufactures conditions. Southdown Nursing & Residential Home DS0000068647.V330416.R01.S.doc Version 5.2 Page 20 The home was free from unpleasant odours and improvements have been made to the overall cleanliness of the building but more attention needs to be given to ensure areas such as the sides and underneath of beds and chair raisers are cleaned to the same standard. The laundry room is situated on the first floor well away from any food preparation or food storage areas. The walls and floors are readily cleanable but areas around and behind the washing machines need some improvement. Discussion with staff confirmed any soiled or infected laundry would be placed in a red alginate bag and put straight into the washing machine. Discussion with residents confirmed they were generally satisfied with the laundry service. One resident commented that their laundry is always done well. Another resident commented: “they take it away and it comes back clean”. The kitchen area was seen and there has been a noticeable improvement in the overall standard of cleanliness since the last key inspection. The cook confirmed a cleaning schedule is in place to ensure all parts of the kitchen are thoroughly cleaned. However the kitchen floor covering was cracked and worn in places and it is recommended that it be replaced. Southdown Nursing & Residential Home DS0000068647.V330416.R01.S.doc Version 5.2 Page 21 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 and 30. Staff numbers and skill mix appear to meet the residents’ needs. The level of care assistants with an NVQ is high and recruitment procedures were satisfactory. Staff training is more organised although further work needs to be done to review individual training needs and to ensure new staff have adequate induction training. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The number of care staff over the two days of this unannounced inspection appeared enough to meet residents’ needs and call bells were answered without any delay. Residents generally reported that there were enough staff to support them and none reported any significant delays in receiving support when asked for. All of the five relatives who had filled in comment cards indicated that they felt there were always sufficient numbers of staff on duty. This is an improvement on previous inspections The recruitment records of four recently recruited staff members were reviewed. Criminal Record Bureau (CRB) checks had been obtained or applied for and references and Protection of Vulnerable Adults (POVA) checks had been obtained prior to the person starting employment in all cases. Other Southdown Nursing & Residential Home DS0000068647.V330416.R01.S.doc Version 5.2 Page 22 documentation required was in place. The home has an equal opportunities recruitment policy. We reviewed the arrangements relating to staff induction training. One staff member who had commenced employment five weeks previous stated that for their first three weeks of employment they ‘shadowed’ one of the carers and watched a moving and handling video and fire drills. They had also been shown how to use lifting equipment and slide sheets. They confirmed that they had a mentor, who was one of the senior care assistants and said that they were soon to start an NVQ qualification. The carer was unaware of any other future training planned. The person’s training record indicated that they had received basic training in fire safety, infection control and the use of moving and handling equipment. Induction training relating to Skills for Care standards had not yet commenced and the manager said that this would be put in place when the new deputy manager commenced employment. A requirement has been set at the previous two inspections relating to induction training and a statutory enforcement notice served in November 2006 related in part to the adequate provision of induction training. Although some improvement is evident, the manager should make every effort to fully comply with this requirement by the stated date to avoid further enforcement action. The training records of two other staff who had commenced employment in January 2007 indicated that they had received training in fire safety, infection control and moving and handling, however the inspector was unable to check of one of the person’s knowledge due to their poor English language skills. One resident also stated: “I have difficulty with staff that don’t speak English, it is difficult to understand what they say.” The manager was aware of the problem and stated that one carer had problems communicating in English and would be commencing domestic duties instead, and that another was attending English classes. The induction records of two cleaning staff indicated that they had received training appropriate to their role. Mrs McHugh had recently purchased a range of training videos for induction and mandatory training purposes and stated that staff were expected to complete question and answer sheets following viewing. A training programme had been produced for the coming year and the manager was aware of the staff that required training updates. Progress needs to be made in recording staff members individual training needs. Mrs McHugh stated that ten of the fifteen care assistants had obtained an NVQ and that four more were due to start an NVQ shortly. Southdown Nursing & Residential Home DS0000068647.V330416.R01.S.doc Version 5.2 Page 23 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 31,33,35, 36 and 38. The overall management of the home has improved and the registered manager has demonstrated an enhanced commitment to meet her responsibilities. Quality assurance systems need further improvement. A formal staff supervision system needs to be fully introduced and staff’s awareness of health and safety issues needs to be raised. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Deborah McHugh is the homes registered manager and has been employed at Southdown since 1990. She is a first level trained nurse and an NVQ Assessor. Mrs McHugh has also obtained the Registered Managers Award. Southdown Nursing & Residential Home DS0000068647.V330416.R01.S.doc Version 5.2 Page 24 The findings of this inspection would indicate an improvement in Mrs McHugh’s ability to meet the responsibilities of a registered manager and she reported that she felt supported by the new owners in achieving this. It is evident that efforts have been made to meet the requirements of the previous inspection, and of the statutory notices served on the home, although she acknowledged that further commitment needs to be maintained to ensure any unmet statutory requirements are fully complied with. The manager stated that further support for her would be available when a new deputy manger started employment in April 2007. One staff member felt that there had been a “great improvement” in the home since coming under new ownership, reporting “an investment in the home, equipment and staff”. She felt staff were “more settled” and that there was a genuine commitment amongst management and staff to improve the home. The quality assurance arrangements were reviewed with the manager and registered provider. The home has an annual questionnaire that is sent to residents, relatives and professionals, although this had yet to be sent out. This was also the finding at the last inspection held in September 2006. The manager discussed her plans to introduce ‘open evenings’ for residents’ relatives on a three monthly basis along with two weekly audits of practice issues. The registered provider had commenced monthly regulatory visits to the home and had reduced a report for the manager and the Commission. The manager stated that she had commenced formal supervision sessions with the nursing staff, but that this had yet to be introduced for other staff members. One staff members training file did contain a supervision record. The manager reported that the home does not handle any personal money on behalf of residents and that no member of staff is involved with any residents’ finances The health and safety arrangements in the home were reviewed. Accidents are recorded correctly and audited in order to monitor any patterns or trends. The fire safety log indicated that checks were being undertaken at the recommended intervals and the homes fire risk assessment has recently been reviewed and updated. Radiators are protected and hot water temperatures are controlled. Environmental risk assessments were last carried out in April 2006. A risk assessment relating to the safety of bedrails has been carried out. Moving and handling equipment is available and staff are trained in its use. The home does not have a health and safety committee. Due to the findings detailed in the Environment section of this report, thought should be given to forming one to enhance staff awareness of health and safety issues. Southdown Nursing & Residential Home DS0000068647.V330416.R01.S.doc Version 5.2 Page 25 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 2 2 2 3 2 2 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 3 2 X 2 Southdown Nursing & Residential Home DS0000068647.V330416.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15 (1) Requirement The registered manager must ensure that residents care plans fully reflect their assessed needs. Unmet requirement from the inspection held 18th September 2006. The registered manager must ensure that residents care plans are reviewed at least once a month, updated to reflect changing needs and current objectives for health and personal care, and actioned. The registered manager must ensure that where practicable, residents who are assessed as nutritionally at risk are regularly weighed. Unmet requirement from the inspection held 18th September 2006. The registered manager must ensure that accurate records are kept of all medicines received and administered in the home to ensure that there is no mishandling. The registered person must supply the commission with a DS0000068647.V330416.R01.S.doc Timescale for action 01/04/07 2 OP7 15 (1) 01/04/07 3 OP8 12 (1,a,b) 01/04/07 4 OP9 13 (2) 01/04/07 5 OP19 13 (4,c) 01/05/07 Southdown Nursing & Residential Home Version 5.2 Page 27 6 OP19 13(4,c) 7 OP20 16(1,c) 8 OP21 12 (4,a) 9 OP24 13(4,a,c) 10 OP27 18 (1,a) 11 OP30 12 (1,a,b) 18 (1,a,c,i) 12 OP30 12 (1,a,b) 18 (1,a,c,i) copy of a current electrical wiring safety certificate The registered person must ensure portable appliance tests are completed on all electrical equipment. The registered person must ensure residents privacy and dignity is maintained by ensuring screening is provided in shared bedrooms. To ensure the privacy and dignity of service users, a suitable lock, which allows access to staff in the event of an emergency must be fitted to the downstairs toilet, located by the kitchen. The registered person must ensure there are sufficient electrical sockets in each of the residents’ bedrooms. The registered person must ensure that staff providing personal care to service users are able to communicate effectively. The registered manager must ensure that all new care staff members receive induction training to the standards specified in the Skills for Care common induction standards (2005) within 12 weeks of employment. Unmet requirement from the inspections held on 1st June and 18th September 2006. The registered manager must ensure that all staff members have an individual training and development assessment and profile. Unmet part of a requirement from the inspection held 18th September 2006. 01/05/07 01/04/07 14/04/07 01/07/07 01/04/07 01/06/07 01/06/07 Southdown Nursing & Residential Home DS0000068647.V330416.R01.S.doc Version 5.2 Page 28 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 4 Refer to Standard OP1 OP7 OP7 OP7 Good Practice Recommendations The registered person should ensure that the homes inspection report is more accessible to relatives and residents. The registered manager should ensure that care plans be agreed and signed by the resident whenever capable and/or their representative (if any) The registered manager should provide instruction to care assistants relating to the use of care plans. It is recommended that residents’ wishes regarding religious practice and death and dying are assessed and recorded separately in care plans. (Recommendation from inspection held 18th September 2006) It is recommended that the manager introduce a quality monitoring system with regard to care practice in the home. (Recommendation from inspections held 1st June and 18th September 2006) It is recommended that service users who are prescribed regular analgesia have corresponding care plans in order to monitor efficacy and prompt reviews. (Recommendation from inspection held 18th September 2006) It is recommended that more staff hours are made available to enhance the current arrangements regarding social activity for service users. (Recommendation from inspection held 18th September 2006) The registered person should review the bathing facilities on the ground floor to ensure they are suitable for maintaining the users privacy. The registered person should ensure the record of meals served is kept up-to-date and any alternative provided is clearly recorded. The registered manager should ensure that the homes complaints procedure is fully adhered to in relation to complainants signing the complaint record. The registered manager should ensure that the date on which a complaint is resolved be recorded. The registered person should replace the kitchen floor covering. DS0000068647.V330416.R01.S.doc Version 5.2 Page 29 5 OP8 6 OP9 7 OP12 8 9 10 11 12 OP10 OP15 OP16 OP16 OP19 Southdown Nursing & Residential Home 13 14 15 OP20 OP22 OP24 16 OP33 17 OP36 The registered person should consider providing additional dining room facilities. The registered person should ensure bath hoists are serviced as recommend by the manufactures instructions. The registered person should complete an audit of all residents’ bedrooms and consult with the resident to ensure they have a choice on the furnishings and provision for their rooms. It is recommended that residents and relatives meetings be held to enhance current quality assurance measures. (Recommendation from inspection held 18th September 2006) The registered manager should ensure that care staff receive formal supervision at least six times a year. Southdown Nursing & Residential Home DS0000068647.V330416.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 © 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 & Residential Home DS0000068647.V330416.R01.S.doc Version 5.2 Page 31 - 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!