Inspection on 27/07/05 for Southerndown Nursing Home

This inspection was carried out on 27th July 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Southerndown Nursing Home 18/03/08

Southerndown Nursing Home 18/07/06

Southerndown Nursing Home 02/03/06

Southerndown Nursing Home 03/01/05

Southerndown Nursing Home 22/07/04

Southerndown Nursing Home 02/02/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Southerndown Nursing Home Worcester Road Chipping Norton Oxon OX7 5YF Lead Inspector Annette Miller Announced 27 July 2005 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. Southerndown Nursing Home H57-H08 S27169 Southerndown V229982 270705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Southerndown Nursing Home Address Worcester Road, Chipping Norton, OX7 5YF 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) 01608 644129 01608 641737 Barchester Healthcare plc Vacant CareHome with Nursing 87 Category(ies) of OP; PD; MD(E); DE(E) registration, with number of places Southerndown Nursing Home H57-H08 S27169 Southerndown V229982 270705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: On admission persons should be aged 60 years and over. The total number of persons that may be accommodated at any one time must not exceed 87 of which 42 may be in either the DE(E) or MD(E) category. Admittance of three named residents under 60 in the PD category Date of last inspection 03 January 2005 Brief Description of the Service: Southerndown Care Home consists of two units that provide a total of 87 beds for residents aged 60 and over. There are 45 beds in the original house (Southerndown) for people who are physically frail. The home was extended in 2002 to add a further 42 beds in a new wing (Memory Lane) for residents with mental health needs, generally dementia. These two units are linked by a covered walkway. Registered nurses are on duty at all times. Southerndown has a mix of single and double rooms, some with en-suite facilities consisting of a washbasin and toilet. Memory Lane provides single rooms with en-suite facilities of a toilet, washbasin and shower. Spacious lounges and dining rooms are provided on each unit. There are extensive grounds surrounding the home with an area of garden at the back of Southerndown that is secured by fencing and a locked gate. Residents on Memory Lane have access to a courtyard garden. Recreational activities are provided by two staff employed specifically for this aspect of residents care. Transport is provided for outings. Southerndown Nursing Home H57-H08 S27169 Southerndown V229982 270705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection carried out by two inspectors between 9.30am and 5.00pm and by a third inspector from 9.30am to 1.00pm. The inspectors spoke to residents and staff to find out their opinion of the home and the standard of care provided. A tour of the building and inspection of documents took place on both units. There is a new manager in post (appointed 6th June 2005) and she was present throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better: One resident reported that staff rarely knocked on his bedroom door and during a conversation with an inspector a carer walked in without knocking. The principles on which the home’s philosophy of care is based must be ones which ensure that residents are treated with respect, that their dignity is preserved at all times, and that their right to privacy is always observed. Southerndown Nursing Home H57-H08 S27169 Southerndown V229982 270705 Stage 4.doc Version 1.40 Page 6 Residents spoken to were not over enthusiastic about the meals provided and there were complaints of food arriving cold, resulting in food being returned to the kitchen. Flies were noted to be a problem in some areas on Memory Lane, notably the communal rooms. It is recommended that commercial units designed to kill flies are fitted where needed. There was a smell of stale urine in three bedrooms, and also an underlying smell of urine on the ground floor on Memory Lane. The home’s cleaning procedures need to be improved in order that the smell of urine is eliminated. 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. Southerndown Nursing Home H57-H08 S27169 Southerndown V229982 270705 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Southerndown Nursing Home H57-H08 S27169 Southerndown V229982 270705 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4 All prospective residents have a pre-admission assessment of their care needs so that the home, the prospective resident and their family are clear that these can be met. During the early part of 2005 a number of complaints were made about the standard of care provided. The new manager is working proactively with the staff team to ensure residents’ needs are met when they enter the home. EVIDENCE: The deputy manager carries out all the pre-admission assessments at the present time. Where possible the assessment is carried out in the individual’s home or hospital. This enables the home to find out more detail about the person and their background, and to meet the family and for the individual to meet a member of staff. The home’s pre-admission assessment form is clear and comprehensive covering all the necessary areas of need and incorporates a risk assessment. This then forms the basis of the resident’s care plan. Southerndown Nursing Home H57-H08 S27169 Southerndown V229982 270705 Stage 4.doc Version 1.40 Page 9 The company provides a good range of training opportunities to enable all staff to have the necessary knowledge and skills to give good care that is based on current good practice, and reflects relevant specialist and clinical guidance. The manager, with support from the company’s care and quality manager, is monitoring the outcome of training to ensure it has the desired effect, as there was a period early in 2005 when a number of complaints were made by relatives, as well as health and social care professionals, about the standard of care received by some residents. The new manager investigated these matters and upheld some of the complaints made, and is working hard to ensure that the home has a well-trained workforce that provides a good standard of care at all times. The manager must continue to review, monitor and audit the skills and knowledge of all staff. Requirement. Three residents were spoken to individually and each one expressed satisfaction with their care. One resident spoke about the concerns he had earlier in the year and the manager confirmed that they had been investigated. This resident made some good comments about his present care and the new manager. Two visitors expressed satisfaction with the home’s services. A private practitioner trained in body massage was in the home visiting five residents to provide hand massage. She praised the home and thought the standard of care was good. She said she found staff friendly and helpful when visiting. Southerndown Nursing Home H57-H08 S27169 Southerndown V229982 270705 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Overall, the standard of care planning is good, although there are some specific aspects of record keeping that need to be improved to ensure the care plans provide staff with the information they need to satisfactorily meet residents’ health and social care needs. An inspector observed a carer enter a resident’s room without knocking and this action did not respect the resident’s privacy and dignity. EVIDENCE: Seven sets of care notes were examined (four on Southerndown and three on Memory Lane). The range of information provided about each person’s care needs was good and in most plans the action that was required was set out in detail. It was considered that, overall, a good standard of care planning was in place, although it was noted that in each of the care plans on Memory Lane some details had been missed and actions not evaluated. For example, a nutritional risk assessment indicated that vitamin supplements should be prescribed but there was no follow-up on file, even though there was a letter from a fall’s specialist nurse recommending this. Also, some records had not been dated and signed on Memory Lane and staff handwriting was occasionally difficult to read. Recommendations. Southerndown Nursing Home H57-H08 S27169 Southerndown V229982 270705 Stage 4.doc Version 1.40 Page 11 A range of risk assessments had been completed, for example to check on residents’ nutritional intake, safe manual handling and skin condition. The assessment of skin condition for one resident included an assessment score, but did not provide a scale to explain the score. Recommendation. A staff member told an inspector that they informed the nurse in charge of any changes to the care plan and there was evidence of improving practice in communication between the nurses and care assistants since the last inspection. Medication procedures were inspected on both units and good standards were found regarding medication records and the storage of medication. Several residents were spoken to on Southerndown and all but one confirmed that they were treated with respect at all times. One resident did not like care assistants coming into his room without knocking and, whilst the inspector was talking to this resident, a care assistant walked into the room without knocking and did not apologise for the intrusion of privacy. Recommendation. Southerndown Nursing Home H57-H08 S27169 Southerndown V229982 270705 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14 and 15 Residents are encouraged to exercise choice over their day. Every effort is made to ensure that residents enjoy their meals but food is not always hot at the point of delivery. EVIDENCE: Residents spoken to confirmed that they were able to make clear choices over how they spend their day. Some residents preferred to remain in their rooms and others spent time in the lounges. There were choices over a variety of activities if they wished to be involved. A harpist provided musical entertainment during the afternoon and it was apparent that residents enjoyed listening to the music. Activities are provided throughout the week and are listed on the activity programmes displayed on both units. Trips out in the home’s mini-bus are arranged and are much enjoyed. The inspector discussed the home’s food arrangements with the host worker. He ensures all residents are aware of the menu for the day and ensures that drinks and fresh fruit are provided throughout the day. Three meals a day are offered and residents can make the choice of having meals in their own rooms or in the main dining room. Southerndown Nursing Home H57-H08 S27169 Southerndown V229982 270705 Stage 4.doc Version 1.40 Page 13 There was ample choice on the day of the inspection and lunch was served in pleasant surroundings with staff being attentive to those less able residents. Residents spoken to were not over enthusiastic about the meals provided and there were complaints of food arriving cold resulting in food being returned to the kitchen. Recommendation. Southerndown Nursing Home H57-H08 S27169 Southerndown V229982 270705 Stage 4.doc Version 1.40 Page 14 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. The home has a satisfactory complaints procedure and there was evidence that residents now feel their views are listened to and acted upon. EVIDENCE: The home’s complaints procedure is in the Service User Guide and Statement of Purpose, which are documents given to residents at the time of admission. Copies are also displayed in the home and further copies are available from the manager on request. The company’s timescale for dealing with complaints is 28 days. Health and social care professionals and relatives raised a number of concerns with the previous manager, and with the Commission for Social Care Inspection (CSCI), about the standard of care provided during the early part of 2005. For example, poor assessment resulting in care needs not being adequately identified, poor communication between nursing staff and relatives, low levels of staffing. CSCI held a number of meetings with the Oxfordshire Social Services adult protection officer and care managers, as well as with senior staff from Barchester Healthcare. The company has worked positively with CSCI and the other parties concerned to address the concerns raised and has carried out a thorough investigation, which upheld some of the concerns raised. The company does not, however, accept that staffing levels were low, but that deployment of staff around the home was not always appropriate. An action plan to deal with the findings was provided and submitted to CSCI. Southerndown Nursing Home H57-H08 S27169 Southerndown V229982 270705 Stage 4.doc Version 1.40 Page 15 As a result of the concerns raised, CSCI sent comment cards to the next of kin of all residents and also to health and social care professionals with clients in the home, to gain an overview of the situation. A mixed response was received from a total of 64 responses, for example: “We visited Southerndown prior to arrangements for her respite week being put into place. We were very courteously received and shown around Southerndown and our questions were answered very freely and willingly. The whole visit was encouraging and reassuring and we were given the impression of an establishment where the staff responded in a very caring, professional way, interacted with the residents well and treated them in a courteous way. We left with a very positive impression.” “Generally my father appears well cared for and content in this home – it compares well with others I have visited to see other relatives.” “There have been two occasions on which I have been upset re my mother’s care since the last inspection. Very unusual I must say. First she was ill for at least two weeeks……… and I was not informed. Secondly, her towel is NOT changed frequently enough – or her clothes.” “Although the staff seemed friendly…… my main memory of the home is a terrible smell of urine. I did ask my mother if she liked the home – she said it was ‘all right’.” “The client’s family were very pleased with placement, and the client had done very well. My only criticism is lack of staff availability, lack of a proper space in which to do a review, and the vagueness of staff when doing the review.” (Care Manager). “The home has been through a difficult period with the new staff not knowing the patients well. Currently this appears to have been sorted.” (GP) “The home’s management is aware of difficulties in communication with GPs in the last year – have high throughput of nurses. Sometimes language is a slight barrier.” (GP) Southerndown Nursing Home H57-H08 S27169 Southerndown V229982 270705 Stage 4.doc Version 1.40 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) 23, 24 and 26 The standard of décor within this home is satisfactory with evidence of improvement through maintenance and redecoration. The home presents as a homely and comfortable place to live, except that there was a slight smell of urine in some areas of the home, which was unpleasant for residents and visitors. EVIDENCE: A resident said she was very happy with her room and was pleased she could have her own possessions around her. The room contained many family photographs and personal ornaments, as well as small items of personal furniture. Another resident, who was happy with her care, did not like being on the first floor and the deputy manager was making arrangements for her to move to a ground floor room as soon as possible. All corridors on Southerndown have been redecorated recently as part of the home’s ongoing programme of redecoration. Work was in progress to provide a separate room to enable care reviews to take place in private. Southerndown Nursing Home H57-H08 S27169 Southerndown V229982 270705 Stage 4.doc Version 1.40 Page 17 The home was warm, clean and most areas were free of odour. The exception was in three bedrooms where there was a smell of stale urine, and on the ground floor on Memory Lane there was a slight underlying smell of urine. A new carpet-cleaning machine was recently purchased and the manager thought it would be effective in removing stale smells from carpets. Cleaning procedures should be monitored to ensure odour is eliminated. Recommendation. There were a number of flies in the lounge/dining area on the ground floor on Memory Lane. A member of staff said that a ‘fly-trap’ was used, but was not very effective. It is unpleasant for residents to be in an environment where there are flies, particularly during mealtimes, and this situation should be managed more effectively. Commercial units that kill flies should be fitted where needed. Recommendation. Southerndown Nursing Home H57-H08 S27169 Southerndown V229982 270705 Stage 4.doc Version 1.40 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 and 29 Progress has been made to deploy staff more effectively around the home during busy periods. Recruitment procedures were good, with the exception that two members of staff had not been checked against the protection of vulnerable adult list held at the department of health and this omission potentially placed residents at risk. EVIDENCE: The nursing and care staff on duty on the day of inspection consisted of: Southerndown (36 residents) 7.30am - 2.00pm 3 nurses and 9 carers 2.00pm - 7.30pm 3 nurses and 6 carers 7.30pm - 7.30am 1 nurse and 4 carers Memory Lane (42 residents) 7.30pm - 5.00pm 3 nurses and 8 carers 5.00pm - 7.30pm 3 nurses and 6 carers 7.30pm - 7.30am 1 nurse and 4 carers The duty rotas for the seven-day period starting 25th July 2005 showed that the number of nurses and carers on duty met the minimum requirements of the home’s staffing statement. During the busy morning period the number of staff on duty consistently exceeded the minimum number required. Southerndown Nursing Home H57-H08 S27169 Southerndown V229982 270705 Stage 4.doc Version 1.40 Page 19 (NB: staffing statements show the minimum number of staff that must be on duty at all times. It is the responsibility of the home’s manager to increase staffing above minimum levels when needed.) Two full-time activity organisers are employed to arrange recreational activities and outings for residents. Three staff files were randomly selected for inspection and each file contained the necessary documents and checks required by The Care Homes Regulations 2001, with the exception that two members of staff had not been checked against the protection of vulnerable adult list held at the department of health. Requirement. A team of ancillary staff is employed to assist in the day-to-day running of the home, for example preparation of meals, domestic duties, etc. Southerndown Nursing Home H57-H08 S27169 Southerndown V229982 270705 Stage 4.doc Version 1.40 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) 32. The manager has a good understanding of the areas in which the home needs to improve. An action plan was in place to show home improvements were planned. EVIDENCE: A new manager came into post in June 2005 and it was apparent that she was already gaining the respect of staff and also their support. The atmosphere in the home was relaxed and friendly and it was clear that the manager is developing a good rapport with her staff. Staff spoke favourably about her management style and said they felt able to approach her about any concerns they had. A member of staff commented there was “a good team spirit”. Southerndown Nursing Home H57-H08 S27169 Southerndown V229982 270705 Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 2 COMPLAINTS AND PROTECTION x x x x 3 3 x 2 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x 3 x x x x x x Southerndown Nursing Home H57-H08 S27169 Southerndown V229982 270705 Stage 4.doc Version 1.40 Page 22 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 4 Regulation 18 Requirement In order that the company can be assured that good standards of care are provided the skills and experience of staff must be kept under review, monitored and audited. The manager must ensure that POVA checks are done prior to the appointment of staff. Timescale for action Formal audit by 31.12.05. 2. 29 19 With immediate effect. 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 7 Good Practice Recommendations The manager should ensure that nursing staff follow the Nursing & Midwifery Councils guidelines for records and record keeping. Risk assessment forms should provide a scale to explain a risk score. The manager should ensure that the privacy and dignity of residents is upheld by all staff at all times. H57-H08 S27169 Southerndown V229982 270705 Stage 4.doc Version 1.40 Page 23 2. 3. 8 10 Southerndown Nursing Home 4. 5. 15 26 The manager should ensure that residents are served food that is hot. The company should arrange for commercial units that kill flies to be fitted in those parts of the home where flies are a problem. Southerndown Nursing Home H57-H08 S27169 Southerndown V229982 270705 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Burgner House, Cascade Way Oxford Business Park South Cowley, Oxford National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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