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Inspection on 24/01/06 for Southlands Nursing and Residential Home

Also see our care home review for Southlands Nursing and Residential Home for more information

This inspection was carried out on 24th January 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides high quality accommodation with a choice of communal areas where residents can choose to sit. There is a coffee lounge and a bar area separate to pleasant sitting areas. Bedrooms are very individualised, and residents can bring in their own belongings. The activities organiser concentrates on providing a number of social activities for residents, who can choose whether they want to participate. Comments from residents included that `staff are good`, `staff are attentive` that they are `assisted with choices`, and that they are `happy with the services`. Residents like the food that is provided, and the choice that is offered within the menu.

What has improved since the last inspection?

The registered manager reported that there has been some improvement made in the response to call bells by staff, when residents ring for attention. Some of the residents spoken with agreed with the registered manager. She intends to continue to monitor this. Care plans are now locked away so that they are kept confidential. Risk assessments have been completed for the glass window shutters in one bedroom to ensure that they are safe. Glass shutters in another room have been removed.

What the care home could do better:

To keep all shelving in the kitchen clean, and to keep the cleaning schedule up to date, and to ensure that care staff wear suitable protective clothing when they enter the kitchen area. Care plans could be more specific about how residents` social needs are to be met, and all plans should be reviewed at least monthly. The heating to one ground floor bathroom could be improved upon, so that it is warm enough for residents to use. A copy of the fire risk assessment should be kept at the home. A letter was left at the close of the inspection about items which needed to be looked at before the home receives this report. These were ensuring that sluice rooms are kept locked, and ensuring that the use of bed rails and overlay mattresses conform to the company safety policy.

CARE HOMES FOR OLDER PEOPLE Southlands Nursing Home 9 Ripon Road Harrogate North Yorkshire HG1 2JA Lead Inspector Anne Prankitt Unannounced Inspection 24th January 2006 09:45 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 Southlands Nursing Home DS0000027979.V277530.R01.S.doc Version 5.1 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. Southlands Nursing Home DS0000027979.V277530.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Southlands Nursing Home Address 9 Ripon Road Harrogate North Yorkshire HG1 2JA 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) 01423 526203 01423 504015 www.bupa.co.uk BUPA Care Homes (GL) Ltd Mrs Susan Lesley Houghton Care Home 68 Category(ies) of Old age, not falling within any other category registration, with number (68) of places Southlands Nursing Home DS0000027979.V277530.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Aged 60 years upwards One identified service user currently resident within the home in the (PD) category may remain in the home until his needs cannot be met by the home or he reaches the category (OP). 28th June 2005 Date of last inspection Brief Description of the Service: Southlands Nursing Home provides physical nursing care for up to 68 service users. The home is close to Harrogate town centre. The accommodation in the home is situated on three floors and has been extensively refurbished to provide exceptional quality accommodation. Southlands Nursing Home DS0000027979.V277530.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over approximately seven hours, and was conducted by two inspectors. Three hours preparation took place prior to the inspection. The registered manager, Sue Houghton, was available to assist throughout the day, and was provided with feedback at the close. During the course of the inspection, some residents and staff were spoken with, some care plans were looked at, and care practices were observed where appropriate. In addition to this, staff recruitment and training files were looked at, residents’ monies were discussed, and health and safety records examined. All communal areas of the home and a selection of bedrooms were inspected. What the service does well: What has improved since the last inspection? The registered manager reported that there has been some improvement made in the response to call bells by staff, when residents ring for attention. Some of the residents spoken with agreed with the registered manager. She intends to continue to monitor this. Care plans are now locked away so that they are kept confidential. Southlands Nursing Home DS0000027979.V277530.R01.S.doc Version 5.1 Page 6 Risk assessments have been completed for the glass window shutters in one bedroom to ensure that they are safe. Glass shutters in another room have been removed. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Southlands Nursing Home DS0000027979.V277530.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Southlands Nursing Home DS0000027979.V277530.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 EVIDENCE: Standard 6 is not applicable. The registered manager confirmed that the home does not provide intermediate care. Southlands Nursing Home DS0000027979.V277530.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 8 Staff ensure that service users have access to health professionals. EVIDENCE: The care plans contained some good information about the needs of service users and how they are to be met by staff. They included plans for acute needs, as well as for long term issues. There was evidence that service users and/or their relatives had been involved in their development. On discussion with a service user, it was clear that their care plan was being used as a working document. There was some information available in the care plans and also in the activities file completed by the activities co-ordinator about the social interests of service users. More information could have been included about how social needs could be met, and the activities file could have been kept more up to date. Not all care plans had been reviewed on a monthly basis. Discussion took place with a member of staff who was aware of this, and who intended to update the reviews. Information available about wishes upon death, or impending death, could also have been improved upon, so that service users could be assured that their needs and wishes would be understood. Southlands Nursing Home DS0000027979.V277530.R01.S.doc Version 5.1 Page 10 Risk assessments were in place where individual risk had been identified over a range of areas. There was good information to support that service users have access to health services where required. A staff member was organising contact with the tissue viability nurse on the day of the inspection, and a service user spoken with confirmed that, should they ask for a doctor’s visit, the staff would organise this on their behalf. There is a physiotherapy room where service users may have treatment which is organised either as part of their package, and in groups, or under private arrangements with the physiotherapist concerned. Southlands Nursing Home DS0000027979.V277530.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 Service users’ right to make choices is protected. EVIDENCE: It was evident throughout conversation with service users that they are very happy that they are able to live their lives as individuals, and that their right to make choices is recognised. They are able to rise and retire when they wish, can receive visitors when they wish, and can choose how they wish to spend their day. They can also choose to participate in a number of activities which are arranged by the activities organiser, who works full time at the home. Bedrooms are individualised, and were occupied by those service users who chose not to sit in the communal areas. Southlands Nursing Home DS0000027979.V277530.R01.S.doc Version 5.1 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Service users are able to voice their concerns, which are listened to and acted upon. EVIDENCE: The registered manager has demonstrated that allegations made which potentially affect the vulnerability of service users are taken seriously. She understands about the need to refer matters to the local authority for consideration of investigation, and to inform the Commission for Social Care Inspection where appropriate. The complaint file included details of issues which had been brought to the attention of the registered manager, and which had been explored. Staff spoken with understood their responsibilities with regard to reporting such matters, and the records evidenced that service users’ complaints were investigated. Southlands Nursing Home DS0000027979.V277530.R01.S.doc Version 5.1 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 25 Provision of suitable heating to one ground floor bathroom would increase the choice of facilities available for service users. EVIDENCE: One bathroom situated on the ground floor was very cold. The registered manager was aware of this issue, and intended to make enquiries in order that the problem could be addressed. The bathroom was not being used. It is recommended that this be attended to in order that service users have a full choice of all bathing facilities. All other areas of the home that were inspected were suitably heated. Southlands Nursing Home DS0000027979.V277530.R01.S.doc Version 5.1 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Further attention to staff provision, training and supervision arrangements would assist in ensuring that service users continue to receive the expected level of service. EVIDENCE: There were 39 service users accommodated at the home at the time of the inspection out of a possible maximum occupancy of 68. The nursing and care staffing numbers were reduced from the agreed staffing notice to take this into account. On occasions, and since the last inspection, there was an additional reduction by one in the number of nursing staff available. On these occasions, one nurse had responsibility for the running of two of the three floors. This brought about subsequent additional demands in order that the quality of the service was maintained. A recent recruitment drive has assisted in recruiting into vacancies in trained nurse positions, and the duty rota for the week following the inspection evidenced that for each day excepting one, three trained staff would be provided during the day time. There has been no reduction in numbers of staff available during the night. Comments made by service users about whether there were sufficient staff were varied. The registered manager has continued to monitor the response to the call bell system, which she feels is generally improved. She identified the issues that the influx of new staff presents to the home. On one floor of the home, specific issues raised with her about the introduction of new staff members and possible training issues were taken seriously, and she assured Southlands Nursing Home DS0000027979.V277530.R01.S.doc Version 5.1 Page 15 that all matters would be looked into in order to ascertain the substance of the claims. The chefs assist at another home owned by the company on the days where they do not have cover. On the day of the inspection, one of the two rostered chefs was required to cover the sister home at short notice. There was also a shortfall in kitchen assistants from that which would normally be provided. Agency staff provided cover. The chef on duty was anxious that, due to the current staff reductions, they were unable to complete their tasks commensurate to their post, such as seeking the views of service users about the menu, completion of paperwork and supervision of the kitchen assistants. On speaking with service users, their general satisfaction with regard to the food provided suggested that the reduction in staff was not having a detrimental effect on service provision. However, it appeared that the cleaning schedule was not being carried out fully. This will be reported further in standard 38. The registered manager has a meeting organised with the chef about the kitchen rota, and agreed to look into the matters raised by him. The staff recruitment files inspected demonstrated that all necessary safety checks are carried out prior to the deployment of new staff to the home. From discussion with staff, and from those training records seen, it was evident that staff receive a range of training to assist them in understanding their role, and meeting the needs of service users. Further training specific to the care provided at the home, and also training for care staff towards accreditation at NVQ Level 2 in care, complements mandatory training. Southlands Nursing Home DS0000027979.V277530.R01.S.doc Version 5.1 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,35,36 and 38 The arrangements in place for the management of health and safety issues could be made more robust to ensure that service users are fully protected from unnecessary risk. EVIDENCE: The general manager for the home has resigned from her position since the last inspection. At the point of this inspection the supernumerary hours that were commensurate to the general manager’s post have not been covered. The company is currently looking at the management structure, but the registered manager stated that she was being provided with good weekly support from the company during the interim period. Care staff spoken with were happy with the management structure and the support that they get within the current arrangement. However, it was evident that supervisory arrangements with the chef were not fully productive, and that the influx of newly recruited staff has presented additional demands. Southlands Nursing Home DS0000027979.V277530.R01.S.doc Version 5.1 Page 17 Service users’ monies can be handled by the company if the individual so desires. An umbrella post office account has been set up into which personal allowances are credited, and from which individuals receive interest. The administrator acts as appointee for one service user, and explained that this is with the agreement of the local authority. She explained that she can access monies for service users upon request. Lockable facilities are provided for those service users who wish to keep monies on the premises. The maintenance records evidenced that the premises are kept maintained. The maintenance man carries out a number of regular maintenance checks within the home. This includes monthly bed rails checks. The measurements of nine beds fitted with bed rails and overlay mattresses did not conform with the company safety guidance. This information has not been included in the individual risk assessment for those residents concerned. The maintenance man stated that the fire safety risk assessment was not available at the home, but was held elsewhere by a representative of the company. Sluice rooms were not locked. They contained a supply of excessively hot water and hazardous chemicals, which were removed at the time of the inspection. The bathroom cupboard containing external creams for service users was not locked. The registered manager locked the cupboard at the time. Care staff were observed entering the kitchen without wearing a white coat, or other suitable protective clothing. In addition, there were no cleaning records kept for the whole of January, and some shelving was not kept clean. Southlands Nursing Home DS0000027979.V277530.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X 2 X STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 2 X 1 Southlands Nursing Home DS0000027979.V277530.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? NO 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 OP38 Regulation 13 Requirement Sluice rooms which contain a supply of hot, unregulated water and hazardous chemicals must be kept locked when not in use. All areas of the kitchen must be kept clean, and records kept of the cleaning schedule. Staff entering the kitchen area must wear suitable protective clothing. Medication must be stored in a locked facility. The responsible individual must 31/01/06 look at the discrepancies noted within the bed rails safety checks carried out by the maintenance man, and provide assurance to the Commission for Social Care Inspection that practices at the home pertaining to their use are safe for service users. The risk assessments in place for the use of bed rails must be updated to include the above discrepancies, to ensure that there are no areas of Southlands Nursing Home DS0000027979.V277530.R01.S.doc Version 5.1 Page 20 Timescale for action 24/01/06 2 OP38 13 unnecessary potential risk to which service users may be subject. 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 The care plans should be more specific and detailed in relation to how identified social care needs are to be met. All care plans should include the individual wishes of service users upon their impending death, and after they have died. 2 3 OP25 OP27 Care plans should be reviewed on a monthly basis. The heating to the ground floor assisted bathroom identified as being cold at the inspection should be improved upon so that use of the facility can be restored. The responsible person should inform the commission where a decision has been made that staffing levels will be decreased in order that agreement can be reached and approval given. The registered manager should satisfy themselves that all new staff understand the policies and procedures at the home. Supervision arrangements should discuss any areas of concern with regard to the smooth running of the kitchen at the earliest point. A copy of the fire safety risk assessment should be kept at the home. 4 OP36 5 OP38 Southlands Nursing Home DS0000027979.V277530.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Southlands Nursing Home DS0000027979.V277530.R01.S.doc Version 5.1 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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