Inspection on 22/06/07 for Stanton Nursing Home

This inspection was carried out on 22nd June 2007.

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

Stanton Nursing Home 11/06/09

Stanton Nursing Home 18/06/08

Stanton Nursing Home 28/06/06

Stanton Nursing Home 22/11/05

Stanton Nursing Home 25/05/05

Stanton Nursing Home 10/11/04

Stanton Nursing Home 29/06/04

Stanton Nursing Home 17/02/04

Stanton Nursing Home 12/12/03

Stanton Nursing Home 28/08/02

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

CARE HOMES FOR OLDER PEOPLE Stanton Nursing Home 8 Queens Road Weston Super Mare North Somerset BS23 2LQ Lead Inspector Juanita Glass Key Unannounced Inspection 09:30 22nd June 2007 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 Stanton Nursing Home DS0000020288.V335646.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. Stanton Nursing Home DS0000020288.V335646.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stanton Nursing Home Address 8 Queens Road Weston Super Mare North Somerset BS23 2LQ 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) 01934 625640 F/P 01934 625640 Mr Charles Larkin Mrs Teresa Larkin To be appointed Care Home 26 Category(ies) of Dementia - over 65 years of age (26) registration, with number of places Stanton Nursing Home DS0000020288.V335646.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Staffing Notice dated 15/12/2000 applies Manager must be a RN on parts 3 or 13 of the NMC register Age range 65 years and over. May accommodate one named person aged under 65 years. This exemption is specific to one individual and will lapse when that person attains 65 or leaves the Home. May accommodate 26 persons requiring Dementia Care only 4. Date of last inspection 28th June 2006 Brief Description of the Service: Stanton Nursing Home is registered with the Commission for Social Care Inspection to provide nursing care for 26 residents suffering from dementia or associated conditions aged 65 years and over, the home is situated above the town centre of Weston super Mare and not far from local amenities. The home is a converted Victorian house and accommodation is provided over three floors, access is provided to all levels via a passenger lift and a stair lift. Stanton Nursing Home DS0000020288.V335646.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Current fees not available This unannounced inspection took place in the presence of the acting manager over 5 hours. During this time a review of documentation was carried out. This included resident care records and staff personnel records. Residents were spoken to and five were able to express a view on their experience of living in the home. Staff and resident interactions were observed in the communal areas. Written surveys were not received however the homes own survey sent to relatives evidenced that people were happy with the care provided and praised staff for their commitment to caring for their family member. Residents able to express a view said they were happy and ‘nice girls’ looked after them. One gentleman said that nothing was too much for them. During this inspection staff were observed carrying out daily routines they had a relaxed and friendly rapport with residents and were conscious of the need to explain clearly what they were doing and why. All interventions were carried out with a clear understanding of the need to promote dignity and privacy. Visitors were welcomed in a friendly manner and one visitor said that she was always welcomed into the home and made to feel at home whilst visiting her mother. Discussion with the acting manager identified that she will be reviewing the way care plans are written. Residents have a named nurse who are responsible for the reviewing of care plans and reviews are discussed with relatives through the year. The manager has commenced the registration process with CSCI. What the service does well: What has improved since the last inspection? Stanton Nursing Home DS0000020288.V335646.R01.S.doc Version 5.2 Page 6 The owners took seriously relatives comments made in their last survey. They have provided extra staff at specific times of the day. A website has been designed to enable people looking for a care home to have adequate information about the home. 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. The summary of this inspection report can be made available in other formats on request. Stanton Nursing Home DS0000020288.V335646.R01.S.doc Version 5.2 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 Stanton Nursing Home DS0000020288.V335646.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5. 6 does not apply Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered providers understand the importance of providing adequate information for people seeking to choose a care home. All people using the service have access to a resident’s guide. They all have a contract or statement of terms and conditions. Admissions to the home only take place after a full assessment of needs is carried out. EVIDENCE: The home has a concise statement of purpose, which sets out clearly the objectives, and philosophy of the home. This is supported by a website which gives people looking for a care home a clear indication of the type of care they could expect to receive at Stanton. The website includes testimonials from people who have used the service. Care records reviewed showed that a pre admission assessment is carried out prior to a prospective resident moving into the home. This is either carried out Stanton Nursing Home DS0000020288.V335646.R01.S.doc Version 5.2 Page 9 by the manager or the registered provider. These assessments were clear and concise; they include information relevant to a person with dementia and formed the basis for the care plans, which are implemented on admission to the home. Residents spoken to were unable to comment on the admission process. The home offers the opportunity for prospective residents to visit before making their final decision, however a relative/representative usually carries this out on their behalf. Stanton Nursing Home DS0000020288.V335646.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal health care needs are clearly recorded in care plans, which identify the need for individual personalised care. Staff respect privacy and dignity and are sensitive to changing needs. People using the service have access to healthcare and remedial services. The home has an efficient medication policy and procedure, which staff understand and follow. EVIDENCE: The care plans for five residents were reviewed they contained all the information required by staff to adequately meet the individual needs of the resident group. The plans were very clear and showed a commitment to person centred care. The manager stated that the qualified staff are responsible for their own group of residents and ensure that the care plans are regularly reviewed and kept up to date. The care plans are not agreed with the residents but relatives are involved in regular reviews with the manager. care records showed that relatives had been involved in key decisions when a Stanton Nursing Home DS0000020288.V335646.R01.S.doc Version 5.2 Page 11 specific need was identified. Surveys returned also confirmed that most relatives felt they were consulted when necessary. Residents spoken to were unable to comment on their care plans. They did say though that they got the help they needed. All the plans showed evidence of regular review with qualifying comments as to why a change was or was not needed. The manager stated that she intended to review the way care plans were written. This will be assessed at the next inspection. Residents have access to health care specialists and care plans showed that the district nurse and community psychiatric nurse were consulted when the home felt they needed some expert advise. Residents are assisted to attend out patient appointments, the dentist and the chiropodist. Regular reviews are carried out with the GP regarding specific health needs and medication. A random audit of medication was carried out and no errors were found however staff demonstrated an understanding of the homes policies and procedures. During the inspection residents were observed to be well groomed, relaxed and happy. They had a friendly and open rapport with staff, chatting and laughing or asking for assistance without hesitation. Residents spoken to said they were happy and that the staff were friendly and helpful; those who could express an opinion said that they felt their privacy was respected and that they were treated kindly. One visitor said that staff always appeared to meet their relative’s needs in a friendly and caring manner. Staff were observed to be open and friendly they responded to residents in an appropriate manner. One lady showing signs of obvious distress was spoken to and reassured in a friendly caring manner alleviating the situation. Stanton Nursing Home DS0000020288.V335646.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are involved in a variety of meaningful activities. They have the opportunity to maintain community contacts, personal and family relationships. Staff working practices promotes choice where possible. Meals are balanced and nutritional catering for a variety of dietary needs. EVIDENCE: In the past staff have maintained a record of activities carried out by residents but this had not been done in recent months. It was difficult to evidence that residents had taken part in the activities advertised on the notice board. This was discussed with the manager and she agreed to ensure that staff maintain a record in future. The activities identified as available included regular walks in the parks, manicures, skittles, hairdressing, outings, exercises to music and games with balloons. Staff were observed involving residents in making decisions about their day in the home. Newspapers and magazines were readily available and staff took the time to sit and read through a paper with a resident. Stanton Nursing Home DS0000020288.V335646.R01.S.doc Version 5.2 Page 13 Residents are provided with a wholesome, healthy, nutritional diet. The homes cook pays specific attention to providing a balanced diet with the use of seasonal fresh vegetables. All the residents spoken to said the meals were very good. Staff were observed to assist residents in a dignified an unhurried manner, several residents enjoyed a glass of sherry just before lunch. The home has been awarded the North Somerset Healthy Eating, Nutrition and Hygiene Award. The Cook said that she was kept well informed of resident’s special needs or preferences for food. Throughout the day residents were observed being offered ample fluids and snacks. A random review of resident’s weights was carried out and this showed that most residents either maintained their weight or gained weight since being admitted to the home. Those residents identified as having specific nutritional needs were being offered nourishing drinks and snacks between meals. Stanton Nursing Home DS0000020288.V335646.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure that is clearly written and easy to understand. The policies and procedures for Safeguarding Adults are available and give very clear guidance to those using them. EVIDENCE: The home has a very clear complaints policy and procedure which one visitor said they are aware of. Residents were not able to express an opinion on the complaints policy. Those who were able to comment said they could talk to the staff or the manager. The home has a robust policy and procedure for the protection of vulnerable adults. Staff spoken to said they knew what action to take, they were aware that there was a local authority procedure and where to access the information if they needed to. Stanton Nursing Home DS0000020288.V335646.R01.S.doc Version 5.2 Page 15 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): 19, 24 and 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the residents. It is well lit, clean and tidy and the management have a good infection control policy. Residents are encouraged to personalise their bedrooms. EVIDENCE: A tour of the premises was carried out. All areas viewed showed evidence of ongoing maintenance and discussion with the manager highlighted the providers intention of continued improvement. All rooms seen were well maintained with evidence of personal possessions and personal furniture being used. During the warmer weather residents also have access to safe and secure gardens from the lounge. The garden area has raised flowerbeds and shaded areas for residents to sit in. Stanton Nursing Home DS0000020288.V335646.R01.S.doc Version 5.2 Page 16 The home is kept clean tidy and free from offensive odours. One visitor stated that it was always clean and tidy whatever time of day they arrived. Staff spoken to and observed during the day showed an awareness of the need to comply with the homes infection control guidelines. Some bedroom doors that need to provide protection in event of fire did not close fully. This was discussed with the manager who agreed to take immediate action. Stanton Nursing Home DS0000020288.V335646.R01.S.doc Version 5.2 Page 17 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): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service are supported by appropriate staffing levels with emphasis on busy times and a skill mix that is relevant to the needs of the resident group. This is supported the commitment of the owners to provide opportunities for continued development of staff. The home does not meet the 50 ratio of care workers with an NVQ qualification. EVIDENCE: Staffing rotas showed that the number of staff employed on each shift in the home meets the assessed needs of the current resident group. The management have taken into account comments made in their relative survey and provided extra staff at specific times of the day. The home does not currently meet the standard that requires them to have at least 50 of care staff with an NVQ level 2 or above. They have experienced problems with accessing the training for foreign staff due to current legislation. It is recommended that the home explore ways in which they can enable staff to obtain these qualifications. A review of staff personnel records showed that all the relevant information had been gathered and checks done. Staff records contained two written references and POVA checks before they commenced employment. Stanton Nursing Home DS0000020288.V335646.R01.S.doc Version 5.2 Page 18 All staff had attended all mandatory training and extra training was being provided by the home in areas such as spoken and written English. External training in subjects’ specific to the needs of the current resident group, such as diabetes, incontinence, wound care and dementia is also provided. Stanton Nursing Home DS0000020288.V335646.R01.S.doc Version 5.2 Page 19 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): 31, 33 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is qualified and has the necessary experience to run the home; she is not yet registered with the CSCI. The manager supports staff training and supervision. The homes quality assurance processes take into account peoples opinions and acts on suggestions made. EVIDENCE: The registered provider has employed a new manager who has experience in the care of the elderly and management of a care home specialising in dementia care. The manager needs to complete the registration process with the CSCI as soon as is practicable. It was evidenced that the necessary forms Stanton Nursing Home DS0000020288.V335646.R01.S.doc Version 5.2 Page 20 had been completed and were ready to be forwarded to the Regional Registration Team. Stanton care home carries out a quality audit by forwarding questionnaires to relatives. The most recent quality audit carried out showed that relatives would like to see an improvement in personal care and appearance of residents, extra staff to improve staff interaction and improved communication between staff and relatives. The registered provider developed a report with aims, objectives and an action plan. The manager now carries out three monthly care plan reviews with relatives and extra staff have been employed at key times during the day. These decisions arose directly from the replies received from relatives and shows a commitment to encouraging people to have a say in the running of their home. The acting manager carries out regular supervision with current members of staff. Supervision sessions include looking at working practices and identifying training needs which staff are encouraged to access either in house or through external organisations. Health and safety within the home is generally satisfactory, with very clear risk assessments that all staff were aware of. The fire log was reviewed and showed that all the relevant checks were being carried out appropriately and that all staff had attended training. As previously mention in outcomes for environment some fire doors did not closed fully. This was discussed with the manager who said it would be dealt with immediately. The home policies and procedure for health and safety and safeguarding residents and staff are regularly reviewed and up dated as necessary. Checks showed that records were up to date and available for inspection. Stanton Nursing Home DS0000020288.V335646.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X 3 X 2 Stanton Nursing Home DS0000020288.V335646.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP12 OP28 OP32 Good Practice Recommendations The manager needs to ensure staff maintain a record of activities carried out by residents. The home needs to explore ways in which they can enable staff to obtain NVQ qualifications. The manager needs to complete the registration process with the CSCI as soon as is practicable. Stanton Nursing Home DS0000020288.V335646.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Stanton Nursing Home DS0000020288.V335646.R01.S.doc Version 5.2 Page 24 - 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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