Inspection on 22/11/05 for Stanton Nursing Home

This inspection was carried out on 22nd November 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

Stanton Nursing Home 11/06/09

Stanton Nursing Home 18/06/08

Stanton Nursing Home 22/06/07

Stanton Nursing Home 28/06/06

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 Unannounced Inspection 22nd November 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Stanton Nursing Home DS0000020288.V264260.R01.S.doc Version 5.0 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.V264260.R01.S.doc Version 5.0 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 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.V264260.R01.S.doc Version 5.0 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 indivudal 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 25th May 2005 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.V264260.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place in the presence of the acting manager Margaret Jones, there was a very pleasant and relaxed, homely atmosphere about the home. Staff were observed to talk with residents with a caring and polite attitude, residents were observed to be relaxed and happy in their presence. During this inspection the Inspector discussed with the manager the need for clear risk assessments around working practices in the kitchen specifically for using sharp knives, hot oil and steam this was not made as a requirement as the kitchen staff are making ongoing progress in providing a portfolio of policies and procedures in the kitchen. The inspector also discussed the level of training in manual handling that staff had received, all staff have received manual handling training however one member of staff was observed to carry out an inappropriate lifting method. The manager agreed to approach this member of staff personally after the inspection. Residents spoken to during the inspection were unable to express an opinion on the care they received however they were observed to be relaxed, happy and ready to talk to people if approached. Two requirements were made at this inspection and no requirements were outstanding from the last inspection. What the service does well: What has improved since the last inspection? It was noted that since the last inspection staff were observed to be less task orientated and spent more time talking with the residents especially during the afternoon. Residents appeared more relaxed and ready to take part in an activity. The manager now seeks consent from relatives regarding the use of cot sides. The Cook continues to work hard developing a portfolio of policies Stanton Nursing Home DS0000020288.V264260.R01.S.doc Version 5.0 Page 6 and procedures for good working practices in the kitchen, this continues to include hygiene and the preparation of raw and cooked food. During the inspection she was observed training a new kitchen assistant. 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. Stanton Nursing Home DS0000020288.V264260.R01.S.doc Version 5.0 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.V264260.R01.S.doc Version 5.0 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): 1, 3, 4 and 5 6 does not apply Prospective residents, and their relatives/advocates are given sufficient information to make an informed choice in the home. The needs of residents are assessed before admission to the home. Prospective residents are offered a chance to visit the home prior to taking up residence. EVIDENCE: The statement of purpose and service user guide have not been reviewed since the last inspection they contain all the required information needed for prospective residents, and their relatives/advocates to make an informed choice about the final decision of which home they wish to stay in. They can also be produced in large print on request. The acting manager confirmed that she visits all prospective residents either at their home or in hospital to carry out the pre-admission assessment. Written assessments in the care records of the most recently admitted residents supported this. The preadmission assessments were holistic in approach and also addressed the mental health needs of the prospective resident. Care records reviewed during the inspection also contained care management plans Stanton Nursing Home DS0000020288.V264260.R01.S.doc Version 5.0 Page 9 for the placing social worker and hospital care plans when needed. Prospective residents are offered a chance to visit the home however relatives or an advocate on the resident’s behalf usually takes this up. Stanton Nursing Home DS0000020288.V264260.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 9 and 10 Resident’s health, personal and social care needs are clearly set out in an individual plan of care Resident’s health care needs are fully met with the exception of the use of wheelchairs. Residents are protected by the homes policies and procedures for the storage and administration of medication. Residents are treated with respect and their right to prove the sea is upheld. EVIDENCE: Care records of six residents were reviewed during this inspection, they showed very clear guidelines were in place enabling staff to meet their identified needs. All the care plans showed evidence of being reviewed regularly and when possible residents who were able were accompanied by relative or advocate at review meetings. Care records reviewed contained very clear risk assessments, which were specific to the identified needs for the individual. These included falls, pressure areas and guidelines for staff to manage aggressive behaviour. There was also clear evidence of involvement in multidisciplinary teams including mental health unit, district nurses, the chiropodist, dentist and optician. During the inspection staff were observed to respect the residents rights to personal dignity, by knocking on doors and asking them if they wished to go Stanton Nursing Home DS0000020288.V264260.R01.S.doc Version 5.0 Page 11 for lunch or be moved. All staff appeared to have a very friendly and relaxed rapport with the residents, and they did not appear to be working in a task orientated fashion as noted in the previous inspection. Residents spoken to were largely unable to express an opinion on the care they received, however they spoke easily and were relaxed in the presence of staff. Comments from residents included ‘Im happy, theyre always nice,’ ‘I come here every day then go home to mum but theyre always nice to me here.’ One lady was observed to be quite sarcastic when talking to staff, but the staffs responses were always kind and caring with a very calm and cheerful approach. During the inspection it was noted the care staff were transferring residents in wheelchairs without using the footplates. This could potentially put residents at risk of falling out of the wheelchair and sustaining an injury. A random audit of the medication held within the home was carried out and no errors were noted. The homes policies and procedures for the ordering, storage and administration of medication are very concise and staff spoken to showed an awareness of these policies and procedures. The storage for medication was appropriate and not overstocked. Stanton Nursing Home DS0000020288.V264260.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, and 15 The home provides a programme of meaningful activities, which are organised by the care staff in the afternoons. Residents are encouraged to maintain contact with their families and friends and there are no restrictions on visiting times Residents receive a wholesome, appealing balanced diet. EVIDENCE: The home still does not have an activities coordinator, however a range of activities continued to be organised by the care staff particularly in the afternoons. A regular dog walking routine is quite popular with those residents able to go out. Records reviewed showed that residents take part in sessions, which included music and movement, newspaper and magazine reviews and taking part in visiting entertainments. Events including outside entertainers are advertised in the entrance hall. During the afternoon residents were observed taking part in a musical session. It was noted that residents had opted to make a choice as to whether they sat in the quiet room or took part in the singalong. Residents family is and friends are encouraged to visit and there are no restrictions on visiting times. A choice of menu is available and residents are offered a choice of meal at the appropriate mealtime rather than being expected to remember what they have chosen in the morning for lunch, which is often the case. The meals provided Stanton Nursing Home DS0000020288.V264260.R01.S.doc Version 5.0 Page 13 appeared nutritious and varied with the use of fresh rather than frozen vegetables, the meal provided on the day was well presented and appetising. Staff were available to help residents when necessary however this was carried out in an unobtrusive and unhurried manner. Residents spoken to who could express an opinion said they had enjoyed their dinner and always enjoyed the food they were given at the home. The environmental health officer has recommended the home for the Somerset Award for food. The Cook continues to put together a portfolio of policies and procedures specific to the kitchen. On the day of the inspection she was observed training a new kitchen assistant. It was discussed with the cook and the acting manager that there needed to be clear risk assessments of working practices in the kitchen that involved areas such as working with sharp knives, hot oil and steam. Stanton Nursing Home DS0000020288.V264260.R01.S.doc Version 5.0 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 the following standard(s): 16 and 18 The home has a satisfactory complaints system which shows evidence that relatives feel their views are listened to and acted on. The home has clear guidelines for the protection of vulnerable adults. EVIDENCE: The home has a very clear complaints policy and procedure which records the complaints, action taken and outcome. One complaint was received by the CSCI since the last inspection the registered provider was required to investigate the issues raised. The complaint was unsubstantiated however the registered provider felt it gave rise to the need for further training for all staff regarding issues surrounding the protection of vulnerable adults. The homes policy and procedure for the protection of vulnerable adults is robust and staff showed an awareness of issues raised, and had all undergone training regarding the reporting of any issue relating to the protection of vulnerable adults. Stanton Nursing Home DS0000020288.V264260.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26 Stanton care home provides a comfortable and homely atmosphere, which is clean, tidy, well maintained and and residents have access to secure gardens. Residents live in comfortable bedrooms with their own possessions around them EVIDENCE: A tour of the premises was not carried out during this inspection however it was noted that the home continues to be furnished in a homely fashion and well decorated. There was evidence of ongoing maintenance being carried out when necessary. Residents were observed using all areas in the home and the quiet room is a particularly popular place with visitors. Communal space within the home is provided in a lounge, a quiet room and a conservatory area, the dining room is on a lower level. During warmer weather residents have access to a secure garden area with raised flowerbeds and this proves to be a popular wander area. Stanton Nursing Home DS0000020288.V264260.R01.S.doc Version 5.0 Page 16 All rooms continue to be well furnished and residents had ranged personal possessions in their rooms. Double rooms are provided with screens to provide personal privacy for residents. Staff were observed to be aware of the need for cleanliness and observation of infection control. Stanton Nursing Home DS0000020288.V264260.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 and 30 Staffing levels continue to be sufficient to meet the needs of the current resident group. The homes recruitment practices do not meet the required standard All staff receive training in dementia care and are encouraged to attend NVQ training EVIDENCE: Due to rotas reviewed on the day of inspection confirmed that staffing levels with the home meet those agreed with the CSCI, the manager confirmed the extra staff can be arranged for hospital appointments trips out or to meet extra knees that may be identified. Residents spoken to were unable to comment on staffing levels however one lady said that ‘there were always lots of girls about.’ Mrs Larkin, the registered provider, arranges ongoing training in dementia care, training records in the home showed that staff have attended mandatory training in manual handling, fire training, infection control, first aid and adult protection issues. Staffing records reviewed for the most recently employed showed that the home had not followed the required procedure and had not obtained a POVA first confirmation before starting a new employee in post. This places residents at risk and a requirement was made to rectify this. Stanton Nursing Home DS0000020288.V264260.R01.S.doc Version 5.0 Page 18 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, 32, 36 and 38 The acting manager is qualified, confident and experience to run the home however is not registered with the CSCI. Management and leadership in the home is open and approachable All new staff are offered a full induction and receive formal supervision. The implementation of health and safety is satisfactory. EVIDENCE: Mrs Jones the acting manager is qualified as an RMN and an RGN. She has many years of experience in the management of care homes that have provided both general care and care of the elderly with dementia. She demonstrates a clear awareness of the needs of the current resident group and was observed to be open and approachable to both residents and staff. During the inspection she was observed to have an easy and cheerful rapport with the residents. However the registered provider needs to consider the importance of registering her manager with the CSCI. Stanton Nursing Home DS0000020288.V264260.R01.S.doc Version 5.0 Page 19 All new staff receive a clear and concise induction and work supervised until considered competent, evidence of induction forms being completed were seen in the staff files. Staff spoken to said they felt they were adequately supported in the home. The acting manager is currently carrying out formal supervision with all staff. Records seen showed the sessions highlighted areas of improvement and then identified courses and training that could be arranged. The implementation of health and safety in the home was satisfactory firelog was reviewed and found to be up-to-date and all staff had received the appropriate training. All service records and generic risk assessments had been reviewed and were all up-to-date. Stanton Nursing Home DS0000020288.V264260.R01.S.doc Version 5.0 Page 20 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 3 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 2 3 X X X 3 X 3 Stanton Nursing Home DS0000020288.V264260.R01.S.doc Version 5.0 Page 21 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. 2 Standard OP8 OP29 Regulation 12 (1) 19 (4c) 12 (1a) Sc 2 Requirement Staff must use footplates on wheelchairs when transporting a resident. The home must obtain a POVA 1st confirmation before a new employee commences employment. Timescale for action 23/11/05 23/11/05 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 Refer to Standard OP38 OP31 Good Practice Recommendations Need to develop risk assessments for working practices in the kitchen. The registered provider needs to consider the registration of the manager with the CSCI. Stanton Nursing Home DS0000020288.V264260.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Stanton Nursing Home DS0000020288.V264260.R01.S.doc Version 5.0 Page 23 - 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!