Inspection on 28/06/06 for Stanton Nursing Home

This inspection was carried out on 28th June 2006.

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 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 Unannounced Inspection 28th June 2006 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.V302299.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.V302299.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 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.V302299.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 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 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.V302299.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a very pleasant and relaxed inspection, which took place in the company of the acting manager Mrs Francis Bird, over approximately 5 hours. Six residents managed to communicate their feelings about living at Stanton Nursing Home. One resident stated that they loved the atmosphere and walked around the garden admiring the flowers whilst talking, she said she was happy and had enjoyed a lovely lunch. Another resident also stated that they were happy and liked their room and the staff were nice and caring, several residents were enjoying listening to a visiting musician who arrived for the afternoon. Two gentlemen said they had enjoyed a wonderful lunch of roast pork and fresh vegetables. Six service user and 7 relative surveys were received, the comments made were largely complementary, they included, ‘staff helpful and cooperative,’ ‘staff work hard and do their best for individual residents,’ ‘staff generally supportive and helpful.’ However more than one reply stated that they felt more staff were needed in the home at critical times, one stated that this would enable more 1-1 sessions with residents. A couple of replies from relatives commented on the lack of continuity they had experienced with the changes in manager within the home, one stated that they felt they had to tell the same information all over again each time a new manager was appointed, however they added that the new manager had dealt with issues raised promptly. 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. What the service does well: What has improved since the last inspection? Staff are no longer task orientated in their approach to care they talk with residents and interact in a dignified manner. All staff have received training in correct manual handling and the correct use of lifting equipment. Stanton Nursing Home DS0000020288.V302299.R01.S.doc Version 5.2 Page 6 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.V302299.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.V302299.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 5, standard 6 does not apply Quality in this outcome group was good. Admissions are not made to the home until a full needs assessment has been carried out; the home then confirms that they can meet the needs of the individual. Prospective residents are offered the opportunity to spend time in the home, however this is usually taken up by a relative/representative on their behalf. EVIDENCE: 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 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 and one visitor said that they had not been involved but believed their relative had been present at an assessment and had visited the home. Stanton Nursing Home DS0000020288.V302299.R01.S.doc Version 5.2 Page 9 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.V302299.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome group was adequate. Each resident has a care plan, which is clear and gives concise guidance to staff, they are not agreed with residents but reviewed with relatives. Residents have access to health care services that meet their assessed needs. The home has a robust policy for the receipt, administration and disposal of medication which is accessible to staff, however staff need to follow instructions. Residents feel they are treated with respect and their privacy and dignity is maintained. EVIDENCE: The care plans for six residents were reviewed they contained all the information required by staff to adequately meet the individual needs of the resident group, they were very clear and showed a commitment to person centred care. They are not agreed with the residents but relatives are involved in regular reviews with the manager, care records showed that relatives had Stanton Nursing Home DS0000020288.V302299.R01.S.doc Version 5.2 Page 11 been involved in key decisions when a specific need was identified. Surveys returned also confirmed that most relatives felt they were consulted when necessary although a few felt that communication had been sporadic following the changes of manager. They felt they had to repeat important information to each manager, however they also felt the current manager had taken their input into care plans seriously. Residents spoken to were unable to comment on their care plans. All the plans showed evidence of regular review with qualifying comments as to why a change was or was not needed, however it was evident that changes were identified in the review but the care plan was not being up dated giving mixed messages for staff. 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, and 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 need to be more aware of the instructions on administering specific medication. The instructions for one medication clearly stated administer half hour before a meal and it was not administered until after lunch. Staff also need to date eye drops, creams and ointments when they are first opened. 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 were hard working and met their relative’s needs in a friendly and caring manner. They felt that staff also understood their relative’s complex needs, and dealt with potentially difficult situations in a relaxed and dignified manner. • Care plans must be up dated when a change or new need has been identified. • Staff must follow instructions on administering specific medication • Staff need to date eye drops, creams and ointments when first opened. Stanton Nursing Home DS0000020288.V302299.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome group was adequate. Residents are given the opportunity to take part in a variety of the activities within the home and the community. Residents are encouraged to maintain contact with family and friends. Where possible staff encourage residents to exercise some choice and control over their lives. Residents receive a wholesome appealing and balanced diet. EVIDENCE: , Dave the inspection and outside entertainer visited the home residents were observed joining in with the singing and some residents were dancing staff. Residents spoken to said that they always enjoyed the man who came to sing. the home maintains a record of activities carried out by residents these included regular walks in the parks, manicure is, skittles, hairdressing, outings, exercises to music and games with balloons. One resident spoken to was enjoying the garden and liked the idea of being able to sit under the gazebo even if it was raining, she enjoyed wandering around the flowers and the freedom to come in and out of the home at her leisure. Residents had helped Stanton Nursing Home DS0000020288.V302299.R01.S.doc Version 5.2 Page 13 plant raised flower beds which appeared to be a focal point for those residents who wish to walk in the garden. One visitor spoken to and a survey returned said that they felt the home could do with more staff in the afternoon to promote more one-to-one sessions for residents, especially for those who do not join in the group activities. Visitor spoken to said they could come and go as they wished within reason, they said startle always welcoming and available to talk to. During the day visitors were observed to be in out and have a clearly friendly rapport with staff. Whenever possible within the restrictions endured by people with dementia staff encourage residents to make personal choices. Residents were observed throughout the day going in and out of the lounge and garden or remaining in their room if they so chose. Care plans showed that residents chose when to go to bed and get up in the morning. 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 although one lady did say the size of the meal had put her off as it was too large. Residents were given the opportunity to sit in the garden for lunch and lunch was observed to be unhurried, and dignified help was offered when necessary. The homes cook said that they had once again been awarded the North Somerset Healthy Eating, Nutrition and Hygiene Award. The Cook also 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 between meals. Stanton Nursing Home DS0000020288.V302299.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome group was adequate. Residents and relatives are confident that the complaints will be listened to and taken seriously. The homes policies and procedures protect residents from abuse. EVIDENCE: Since the last inspection the home has had two complaints forwarded to the CSCI, these had the potential of raising adult protection issues within the home, however both complaints were unfounded. The way in which the registered provider dealt with these concerns was commendable, and showed an acute awareness of policies and procedures to be followed within the home. Although the complaints were unfounded additional training was provided for staff to ensure such a misunderstanding could not happen again, this included training in the awareness of adult protection and the local authority policies and procedures. The home has a very clear complaints policy and procedure which visitors said they are aware of, residents were not able to express an opinion on the complaints policy, however those who could express an opinion said that if they had any worries 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.V302299.R01.S.doc Version 5.2 Page 15 Stanton Nursing Home DS0000020288.V302299.R01.S.doc Version 5.2 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 the following standard(s): 19 and 26 and Quality in this outcome group was adequate. Stanton Care Home provides a homely environment, with a rolling programme of planned maintenance and improvement. The home is clean, pleasant and hygienic. EVIDENCE: A tour of the premises was carried out, all areas showed evidence of ongoing maintenance and discussion with the manager highlighted the providers intention of continued improvement by providing single ensuite rooms in existing double rooms. 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, these have raised flowerbeds and shaded areas for residents to sit in, this proved to be a popular area during the inspection. Stanton Nursing Home DS0000020288.V302299.R01.S.doc Version 5.2 Page 17 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. Stanton Nursing Home DS0000020288.V302299.R01.S.doc Version 5.2 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 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 Quality in this outcome group was good. Residents needs are met by the numbers and skill mix of staff. Residents are in safe hands all time. Residents are protected by the homes recruitment policies and procedures. Staff receive training appropriate to the needs of the current resident group. EVIDENCE: Staffing rotas showed that the number of staff employed on each shift in the home meets the staffing notice, however visitors spoken to, surveys received and the homes quality assurance survey indicated that there are key areas where extra staff would be beneficial. The manager stated that following the homes survey extra members of staff are planned for 7 a.m. and 5 to 9 p.m. Relatives felt that extra staff in the afternoon would enable residents to have more one-to-one sessions. It was difficult from records reviewed on the day to identify how many current members of staff have an NVQ 2 In Care or equivalent, this will be assessed at the next inspection. Stanton Nursing Home DS0000020288.V302299.R01.S.doc Version 5.2 Page 19 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. All staff had attended all mandatory training and extra training was being provided by the home in areas such as spoken and written English and subjects specific to the needs of the current resident group, such as diabetes, incontinence, wound care and dementia. Stanton Nursing Home DS0000020288.V302299.R01.S.doc Version 5.2 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 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, 33, 36 and 38 Quality in this outcome group was adequate. The manager is qualified and has the necessary experience to run the home, however needs to complete the registration process with a CSCI. Resident and relative opinions are taken into consideration when monitoring practice within the home. The manager has commenced regular staff supervision; all staff undergo an induction process. Health and safety within the home is appropriate however some areas need further attention. Stanton Nursing Home DS0000020288.V302299.R01.S.doc Version 5.2 Page 21 EVIDENCE: The registered provider has employed a new manager who has experience in the care of the elderly under management of a care home specialising in dementia care. The manager needs to and complete the registration process the CSCI as soon as is practicable. 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 will now carry out three monthly care plan reviews with relatives, a quarterly newsletter will be forward to all relatives, staff meetings will be held and extra staff will be employed at key times during the day. These decisions arose directly from the replies received from relatives. The new manager has started to carry out supervision with current members of staff. Supervision sessions include looking at working practices and identifying training needs which staff are encouraged to access. Health and safety within the home is generally satisfactory, with very clear risk assessments that all staff were aware of. However there were three areas requiring action. The records appertaining to fire checks were all well maintained and within current guidelines; however night staff must attend and take part in fire drills, as residents are most at risk during the night. Two windows were noted to be wide open to allow the access of air through the home, however both windows were easily accessible by residents who could fall from a height, and one window could provide easy access for somebody trying to gain entry to the home. This was discussed with the manager who said it would be dealt with immediately. During a tour of the premises it was noted that residents being assessed as requiring cot sides in two rooms had both a mattress and a pressure relieving mattress on the bed, which rendered the cot sides inappropriate as the resident could roll straight over the top of the cot sides and have further distance to fall to the floor. • All of the staff including night staff must take part in a fire drill in line with current guidelines. • Suitable restrictors must be attached to the identified windows. • Use of cot sides with pressure mattress and ordinary mattress must be reviewed as it presents a potential health and safety risk to the resident. Stanton Nursing Home DS0000020288.V302299.R01.S.doc Version 5.2 Page 22 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 X X 3 STAFFING Standard No Score 27 3 28 3 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.V302299.R01.S.doc Version 5.2 Page 23 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 2 3 4 5 Standard OP7 OP9 OP38 OP38 OP38 Regulation 15 (2) (b) 13 (2) 23 (4) 13 (4) (a) 13 (4) (c) Requirement Care plans must be up dated when a change or new need has been identified. Staff must follow instructions on administering specific medication All of the staff including night staff must take part in a fire drill in line with current guidelines. Suitable restrictors must be attached to the identified windows. Use of cot sides with pressure mattress and ordinary mattress must be reviewed as it presents a potential health and safety risk to the resident. Timescale for action 18/08/06 18/08/06 18/08/06 18/08/06 18/08/06 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 OP9 Good Practice Recommendations Staff need to date eye drops, creams and ointments when first opened. DS0000020288.V302299.R01.S.doc Version 5.2 Page 24 Stanton Nursing Home Stanton Nursing Home DS0000020288.V302299.R01.S.doc Version 5.2 Page 25 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. 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