Inspection on 28/05/08 for Steep House Nursing Home

This inspection was carried out on 28th May 2008.

CSCI found this care home to be providing an Adequate service.

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

Steep House Nursing Home 16/05/07

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Winton House

Newbeech House

Treloar College

Rush Court

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Steep House Nursing Home Tilmore Road Petersfield Hampshire GU32 2HS Lead Inspector Christine Bowman Unannounced Inspection 28th May 2008 10:30 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 Steep House Nursing Home DS0000068710.V363740.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. Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Steep House Nursing Home Address Tilmore Road Petersfield Hampshire GU32 2HS 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) 01730 260095 01730 231148 Info@LRH-Homes.com London Residential Healthcare Ltd Care Home 46 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0), Physical disability (0), of places Physical disability over 65 years of age (0) Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Physical disability (PD) Physical disability (PD) over 65 years Old age, not falling within any other category (OP) Dementia (DE). Physical disability over 65 years of age - Code PD(E) and old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is 46. 16th May 2007 2. Date of last inspection Brief Description of the Service: Steep House is a care home with nursing, providing care and accommodation for 46 residents. The home has twenty-eight single rooms and six double rooms on three floors and a passenger lift allows access to all floors. Communal areas include a large lounge, a dining room and a reception area. The provider is in the process of extending the home to increase the number of residents, to upgrade the bathrooms and kitchen facilities to provide a new laundry and an additional lounge. The home has large surrounding grounds with patio areas around the home that are accessible to the services users. London Residential Homes Ltd owns the service in addition to three other homes in the area. Steep House is situated in a rural area near Petersfield within reach of some local amenities. The current fee charged is £500-£800. Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use the service experience adequate quality outcomes. This unannounced site visit was conducted as part of a key inspection using the Commission’s ‘Inspecting for Better Lives’ (IBL) process. The site visit took place over seven hours commencing at 10.30 am and ending at 17.30 pm and was undertaken by Ms Christine Bowman, Regulation Inspector. The home did not have a Registered Manager at the time but the Responsible Individual, the Provider and other senior staff, employed by the company, were available throughout the day and assisted with the inspection process. Staff from several departments were spoken with and a tour of the premises was undertaken. A number of residents’ bedrooms were viewed. Several residents and visiting relatives were spoken with and all expressed satisfaction with the service offered by the home. One relative stated, ‘It is took a long time to find this home, many of the homes visited had an unpleasant odour, but this one was clean and fresh smelling.’ The key inspection standards for care homes for older people were inspected and the statement of purpose and the service user guide were viewed. Resident’s files including assessments, care plans, medication administration records and risk assessments were viewed and staff personnel files, including recruitment, induction and training records were sampled. The home’s quality assurance system, complaints and compliments, policies and procedures and maintenance certificates were also sampled. The service had completed an Annual Quality Assurance Assessment (AQAA) and information recorded in this and on the inspection record since the previous site visit has been taken into consideration in the writing of this report. After the previous site visit, an improvement plan had been sent to the home because a number of requirements had been made for the health, safety and protection of the residents and the home had responded to inform us of the action they would be taking. A ‘Thematic Inspection’, which is a short focussed inspection that looks in detail at a specific theme within a home, had also been carried out on 24/09/07. This inspection looked at the quality of care people with dementia experienced when living at the care home and focussed on ‘dignity’ as an important part of the residents’ quality of life. Because people with dementia are not always able to tell us about their experiences, a formal way to observe people was used to help us to understand. This is called a ‘Short Observational Framework for Inspection’ (SOFI) and involved the observation of five people Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 6 who use the service over a period of two hours. References to the findings of the thematic inspection will be included in this report. Health care professionals, residents and staff completed surveys and comments from these sources have been included in this report. References to the homes’ own quality assurance assessment have also been made. Thanks are offered to the management and the staff of Steep House Nursing Home for their assistance and hospitality on the day of the site visit and to those who completed surveys for their contribution to this report. What the service does well: What has improved since the last inspection? The themed inspection carried out in September 2007 noted that ‘on most of the care plans for the three individual plans seen the additional “Actions unique to the individual” were blank’. Care plans viewed on this occasion contained Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 7 information unique to the individual. Goals were included and actions required by staff to fulfil the health, personal and social care needs of the residents were detailed. A requirement made at the previous site visit that all prescribed creams/ointments must have the service users’ names on them to ensure that the residents do not receive the wrong medication, and that a system to record the administration of prescribed creams must be implemented to ensure that the service users do not miss receiving the medical care they need, had been implemented. This action ensured that the high risk of infection from receiving cream meant for another resident was reduced. An activities organiser had been recruited and was in the process of assessing the residents and putting in place a plan to assist them in doing things that they enjoyed doing prior to coming to live at the home. Residents, whose files were sampled, had a social and leisure profile, which recorded their social involvement, social activities they liked to attend, interests and hobbies and participation in religious activities. A requirement that, people who use the service must be enabled to exercise autonomy and choice wherever possible, had been made after the thematic inspection in September. Improvements had been made in recording and practice and observation of residents over lunch confirmed satisfaction with the support they received. Residents spoken with, confirmed they were able to make choices. Some staff training in the Protection of Vulnerable Adults and Whistle blowing had been conducted to ensure individuals were aware of their duty to make prompt referrals independently, should the need arise, and to report poor practice. Planned improvements with respect to the environment were in progress, which, when completed, will result in improved facilities for the residents and the staff. Improvements had been made with respect to staff recruitment, in that the necessary checks to ensure safe recruitment had been carried out prior to employment to protect the residents. Some staff had undertaken training in dementia, as required in the thematic inspection, to promote greater understanding of, and improved communication with residents with impaired understanding. A staff-training matrix had been put in place to record and identify any gaps in staff training. Requirements made at the previous site visit with respect to health and safety had been complied with. Records confirmed the staff had received training in fire prevention and that fire drills had been carried out on a regular basis. Fire Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 8 alarms had been tested at regular intervals and a record kept ensuring they were kept in good working order. The Control of Substances Hazardous to Health (COSHH) cupboard was secure and no cleaning trolleys were left unattended, ensuring residents were protected from the accidental misuse of chemicals which could be detrimental to their health. Steps had been taken to ensure the water was delivered at the correct temperature to avoid the risk of scalding where residents directly accessed the water in their bedrooms and bathrooms. What they could do better: Pre admission assessments could include more detail with respect to equality and diversity to ensure these individual needs are taken into consideration in the initial care planning exercise. Individual care plans should be in a format, which is accessible to the residents, including those with dementia and those with communication needs. The complaints procedure should be reviewed to include a more realistic timescale to report investigation findings back to the complainant, and up to date contact details for the Commission for Social Care Inspection (CSCI) should be included. Measures must be put in place to ensure that all staff receive training in the Protection of Vulnerable Adults and are provided with a clear local policy reflecting the local authority Safeguarding Adults Policy and Procedure to make them aware of their individual responsibility in preventing residents from being harmed, suffering from abuse or being placed at risk of harm or abuse. All staff employed at the home must receive induction, mandatory and specialist training appropriate to the work they are to perform and to meet the needs of the residents. The Skills for Care Common Induction standards should be accessed by newly appointed staff in addition to the home’s own induction programme, as an introduction to the caring role and a plan should be in place to make sure that the home achieves a 50 ratio of National Vocationally Qualified staff at the earliest opportunity. The responsible individual, as representative of the provider organisation, has a responsibility to ensure the home is managed with sufficient care, competence and skill, which means ensuring a registered manager is in post, and suitably supported particularly with respect to nursing expertise, to provide the staff at the home with leadership and to offer continuity to the residents. Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 9 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. Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 10 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 Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 11 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): Standards 1,3, 6 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Sufficient information is available to prospective clients to help them to make a decision about the suitability of the home to meet their needs and expectations. The assessment of prospective residents’ individual needs did not include references to equality and diversity to ensure consideration was given to those needs prior to admission and to ensure those needs could be met at the home. The home does not provide intermediate care. EVIDENCE: The home’s service user guide and statement of purpose gave detailed information about the home to help prospective residents and their relatives and representatives to make up their mind about its suitability to meet their needs. The service user guide was available in large print, audiotape or in Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 12 other languages on request and contained comments made by residents about the home and photographs and drawings to illustrate the care and support provided. The pre-admission assessments of two residents were viewed and the prospective resident’s physical and health needs, including dietary preferences, mobility needs, continence, oral care, history of falls, communication and mental state were explored. Some reference was made to the resident’s personal history in that their previous occupations were recorded and places they had lived during their adult years. Other information with respect to equality and diversity such as the individual’s ethnic and cultural background, first language, social needs, interests and hobbies was not gathered at this point and there was no statement in the service user guide with respect to equality and diversity. A relative spoken with on the day of the site visit stated she had visited the home on behalf of her relative and been impressed by the cleanliness. Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 13 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): Standards 7,8,9,10 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are recorded to inform the staff of how to support them and access to health and social care professionals is promoted. Medication is handled safely, the residents are treated with respect and their right to privacy is largely upheld. EVIDENCE: Care plans viewed contained more information collected after the resident had been admitted including the individual’s religion and details of health care professionals involved. A member of staff stated that the assessment process continued throughout the first month of residence. They also stated that, where possible, relatives were consulted and a personal profile, including social activities, interests and hobbies and religious activities was compiled in some detail to enable an appropriate plan to be drawn up for each individual. Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 14 Records showed that nutritional screening had been undertaken and an up-todate record was kept of the residents’ weight. Care plans had been signed by residents and/or their relatives/representatives to confirm acceptance. It was noted, however that the information written in the care plans was not presented in an accessible format for the residents and particularly those with dementia. The themed inspection carried out in September 2007 noted that ‘on most of the care plans for the three individual plans seen the additional “Actions unique to the individual” were blank’. Care plans viewed on this occasion contained information unique to the individual. Goals were included and actions required by staff to fulfil the health, personal and social care needs of the residents were detailed. Daily notes were kept and monthly reviews recorded. A relative wrote in a survey, ‘we are pleased with the care that mum receives at Steep. I understand some staff are being trained to care for dementia sufferers, which will help. I realize communication is very difficult but mum does appreciate being talked to and is able to talk to people.’ The thematic inspection had identified examples of good practice that had been observed of the staff upholding the resident’s individuality and supporting their uniqueness. However other observations of a number of staff supporting individuals with dementia led to a requirement that the residents would benefit from the staff undertaking training in dementia care and communication with people who have impaired understanding. Staff training records confirmed this had been carried out. Two healthcare professionals, who returned completed surveys, confirmed that, ‘the care service usually seeks advice and acts upon it to manage and improve individuals ’ healthcare needs and that individuals’ health care needs are usually met by the service’. Records were kept of General Practitioner visits including reasons for the call and comments and referrals to consultants and outcomes. Details of visits to the dentist, optician and chiropodist were also recorded. A resident spoken with over lunch, confirmed they had recently had some dental work completed by a local dentist. The tissue viability nurse had attended a client, who was currently bed-fast, and they were making good progress with plans in place to transfer to a chair in the near future. Equipment for the prevention of pressure sores was in place. A requirement made at the previous site visit that all prescribed creams/ointments must have the service users’ names on them to ensure that the residents do not receive the wrong medication, and that a system to record the administration of prescribed creams must be implemented to ensure that the service users do not miss receiving the medical care they need, had been implemented. This action ensured that the high risk of infection from receiving cream meant for another resident was reduced. A senior nurse explained the home’s medication policy and administration procedures and they confirmed that all the nursing staff had received up-dated medication training, although the certificates had not yet been received. An audit trail was kept of Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 15 medication received, administered and disposed of through a contract with a specialist disposal service. The service user guide informed prospective residents that, ‘From the moment you come to us our staff will start building a relationship of respect and trust, ensuring that the personal privacy that you have become accustomed to will continue as well as the understanding for control over your life and affairs, respecting your dignity and personal feelings as if you were still in your own home.’ The home did not have specific policy on privacy and dignity but it is referred to in all the policies seen that relate to personal care and it runs through the written philosophy of the home. A healthcare professional, who completed a survey, thought the service always respects the privacy and dignity of individuals, and another that it usually does. Residents spoken with and visiting relatives confirmed that social contacts were promoted and maintained. Some residents had their own telephone lines and the home had mobile pay phones, which could be used in residents’ bedrooms for privacy. The residents who did not benefit from privacy for medical examination, treatment and meeting with relatives and friends in a dedicated private space were those residents sharing bedrooms, whose only possibility of access, was a curtain, which could be drawn around their bed. This did not prevent others in the room from over-hearing private conversations. Staff confirmed that the home’s induction included, ‘ treating residents with respect’ and good examples of caring and respectful interaction between staff and residents were observed throughout the day. The home held information with respect to the Skills for Care Common Induction Standards, but no records were seen to confirm that newly inducted staff had undertaken this work. A relative wrote to the home, ‘The care and attention given to our mother has been very good and has resulted in a vast improvement in her health and state of mind since her arrival.’ Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 16 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): Standards 12, 13, 14,15 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. This judgement has been made using available evidence including a visit to this service. Improvements had been made in matching the residents’ lifestyle experiences with their expectations and preferences with respect to their recreational interests and needs. Residents’ contact with family and friends was promoted, access to the local community improved, satisfaction with the diet expressed, and support given to empower residents to remain in control of their lives and make choices. EVIDENCE: A requirement had been made at the previous site visit that an activity programme must be further developed, ensuring that it meets the needs of all the residents so that their social and cultural needs are met and they can lead a fulfilled life according to their wishes and capabilities. An activities organiser had been recruited and was in the process of assessing the residents and putting in place a plan to assist them in doing things that they enjoyed doing Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 17 prior to coming to live at the home. Residents, whose files were sampled, had a social and leisure profile, which recorded their social involvement, social activities they liked to attend, interests and hobbies and participation in religious activities. Planned activities were posted on the notice board and included organised trips and one-to-one sessions for those, who did not enjoy group activities, or were unable to participate. Some of the regular activities included, ‘Look at the newspapers and have your say!!!’ ‘Sarah sings with songs down Memory Lane’, ‘Test your wits with Margaret’s Quizzes’, hairdressing, massage, aromatherapy, bingo, crafts, garden walks and videos. A summer Carnival and Fete had been planned for the end of June, a letter to relatives and friends from the social activities organiser informed everyone. The event included a dog show, cream teas, a dancing display and various stalls including cards made by the residents. A member of staff stated that the last organised outing was two weeks ago, and eleven residents accompanied by eleven staff had visited Marwell Zoo. Plans were also in place for an outing to Bognor Regis in the near future. The AQAA recorded, that as a result of listening to the residents, a minibus had been purchased to enable improved access to community facilities for the residents. A church service was organised monthly at the home and some residents, including a resident spoken with over lunch, attended a local church and a social club on a regular basis. Some residents maintained their own transport. On the day of the site visit, no organised activities were seen, but some residents were entertaining visitors, others were watching the widescreen television in the lounge and others were enjoying the views from the windows and engaging in social interaction with the staff. A requirement that, people who use the service must be enabled to exercise autonomy and choice wherever possible, had been made after the thematic inspection in September. Some good practice had been observed of individuals being supported with empathy and understanding to make choices based on how they were feeling at the time, but there were also examples of some staff rushing residents and not following special instructions recorded in their care plan, and of care plans not including the preferences of the residents to inform the staff. Improvements had been made in recording and practice and observation of residents over lunch confirmed satisfaction with the support they received. Residents spoken with confirmed they were able to make choices. A diabetic resident asked for ice cream as a dessert, which was promptly delivered, and a staff member confirmed this was diabetic ice cream, which did not contain sugar. The meal was nicely presented and well balanced, choices were available and residents who required support, received discreet and sensitive assistance from the staff. The home’s quality assurance questionnaires completed by residents, their relatives and representatives rated the diet as 50 good, 30 very good and 20 excellent. A relative commented, ‘The Easter Sunday lunch looked excellent and the table decorations and Easter baskets a nice idea’. Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 18 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): Standards 16,18 People who use the service experience adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The residents are confident that their complaints will be listened to and taken seriously. A lack of prompt referral to safeguarding and to specialist community support had resulted in residents not being adequately protected from abuse, but much had been achieved to improve the situation and to restore the confidence and trust residents had in those caring for them. EVIDENCE: The complaints procedure was available to all the residents in a copy of the Service User Guide in their bedrooms and because the print was small, residents were informed on the front cover that the publication was available on audiotape, in large print or in other languages on request. The AQAA recorded that the home had received six complaints over the previous twelve months. Two complaints had been upheld and all had been responded to within twenty–eight days and resolved. The Complaints and Feedback record had been completed and contained copies of letters written by the provider to the complainants. One healthcare professional, who completed a survey, confirmed the care service had always responded appropriately when they or the person Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 19 using the service had raised concerns. A second healthcare professional thought the home usually responded appropriately to concerns raised. Residents spoken with stated they had no complaints but were confident they would be listened to if they did. The home should revise the complaints procedure to inform residents, their relatives and representatives that the CSCI does not investigate complaints, but ensure they have up-to-date information should they wish to contact us. The complaints procedure also gives the home a very short period of time to resolve matters, which would be impossible to comply with, should an internal investigation be required. The CSCI had received no complaints since the previous site visit. Five safeguarding adults referrals had been made over the previous six months, resulting in five investigations and two staff members had been referred for consideration for inclusion on the Protection of Vulnerable Adults register. Referrals for community support and to the local authority safeguarding adults teams had not been sufficiently prompt and consequently staff training in the Protection of Vulnerable Adults and Whistle blowing had been conducted to ensure individuals were aware of their duty to make prompt referrals independently, should the need arise, and to report poor practice. The home held a copy of the local authority Adult Safeguarding Policy and Procedures and should ensure that a local policy based on this, informing the staff of their individual responsibilities and giving referral details, be drawn up and made available to all staff. The staff training matrix showed that not all staff had received this updated training, which should be undertaken with some urgency. Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 20 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): Standards 19,26 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a comfortable, safe and pleasant environment, which is clean and hygienic. EVIDENCE: The home is situated in a rural position in the village of Steep and accessed by a drive, which was well maintained. A good-sized car park was included in the pleasant, mature grounds, which surrounded the large house and an area of garden had been specially designed for the safety and pleasure of the residents and had been supplied with appropriate seating. The home’s development plan noted that an aim over the next six months is to create a secure garden to Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 21 enable residents diagnosed with dementia to enjoy in safety. The entrance to the home, which had been added by the present proprietor, was light, airy and welcoming. This area provided seating for visitors and residents and a reception area, which was manned by an administrator. French doors allowed access to the garden, when the weather permitted, and a digital screen welcomed visitors and gave them important information about the home. The menu of the day was also displayed here along with hard copies of information about the home. Communal space consisted of a large sitting room, divided into sections around a central area. These spaces were open to walk through, but provided separate areas for groups of residents to gather. One area contained a large, widescreen television, and a relative commented in a survey that, ‘Possibly it would be nice to have another television so that more residents are able to see.’ Comfortable seating was arranged around the room and there were pleasant views of the gardens, and doors, which could be opened for easy access to this area when the weather permitted. A notice board gave information about weekly activities and forthcoming events. Residents spoken with appeared content and responded to the interaction of the staff with smiles. Some residents were entertaining visitors. Radiators were attractively covered to prevent the residents from burning themselves; large windows provided natural light and modern ceiling spotlights enhanced this, giving the room a light and airy feel. The other communal space was the dining room, which was set out formally for its intended purpose. The provider stated that two new lounges, one of which would be a designated ‘quiet room’ were included in the new build, along with the sixteen new en-suite bedrooms. The building work, which was currently in progress, was not causing undue disruption to the residents. Access to the dining room was through a room described as a nurse’s station, in which records were stored in a lockable cabinet and where a staff member was working at a desk. There was no dedicated activities room, in which messy activities could take place, but a staff member stated that the reception area was sometimes used for conducting activities and some activities took place in the lounge. A lift provided access to the two upper floors, and a second lift was included in the new build plans. Some of the resident’s bedrooms were viewed and it was clear that encouragement had been given to residents to personalise them. Some residents had brought items of their own furniture, pictures, photographs, decorative items such as ornaments and lamps and had their own televisions, radios and telephones. The furniture provided by the home was attractive and of good quality. Many of the bedrooms had benefited from refurbishment, which had been carried out to a high standard and was well coordinated with respect to colours. ‘Residents are encouraged to choose their colour schemes and flooring from samples’, a staff member stated. Some of the bedrooms viewed had ensuite toilet and washing facilities and all had a Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 22 nurse call facility in case of an emergency. Since the previous site visit, measures had been taken to ensure that the hot water provided in the residents’ bedrooms and bathrooms was within the recommended safety levels to protect them from potential scalding. There were three double bedrooms occupied, which the provider stated, were shared only through positive choice. These bedrooms were provided with a curtain around one of the beds as a means of protecting the privacy and dignity of the residents. This did not, however, mean that residents could speak privately to visiting professionals or relatives in their own private space if the other resident was present. Part of the second floor provided staff accommodation and was screened off from the residents’ accommodation, but was accessible by the same staircase/lift. A bathroom on the ground floor was temporarily out of use and due to be refurbished and a bathroom on the first floor was also in need of refurbishment. Residents spoken with had not been inconvenienced by this and were happy with their shower and bathing arrangements. The AQAA confirmed that three new fully assisted bathrooms, nurse and treatment rooms were also included in the building plans. Aids and moving and handling equipment were available throughout the home to support those with mobility needs. The basement laundry, which was found to be in a poor state of repair with limited space with no natural ventilation at the previous site visit, was in the process of being replaced by a new purpose built extension. Infection control was promoted by the supply of alcohol gel and the provision of protective clothing for the staff, including gloves and aprons and the supply of liquid soap dispensers and paper towels. Of the residents who completed surveys, 70 thought the environment and general cleanliness of the home was very good and 30 thought it was excellent. On the day of the site visit the home was clean and there were no unpleasant odours. Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 23 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): Standards 27,28,29,30 People who use the service experience adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Sufficient staff were available to meet the resident’s needs and recruitment procedures had improved, promoting residents’ safety. Further work is needed to improve induction and foundation training for all staff, and specialist training for nurses to ensure the residents’ needs are fully met. EVIDENCE: The AQAA recorded that, ‘the staff turnover had been significantly reduced over the previous year,’ but the numbers of staff recorded as having left the employment of the home over the last twelve months was approximately a third of the present total. The staff rota recorded that two nurses were on duty at all times and that a senior nurse was supernumerary from 8.00am to 5.00pm for support and supervision. Six carers were on duty in the mornings, four in the afternoons and three at night. In addition to the nursing and care staff, there was a full-time activities co-ordinator, a chef and kitchen assistant. A laundry assistant and three housekeepers were employed in the mornings completing domestic duties. A staff member stated that local recruitment had been difficult and that this had led to staff being transported in the home’s minibus from the Portsmouth area. Accommodation was available to staff in Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 24 cottages in the grounds and in self-contained units on the top floor of the house, a staff member commented. Access was through the home, which could have compromised the safety of the residents, but assurances were given that staff did not receive visitors in their off-duty time. The AQAA recorded that seven of the thirteen care staff had achieved a National Vocational Qualification at level 2 or above and that three were working towards one, but the staff training matrix recorded only four staff, as having achieved these qualifications in 1999, 2001, 2004 and one in 2007, and only one of these staff had achieved the qualification after joining the home. At the previous site visit a requirement had been made that there must be a robust recruitment process in place and all necessary staff checks must be completed prior to their employment to protect the residents from the risk of harm, poor practise or abuse. The staff personnel files of two staff recruited since the previous site visit were sampled, confirming that checks had been carried out satisfactorily. Three staff, who completed surveys, confirmed their employer had carried out checks, such as your Criminal Record Bureau checks and references, before they started work. The home had an equal opportunities policy, but it was noted, the AQAA recorded that a high proportion of the staff were of one race, which was not reflected in the diversity of the local population or in the ethnicity of the residents, who were all of a different race. The home takes a positive stance to ensure all carers and nurses can be understood by the residents. All the overseas nurses are trained via the NMC Overseas Nursing Programme and English language is a mandatory course, which must be completed before they receive a PIN number. The staff had individual training and development files and some staff had benefited from accessing a variety of courses over the last six months. Some of the courses included, dementia awareness, The Mental Capacity Act, challenging behaviour, diabetes, the prevention and management of pressure ulcers and catheter care. There were some notable gaps in that there were no staff names recorded for person-centred care planning, equality and diversity, continence care, specialist equipment or for the Skills for Care Common Induction Standards. Only four staff were recorded as having completed the home’s in-house induction. A staff member stated that many of the courses were through distance learning, including the medication training for the nurses. Staff and resident interaction was observed as warm and friendly and the staff were caring, patient and respectful as they supported the residents. One resident commented, ‘Help from the staff is always given with good will and a smile,’ and another resident stated, ‘I watch the staff they are very patient and very good.’ The home’s quality assurance questionnaires rated the attitude of staff to residents as 10 good, 50 very good and 40 excellent. Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 25 The home displayed an ‘Investors in People’ poster and the Responsible Individual confirmed this continued to apply until 2010 confirming that the standard of staff development had been externally assessed and had achieved a recognised level to receive the award. Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 26 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): Standards 31,33,35,38 People who use the service experience adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Residents have not benefited from living in a home with consistent management over the previous twelve months. A new manager has been appointed and the organisation are committed to providing support to enable them to register and discharge their responsibilities fully. Consultation with residents, their relatives, and representatives ensures the home is run in their best interests and that their financial interests are safeguarded. Improvements had been made with respect to Health and Safety policy and practice to safeguard the residents. Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 27 EVIDENCE: Since the previous site visit, the home had not benefited from the leadership of a registered manager. Although a manager appointed in November 2007 and had instigated improvements in the home’s practice, they had resigned prior to applying for registration by the CSCI, and a manager registered in May 2007 had resigned after only two months in the role. Between July and November 2007, a senior nurse had been managing the home. Over that period of time, a high number of deaths had been notified and an outbreak of disease. The manager appointed in November discovered that four residents had developed severe pressure sores, which had not been notified to the CSCI. Appropriate referrals to healthcare professionals had not been made in a timely fashion. The senior nurse had been dismissed and referred to the POVA list and the NMC for poor practise. A second Head of Care, which is the senior nursing position at the home, was also dismissed for not following safeguarding procedures. The responsible individual stated that a suitably qualified and experienced manager had recently been appointed and was due to take up post at the beginning of June. As the new manager was not a Registered General Nurse, recruitment was in progress, the provider stated, for a Head of Care with this qualification and experience to support the manager by taking the lead in relation to nursing practise. A system was in place to ensure the views of the residents, their relatives and representatives were sought. Completed quality assurance questionnaires had been returned to the home and were available to be viewed. Good feedback had been received by the home from surveys completed by the residents and their relatives. Of the ten surveys returned, all were positive about the level of satisfaction they received from the service, 60 thought the service provided was very good and 40 thought it was excellent. Comments included, ‘we have no complaints and are very happy with the home,’ and ‘the Easter Sunday lunch looked excellent, the table decorations and Easter baskets a nice idea and generally we are happy with the care.’ Records were kept of ‘Friends Meetings’, which were regular meetings for relatives and representatives and which residents could also attend. Regular newsletters also kept residents, their relatives and representatives up to date with respect to events and information about the home. Regular meetings were also held for residents to enable them to give their views on the running of the home. The home did not manage any of the residents’ money and the administrator sent invoices to their representatives for all financial transactions. A lockable facility was available to residents in their bedrooms and they were advised to keep only small amounts of cash in the home. Standard 36 was not fully inspected but a requirement had been made at the previous site visit, that a supervision programme must be developed. The requirement stated that all care staff must receive supervision at least six Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 28 times a year as part of their practice so that gaps in their practice/ knowledge or training needs can be identified and appropriate action taken. The records of two staff sampled confirmed they had received appropriate supervision and records also showed that senior staff had received training in supervision and mentorship. Requirements made at the previous site visit with respect to health and safety had been complied with. Records confirmed the staff had received training in fire prevention and that fire drills had been carried out on a regular basis. Fire alarms had been tested at regular intervals and a record kept ensuring they were kept in good working order. The Control of Substances Hazardous to Health (COSHH) cupboard was secure and no cleaning trolleys were left unattended, ensuring residents were protected from the accidental misuse of chemicals which could be harmful. Steps had been taken to ensure the water was delivered at the correct temperature to avoid the risk of scalding where residents directly accessed the water in their bedrooms and bathrooms. Records of water temperatures throughout the home were recorded confirming the residents had been protected from this risk. Staff files sampled contained certificates to confirm mandatory training in moving and handling, first aid, food hygiene and infection control in addition to the fire training already mentioned. However, except for the fire training, which the staff-training matrix confirmed all the staff had accessed, gaps were noted for other mandatory training. The Annual Quality Assurance Assessment, completed by the responsible individual, confirmed that policies and procedures with respect to health and safety had been reviewed since the previous site visit, and that the essential maintenance of equipment had been carried out according to manufacturers’ recommendations. A sample of certificates were seen on the day of the site visit confirming that maintenance checks had been carried out in a timely fashion. Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 29 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 30 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 OP18 Regulation 13(6) Requirement Timescale for action 23/07/08 2. OP28 OP30 OP38 18(1)(a) (c)(i) 3. OP31 10(1) Measures must be put in place to ensure that all staff receive training in the Protection of Vulnerable Adults and are provided with a clear local policy reflecting the local authority Safeguarding Adults Policy and Procedure to make them aware of their individual responsibility in preventing residents from being harmed, suffering from abuse or being placed at risk of harm or abuse. All staff employed at the home 20/08/08 must receive induction, mandatory and specialist training appropriate to the work they are to perform and to meet the needs of the residents. 23/07/08 The responsible individual, as representative of the provider organisation, has a responsibility to ensure the home is managed with sufficient care, competence and skill, which means ensuring a registered manager is in post, and suitably supported particularly with respect to nursing expertise, to provide the staff at the home with leadership DS0000068710.V363740.R01.S.doc Version 5.2 Steep House Nursing Home Page 31 and to offer continuity to the residents. 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 OP3 Good Practice Recommendations Pre admission assessments should include more detail with respect to equality and diversity to ensure the individual needs of prospective residents are taken into consideration in the initial care planning exercise. Individual care plans should be in a format, which is accessible to the residents, including those with dementia and those with communication needs. The complaints procedure should be reviewed to include a more realistic timescale to report investigation findings back to the complainant and up to date contact details for the Commission for Social Care Inspection (CSCI) should be included. A plan should be in place to make sure that the home achieves a 50 ratio of National Vocationally Qualified staff at the earliest opportunity. The Skills for Care Common Induction standards should be accessed by newly appointed staff in addition to the home’s own induction programme, as an introduction to the caring role. 2. 3. OP7 OP16 4. 5. OP28 OP30 Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Steep House Nursing Home DS0000068710.V363740.R01.S.doc Version 5.2 Page 33 - 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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