Inspection on 22/07/08 for Stephenson Court Nursing Home

This inspection was carried out on 22nd July 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Stephenson Court Nursing Home 29/07/09

Stephenson Court Nursing Home 04/02/09

Stephenson Court Nursing Home 14/08/07

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Mendip House

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Extracts from inspection reports are licensed from CQC, this page was updated on 20/03/2009.

CARE HOMES FOR OLDER PEOPLE Stephenson Court Nursing Home Station Road Forest Hall Newcastle Upon Tyne NE12 9BQ Lead Inspector Janet Thompson Key Unannounced Inspection 22nd July 2008 10:00 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 Stephenson Court Nursing Home DS0000069661.V371356.R02.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. Stephenson Court Nursing Home DS0000069661.V371356.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stephenson Court Nursing Home Address Station Road Forest Hall Newcastle Upon Tyne NE12 9BQ 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) 0191 2702000 0191 2150040 stephensoncourt@schealthcare.co.uk Southern Cross Healthcare (Focus) Limited Mrs Christine Cass Care Home 46 Category(ies) of Old age, not falling within any other category registration, with number (45), Physical disability over 65 years of age (2) of places Stephenson Court Nursing Home DS0000069661.V371356.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Should any of the residents in the PD category leave the home, the Commission for Social Care Inspection must be notified immediately. 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 categories: Old age, not falling within any other category - Code OP, maximum number of places 45. Physical disability, over 65 years of age - Code PD(E), maximum number of places 1. The maximum number of service users who may accommodated is 46. 3. Date of last inspection 14th August 2007 Brief Description of the Service: The premises are purpose built and are located within a residential area of Forest Hall. The home is close to shops and local facilities including the Metro station. The home can accommodate 46 frail elderly residents who require nursing care. Short stay respite care is also offered when rooms are available. All accommodation is within single rooms with en-suite facilities. There are two dining rooms in the home and three lounges. There is no smoking area inside the home at the moment, but adaptations that comply with new legislation are currently being considered. Car parking is situated to the front of the building and there are gardens at the back. The weekly fees range from £361:00 to £450:50. Stephenson Court Nursing Home DS0000069661.V371356.R02.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 was an unannounced inspection. How the inspection was carried out: Before the visit we looked at: Information we have received since the last inspection visit. How the service dealt with any complaints or concerns since the last visit. Any changes to how the home is run. The manager’s views of how well they care for people. We always seek the views of people who use the service, their relatives, staff and other users of the service. This is usually given to us in the form of questionnaires. At the time of writing this report we had received two responses from questionnaires. During the unannounced visit we: Talked with people who use the service and some of the staff. Looked at the information about people who use the service and how well their needs are met. Looked at other records the home is required to keep. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building to make sure it was clean, comfortable and safe. Checked what improvements had been made since the last inspection visit. The manager was present during the inspection. Feedback was given to her at the end of the visit. Stephenson Court Nursing Home DS0000069661.V371356.R02.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Some redecoration has taken place resulting in a more pleasant home for residents to live in. The recording of residents needs in their case files has improved. This helps staff to plan care for people based on their individual needs, wishes and abilities. At the last inspection the manager had accepted testimonials for staff employed at the home. This no longer happens. Staff are screened before employment for the protection of residents. Stephenson Court Nursing Home DS0000069661.V371356.R02.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Stephenson Court Nursing Home DS0000069661.V371356.R02.S.doc Version 5.2 Page 8 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 Stephenson Court Nursing Home DS0000069661.V371356.R02.S.doc Version 5.2 Page 9 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): 3, standard 6 does not apply. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are properly assessed, taking account of their needs and wishes, so that they can be assured this is a suitable home and receive an individual care service. EVIDENCE: Three pre-admission assessments were seen. They contained enough information to enable staff to assess if they could meet the individual needs before admission. Stephenson Court Nursing Home DS0000069661.V371356.R02.S.doc Version 5.2 Page 10 We spoke to residents about the admissions procedure but they could not remember the details. In questionnaires, one resident said ‘I came to look around and quite liked it. Stephenson Court Nursing Home DS0000069661.V371356.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People receive personal care that is well planned and takes account of their diverse needs. However, people are not protected through good medication procedures. EVIDENCE: Three care plans were examined and two were case tracked. This means that we spoke to the individual residents or observed their care then matched our observations to what was written in the care plan. Both case tracked care plans did reflect the actual care needed by the residents. Care plans took account of peoples diverse and differing needs. People were supported to achieve independence and meet individual goals. Other health professionals contributed to the planning of care. These contributions were clearly recorded. Stephenson Court Nursing Home DS0000069661.V371356.R02.S.doc Version 5.2 Page 12 Care records showed that three residents in the home suffered from pressure sores. These had been acquired prior to their admission to the home or whilst in hospital. The records showed good recording of dressing changes, body maps and progress charts. Advice had been sought from the tissue viability nurse and was being followed. Residents looked clean and well cared for. Those spoken to did say they were well looked after. One resident told us “I am kept clean and tidy with the minimum of fuss, the staff are very kind”. A visitor to the home said “they do pay attention to health, Doctors are called whenever needed”. Medication ordering, administration, storage and disposal were examined. The manager audits all medicines monthly and the operations manager also carries out an audit. Medicines kept for normal use were all recorded and administered correctly. However, there were 74 MST tablets in the controlled drug cupboard that were dated December 2007. There were not recorded in a controlled drug register. Some of the boxes were open but the nurse on duty could not identify when any tablets had been administered. The manager reported that the drug audit does not include controlled drugs. The controlled drug cupboard is too small. The Oramorph would not fit in. This makes stock control and auditing very difficult and increases the risk of drug error. Stephenson Court Nursing Home DS0000069661.V371356.R02.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported to lead a fulfilling personal lifestyle, which takes account of their wishes and diverse abilities. EVIDENCE: An activities co-ordinator, referred to by the organisation as the diversional therapist, is employed at the home for 27 hours per week. She supports residents to use a range of services within the local community. Residents are encouraged to be in control of their own lives and enjoy their own interests and hobbies. Residents said: “yes there is enough to do if you want” Stephenson Court Nursing Home DS0000069661.V371356.R02.S.doc Version 5.2 Page 14 ”I can do what I like really, there is allsorts going on” We observed staff giving choices to residents about where they wanted to sit and how they spend their day. Residents said that they could choose when to go to bed and get up in the morning. Residents also said they liked the food. A resident did say that, depending which Cook was on, there was not always a cooked breakfast. She did have a cooked breakfast on the day of inspection. We ate the food at the home. It was well presented. The food was hot enough and very tasty. The standard of the cooking was very good. The home has taken on a new nutritional system. This is an independent nutritional tool that devises balanced menus and promotes healthy living. We were concerned that this was not being followed. On the day of inspection the menu was egg and chips or curry and rice. The food on offer that day was egg and chips or curry and chips. The nutritional values were therefore changed and choice reduced. There were not enough ingredients in the kitchen to follow the menu. There were a lot of tins in the kitchen store, of fruit, soup etc. All vegetables used are frozen. Stephenson Court Nursing Home DS0000069661.V371356.R02.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are protected from harm through thorough policies, procedures, though some staff need more training. EVIDENCE: Staff follow the home’s policies and procedures relating to the management of complaints and allegations of abuse. Staff training in this area has fallen behind due to turnover of staff, only 38.5 of staff are trained in the protection of vulnerable adults. Residents are told how to complain through the complaints procedure. This was clearly visible within the home. Residents spoken to said they would complain if they needed to but none of them had any current complaints. There were 16 complaints and one adult protection issue recorded since the last inspection in August 2007. Records showed that these were resolved to the satisfaction of the complainants. Stephenson Court Nursing Home DS0000069661.V371356.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a safe comfortable home that is generally pleasant and clean but not fully hygienic. EVIDENCE: The home was generally clean and free from odours. The furniture and general décor provides residents with a comfortable homely environment. Recent decoration of communal areas has improved this for residents. They said the home was warm enough and: “yes it is usually very clean, they work hard at it” “I like my room, it’s cosy” Stephenson Court Nursing Home DS0000069661.V371356.R02.S.doc Version 5.2 Page 17 A visitor said: “the home seems warm enough in winter, it is generally clean. Sometimes it looks a bit untidy or shabby but on the whole it is good.” There were some areas of the home that needed to be more hygienic to protect residents from the spread of infection. These were: In the ground floor shower room a continence pad was draped over the hoist, two face clothes were stored on top of a bin, the drain was rusty, the pipes were exposed and the grouting and skirting were black. The kitchen floor is lifting and worn. This makes it difficult to keep clean. The preparation tables in the kitchen appeared old, they were wobbly and had rusty feet. Some of the shelves in the fridge were rusty. Some of the bins in the home do not have lids that are operated by foot. This is essential to limit contamination and the spread of infection. Records show that the water in some staff hand washing sinks is as hot as 5052 degrees. This means that good hand washing techniques cannot be followed, as staff cannot wash their hands under running water. None of the staff have had training in infection control. Stephenson Court Nursing Home DS0000069661.V371356.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service are supported and protected through staff numbers, skill and ability. EVIDENCE: The staffing requirement is currently: Two First Level Nurses at all times. Seven carers in the daytime. Three carers at night. Training records showed and staff confirmed that over 50 of staff had achieved NVQ level 2. Some essential training had lapsed. For example, only 38.5 of staff are trained in adult protection and staff are not trained in infection control. Stephenson Court Nursing Home DS0000069661.V371356.R02.S.doc Version 5.2 Page 19 Three staff recruitment files were examined. These were for one new carer, one nurse and one long term employed carer. All contained good information. Thorough background checks had been carried out before employment. Residents were protected through checking of criminal records information for all employees. Interviews were conducted against a person specification list to ensure fair and equal employment. Stephenson Court Nursing Home DS0000069661.V371356.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using this service are not protected through reflective management that takes account of the diverse needs of the service. EVIDENCE: The home does have a registered manager. The manager has been assessed by CSCI as ‘fit’ to run the home. The manager is experienced in nursing and management. There are clear lines of accountability in the home. Stephenson Court Nursing Home DS0000069661.V371356.R02.S.doc Version 5.2 Page 21 Staff spoken to were clear about their role and responsibilities. There have been some issues leading to requirements and recommendations made in this report that we feel the manager should have identified before the inspection. These concern the unaccounted controlled drugs and lapses in health and safety checks. There are clear auditing arrangements within the organisation for safeguarding residents and staff. These have not been effectively carried out. Servicing and maintenance agreements are in place for facilities and equipment. Some health and safety checks were not up to date or identified issues not resolved. We found that: Weekly fire tests and checks were missing for three weeks between 14/04/08 and 12/05/08 and for one week between 13/06/08 and 26/06/08. Checks for fire doors were missing for a period of four weeks. The reason given on the record for those times was ‘unable to check off work sick’. The handyman wrote this as he is the person designated to carry out these checks. An entry dated June 2008 stated the shower room floor was leaking and this room could not be used. A new floor had been ordered. This had not been resolved at the time of inspection. The hot water at staff hand washing sinks was 52 degrees C. It should be below 43oC. The electrical installation certificate was issued in 2002. These are valid for five years. It is therefore out of date by a year. This compromises the safety of the building and all in it. Remaining checks for gas, hoists, lifts and water chlorination were up to date. There were no obvious trip hazards in the home. Fire exits were clear of obstruction and all hazardous fluids locked away. Residents personal monies were well accounted for. Records were examined and showed that two signatures were obtained for all transactions. Money is pooled therefore could not be counted. A regional administration manager audited the monies two weeks previously on behalf of Southern Cross and found all to be correct. Stephenson Court Nursing Home DS0000069661.V371356.R02.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 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 X X 2 Stephenson Court Nursing Home DS0000069661.V371356.R02.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 OP9 Regulation 13(2) Requirement Ensure storage, recording and administration of all medicines complies with the appropriate legislation and the homes own procedures. Conduct a review of infection control practice to take account of the comments in this section. Train staff in infection control. Ensure that all staff have up to date training in all the required areas. Outstanding from August 2007 The home’s quality assurance and quality monitoring systems must be effective and consistently carried out. Timescale for action 01/10/08 2. OP26 13(3) 16 01/11/08 3. OP30 18.1 01/10/08 4. OP33 24.3 01/11/08 5. OP38 13(4) Provide the Commission with evidence that essential safety checks for the building have been carried out. Ensure that these continue to be kept up to date. DS0000069661.V371356.R02.S.doc 01/10/08 Stephenson Court Nursing Home Version 5.2 Page 24 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 OP15 OP32 Good Practice Recommendations Ensure that the devised menu is followed and that residents have access to fresh produce. Ensure the manager communicates a clear sense of direction and leadership to staff. Stephenson Court Nursing Home DS0000069661.V371356.R02.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Stephenson Court Nursing Home DS0000069661.V371356.R02.S.doc Version 5.2 Page 26 - 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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