CARE HOMES FOR OLDER PEOPLE
Stonecross Nursing Home Milnthorpe Road Kendal Cumbria LA9 5HH Lead Inspector
Elaine Brayton Unannounced Inspection 1st March 2006 9:00 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 Stonecross Nursing Home DS0000006156.V284274.R01.S.doc Version 5.1 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. Stonecross Nursing Home DS0000006156.V284274.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Stonecross Nursing Home Address Milnthorpe Road Kendal Cumbria LA9 5HH 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) 01539 721673 01539 730752 Stonecross Care Limited Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Stonecross Nursing Home DS0000006156.V284274.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 23rd June 2005 Brief Description of the Service: Stonecross is registered to offer general nursing care for up to 42 older people, although the home has reduced its bed numbers to 38, by changing double bedrooms into singles. The building is a three storey Victorian town house, set in the outskirts of Kendal. It has been adapted for its current use by the installation of a passenger lift; grab rails, and an extension to the rear. The home now has 34 single, and 2 double bedrooms. There is a large lawned garden to the rear of the home, but as this has a steep gradient, it is not easily accessible to service users, but is pleasant to look at. There are patio areas with seating and sunshades where service users can sit out. Stonecross Nursing Home DS0000006156.V284274.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection of the home carried out by Elaine Brayton and Jenny Donnelly. The inspection took place between 9am and 2pm. During the inspection the Inspectors spent time talking with service users individually and in small groups. Staff were spoken with, including the new manager of the home, and a selection of records relating to the care of service users and the day to day running of the home were examined. All parts of the accommodation were visited during the inspection. What the service does well: What has improved since the last inspection? What they could do better:
The care plans in this home are very poor and do not include full details of resident’s health and social care needs and how those needs are to be met. The care plans were not reviewed and updated on a regular basis. Other records such as moving and handling assessments, nutritional assessments, weight monitoring charts and skin integrity assessments were either not completed, or if they had been completed they were not updated or reviewed. Health care needs were not recorded in sufficient detail, including visits by GPs and information about hospital appointments. Residents were not able to make their own decisions about some aspects of their daily routines, and fitted in with staff routines and working practices rather than receiving their care, as they would wish. Not all residents were given a choice of menu at meal times. Stonecross Nursing Home DS0000006156.V284274.R01.S.doc Version 5.1 Page 6 The home did not have an adult protection policy and procedure in place that all staff were aware of and familiar with. Staff had not completed protection of vulnerable adult training. Some areas of the home are looking a little shabby, in particular the dining room, and some of the armchairs and tables in the lounges and would benefit from refurbishment. The staff routines in the home looked disorganised and chaotic during the inspection, and efforts should be made to ensure that staff work in an effective and efficient way in the best interests of the residents. Cleaning fluid was found un an unlocked cupboard on the third floor, this has been highlighted as a problem in the past, and staff should ensure that these products are always stored securely. The night staff had not been receiving regular training in what to do in the event of a fire, they should be receiving this training every three months. 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. Stonecross Nursing Home DS0000006156.V284274.R01.S.doc Version 5.1 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 Stonecross Nursing Home DS0000006156.V284274.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Prospective residents are provided with an information pack about the home to enable people to make a decision about whether the home can meet their needs. EVIDENCE: The home has an information pack to give or send out to those people who request it. A copy of this pack was also found to be in residents’ rooms who had recently moved into the home. It provided new residents with information about how the home operates and other useful information. Residents who had recently moved into the home confirmed that they had received an information pack on admission to the home. Stonecross Nursing Home DS0000006156.V284274.R01.S.doc Version 5.1 Page 9 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, The care plans and health care records in this home are poor, this could potentially lead to people not receiving appropriate care. EVIDENCE: A selection of care plans and health care records were examined as part of the inspection. The care plans were not completed fully, and important records about nutrition, skin care, weight and moving and handling were either not completed at all or not updated to reflect the persons changing needs. Proper records were not kept about hospital and GP appointments. It was not possible to determine the health and social care needs of residents through the care planning systems in place. Where health care issues had been identified there was not clear information about the care and treatment to be provided, or information about health care appointments and follow-ups. Care plans were not reviewed and updated on a regular basis. Residents spoken to had not been involved in the development of their care plan. Stonecross Nursing Home DS0000006156.V284274.R01.S.doc Version 5.1 Page 10 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, 14 Residents in this home do not always have sufficient choice and control over some aspects of their lives, which could mean that people’s needs are not always met. A range of social activities are available for residents to participate in if they wish. EVIDENCE: There was a person employed in the home to arrange social activities 2 – 3 times per week. There were various activities available that people could participate in if they wished to, and residents spoken to very much enjoyed these opportunities, and the home should continue to develop the activities programme. Because of the way staff are deployed in the home, residents are not always receiving the assistance they require when they wish to receive it. Residents were found to have been left in bed most of the morning as the staff had not had time to assist people with their personal care. Mealtimes are, at times, chaotic with residents not receiving the help they need in a timely way to ensure their meal is eaten while still hot. All residents do not always have a choice of menu at each mealtime.
Stonecross Nursing Home DS0000006156.V284274.R01.S.doc Version 5.1 Page 11 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): 18 There are no robust adult protection systems in place, and staff have not received any training about the protection of vulnerable adults. This could potentially put residents at risk. EVIDENCE: Care staff were not aware of any adult protection policies and procedures in the home. Staff had not received any training in this area, training would provide staff with the skills and confidence to recognise and report any incidences of abuse or abusive practices either intentional or unintentional. This must be addressed immediately. Stonecross Nursing Home DS0000006156.V284274.R01.S.doc Version 5.1 Page 12 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, 22, 26 The home provides accommodation that is clean and suitable for the people living there. There are some areas of the home that would benefit from refurbishment, to provide residents with a comfortable and attractive environment. EVIDENCE: On the day of the inspection the home was found to be clean and tidy. Some areas, such as the entrance hall are very pleasant and welcoming, but other areas need decorating, new carpets and furniture. The dining room would greatly benefit from re-decoration, and many of the comfortable chairs in the lounges need replacing. The Inspectors were informed that a refurbishment of the home would be starting in the near future, and this will include purchasing new armchairs, tables and carpets as well as re-decoration work. Residents spoken to thought the home comfortable and liked the light and airy lounges. There was a range of equipment in the home to assist people in their day to day lives.
Stonecross Nursing Home DS0000006156.V284274.R01.S.doc Version 5.1 Page 13 Stonecross Nursing Home DS0000006156.V284274.R01.S.doc Version 5.1 Page 14 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, 30 Sufficient staff are employed in this home, however, staff are not always deployed in the best way to ensure that peoples needs are met in a timely and appropriate way. EVIDENCE: The Inspectors observed the staff going about their duties during the day of the inspection, and noted that there was no routine, and the day appeared chaotic and disorganised. Residents care needs were attended to, and assistance was provided to people at mealtimes, but often people were left waiting for some considerable time before a member of staff attended them. This was discussed with the manager, who has agreed that the working routines in the home need to be reviewed, so that the staff are working in the best way for the people who live in the home. An up to date training plan is needed for the home, as there was little evidence available of any training that had taken place in the home in recent months. Some care staff require updates in mandatory training such as moving and handling, adult protection and infection control. Stonecross Nursing Home DS0000006156.V284274.R01.S.doc Version 5.1 Page 15 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, 38 An experienced manager has recently been appointed, and is currently in the process of registering with the Commission for Social Care Inspection. Some practices in this home do not protect the safety and welfare of residents and staff. EVIDENCE: The new manager had only been in post for a few weeks at the time of the inspection, and was still familiarising herself with the residents, staff and daily routines of the home. The Company have a quality assurance system, but this has not been utilised in the home for several months, and this a task that the new manager must carry out. A cupboard on the third floor was unlocked, despite there being a notice on the day saying it should be kept locked, and it contained cleaning fluid which should be stored in a locked cupboard at all times.
Stonecross Nursing Home DS0000006156.V284274.R01.S.doc Version 5.1 Page 16 The fire log book was looked at and all of the tests and checks of the fire safety equipment were being carried out at the required intervals. Day staff were receiving training in what to do in the event of a fire as required, but the night staff were not receiving this training. Stonecross Nursing Home DS0000006156.V284274.R01.S.doc Version 5.1 Page 17 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 X X x N/a HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 X 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 2 15 x COMPLAINTS AND PROTECTION Standard No Score 16 X 17 x 18 2 2 X X 3 X X X 3 STAFFING Standard No Score 27 3 28 X 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X x X x X X 2 Stonecross Nursing Home DS0000006156.V284274.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 17 Requirement Timescale for action 30/04/06 2. OP18 13(6) Each resident must have a care plan that details their health and social care needs and this should be updated as required and reviewed on a regular basis. The home must have policies 31/03/06 and procedures in place, and staff must receive training regarding the protection of vulnerable adults. (This was to have been met by 31/01/06) Health care needs must be recorded in the persons care plan and attended to as required with details recorded Residents must be enabled to have choice and control in all aspects of their life. All areas of the home should be kept in good decorative order and old and worn furniture and carpets must be replaced. A staff training and development plan must be devised, with records kept of all training completed by staff. The Manager must ensure that the staff in the home are
DS0000006156.V284274.R01.S.doc 3 OP8 12(1) 31/03/05 4 5. OP14 OP19 12(2) 23(2) 31/03/06 30/06/06 6 OP30 18(1) 30/05/06 7 OP27 18(1) 31/03/06
Page 19 Stonecross Nursing Home Version 5.1 8 9 10 OP33 OP38 OP38 24 13(4) 23(4) deployed in a way that meets the needs of residents in a timely and appropriate way. An effective quality assurance 30/05/06 and monitoring system must be implemented. Cleaning fluids must be stored 31/03/06 securely at all times. Night staff must receive training 31/03/05 in what to do in the event of a fire every three months. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Stonecross Nursing Home DS0000006156.V284274.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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