Inspection on 11/07/08 for Stonecross Nursing Home

This inspection was carried out on 11th 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

Stonecross Nursing Home 03/06/09

Stonecross Nursing Home 25/01/08

Stonecross Nursing Home 15/10/07

Stonecross Nursing Home 28/06/06

Stonecross Nursing Home 01/03/06

Stonecross Nursing Home 23/06/05

Stonecross Nursing Home 23/11/04

Stonecross Nursing Home 17/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Stonecross Nursing Home Milnthorpe Road Kendal Cumbria LA9 5HH Lead Inspector Jenny Donnelly Unannounced Inspection 11th July 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Stonecross Nursing Home DS0000006156.V362204.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. Stonecross Nursing Home DS0000006156.V362204.R01.S.doc Version 5.2 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 Mrs Susanne Edmondson Care Home 38 Category(ies) of Dementia (5), Old age, not falling within any registration, with number other category (38) of places Stonecross Nursing Home DS0000006156.V362204.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 people 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: 38). Dementia: Code DE (maximum number of places: 5). The maximum number of people who can be accommodated is: 38. Date of last inspection 25th January 2008 Brief Description of the Service: Stonecross is registered to offer general nursing care for up to 38 older people, including 5 people with dementia cared for in a separate unit. The home tends to run at 36 places as double bedrooms are generally let singly. Stonecross Care Ltd operates the home; the registered manager is Mrs Susanne Edmondson who came into post in February 2008. 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 people, but is pleasant to look at. There are patio areas with seating and sunshades where people can sit out. The weekly fees at the time of this inspection ranged from £550.00 to £600.00, plus any registered nursing care contribution entitlement from the primary care trust. The home had information for prospective residents and their families, in the form of a statement of purpose, service user guide and CSCI inspection reports. Stonecross Nursing Home DS0000006156.V362204.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 this service experience adequate quality outcomes. This was the second main or ‘key’ inspection of this service this year. Following the last inspection in January 2008 twelve statutory requirements and eight good practice recommendations were made, and the registered provider was required to supply the commission with an improvement plan to demonstrate how standards in the care home would be improved. This was not provided by the due date and a ‘warning letter’ was issued to the provider about this. The new manager then submitted an improvement plan, and this second inspection took place to monitor the homes’ progress with the meeting the requirements and recommendations made in January. Jenny Donnelly inspector and Penny Wilkinson regulation manager, made an unannounced visit to the service on 11th July 2008 between 09.30 and 15.00 hours. During the visit we toured the building, spoke with residents, staff and the management. We looked at care, staffing and management records. We saw how people were spending their day, and observed lunch and the day’s activities. The pharmacist inspector visited separately and assessed the handling of medicines through inspection of relevant documents, storage and meeting with the manager and other staff. The pharmacy inspection took four and three-quarter hours. Prior to this inspection the manager had completed and returned an Annual Quality Assessment Audit (AQAA) that we had requested. The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We also sent surveys out to some of the people who live in the home, their relatives and to staff. The findings of the surveys are included in this report. What the service does well: The admission arrangements for people moving into the care home were good and included a detailed pre-admission assessment. People told us they were well looked after and were happy with the level of care provided. The home has a friendly and welcoming atmosphere. Arrangements for healthcare were good and the staff worked well with external health professionals and specialists. Good records for medication were kept to show that people received the correct treatment to keep them well. The provision of activities was good and there were opportunities for walks out side and trips into town. People praised Stonecross Nursing Home DS0000006156.V362204.R01.S.doc Version 5.2 Page 6 the choice and quality of meals served, and meal times were well organised and people were helped with eating. There were regular residents meetings where people were able to comment on the meals, activities and the quality of care. The staff group were caring and friendly and knew residents well. The home was clean and tidy, and the service was being well managed by the new manager. What has improved since the last inspection? There have been many improvements made since the last inspection of January 2008. These have been implemented as a result of a new manager being appointed in February. The statement of purpose had been re-written and now provided accurate information about the facilities and services offered at Stonecross. Care plans had been improved, and were being fully completed in more detail, and the manager was auditing these regularly. The delivery of care had improved through increased staffing levels and better allocation and organisation of the work. This also had a positive effect on the serving of meals, which was calmer and more organised, and significantly reduced the risk of people missing meals. There was more emphasis on activities and some people had had the opportunity to go out of the home. Local transport was being accessed to help people get out. Regular residents meetings were being held, which enabled people to make their views known. Regular audits of medication are done to improve the management of medicines and to keep people safe. A system for regularly checking medicines liable to misuse, called Controlled Drugs had been introduced so that they are accounted for at all times. The manager was handling complaints in a more constructive way and making herself available to people so minor issues did not grow into complaints. Staff had received training in dementia, and basic training in safeguarding vulnerable people and more in depth training was planned. The environment had been improved, with new flooring laid throughout the ground floor communal areas and in the kitchen. The decoration of the first floor corridor had been completed. A new wheel in shower had been provided, and a second was in progress. One bath had been adapted to accommodate the hoist and another bath was to be replaced with a new model. The handyman had attended fire warden training and the fire safety checks had been completed regularly. The manager had been notifying the commission of untoward incidents such as accidents, serious illness and deaths, and the registered provider had made written reports of his monthly monitoring visits. Stonecross Nursing Home DS0000006156.V362204.R01.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. Stonecross Nursing Home DS0000006156.V362204.R01.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 Stonecross Nursing Home DS0000006156.V362204.R01.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): 1, 3 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provided good information for people interested in their services and admission arrangements were thorough and served to help people settle in. EVIDENCE: Further to a requirement made at the last inspection, a new statement of purpose had been produced. A copy of this had been forwarded to us and was also seen on display in the entrance of the home. The document had been rewritten to remove incorrect information and give a more accurate picture of the services and facilities provided at Stonecross. The new statement of purpose included all the information required under regulation and provided good information about the care home to anyone interested. Admission arrangements for new people moving into the care home were good. The new manager had introduced an updated pre-admission assessment form, which was thorough and covered in detail people’s personal, social and healthcare needs. We saw these had been completed to a good Stonecross Nursing Home DS0000006156.V362204.R01.S.doc Version 5.2 Page 10 standard. The home also gathered information on new people from other professionals involved in the persons care such as social workers, hospital staff and community nurses. There was information on file about peoples funding arrangements and there was evidence that these had been reviewed periodically. People, or their representatives, had been able to visit the home before choosing to move in and surveys told us: • “A friend came to have a look around and I also was visited by the manager and given information about the home” • “The manager came to visit me in hospital and gave me all necessary information” • “My friend came to see the home and room available, to see if it was suitable”. Stonecross Nursing Home DS0000006156.V362204.R01.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 were receiving a good standard of personal and health care, although care records still need further improvement. People’s health was protected by good systems for managing medication. EVIDENCE: People told us they felt well looked after at Stonecross, and felt that care and attention from staff had improved of late. We saw that compared to our last visit, many more people were up and about, taking part in activities and eating meals in the dining room. Only a small number of people were being cared for in bed. We did not see any evidence of people waiting a long time to be attended to, as on previous inspections. We also noted that people were being offered regular baths. We chatted with people in groups in the lounge, and individually in bedrooms, and gained a positive impression of the care provided at Stonecross. The surveys we received said: • “They told us when they thought it necessary to get the doctor to visit mum” Stonecross Nursing Home DS0000006156.V362204.R01.S.doc Version 5.2 Page 12 “My mother is in bed all the time but she does get uncomfortable, I do not know if an air bed would be better” • “They are very good to my father and comfort him when he is upset” • “Nursing care is excellent” • “Sometimes busy, but I understand that they are dealing with other residents” • “Sometimes I have to wait” Further to a requirement made at the last inspection further work had been done to improve care plans. They were generally more detailed, with evidence of more frequent updating. Peoples social care interests were recorded in more detail. The new manager had commenced monthly audits of care plans and was picking up on, and addressing some shortfalls. Care plans were divided into long term plans for ongoing needs, and short term plans for temporary needs such as infections or minor injuries. There were some instances of short-term care plans continuing for some months, and staff need to consider when a short-term need becomes long term. Records of wound care had improved with good information about the wound and the dressing regime in place, but there was still a lack of detail about the wounds progress. For example there were regular entries stating whether dressings had been changed or left intact, but no ongoing description as to the appearance of the wound to see if it was getting better or worse. There was also an instance where a care plan stated a person was to be weighed weekly, but this had not happened, and staff said it was no longer appropriate as the person was too poorly. This care plan needed updating to reflect the changes in the persons overall condition, and to discontinue the weight plan. Records showed that people had good access to their doctor and were able to see other healthcare specialists as needed. Some people had been seen by the speech and language therapist to assess their swallowing ability and to advise on the type of food they could eat, and this information was clearly recorded in the persons plan. The wound care specialist nurse had seen other people to advise on their treatment, and this information had also been recorded. • We looked at records for receipt, administration and disposal of medicines and these were very well kept and showed that people received the correct treatment. Many medicines were packed by the pharmacy into monthly blister packs but some were dispensed into bottles and boxes. In these cases running balances of medication were kept so that they could be checked easily and accounted for at all times. We checked a sample of medicines against records and these were in order. A tablet was found to be missing on only very rare occasions. The manager also did regular checks of medication to look for discrepancies that could be dealt with promptly to keep people safe. We checked a sample of care plans relating to medication. These were variable in the level of information they contained. Some were quite good but others for “when required” sedatives needed more detail. These care plans did not give enough information for staff to follow to make sure sedatives were administered only when needed to prevent inappropriate use that could affect Stonecross Nursing Home DS0000006156.V362204.R01.S.doc Version 5.2 Page 13 people’s health. Daily records were also checked for the days when sedatives were given but there was little information to justify their use although staff were able to explain why they were needed. Doctors’ visits and medication changes were well recorded and followed up promptly. People were able to receive paracetamol that was not prescribed to provide prompt relief of minor pain without the need to call out a doctor. Records for these were kept but lacked information on the times of administration. New arrangements for this were put into place during the inspection, so that staff could see exactly what had been administered and what further doses could be given safely after the correct time interval. Medicines that are liable to misuse, called Controlled Drugs, were well managed. The manager had introduced a system of frequent daily checks so that they could be accounted for at all times. Stonecross Nursing Home DS0000006156.V362204.R01.S.doc Version 5.2 Page 14 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. The home provided a range of suitable activities and entertainment, and meals were of good quality with plenty of choice. EVIDENCE: There was an activities programme on display in several places around the home. This showed that hand care and manicures were due to take place that day, and we saw this happening throughout the morning. There was an activity records file that showed who had taken part in what activities each day, and this demonstrated a good variety of activities had been provided to a wide range of people. These included arts, crafts, games, quizzes, chair exercises, walks outside and one to one chats. Two people had recently been taken into town on a shopping trip. There were regular non-denominational religious services and communion. Some people had their own personal hairdresser to attend to them in the care home, whilst other people relied on staff to do their hair. The new manager said she was trying to recruit a regular visiting hairdresser for those people without any personal arrangement. In the past, people had complained about the lack of a mini bus for outings, and the homeowners told us a new bus had been ordered. The Stonecross Nursing Home DS0000006156.V362204.R01.S.doc Version 5.2 Page 15 new manager had no knowledge of this but had researched the provision of local community minibuses and wheelchair friendly taxis for hire as needed. Residents had agreed this was a suitable way forward. Venues for a day trip were being discussed at residents meetings and a summer fete was already organised. People we spoke with said the activities organiser was ‘wonderful’ and they enjoyed the attention she paid them. The surveys we received commented: • “Very good activities arranged” • “Very good entertainment plan” • “External trips in a minibus to Windermere/Arnside would be great” People said they were very happy with the quality and choice of meals served. We saw lunch being served in the dining room and lounge, with just a few people eating in their bedrooms. The meal was fish, cooked in a choice of styles, or minced beef, with chips, potatoes and vegetables. There was a hot and a cold dessert. People said they had ordered in advance and were confident the chef would prepare them something different if they asked. The organisation of serving meals was much improved, with better systems in place to monitor who had eaten what, and to ensure no one was missed out. The chef alerted the manager to any trays returning to the kitchen with food and drink uneaten. Surveys told us: • “The food is good, but smaller potions and more delicate would be welcome” • “Food is always hot enough” • “The chef is prepared to make anything that is not on the menu” One person said ‘food seems to be a problem’ but this was not explained further. Everyone we spoke to was very happy with the meals provided. Stonecross Nursing Home DS0000006156.V362204.R01.S.doc Version 5.2 Page 16 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. The new manager was managing and responding to complaints well and had started to improve staff knowledge on keeping people safe. EVIDENCE: There was a copy of the complaints procedure on display asking people to make complaints to the manager, or to the registered provider at the address of another of their care homes. Further to the last inspection the service was required to ensure complaints were fully investigated and responded to. The new manager advised that she had dealt with one complaint between staff members and she had kept a record of this and her judgment in dealing with it. No other complaints had been logged, but some issues had been picked up and dealt with through the residents meetings that might have become complaints if not addressed at an early stage. We felt the new manager was good at picking up and addressing minor issues before the situation deteriorated, and this is a good approach. Since the last inspection, no complaints had been made to the commission. People told us they knew how to complain if necessary, commenting; • “I would complain there and then” • “If I was unhappy, I would speak to the manger” • “[I would tell] matron on her visits to my room if needed” • “Never had need to complain” Stonecross Nursing Home DS0000006156.V362204.R01.S.doc Version 5.2 Page 17 At the last inspection we were very concerned about the lack of awareness amongst staff in relation to safeguarding vulnerable people from harm. Since then most staff had received basic awareness training in safeguarding and knew how to report abuse. The manager recognised that more in depth training would be beneficial and was trying to organise this. Stonecross Nursing Home DS0000006156.V362204.R01.S.doc Version 5.2 Page 18 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, 20, 21 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People lived in a clean, comfortable and well maintained home, with improving bathing facilities. EVIDENCE: Stonecross 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 people, but is pleasant to look at. There are patio areas with seating and sunshades where people can sit out. At the last inspection the redecoration works had come to a standstill, but these have since been completed. New flooring had been laid in the main entrance, corridor, lounges and dining room. The decoration to the first floor Stonecross Nursing Home DS0000006156.V362204.R01.S.doc Version 5.2 Page 19 corridor had been completed and new flooring was on order for that. The kitchen flooring had been replaced. Further to the last inspection, a requirement was made to improve the bathing facilities for people with infirmities. One bath had been removed and a large wheel in shower cubicle was in the process of being fitted. The same was happening in another bathroom. The third bathroom had the bath panel cut out to accommodate the hoist, so people could be safely hoisted in and out of the bath. The new manager was looking into replacement baths for one of the other two bathrooms, but no decision had been made on this yet. It is important that this work is fully completed to enable people to have a choice of safe bathing or showering. The communal rooms had been cleared of stored wheelchairs and other equipment, so they were accessible for people. The conservatory door handle had been changed so people could no longer get trapped in there. The top floor lounge had been re-instated for people to use. We found the home was clean, and fresh smelling throughout, and domestic staff were going about their duties in an orderly way. The laundry was being well managed and new driers were on order. People said their clothes were nicely laundered and they got things back in good time. Thirteen staff had attended infection control training People were generally very happy with the environment, as they had seen so much improvement. There was a part time maintenance person who saw to the day-to-day maintenance and repairs. Stonecross Nursing Home DS0000006156.V362204.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels and training had improved and this was having a positive effect on people living in the home. Recruitment procedures need further improvement. EVIDENCE: Since the new manager came into post, staffing levels had been increased and shift patterns had been altered to reduce staff handover times. There were two nurses and seven care staff during the morning, reducing to five carers in the afternoon, and there was one nurse and 3 carers at night. This was an improvement, and both staff and residents felt the home was more organised and less chaotic. Staff were allocated to work with certain people each day, and in this way the manager knew who was responsible for each persons care, and staff were more accountable. There was a notice board in the entrance hall showing the photographs and names of staff on duty that day, and this was helpful to residents and visitors. Some overseas staff were due to leave soon, and the manager had been assured by the owners that new staff were being recruited to these posts. Staff training had taken place this year on safeguarding and dementia care. A moving and handling training update was booked. Three care staff had completed a National Vocational Qualification in care and another staff member was working towards this. People were very complimentary about the staff team, saying: Stonecross Nursing Home DS0000006156.V362204.R01.S.doc Version 5.2 Page 21 • • • • “I visit every day and I find all the staff helpful and caring” “The staff are very good - but they are under pressure, especially at meal times when there is not enough staff” “Caring and warm staff who support me whenever needed” “Always very good, staff approachable and listen to what I have to say” We looked at staff files to check the homes recruitment procedures, and found these were generally much improved. However, there was one person in post since March 2008 who was working unsupervised without having a criminal records bureau check in place. The manager was not aware of this and began to investigate this mistake during the inspection. Stonecross Nursing Home DS0000006156.V362204.R01.S.doc Version 5.2 Page 22 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, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home were seeing the benefits of having a manager with good leadership skills who listens to what people want and runs the service in their best interests. EVIDENCE: The new manager Mrs Susanne Edmondson was appointed in February 2008. She is registered with the commission and a new registration certificate had been issued with her name on. Residents meetings and staff meetings were taking place regularly, and there was clear evidence that comments and suggestions brought up at residents meetings were then picked up at staff meetings. Stonecross Nursing Home DS0000006156.V362204.R01.S.doc Version 5.2 Page 23 To monitor the quality of the service, the manager completed a monthly home audit, which looks at all areas of the service, including the building, care documents, accident records, complaints, personnel files, finance, maintenance and social activity programmes. The new manager implemented residents meetings monthly, but these have reduced to every two months in accordance with residents’ wishes. The manager intends to send out satisfaction surveys to people later in the year. Staff supervision had begun to take place with all seniors having undertaken some supervision sessions, but this is not fully established yet. Further to previous requirements the new manager was now sending the commission notifications of events affecting people, such as serious illness, accidents and hospital admissions. We also saw reports from the registered provider of his monthly visits to the home. These were quite basic but did evidence that residents and staff had been spoken to, the premises had been inspected and some records had been examined. Since the last inspection the handyman had attended a fire wardens training course and the homes fire records were now up to date. The overall management of the service had improved greatly, and there was a clear commitment to listening to the views of people living in the home. Stonecross Nursing Home DS0000006156.V362204.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 2 X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 2 X 3 Stonecross Nursing Home DS0000006156.V362204.R01.S.doc Version 5.2 Page 25 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 OP7 Regulation 15 Requirement Care plans need to be kept regularly updated, to ensure they correctly reflect peoples current care needs. Wound care records need to be more clearly maintained to show whether healing is taking place. Timescale for action 01/09/08 2. OP8 15 01/09/08 3. OP29 19 All staff employed by the care 01/08/08 home must have a satisfactory criminal records bureau disclosure. (Previous timescale of 01/03/08 not met). RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations It is recommended that care plans for “when required” sedatives include clear instructions for staff to follow so DS0000006156.V362204.R01.S.doc Version 5.2 Page 26 Stonecross Nursing Home that people receive treatment appropriately and when necessary. 2. OP9 It is recommended that records are kept to show why “when required” sedatives are given so that their use can be justified. It is recommended that the work to improve bathing facilities be completed so that infirm people can bathe safely and comfortably. The home should aim to have 50 of the care staff qualified to NVQ level 2 in care, so people can be cared for by trained and competent staff. All staff should receive regular supervision to assist them to do their job well, identify training needs and develop their skills. 3. OP21 4. OP28 5. OP36 Stonecross Nursing Home DS0000006156.V362204.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Stonecross Nursing Home DS0000006156.V362204.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!