Inspection on 15/10/07 for Stonecross Nursing Home

This inspection was carried out on 15th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Stonecross Nursing Home 03/06/09

Stonecross Nursing Home 11/07/08

Stonecross Nursing Home 25/01/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Stonecross Nursing Home Milnthorpe Road Kendal Cumbria LA9 5HH Lead Inspector Jenny Donnelly Unannounced Inspection 15th October 2007 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 Stonecross Nursing Home DS0000006156.V345486.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.V345486.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 Susan Williams 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.V345486.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 28th June 2006 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 operate the home, and Mrs Sue Williams is the manager. 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. The weekly fees at the time of this inspection ranged from £485.00 to £657.63, 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.V345486.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the main or “key” inspection of the service this year. Since the key inspection last June, a “random” inspection was done in October to follow up on requirements made at that time. A copy of this random visit report is available on request from CSCI. As part of this inspection, the registered manager completed an Annual Quality Assurance Assessment (AQAA) telling us about the improvements the service has made over the last year and about areas of weakness they are working to improve. We also sent surveys out to residents, their relatives and other professionals who visit the home. We made an unannounced visit to the care home on 15th October from 10am until 16.30 hours. We toured the building, talked to residents, visitors and staff, and checked records relating to care, medicines, staffing and management. We observed the general running of the day. The information gathered through the surveys and by talking to people is included in the relevant sections of this report. The registered manager was not present during this inspection. She had been absent from the home for some time and the deputy was managing the home in her absence. What the service does well: Stonecross has very good admission procedures, which help to make sure people know what the home will be like and know that the staff will be able to meet their needs. People living in the home said they were content, happy and felt well looked after. People appeared well groomed and dressed appropriately in clean clothing with their hair tidy. The activities organiser was popular and arranged a good variety of in-house activities and visiting entertainers which people enjoyed. The meals were also popular with people saying they had been asked their dietary preferences, and the cook knew what they liked. Stonecross maintains good links with the local community and there were generally a lot of visitors in the home, which enables residents to keep contact with the wider community. People were able to exercise choice in how and where they spent their day and staff accommodated people’s wishes in this. Staff were highly thought of and described as kind, caring and friendly. People said they felt safe at Stonecross and felt that staff “looked out” for them. The home was clean and fresh smelling, and people said their clothing was laundered quickly and to a good standard. Stonecross Nursing Home DS0000006156.V345486.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There are a number of areas where the progress made last year has slipped, and we were disappointed to see this. People’s care plans were not as up to date and as detailed as they should be, and could lead to them receiving inconsistent care. There was a lack of bathing, and while staff said people did not like having baths, some people said they weren’t offered very often. The advertised activity did not take place on the day of the inspection and staff were unaware that anything was advertised. The recording of complaints needs to be tightened up to show the outcome of any investigations, and the contact details of the registered provider should be on the complaints procedure. The refurbishment of the home had stopped and this needs to be completed, so people can have a pleasant environment to live in. The bathing facilities would benefit from being upgraded, and this may encourage people to bath more often. Staffing levels had reduced and these need to be maintained in order to fully meet peoples personal, health and social care needs. The quality assurance process has slipped with no residents and relatives meetings being held this year, and no had action taken on suggestions made in the quality survey undertaken. No progress has been made on training someone to take charge of the homes fire precautions and there have not been any fire drills. Forward planning and managerial oversight of the service is lacking. Please contact the provider for advice of actions taken in response to this Stonecross Nursing Home DS0000006156.V345486.R01.S.doc Version 5.2 Page 7 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.V345486.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.V345486.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process helped people to know what the home would be like, and made sure that staff could meet new peoples care needs. EVIDENCE: Stonecross has a thorough admission process, which ensures the home can adequately meet the needs of new people. People are welcome to look around the home, with or without an appointment, and speak with staff and other residents. A new “enquiry” form has been developed to record basic details about any prospective resident. This is followed up by one of the senior nurses going to meet with the prospective resident to undertake a detailed assessment of their needs. This assessment also includes information from the persons’ social worker, hospital staff and relatives. Through this process staff can ensure that they will be able to meet the personal, health and social care needs of the person seeking admission, and that they will “fit in” with homes Stonecross Nursing Home DS0000006156.V345486.R01.S.doc Version 5.2 Page 10 statement of purpose and registration categories. This planning also allows time for the room to be made ready and any specific equipment to be in place for the new persons arrival. We looked at the assessments of two people quite new to the service and found they were detailed and gave staff a good picture of the people they were expecting. These people told us they had settled well into Stonecross, although in both cases relatives had viewed the home on their behalf, as they had been too ill to visit themselves at the time. Stonecross Nursing Home DS0000006156.V345486.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 felt they received a good standard of personal and health care, although the systems for managing this could be improved to ensure more consistent delivery of care. EVIDENCE: People told us they felt they were very well looked after at Stonecross. We noticed that people appeared well groomed, the men had been helped to shave, hair was tidy and people were smartly dressed in clean clothing with appropriate stockings and footwear. The surveys we received raised some concern about the frequency of bathing, and although a “bath list” in the office showed several people were due for a bath that day, none took place. One person was indeed too poorly to be bathed, and staff said a number of people did not like having a bath. One person thought they “had a bath every 12 days or so” but was not certain. Care plans did not specify any particular time or day for bathing and the “bath list” did not appear to be followed. Stonecross Nursing Home DS0000006156.V345486.R01.S.doc Version 5.2 Page 12 Other comments about care received included; • “The home has enough time to attend to peoples’ needs without rushing” • “My relative always looks clean and tidy and content” • “We could not fault the care given by staff” • “I shouldn’t have to ask for my relative to have a bath, it should be done at least weekly”. Each person had a care plan that was well set out and followed a sequence from admission information, life history and social interests, risk assessments, individual long and short-term care plans. The system was straightforward and easy to find the information you need. Each person was allocated a named nurse and a special carer called a keyworker, to oversee their care. We looked at a number of care plans in detail and found that some risk assessments and some care plan instructions had not been reviewed for a number of months. These need to be reviewed and updated at least monthly to ensure people are receiving the right care. In some cases the care plans were not detailed enough, for example there was a plan for a wound dressing that did not specify the type of dressing or frequency of changing, and a catheter care plan did not state the type and size of catheter in use or the due date for its’ renewal. These need to be improved. The nighttime care plans had been updated and were nicely personalised and detailed about people’s wishes and choices. The management of medicines was much improved since the last inspection when the pharmacist inspector had made a number of requirements and recommendations to the home. The majority of peoples’ medicines were supplied in a pre-packed system from the pharmacy, and medicines outside of this system were being tightly monitored and a running stock balance was being recorded. There was no evidence of the home being over stocked with medication, which can lead to mistakes. Neither was there any evidence that peoples’ medicines had run out and not been available when needed. Medicines were securely stored and kept at the right temperature. Medicine records were maintained in good order, and there were no gaps in the administration charts. Staff had recently attended a medicines update with their supplying pharmacy. People were able to manage their own medicines if they wanted, but uptake of this was quite minimal. The morning medicine round, which had been put to a later time, had been brought forward again to ensure medicines were properly spaced between doses, and so people got their pain killers before being got up out of bed. We surveyed the local doctors who said, “ Medical liaison is usually good”. There was some evidence that communication about peoples’ care needs could be improved between nurses and care staff. Stonecross Nursing Home DS0000006156.V345486.R01.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 adequate. This judgement has been made using available evidence including a visit to this service. There was good provision of in-house entertainment and activities, but this was not consistent and not always as advertised, opportunities to go out were limited. EVIDENCE: Stonecross employs an activities organiser for 3 days each week. There was a monthly activity programme displayed on the notice board showing something for every weekday such as, what the papers say, films, exercises, board games, art, massage and crosswords. In addition to this were visiting entertainers, and photographs of various events were on display in the home. Some people commented that they really enjoyed the last visiting entertainers, and how good they were “best I’ve ever seen anywhere”. We received many positive comments about the activities organiser and her role. The activity advertised for the day of the inspection was a “film”, but there was no evidence of this taking place, and when asked, staff did not know anything about it. Clearly the advertised activity programme does not happen when the activity person is not there, and this needs to be addressed. The home used to produce a monthly newsletter for residents, but sadly this has Stonecross Nursing Home DS0000006156.V345486.R01.S.doc Version 5.2 Page 14 stopped. Visitors said they were made very welcome in the home, and residents benefited from some local people who “just popped in to see how everyone is and have a natter”. Individual care plans contained information of people’s interest and past hobbies, which is helpful in planning activities. Care plans also contained information on people’s religious and spiritual needs, but there was some staff misunderstanding here as the care plan for a devout Methodist stated, “invite (that person) to Communion”. It was evident that people could choose whether to spend time in their bedrooms or in the communal lounges. Some people had a set pattern to their day; others decided from day to day where they wanted to be, and staff accommodated this. A number of the surveys we received commented on the lack of outings due to difficulties accessing transport. • • • “Some outings for a change of scenery would be good” “For the past two years there’s not been any minibus outings, my relative used to enjoy these” “I would like to see the homes’ promised minibus appear” A number of people commented on the lack of a minibus for outings. The registered provider confirmed that a bus had been ordered in July for delivery in October. People told us the provision of meals was good and that the cook always made something special if needed. The menus had been updated last year with a lot of input from residents and relatives as to their favoured dishes and suggestions. Meals could be taken in the dining room, the lounges or in people’s bedrooms as they chose. We saw that lunchtime was well organised with meals being served quickly and people getting the help they needed to eat it. We saw that cold drinks were freely available around the home and hot drinks were served regularly throughout the day along with snacks of cake, biscuits and fresh fruit. The kitchen staff had attended an information day earlier this year, run by the Environmental Health department to advise care homes on changes to recommended kitchen records. The cook was now using this new system, which is good practice. Stonecross Nursing Home DS0000006156.V345486.R01.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 knew how to complain about the service and felt they would be listened to. Staff were aware of safeguarding procedures and people living in the home felt protected. EVIDENCE: Stonecross had a complaints procedure on display in the home, asking people to make their concerns known to the manager. It would also be helpful to have the registered providers contact details listed in the procedure, so people can write to them directly if they wish. People we surveyed said they knew how to complain and hadn’t felt it necessary. • “We have not needed to complain as care given was always satisfactory” • “We’ve never had any concerns”. Since the last inspection, one complaint about care practices and staffing at Stonecross was made to us, and we asked the provider to look into this and respond to us and to the complainant. The providers worked with the social worker connected with this family to provide a considered and detailed response. The complaint was not upheld and the social worker contacted us to say how pleased she was with the manager’s attitude and efforts to alleviate this difficult situation. The manager reported another complaint made directly to the home, and although there was one letter on file acknowledging the complaint and promising further action, there was no other letter on file to confirm what that action was. The deputy manager thought this matter had Stonecross Nursing Home DS0000006156.V345486.R01.S.doc Version 5.2 Page 16 been resolved satisfactorily with the family at the time. Complaint investigation records need to be tightened up, to demonstrate what action has been taken. All staff had received training in safeguarding adults (abuse) last year and were aware of their responsibilities to protect residents, and report any concerns. Staff said there was a recap of this in some recent training on another topic. Residents said they felt content, happy and safe living in Stonecross and believed the staff would protect them from harm and generally “look out” for them. Stonecross Nursing Home DS0000006156.V345486.R01.S.doc Version 5.2 Page 17 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, 22, 24, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People were comfortable in their surroundings. The majority of the home had been re-furbished to a good standard, although some areas were still in need of attention. 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. Over the last year a lot of refurbishment work has taken place, but more work needs to be done. The whole of the ground floor was fully refurbished with Stonecross Nursing Home DS0000006156.V345486.R01.S.doc Version 5.2 Page 18 new flooring, wallpaper, and paintwork. Sadly the new corridor and lounge carpets have not been able to withstand the heavy traffic of wheelchairs and hoists, and this is now so badly worn and faded that it needs to be replaced again. There were plans to refurbish the whole building, and although the bedrooms on the middle floor have been done, the workmen had left. There was a section of corridor on the middle floor that had been stripped to bare plaster and left, the bathrooms had not been done, and no work had taken place on the top floor. Of the bedrooms that had been redecorated about 10 of them still had the faded old curtains that were there before. Some of the furniture around the home, especially bed tables were quite aged and shabby. Staff said these were being replaced at so many each month, and we saw that some people did have a new table. Some new nursing equipment including four specialist mattresses, a blood pressure machine and digital thermometer had been purchased. The weighing scales had recently been sent for re-calibration. There are bathrooms on each of floor of the home, totalling five. Each of these baths has a hoist seat fitted but only one of them is a freestanding bath, i.e. not fitted into the corner walls. The homes shower cubicle has been out of use for many years, and although there was talk of creating a walk/wheel in shower, nothing has happened with this. In view of the increasing age and dependence of the resident group, and the lack of bathing currently taking place, some improvement to the bathing facilities would be beneficial to both residents and staff in making this a more pleasant experience. We found the home was clean, and fresh smelling throughout, and two domestic staff were going about their duties in an orderly way. The laundry was being well managed and a third washing machine had been purchased to help with laundry turnaround and as a back up in case of breakdown. People said their clothes were nicely laundered and they got things back in good time. Staff had attended infection control training and were adhering to the homes colour coded cleaning procedures. People were generally very happy with the environment as they had seen so much improvement over that last year, and people had been included and asked to help choose the décor, which is good practise. This refurbishment work now needs to be completed so all areas of the home are to the same standard. Stonecross Nursing Home DS0000006156.V345486.R01.S.doc Version 5.2 Page 19 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, 18, 19 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff team are very friendly and caring but the reduction in staffing levels and training could impact on the quality of care people receive. EVIDENCE: We noticed that the homes’ staffing levels had dropped since last year, when there were 2 nurses and 7 carers on duty in the morning. Now the deputy said they aim for 2 nurses and 6 carers, but some days, like today, had only 5 care staff. Whilst this did not appear to have an overly negative effect on the care delivery, as people were up and dressed and felt well looked after, no bathing had been done and the afternoon activity did not take place. One registered nurse had left, and one was on sick leave, and this had increased the workload of other nurses in respect of being “named nurse” for more people, and responsible for more care plans. There were vacancies for care staff, and interviews were taking place on the day for this. In the absence of the manager, the deputy had tried to keep up with staff training, and in addition to the use of training DVDs on fire and dementia, Boots the chemist had provided medicines training, and a manager from another care home had provided moving and handling, basic life support and health and safety training for the majority of staff. At our random inspection last October, we were told that two care staff had a National Vocational Qualification (NVQ) in care, and five carers would be Stonecross Nursing Home DS0000006156.V345486.R01.S.doc Version 5.2 Page 20 starting this in January; a recommendation on NVQ training was lifted. However, at this inspection, we were told that one carer had an NVQ (the other had left), none had commenced training in January but 3 had just started their NVQ last month. The recommendation for 50 of care to have an NVQ in care is repeated. Staff files showed that the home is following good recruitment practice and making thorough checks on new staff prior to employing them. Comments and surveys we received, spoke well of the staff team, saying; • “The home employs empathetic staff” • “The care home has a good mix and continuity of staff who take the trouble to communicate with residents even though English is not the first language for some of them” • “Staff are always pleasant and friendly” • “The staff are approachable” Stonecross Nursing Home DS0000006156.V345486.R01.S.doc Version 5.2 Page 21 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, 36, and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered manager has been absent for some time and whilst the interim management arrangements keep the home ticking over, there is a lack of progress and forward planning. EVIDENCE: The registered manager, Sue Williams, has been in post since February 2006 and is registered with the Commission for Social Care Inspection. We were advised in August that the manager was spending some time away from Stonecross to support the providers other care homes. Since then we have been notified that the manager is on sick leave, and the deputy would be managing Stonecross in her absence. Stonecross Nursing Home DS0000006156.V345486.R01.S.doc Version 5.2 Page 22 When the manager came into post she set up residents / relatives meetings and introduced a quality assurance system that included surveys to residents and relatives, as well as internal audits. Surveys forms told us; • “The manager is not there all the time” • “There are supposed to be meetings, but so far this year, nothing”. Staff confirmed that no residents or relatives meetings had taken place this year, although the deputy said she saw most relatives daily, when they visited. There were some completed satisfaction surveys from residents and relatives dating from February to August of this year. The deputy said she’d found them in a drawer, and had not seen them before. We looked at the surveys and found that whilst they were mostly very positive, several made suggestions of how the service could be improved. It appears that no action had been taken on any of these suggestions, and the survey was therefore wasted. Staff told us the registered providers visited the home frequently and could be contacted for advice and assistance at any time. A new system for managing residents “pocket money” had been introduced, so instead of being invoiced for extras such as hairdressing, cash was to be held in the home for this. However, there was no system for Stonecross to bank cheques sent in by relatives, so these have been handled at head office and the invoicing system continues. The deputy manager has been meeting individually with staff to keep their supervision records up to date, but records show she has not received any formal supervision herself since April 2006. Records showed that servicing of equipment and facilities was up to date. The handyman kept the fire logbook up to date and did the fire safety induction with new staff. At the last inspection the manager was looking into the new fire regulations with a view to training up a fire a warden, there has been no progress with this, and no fire drills for staff. Whilst the day-to-day management of the home appears to be “ticking over” during the registered managers absence, there has been slippage of standards in a number of areas, and the lack of progress and absence of forward planning is a real concern and needs to be addressed. Stonecross Nursing Home DS0000006156.V345486.R01.S.doc Version 5.2 Page 23 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 2 2 3 X 2 3 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 2 X 2 Stonecross Nursing Home DS0000006156.V345486.R01.S.doc Version 5.2 Page 24 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 OP7 Regulation 15 Requirement Peoples care plans must be reviewed and updated at least monthly to ensure the care delivered by staff is appropriate to the persons needs at that time. Staffing levels must be sufficient to fully meet all peoples’ assessed personal, health and social care needs. Timescale for action 31/12/07 2. OP27 18 30/11/07 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 3 Refer to Standard OP7 OP12 OP16 Good Practice Recommendations People should be offered a bath at least weekly and their preference about how this happens should be recorded in their care plan. Activities should take place as advertised and more opportunities should be made for people to go on trips out of the care home. The complaints procedure on display should show the DS0000006156.V345486.R01.S.doc Version 5.2 Page 25 Stonecross Nursing Home 4 5 6 7 8 9 10 OP16 OP19 OP21 OP28 OP33 OP36 OP38 contact details of the registered provider so people can contact them directly if they wish. Records of complaint investigations should be complete and show the final outcome of each investigation. The refurbishment of the home should be completed so everyone has a pleasant environment to live in. Consideration should be given to improving the bathing facilities so that bathing can be easier and more pleasant for both residents and staff. 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. The quality assurance system should be more effective in seeking and acting on peoples suggestions to improve the service. All staff including managers should receive regular supervision to assist them to do their job well, identify training needs and develop their skills. The home should have a suitably trained fire warden on the staff group, and periodic fire drills should be carried out. Stonecross Nursing Home DS0000006156.V345486.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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. 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