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Inspection on 23/06/05 for Stonecross Nursing Home

Also see our care home review for Stonecross Nursing Home for more information

This inspection was carried out on 23rd June 2005.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff have been keeping the care records up to date and accurate, with all important events recorded and the care regularly reviewed. In the entrance hall photos of all the staff members had been displayed, with their names below so that visitors to the home could put names to faces. The Home is communicating well with residents and their families and this was through a regular newsletter and information displayed on notice boards. Residents said that they found the newsletter informative and useful. Through looking at the care records it was evident that families were kept informed about the health and wellbeing of their relative.

What has improved since the last inspection?

Since the last inspection of the home an Activities Co-ordinator has been appointed. This person has arranged various activities for residents, in groups and individual activities. These take place three days each week. Residents were enjoying these opportunities to participate in social activities and look forward to the days the activities person works. Lunchtimes has improved since the last inspection, the atmosphere in the home during lunchtime was calm and friendly. Residents taking meals in their own rooms were provided with assistance in a suitable way, and a meal was not served unless there was a member of staff available to assist the person. In the dining room and lounge residents received the help they needed and the mealtime was relaxed and sociable.

What the care home could do better:

There is no leadership in the home, and important management tasks are being neglected. A manager must be appointed as soon as possible and registered with the Commission for Social Care Inspection. Cleaning staff had again left cleaning fluids in an unlocked cupboard, and it must be reinforced to them about the importance of locking away these products. Covering staff holidays and periods of sickness is an ongoing problem, and residents commented on the poor effect it has on people when the home is short staffed. People said staff were often rushed when attending to them, and could be sharp in their manner, which was put down to having too much to do. The staff on duty had very limited knowledge of the adult protection policies and procedures, and not completed any training in this area. This must be addressed promptly, as it is essential that residents are afforded the maximum amount of protection, and this is only so, if staff are trained in this area and aware of their role and responsibilities to protect people. The Commission for Social Care Inspection are concerned that there are some requirements that have been outstanding for some time, and legal action will be taken if the home fails to comply.

CARE HOMES FOR OLDER PEOPLE Stonecross Nursing Home Milnthorpe Road Kendal Cumbria LA9 5HH Lead Inspector Elaine Brayton Unannounced 23 June 2005 10:00 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 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 F58 F10 s6156 stonecross nh v245624 230605 ui stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Stonecross Nursing Home Address Milnthorpe Road Kendal Cumbria LA9 5HH 01539 721673 01539 730752 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Stonecross Care Limited Vacant Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Stonecross Nursing Home F58 F10 s6156 stonecross nh v245624 230605 ui stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23/11/04 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 F58 F10 s6156 stonecross nh v245624 230605 ui stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection of the home and took place over one day. During the inspection time was spent talking to service users individually and in small groups, some staff on duty were spoken to, as were the nurses on duty. A selection of the records relating to the day to day care of service users and the safe maintenance of the home were looked at. Since the last inspection there have been two additional visits to the home to check on compliance of requirements made at the last inspection and to investigate a complaint, and a brief report about this is attached to this report. The home has still not recruited a manager. The home, therefore has been without a Registered Manager since December 2003. What the service does well: What has improved since the last inspection? Since the last inspection of the home an Activities Co-ordinator has been appointed. This person has arranged various activities for residents, in groups and individual activities. These take place three days each week. Residents were enjoying these opportunities to participate in social activities and look forward to the days the activities person works. Lunchtimes has improved since the last inspection, the atmosphere in the home during lunchtime was calm and friendly. Residents taking meals in their own rooms were provided with assistance in a suitable way, and a meal was not served unless there was a member of staff available to assist the person. In the dining room and lounge residents received the help they needed and the mealtime was relaxed and sociable. Stonecross Nursing Home F58 F10 s6156 stonecross nh v245624 230605 ui stage 4.doc Version 1.30 Page 6 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. Stonecross Nursing Home F58 F10 s6156 stonecross nh v245624 230605 ui stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Stonecross Nursing Home F58 F10 s6156 stonecross nh v245624 230605 ui stage 4.doc Version 1.30 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 standard(s) 3 There was a satisfactory assessment procedure in place, which provided sufficient information for staff to ensure a persons needs will be met on admission to the home, EVIDENCE: A selection of assessments were looked at, including those for people recently admitted to the home. They included information about all of the person’s health and social care needs, so that staff could assess if the home could meet the care needs of the person. The assessment document had recently been improved so that all relevant information was collected. Stonecross Nursing Home F58 F10 s6156 stonecross nh v245624 230605 ui stage 4.doc Version 1.30 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 standard(s) 7,8,9,10 The new care planning system now provides staff with the information they need to satisfactorily meet service users needs. The medication procedures and systems ensured people received their medication as prescribed. EVIDENCE: Staff had started completing the new care plans, and they contained much more comprehensive information about residents health and social care needs and how they were to be met, and this assisted in making sure people received consistent care. The care plans showed evidence of regular reviews, and records were kept of all health related appointments, and a written report is made after each shift. This information shows how residents care is monitored, to ensure any change in need is attended to. Residents said that staff treated them in a respectful way, and upheld their privacy. Staff were observed knocking before entering peoples private rooms, and addressing people in a courteous manner. A nurse on duty was observed dispensing medication, and this was carried out safely and appropriately. Stonecross Nursing Home F58 F10 s6156 stonecross nh v245624 230605 ui stage 4.doc Version 1.30 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 standard(s) 12,13,15 Social activities and meals had improved, and now provided daily variation and interest for people living in the home. EVIDENCE: A number of people were spoken to and said that they now were provided with a weekly menu, and that the chef or staff discussed with them their likes, dislikes and alternative meal choices. A menu was observed in each private bedroom, and on the notice board in the reception area. During lunchtime a variety of meals were served according to people’s selections and preferences. The mealtime was relaxed and sociable in the communal areas, and people eating in their own rooms were provided with the assistance they required. The Home have recruited a person three days a week to organise a variety of activities for people, notices are displayed about what is going on and when. Everyone was enthusiastic about this development and had enjoyed the activities arranged so far, which provided stimulation and sociable events for people. Residents said that their family and friends could visit at any time, are always welcomed into the home. Stonecross Nursing Home F58 F10 s6156 stonecross nh v245624 230605 ui stage 4.doc Version 1.30 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 standard(s) 16,18 There is a satisfactory complaints system, and information is provided to people about how to complain. However, staff on duty had no knowledge of adult protection procedures, and so were possibly, not able to protect service users from abuse. EVIDENCE: Since the last inspection the Home has improved the systems for dealing with complaints, and residents are provided with information to tell them how they can make a complaint, and how it will be dealt with. The way complaints are recorded has improved, and it is now clear to see what the complaint was, how it was addressed and if this was satisfactory. The Home did not have an adult protection policy and procedure, the staff had not received training in this area and this means that residents are at possible risk from abuse. The Home have been informed that this must be attended to quickly so that residents have maximum protection from abuse. Stonecross Nursing Home F58 F10 s6156 stonecross nh v245624 230605 ui stage 4.doc Version 1.30 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 standard(s) 24,26 Resident’s private accommodation is spacious, comfortable and furnished according to the wishes of the occupant. The accommodation overall provides a clean and hygienic environment for residents. EVIDENCE: Resident’s bedrooms that were visited during the inspection had been personalised by the resident and their families and provided homely accommodation. Residents said that they were happy with their bedrooms and found them comfortable. The home was clean and hygienic on the day of the inspection providing a safe and pleasant place for people to live. Stonecross Nursing Home F58 F10 s6156 stonecross nh v245624 230605 ui stage 4.doc Version 1.30 Page 13 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 Only limited progress has been made in addressing staffing shortages, and as a result service users do not receive consistent care and often feel rushed when being attended to. The recruitment procedure is robust and provides safeguards for the protection of residents. EVIDENCE: Due to staff sickness there were only four members of staff on duty instead of the usual five. The Home are still experiencing difficulties in covering sickness and holidays, and more staff need to be recruited so that all shifts can be covered at all times, and residents are attended to in a relaxed and good natured way. Many residents did say that sometimes staff were very rushed when attending to their needs, and as a result sometimes seemed sharp in their manner. The personal files for new members of staff included information about the checks carried out to ensure residents are protected from abuse. Stonecross Nursing Home F58 F10 s6156 stonecross nh v245624 230605 ui stage 4.doc Version 1.30 Page 14 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,38 There is no Manager for the home, and therefore no effective leadership, which at times, results in an inconsistent and unsatisfactory service. There are systems in place, with records kept to safeguard the health and safety of residents. However, there were cleaning fluids, hazardous to health stored incorrectly. EVIDENCE: The home has been without a manager, registered with the Commission for Social Care Inspection since December 2003. This is not an acceptable situation, and means staff have no clear leadership, the home does not operate consistently, and there is nobody who has day to day overall responsibility for safeguarding the welfare and interests of residents. Also, some tasks are totally neglected such as individual staff supervision, and this was commented on after the last inspection of the home. There are records available which show all of the tests and checks are carried out to ensure the Stonecross Nursing Home F58 F10 s6156 stonecross nh v245624 230605 ui stage 4.doc Version 1.30 Page 15 home is a safe place to live and work. Cleaning fluids were found stored in an unlocked shower room on the first floor. The home has been asked to attend to this immediately, and this is particularly poor, as this issue was identified at the last inspection. Stonecross Nursing Home F58 F10 s6156 stonecross nh v245624 230605 ui stage 4.doc Version 1.30 Page 16 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION x x x x x 3 x 3 STAFFING Standard No Score 27 2 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 1 x x x x 2 x 2 Stonecross Nursing Home F58 F10 s6156 stonecross nh v245624 230605 ui stage 4.doc Version 1.30 Page 17 yes 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 37 Regulation 26 Requirement The registered provider must visit the home monthly in accordance with this regulation, must prepare a written report on the conduct of the home, and supply a copy of this to CSCI. (This was to have been met by 28.02.05 and then 30.04.05) Care staff must receive formal supervision six times per year, and other staff must be supervised as part of the management process. (This was to have been met by 31.01.05, 31.03.05 and 30.04.05) The home must produce an annual business and financial plan, which is open to inspection. (This was to have been met by 31.01.05, 31.03.05 and 30.04.05 Cleaning fluids must be stored in a suitable locked cupboard. (This was to have been met by 30.04.05) Sufficient staff must be recruited to be able to cover all holidays and periods of sickness. (This was to have been met by 31.05.05) The home must have policies Timescale for action 30.06.05 2. 36 18(2) 31.07.05 3. 34 25 31.07.05 4. 38 13(1) 30.06.05 5. 27 18(1) 31.07.05 6. 18 13(6) 31.07.05 Page 18 Stonecross Nursing Home F58 F10 s6156 stonecross nh v245624 230605 ui stage 4.doc Version 1.30 7. 31 8 and procedures in place, and staff must receive training regarding the protection of vulnerable adults. A competent manager must be appointed, and must register with the Commission for Social Care Inspection. 30.08.05 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 Good Practice Recommendations Stonecross Nursing Home F58 F10 s6156 stonecross nh v245624 230605 ui stage 4.doc Version 1.30 Page 19 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 © 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 F58 F10 s6156 stonecross nh v245624 230605 ui stage 4.doc Version 1.30 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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