Inspection on 10/12/07 for Stowlangtoft Hall Nursing Home

This inspection was carried out on 10th December 2007.

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

Stowlangtoft Hall Nursing Home 18/05/10

Stowlangtoft Hall Nursing Home 23/02/10

Stowlangtoft Hall Nursing Home 10/12/09

Stowlangtoft Hall Nursing Home 28/10/09

Stowlangtoft Hall Nursing Home 07/10/09

Stowlangtoft Hall Nursing Home 18/11/08

Stowlangtoft Hall Nursing Home 15/03/07

Stowlangtoft Hall Nursing Home 06/02/06

Stowlangtoft Hall Nursing Home 18/07/05

Stowlangtoft Hall Nursing Home 03/02/05

Stowlangtoft Hall Nursing Home 19/07/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Stowlangtoft Hall Nursing Home Stowlangtoft Bury St Edmunds Suffolk IP31 3JY Lead Inspector Kevin Dally Unannounced Inspection 10 December 2007 09:00 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 Stowlangtoft Hall Nursing Home DS0000024506.V354252.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. Stowlangtoft Hall Nursing Home DS0000024506.V354252.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stowlangtoft Hall Nursing Home Address Stowlangtoft Bury St Edmunds Suffolk IP31 3JY 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) 01359 230216 01359 233346 iain@stowlangtofthall.co.uk Mr Hector Iain MacDonald Mrs Hilary Anne MacDonald Mrs Hilary Anne MacDonald Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37), Physical disability (37) of places Stowlangtoft Hall Nursing Home DS0000024506.V354252.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th March 2007 Brief Description of the Service: The present Stowlangtoft Hall was built in 1859 for the Maitland Wilson family and stands in seven acres of garden and woodland. In 1939 the property was let to London County Council as an evacuation centre for mothers and babies from the East End of London. The Hall has been used as a nursing home since 1969. Many of the original features of the hall have been retained for the enjoyment of the residents and visitors, including an Orangery with a glazed dome roof where residents may sit in the warmer weather. The home has established strong links with the local community and the larger grounds around the home are often used for community events. The home is currently registered for 37 places for older people or those with physical disabilities and are admitted for either short or long term care. The home actively encourages prospective residents and their relatives to visit and talk to management and residents about the services provided and to attend for trial visits. The fees range from £471 to £695 per week. Stowlangtoft Hall Nursing Home DS0000024506.V354252.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 unannounced inspection was undertaken over two days on the 10th December 2007 and the 7th January 2008 to assess the core standards that related to the nursing care provided to elderly residents. The report has been written using all the information gathered prior to and during the inspection process, including information from the Annual Quality Assurance Assessment (AQAA), provided by the home. The AQAA gives the service the opportunity of recording what they do well, what they could do better, and what has improved in the previous twelve months as well as future plans for improving the service. The registered manager Mrs. Hilary MacDonald, the manager Mr. Mark Roscoe, who is the deputy to the registered manager and nurse manager Mrs. Maureen Tilbrook were present on both days and contributed fully to the inspection process. At the inspection the care and nursing support provided by the home was checked, and the outcomes provided for residents assessed. The daily routines and lifestyle opportunities where observed as was the meal provision, the medication practises of the home, and the environment. Residents’ care plans, risk assessments, needs assessments and accident and incident reports were checked for evidence of care and management monitoring. Staff recruitment procedures, rosters and the numbers of staff on each shift were checked. The way the home was managed, including the management of complaints and quality assurance, were assessed. Comment cards were received from residents (2) and relatives/advocates (10), and via direct interviews with residents, relatives and the staff group. A selection of their views and comments received has been included throughout this report. Four staff members’ records were checked, including the staff training and the supervision practises of the home. What the service does well: Feedback received from residents and relatives showed that the home had an experienced staff group who met the residents nursing care needs. Residents and relatives expressed their appreciation of the support and care provided by Stowlangtoft Hall Nursing Home DS0000024506.V354252.R01.S.doc Version 5.2 Page 6 the staff, and said they were respectful and caring. Examples of positive comments are provided throughout this report. On both days at the home the atmosphere was relaxed, and staff worked hard during the morning periods to meet residents’ nursing needs. Residents were well groomed, and staff were seen to be responsive to their requests for assistance. The meal selection was good with a new menu in place, which residents said they enjoyed. The key recruitment procedures checked showed that only suitable staff are employed by the home. Residents’ were provided with an agreed plan of care and risk assessments, which should ensure that their care would be delivered in a safe way. The environment was found clean and tidy, odour free and well maintained. The owners continued the refurbishment programme, which included the redecoration of some of the resident’s rooms, and the development of a staff-training centre. What has improved since the last inspection? What they could do better: This inspection showed the positive provision of a care service, however a number of improvements are required to ensure that it can meet the key standards. This includes the provision of improved staff training records to ensure the home can evidence the staff training undertaken. Further, the home must evidence that all staff have received adult protection training. Staff supervision must be undertaken on a regular basis and written evidence be retained to demonstrate this. Where any resident is prone to falls, records must show that all aspects of these risks have been fully assessed. Residents weight must be regularly monitored and recorded to evidence any changes in their healthcare or nutritional status. When medicines are transported to the residents around the home, it must be done so in a secure manner. The home must ensure that it has a quality assurance system in place to receive feedback from the residents, about all aspects of the quality of the service provision. Recommendations included that a standardised fall risk assessments form should be used for residents at risk of falls, to ensure ongoing assessment. The three residents’ records checked did not have nutritional risk assessments in place, and which is strongly recommended for all residents, to provide evidenced based nutritional information on the status of a resident’s nutritional needs’. Stowlangtoft Hall Nursing Home DS0000024506.V354252.R01.S.doc Version 5.2 Page 7 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. Stowlangtoft Hall Nursing Home DS0000024506.V354252.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 Stowlangtoft Hall Nursing Home DS0000024506.V354252.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): 1,3,4,6. The quality in this outcome area is good. New residents can expect to have their basic care needs assessed prior to them entering the home and their nursing care needs would be met by the staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Feedback received from relatives (10) confirmed they had received information to help them make a decision when choosing this home. The AQAA stated ‘before admission an information pack is sent to the potential resident/their family outlining the environment and the services offered. Potential residents and their families are invited to view the home, prior to admission’. The home undertakes a pre-admission assessment to decide whether they can meet a new resident’s care needs. The AQAA stated, ‘All residents are admitted to the home only after a full pre-admission assessment is carried out by one of the qualified management team. This allows for care planning for the individual for the individual resident on an ongoing basis’. Records checked showed that pre-admission assessments were undertaken including compass reports from social services, or the home’s own needs Stowlangtoft Hall Nursing Home DS0000024506.V354252.R01.S.doc Version 5.2 Page 10 assessment. One resident’s records checked showed that the assessment included information around their current medicine needs, allergies, daily living needs, communication issues, breathing, eating and drinking, medical history, medical professionals involved, admission weight, elimination needs, personal care needs, falls history, mobilisation needs, sleeping, work and play. This information would be used to plan the care required for the new resident. From the information gathered it was apparent that the home had a stable staff group who were committed to providing good care and support for the residents. This was confirmed by the feedback received from residents, relatives, and staff members. Records checked showed that the staff group usually received training appropriate to the needs of the residents. However the training received did vary within the staff group. (Please refer to Standard 30) Specific staff training provided in 2007 included feeding and swallowing training, communication awareness, wound training for nurses, nutrition training, continence care training, falls and osteoporosis training. This evidenced that training appropriate to the needs of residents was being undertaken, but needs to be provided to more of the staff group. The home evidenced in the AQAA that around 66 of their care staff (20 of 35) had achieved a national vocational care qualification (NVQ2), which showed the home’s commitment to a skilled and qualified work force. Feedback from the residents’ survey (2) stated they ‘always or usually’ received the care and support they needed. Feedback from the relatives/visitors (10), stated that the care home ‘always (3) or usually (7)’ met the needs of their relative. The following is a selection of residents and relatives’ comments about the care provision. ‘We have found the staff welcoming, friendly and we feel reassured and informed about our relative’. ‘I find the home all right, but sometimes the staff are too busy’. ‘If I was my relative, I would like to be at the home. I don’t think they could be anywhere better’. ‘I think the home is rather nice most of the time, and the staff are very nice’. ‘I find the home a warm, inviting and friendly environment for patients, and they support relatives’. The home continues to provide short-term respite care for residents. Stowlangtoft Hall Nursing Home DS0000024506.V354252.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, 10 The quality in this outcome area is adequate. Residents could expect to receive planned nursing care that would be provided in a responsive and dignified way. Medication administration methods, and some omissions in key nursing information may compromise some residents’ healthcare safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans for three residents, one prone to falls, one with nutritional problems, and one who experienced confusion, were checked. Time was spent with these residents to check that the level of support written in the care plan reflected the care given. The nurse manager uses the ‘activities of daily living’ nursing model, when planning the required nursing care. The care plan profile was a pre-printed form where nursing care problems can be identified. These included assessment of the resident’s needs around maintaining a safe environment including any medical problems, communication, breathing, Stowlangtoft Hall Nursing Home DS0000024506.V354252.R01.S.doc Version 5.2 Page 12 eating and drinking, elimination, risk assessment, sleeping, mobilising, work and play, sexuality, psychological assessment, drug compliance, dying, catheterisation, and cleaning and dressing. Each area described the problem, the aims and objectives of the care, the nursing intervention required, and an evaluation of the nursing intervention. These care plans and layouts were very well written and provided clear, thorough guidance for nursing staff around the nursing care needed. Two of the three residents’ care records checked showed that appropriate care plans were in place, which had been reviewed each month, and were signed and dated to confirm their continued relevance. One resident’s records did not contain a full care plan, only a brief assessment of their care. This was discussed with the nurse manager who said that the resident had been at the home for 3 weeks, and staff continued to assess their care needs. This was of concern, as the particular resident did have a number of challenging care issues. However, the nurse manager resolved this concern by immediately writing a full plan of care. On the return inspection, this care plan was checked, and was seen to reflect the level of the care needed. The 3 care plans checked also provided various links to other nursing assessments, for example pressure area risk assessments, wound dressings, nutritional information, falls information, and a moving and handling risk assessment. These care records did not include separate falls or nutritional risk assessments, although information about these issues were found in various other documents. For example, brief notes about falls were contained within the moving and handling risk assessment, or nutritional information was located within the care plan. By the second day of the inspection, the nurse manager had provided a nutritional risk assessment, for the new resident, which reflected their needs. Records of these residents did not include their weight on admission or evidence that this was routinely checked, which could provide important healthcare or nutritional information. The nurse manager did provide evidence of how nursing staff could monitor and report changes in a resident’s weight, for example, if clothing was loose or if there was a loss in appetite etc, which might indicate a problem. In discussion with the owner, it was found that the home had access to hoist weighing scales, which could be used to provide this information, particularly for bed bound residents. The care plan for one resident identified with ‘a history of falls’ was checked and tracked for continuity. The plan identified the resident as ‘unable to maintain their own safety’, who had a history of falls due to Parkinson’s disease. Bed rails were therefore used to help keep the resident safe. I also checked the accident records and identified that the resident had experienced around 26 falls over the previous year. In discussion with the deputy, it was stated that a number of options had been tried by the home in Stowlangtoft Hall Nursing Home DS0000024506.V354252.R01.S.doc Version 5.2 Page 13 order to reduce and better manage the falls. Although there was no specific falls assessment document, the problem was briefly identified in the care plan, and mentioned in the moving and handling assessment. On the second day of the inspection the deputy showed me a falls risk assessment form he had obtained, which he proposed to develop for further use in the home. Another care plan for one vulnerable resident with nutritional issues was checked and this provided good information around Percutaneous Endoscopic Gastrostomy (PEG) feeds. This means that the resident is unable to take food via their mouth so nursing staff provide nutritional sustenance via a tube to the resident. The records were detailed and provided good guidance for nursing staff around PEG fed quantities. These had been complied in consultation with the dietician, who provided specialised support to the home. As stated previously, the records did not include a separate nutritional risk assessment. This resident and their relatives were spoken with at the home, and observation and feedback showed they were being well cared for. Accident records were checked for the period 3rd December 2006 to 3rd December 2007, and 74 accidents had been recorded for this period, or an average of 6 falls per month. The accident records checked showed that only one resident had sustained more than 4 falls during the entire 12 month period. This resident was tracked as above. There were no other concerns noted. During the inspection I did not observe any residents being hoisted. However moving and handling assessments were provided within the care plans, and these had been reviewed on a monthly basis. On the first morning of the inspection I spent time visiting residents in their rooms and observed the support and assistance they received from are staff. Residents were being positively cared for by sufficient numbers of staff, (refer to standard 27) were well groomed and looked well cared for. The residents I saw had access to drinks on their tables, and staff were seen assisting residents with morning tea. Some more vulnerable residents received closer help from the staff. The home had a relaxed atmosphere, and while staff did not rush their morning tasks, they did work constantly through out this time to meet the residents’ care needs. The staff group were responsive to residents’ requests for assistance, and this was provided in a dignified way. Records checked, and feedback received showed the residents had access to healthcare professionals including their doctor, the dentist, the optician or the chiropodist. Nursing staff also called on the expertise of other healthcare professionals for advice, for example the dietician, with regard to PEG feeds. This was seen as positive healthcare practice. A check of the home’s continence care practices was not undertaken on this occasion, but no Stowlangtoft Hall Nursing Home DS0000024506.V354252.R01.S.doc Version 5.2 Page 14 concerns were raised or observed during the inspection about this. Continence care policy was in place for staff guidance. The nurse manager assisted me, while I audited the medicine practices of the home, to assess their compliance with the relevant standard. This included checking how nursing staff delivered medicines to the residents, as this was an area of concern, at the last inspection. The medicine policy was checked and found to provide detailed guidance for nursing staff including information around the storage, administration, use of controlled drugs, record keeping, disposal, self-administration, homely remedies, and the use of oxygen. There was a system in place for the reordering of medicines, which was completed every 28 days. The medication round was observed and the nurse manager was seen to administer three or four medicines into pots, with the names of the resident, and these were placed on a small tray, and then taken to each resident in the home. The medicine trolley was located in the medicine cupboard and secured to the wall, which was not removed from the cupboard during this time, to ensure the safety of the medicines. The medication administration records (MAR) accompanied the nurse, who was seen to sign the chart following the administration of medication to each resident. This procedure continued until all the medicines were administered. This practice was unaltered since the last inspection, and was of concern. This practice was checked with the pharmacy inspector who confirmed this practice was unsafe. In discussion with the owner, it was agreed that the home would review this practice with the nursing staff, to find a more suitable and safer way of delivering medicines to each resident. The controlled drugs book was checked and the entries found to have been signed by two members of staff. An audit of three residents medicine stocks and MAR sheets was undertaken, in which the recorded totals were checked against the monthly supply. In every case the medicines remaining, balanced with records, which was evidence of good practice. Residents (2) when asked, ‘Do you receive the care and support you need?’ 2 said ‘always or usually’. Both residents said they ‘usually’ receive the medical support they need, and that staff ‘always’ listen and act on what I say. Two of 2 residents said that staff were available when they needed them. Relatives (10) when asked, ‘Does the care home meet the needs of your relative?’ 3 stated ‘always’, 7 stated ‘usually’. All relatives said they were ‘always or usually’, kept up to date with important issues affecting their relative, and that their relative ‘always or usually’ received ‘the support or care that they expected or had agreed’. Four of 10 relatives said the nursing care staff ‘always’ have the right skills and experience to look after people properly, 6 said, ‘usually’. Stowlangtoft Hall Nursing Home DS0000024506.V354252.R01.S.doc Version 5.2 Page 15 Feedback from relatives about the personal care provided included a selection of the following views. ‘The care home allows my relative to be treated with dignity and responds appropriately to their needs’. ‘The home does their basic jobs well’. ‘They offer appropriate support for the residents and relatives alike’. ‘They are very patient with my relative who can sometimes be difficult’. ‘Panic alarms [call bells] need to be closer and within reach of the patient. I would like to see a member of staff on all floors at all times’. ‘My observations of the home, the staff and the conditions generally, lead me to believe that my relative is being well care for and always looks to be contented’. One staff member’s view on the care provision said this. ‘The home looks at the residents in a holistic manner, providing them with a very good level of care, dignity and respect’ Stowlangtoft Hall Nursing Home DS0000024506.V354252.R01.S.doc Version 5.2 Page 16 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): 12,13,14,15 The quality in this outcome area is good. Residents can expect access to a choice of positive lifestyle opportunities, would be able to meet with their family and friends, and choose their preferred meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides residents with varied social and leisure opportunities. The AQAA stated, ‘A full time social activity person, who also has a nursing qualification, is employed. She arranges a programme of events through discussion with the residents and their families. A weekly programme is circulated to each resident so that they can choose the events they wish to attend. Families are also encouraged to participate and staff help with events. Services are arranged with local clergy and churches as part of the activities programme’. On the first day of the inspection I visited residents in their rooms, some of whom were completing their breakfasts. One resident told me they had enjoyed a good breakfast, and they were now enjoying the view of the grounds from their window. They also told me they had been invited to a local school for pre Christmas celebrations, which had been arranged by the home’s activities person. Stowlangtoft Hall Nursing Home DS0000024506.V354252.R01.S.doc Version 5.2 Page 17 Another resident told me they preferred to take breakfast in their own room, but would join other residents later in the day in the day room. They said they had made a few friends at the home, and their relatives frequently visited them. The resident said the activities at the home were good and gave me some examples of the Christmas events so far. These included a visit from the Salvation Army, making Christmas cards, table decorations, and helping decorate the Christmas tree. They also told me that their relative could obtain a meal at the home, which meant they could visit longer. There was a church service each month and could see the visiting priest in private. The resident said that although they were not a big eater, the meals at the home were quite enjoyable. I met the activities person who discussed some of the events that had been arranged for the residents. These included afternoon teas, gentle exercises to keep healthy, table games, gardening, and craft activities. The activities person also spent time with any bed-bound residents and would talk with them or provide other support assistance, for example, a personal manicure. I also saw the ‘craft room’ where the residents made various items, and this provided an important social focus area for them. A hairdresser regularly visited the home, and residents could visit them on request. On the second day of the inspection I saw a group of residents enjoying a social afternoon together playing a board game. This was followed by afternoon tea and cake, and an opportunity to catch up with other residents. Feedback from residents and relatives confirmed that the standards of the meals and the food at the home had improved. This was because a new catering manager had been appointed, who had consulted the residents around their preferred menu choices. The AQAA stated, ‘Menu choices are discussed with the residents through group discussion and also individually, with staff and the catering manager. On a recent questionnaire, we received responses from all the residents, some with the help of family and friends. This enabled the menu to be constructed to suit the needs and preferences of residents.’ Further, ‘A catering manager has been appointed to widen the menu options’. The catering manager provided a sample of their menu for the period the 3 10th December 2007. Menu choices are taken each day and provided to the kitchen where meals are prepared. The selection included at least one daily hot menu option, for example, shepherds pie or ham salad; smoked mackerel or jacket potato; roast lamb or omelette; bacon, eggs, chips or home made soup; cod in parsley sauce or cheese and potato pie; roast chicken or pork pie. Menus had been compiled with the service user group in mind, and at least one option provided soft palatable food for ease of eating, and good nutritional value. The catering manager also said that the food was whenever possible, sourced locally to ensure fresh vegetables, fruit and meat was served to the residents. Stowlangtoft Hall Nursing Home DS0000024506.V354252.R01.S.doc Version 5.2 Page 18 Lunch on the day of the inspection was shepherds pie or ham salad, served with carrots, cauliflower, and potatoes. Dessert was fruit pudding and custard. Residents seen in their bedrooms had access to drinks, and more vulnerable residents were provided with assistance. Residents’ care plans checked showed that relevant nutritional information had been taken and recorded under ‘eating and drinking’. Staff training records checked evidenced that some staff had received nutritional training. The three residents’ records checked did not have nutritional risk assessments in place, and which is strongly recommended for all residents, to provide evidenced based nutritional information on the status of a resident’s nutritional needs’. Comment cards received from residents (2) asked, ‘Do you like the meals?’ 1 stated ‘always’ 1 said ‘usually’. A selection of comments received from residents (2) and relatives (10) included the following feedback. ‘The food is good. The social activities, for example films and exercise groups are well arranged. Generally most things seem to be done well’. ‘Until a few weeks ago the food was very boring and not good, but we now have a new chief, and standards have improved’. ‘I think they could give more attention to my relative at meal times. I have visited when they were unable to use a knife or fork properly, and their meal would be better served cut up’. ‘More thought is needed with the food/meals, as it often arrives cold’. Stowlangtoft Hall Nursing Home DS0000024506.V354252.R01.S.doc Version 5.2 Page 19 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 The quality in this outcome area is adequate. Residents could expect the home to investigate any concerns, and adult protection procedures should keep residents safe. Failure to provide adult protection training for some staff may place residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the complaints policy is displayed in the entrance of the home and is included as part of the statement of purpose. Complaints referred to the home would be investigated, and complainants would be provided with written feedback, at the conclusion of any investigation. The home had not received any formal complaints since the last inspection. Feedback received from residents (2) said they ‘knew who to talk to if they were unhappy’ and confirmed they ‘knew how to make a complaint to the home’. Ten of 10 relatives confirmed they were aware of ‘how to make a complaint about the care provided, to the home’. No complaints had been made to the home, since the previous inspection. The home had an adult protection policy available for staff to read and refer to, and new staff continued to be instructed in these policies during their induction. The AQAA stated, ‘the home has detailed policies and procedures for the safeguarding of residents from abuse of violence. Staff are trained to identify signs of abuse and report suspicions to senior staff. Management keep updated through training sessions and briefings’. Stowlangtoft Hall Nursing Home DS0000024506.V354252.R01.S.doc Version 5.2 Page 20 Staff records checked evidenced that the home had obtained or requested Criminal Records Bureau checks (CRB), and protection of vulnerable adults checks (POVA), for these staff members. This would ensure that only suitable staff members would be employed. However staff records checked (refer to standard 30) did not provide sufficient evidence that staff had received adult protection training. Adult protection training was discussed with the registered manager who said that the home had a qualified nurse who takes adult protection training. Further, that courses were planned shortly to ensure that all staff would receive this training. The manager said that adult protection training was included in the Common Induction Standards that new staff complete on commencement of the employment. Staff spoken with confirmed that they had received adult protection training, and understood what they should do, if they ever suspected abuse of a resident. Again, there was no written evidence of adult protection training in the records checked. Stowlangtoft Hall Nursing Home DS0000024506.V354252.R01.S.doc Version 5.2 Page 21 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, 20,23, 26 The quality in this outcome area is good. People could expect to live in a home that was odour free, clean and hygienic, and that this would meet individual preferences and needs of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Stowlangtoft Hall stands in seven acres of garden and woodland. The house is large and has been adapted to offer suitable accommodation for residents on separate floors, which can be accessed by lifts. Many of the original features of the hall have been retained for the enjoyment of the residents and visitors, including an Orangery with a glazed dome roof where residents may sit in the warmer weather. There is a large dining room and lounge with good views over the estate. The home where the residents live was well maintained, warm and clean. All bedrooms are carpeted. There is some wooden flooring for example, in the main entrance hall of the home. One room is located off the main entrance. There is an activities room for crafts etc, and the owners are currently developing another unused ground floor room, which will be used as a staff-training centre. Stowlangtoft Hall Nursing Home DS0000024506.V354252.R01.S.doc Version 5.2 Page 22 The bedrooms visited were spacious, clean and tidy with furniture and furnishings that are domestic in character and of good quality. There is a lift to the upper floors, therefore residents and staff are able to access all parts of the home if required. Stowlangtoft Hall Nursing Home DS0000024506.V354252.R01.S.doc Version 5.2 Page 23 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, 30 The quality in this outcome area is good. People can expect the home to provide adequate numbers and skill mix of staff to meet their needs. They cannot be consistently assured that staff had received adult protection training to protect people. EVIDENCE: Stowlangtoft Hall provides nursing care services for up to 37 elderly residents. The staff group comprises of around 10 registered nurses, 30 care staff, 6 domestics, and the kitchen staff. There was a registered nurse on duty to cover the 24 hour period. The staff rota for the period the 9th to 15th December 2007 was checked. This showed that in the morning (8am - 6pm) rotas were maintained at around 1 registered nurse, 6 or 7 carers. This provided a ratio of approximately 1:5 carers to residents. The average staffing levels in the afternoon (2-6pm) was 1 registered nurse, 5 carers, and the evening (6pm to 10pm) was 1 registered nurse, 5 carers. (a ratio of around 1:6 carers to residents). Staffing levels at night were, 1 registered nurse with 3 care staff. The staff group confirmed this. Observation during the inspection showed that care staff time was mainly spent managing the care needs of the residents. The deputy manager usually worked during the week, but the rota showed that he had covered an evening shift during this period. The nurse manager, when on duty works both morning and afternoon shifts. Stowlangtoft Hall Nursing Home DS0000024506.V354252.R01.S.doc Version 5.2 Page 24 The rota evidenced sufficient numbers of staff were on duty, and should be able to meet the needs of the residents. Staff schedules included sufficient breaks and adequate days off for care staff. Feedback received from residents, relatives and the staff group confirmed that they believed there were adequate staff numbers at the home to meet their needs, although some relatives did raise some concerns about staff shortages. A selection of their views are recorded below. The AQAA stated that 20 of 35 care staff (66 ) currently hold a national vocational qualification (NVQ) level 2 award or above, therefore the home meets the nationally recommended standard of 50 care staff with an NVQ 2 or above. There are 10 registered nurses with a professional nursing qualification. During the inspection, staff records were requested but withheld by the owner, while further clarification was sought about the sharing of information subject to data protection. This was clarified by the CSCI in writing to the owner, who then provided these records. Four staff members’ recruitment records were checked. Two employees who were new staff members, showed that the home had applied for a criminal records bureau (CRB) check for these staff, and had undertaken a protection of vulnerable adult checks (POVA) for them. The two other employees had their CRB in place. Three of 4 employees’ records checked also included 2 written references for each staff member, while one did not. This was discussed with the provider, and it was determined that the staff member had been employed at the home prior to the current owner’s purchase of the business. It was agreed with the provider that a character reference would be obtained for this staff member, and a note would be retained on their records outlining the circumstances around this situation. A copy of each staff members ID had been checked. One registered nurse’s records checked evidenced they were suitably experienced and skilled to meet the needs of the residents. The home had checked their professional identification number (PIN) for the nurse to verify their current registration with the nursing and midwifery council (NMC). Four staff members’ training records, 1 for a registered nurse, 1 for a care staff member, and 2 new care staff, were checked. The nurse’s training records provided good evidence of on-going professional training. Training had been accessed around mobility training, a neurological study day, syringe driver use, emergency first aid, PEG feeding, wound dressings, continence care training and moving and handling training. However, there was no record of adult protection training having been received by the nurse. Two of the 3 carer’s records checked were new staff members, so had yet to complete their induction training sessions. They were therefore not assessed against the standard. Stowlangtoft Hall Nursing Home DS0000024506.V354252.R01.S.doc Version 5.2 Page 25 The final carer’s records checked included evidence of moving and handling training, nutritional training, and communication training, but there was no further evidence of core training around adult protection or fire training on their records. The manager provided me with the home’s staff training records for 2007, which evidenced that the home had invested time in training the staff around the specific nursing care needs of the residents. This included nutritional training for 10 staff, communication training for 5 staff, wound care for nurses, speech and language training for 5 staff, syringe driver training for 1 nurse, continence care training for 5 staff, falls and osteoporosis training, moving and handling training for 26 staff, and MUST nutritional training. Induction training during 2007 for new staff recorded unisafe training, moving and handling, and risk assessment for these new employees. The staff training and development records evidenced adequate training for some of the staff group, but was difficult to evidence what each individual staff member had received. Feedback received from staff members (2) thought they received sufficient training to assist the residents, and meet their needs. Feedback received from relatives (10) stated they thought that care staff ‘always’ (4) or ‘usually’ (5), ‘have the right skills and experience to look after residents properly’, (1) stated ‘sometimes’. A selection of comments received from residents or relatives about the staff group included the following views. ‘The staff are always pleasant to visiting relatives and to the residents’. ‘The staff appear very friendly, caring and concerned. They know how much I worry, so they do contact me’. ‘The carers I see are competent. My relatives different needs are met’ ‘I think there is one qualified nurse on duty. Sometimes I think the junior staff seem rather hard pushed’. ‘Staff shortages means that the expected or agreed care is not always available’. ‘I believe the staff usually have the right skills to look after people properly, though some of the junior staff lack experience in handling someone with mental depression problems’. Stowlangtoft Hall Nursing Home DS0000024506.V354252.R01.S.doc Version 5.2 Page 26 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, 33, 35, 36,37, 38 The quality in this outcome area is adequate. People could expect the home to be responsively managed including addressing any concerns or worries. Quality assurance processes, and staff supervision could not be consistently assured. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager, the deputy manager, and nurse manager were present for various parts of both days of the inspection, and were available to answer any of my questions. The deputy manager assists the manager in the running the day-to-day operation of the home, while the nurse manager is responsible for many aspects of the nursing care provision. The home was unable to show me evidence of an active formal quality assurance programme, for example, receiving regular feedback from residents Stowlangtoft Hall Nursing Home DS0000024506.V354252.R01.S.doc Version 5.2 Page 27 or their relatives about the overall service provision, however they had recently undertaken detailed quality monitoring of the service around the food provision. This had involved the catering manager receiving feedback about the food preferences and choices of the residents, and then implementing new menus. The home had received a number of letters of thanks and appreciation from relatives, for the care received, and some of the relative’s views are recorded below. The home also had a complaints system, which residents could access. Residents or staff could raise concerns directly with the management team, and problems could be resolved. A selection of feedback received by the home directly, included the following views. ‘May I offer my sincere thanks for all the care and kindness you all showed, whilst nursing my relative’. ‘We just wanted to say thank you for the care you gave my relative. Not only that but you made us feel so welcome.’ ‘Would you please pass on our most sincere thanks to everyone at Stowlangtoft Hall. Firstly for the six months of the highest quality care everyone gave to our relative. Secondly, for the help everyone has shown me.’ ‘My deepest thanks for your affection and wonderful care of my relative.’ The provider said that residents could access personal money at any time, and any money incurred for services, for example hairdressing, was recorded and the bill forwarded to the appropriate relative or advocate for paying. The home said they did not manage any residents’ key finances, which was left to the resident’s advocate or appointed relative. The provider stated they were responsible for the invoices and accounts and maintained a spreadsheet to ensure there was a record for all residents. The supervision records for 2 staff members were checked, but these did not provide evidence of any recent supervision. The manager showed me that the home had prepared a supervision list and that staff would receive supervision shortly. The manager also showed me the home had developed a detailed appraisal form, which would be used for recording staff supervisions. Feedback received from staff confirmed they could approach the manager or nurse manager with any issues of concern, and that these would be addressed. They confirmed that they had not recently received formal written supervision. Residents records checked included a detailed care plan, moving and handling risk assessments, some nutritional and falls information. Records of residents weight had not been routinely maintained. Individual staff records checked Stowlangtoft Hall Nursing Home DS0000024506.V354252.R01.S.doc Version 5.2 Page 28 included key employment checks, but some of the training records had not been regularly maintained, so were difficult to determine the training received by these staff members. The general staff training and development records showed that there had been a number of training sessions during 2007. Safe working practices were evidenced as in operation at the home. The staff had attended nutritional training and manual handling training. There was safe storage of substances hazardous to health with an appropriate secure cupboard. Health and safety policies and procedures were available for staff to refer to, and all accidents and incidents were recorded. On the first day of the inspection, an armchair had been placed against the inside of the double fire exit doors, located at the top of the main stairwell. This exit was identified as a fire escape. Further, the door had an operational alarm system. The manager did immediately remove the armchair. The owner responded to an immediate requirement letter about this matter, in which he confirmed that the issue was taken most seriously by the home, and had been raised with the staff group, which should prevent any similar reoccurrence. Stowlangtoft Hall Nursing Home DS0000024506.V354252.R01.S.doc Version 5.2 Page 29 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 2 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 X X 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 1 2 2 Stowlangtoft Hall Nursing Home DS0000024506.V354252.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes, requirements 3 & 5 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 OP8 Regulation 13.4.b 17.1.a Sch3.m Requirement The home must evidence that residents ‘at high risk of falls’, what actions they have taken to reduce or eliminate these falls. This is to ensure that residents are kept safe. The home must undertake regular weight monitoring of residents. This is to evidence that vulnerable residents’ healthcare and nutritional status is continually monitored. When medicines are transported to the residents around the home, it must be done so in a secure manner. Medicines transported around the home must be quickly and securely locked away in the event of an emergency. This is to keep people safe. This is a repeat requirement. The home must maintain a complete record of training for each staff member, including adult protection training, to evidence that staff have received training appropriate to the needs DS0000024506.V354252.R01.S.doc Timescale for action 01/03/08 2. OP8 13.4.b 17.1.a Sch3.m 01/03/08 3. OP9 13.2 07/02/08 4. OP30 17.2 sch.2.f.g 18.1.c 01/04/08 Stowlangtoft Hall Nursing Home Version 5.2 Page 31 5. OP33 24.1 of the residents, and the work they perform. The home must establish and maintain a system for reviewing at appropriate intervals the quality of care provided in the home, including direct feedback from the residents and or their relatives. This is to ensure that residents can express their views about the quality of the care provision. This is a repeat requirement. The home must ensure that staff receive regular supervision. This is to evidence that staff are supported in their care roles. Key home records must be maintained to provide evidence of assessment, training, or supervision. 07/02/08 6. OP36 18.2 01/04/08 7. OP37 17.1.a sc 3.3.m sc 4.6.g 01/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP8 OP8 Good Practice Recommendations Fall risk assessments should be undertaken for residents at risk of falls, to ensure ongoing assessment. The home should consider the introduction of an evidenced based nutritional screening tool to identify those residents at most nutritional risk.. Stowlangtoft Hall Nursing Home DS0000024506.V354252.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Colchester Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Stowlangtoft Hall Nursing Home DS0000024506.V354252.R01.S.doc Version 5.2 Page 33 - 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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