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Inspection on 18/07/05 for Stowlangtoft Hall Nursing Home

Also see our care home review for Stowlangtoft Hall Nursing Home for more information

This inspection was carried out on 18th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

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 home continues to operate to a good standard, with a low turnover of staff, good management structure and training and development as three key aspects of this standard. The activities are excellent, six resident questionnaires supported this. The home has a reminiscence room where many books, magazines and clothing are displayed. The residents have the opportunity to visit the room with the activities person or on their own. The variation of activities demonstrates that residents have the opportunity to visit places of interest in the local community in addition to activities in the home. The meal preparation, presentation and choices were assessed as excellent. There was additional staff employed for specific times of the day to focus on the preparation and presentation of the diets and the liquidised meals. The selection of food by the residents each day was wide ranging therefore giving the required choice to each individual. The pre admission assessments were relevant and evidenced that the information from the assessment formed the basis for an initial care plan. This ensured the residents needs were met by all staff in a consistent way.

What has improved since the last inspection?

The manager and owner have developed the information contained in the residents contract and terms of conditions. This document ensures that residents are clear about the service they will receive and the fees they pay. The administration of medication practices has been reviewed for the home. The manager has ensured that all nurses sign each resident`s Medication Administration Record (MAR) after giving each medication. This has ensured safe working practices for medication administration.

What the care home could do better:

There were no immediate requirements from this inspection. The provision of a lockable cabinet or drawer for one resident, who self-administers their medication, is required.

CARE HOMES FOR OLDER PEOPLE Stowlangtoft Hall Nursing Home Stowlangtoft Bury St Edmunds Suffolk IP31 3JY Lead Inspector Iain Smith Announced 18 July 2005 th 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. Stowlangtoft Hall Nursing Home I54-I04 S24506 Stowlangtoft V232965 050718 Stage 4.doc Version 1.40 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 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 None Mr H I MacDonald Mrs Hilary MacDonald CRH 37 Category(ies) of OP - 37, PD - 37 registration, with number of places Stowlangtoft Hall Nursing Home I54-I04 S24506 Stowlangtoft V232965 050718 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 03.02.05 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 service users and visitors, including an Orangery with a glazed dome roof where service users 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 service users who are elderly frail and are admitted for either short or long term care. The home actively encourages prospective service users and their relatives to visit and talk to management and service users about the services provided and to attend for trial visits Stowlangtoft Hall Nursing Home I54-I04 S24506 Stowlangtoft V232965 050718 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was arranged as an announced inspection, the first inspection for the year 2005/2006. The visit commenced at 8.45 and lasted 7.15 hours. during which time the inspector spoke to residents, the two owners, the chef, in addition to the activities organiser and the care staff who were on duty throughout the day. The registered manager was present throughout the inspection and contributed fully to the process. A tour of the premises was made, rooms and communal areas were visited including a dedicated reminiscence room located on the ground floor. Two care plans were read as part of the tracking process and two staff files were examined. Two relatives and six resident questionnaires were received prior to the inspection and comments are included in the report. What the service does well: The home continues to operate to a good standard, with a low turnover of staff, good management structure and training and development as three key aspects of this standard. The activities are excellent, six resident questionnaires supported this. The home has a reminiscence room where many books, magazines and clothing are displayed. The residents have the opportunity to visit the room with the activities person or on their own. The variation of activities demonstrates that residents have the opportunity to visit places of interest in the local community in addition to activities in the home. The meal preparation, presentation and choices were assessed as excellent. There was additional staff employed for specific times of the day to focus on the preparation and presentation of the diets and the liquidised meals. The selection of food by the residents each day was wide ranging therefore giving the required choice to each individual. The pre admission assessments were relevant and evidenced that the information from the assessment formed the basis for an initial care plan. This ensured the residents needs were met by all staff in a consistent way. Stowlangtoft Hall Nursing Home I54-I04 S24506 Stowlangtoft V232965 050718 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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. Stowlangtoft Hall Nursing Home I54-I04 S24506 Stowlangtoft V232965 050718 Stage 4.doc Version 1.40 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 Stowlangtoft Hall Nursing Home I54-I04 S24506 Stowlangtoft V232965 050718 Stage 4.doc Version 1.40 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) 2,3,4 and5. People who use the service receive clear information to enable them to make a choice about whether or not they wish to live in the home. EVIDENCE: The statement of purpose and the philosophy of care were displayed in the foyer of the home. The service user guide and a contract for each resident are provided. The contract includes the room number, fees and what the home do not directly provide for example, chiropody, although this can be purchased from an outside professional. One private contract was examined and found to include relevant information. This included the range of services provided by the home and was signed by the residents representative. One residents contract from social services was not available. The owner stated that the contract had been overdue by four months, since the admission of the resident. There had been no payment for this resident from social services although they had reassured the manager that payment would be made once the contract was provided. The manager in the meantime had provided the resident with the homes terms and conditions. Stowlangtoft Hall Nursing Home I54-I04 S24506 Stowlangtoft V232965 050718 Stage 4.doc Version 1.40 Page 9 The pre admission form for all prospective residents was examined. This was found to encompass relevant information prior to the admission of the resident. Information included the health and social needs and the reason for the admission. An example of the resident’s assessment for admission was that of a general physical deterioration and leg ulcers. This information formed the basis for the care plan therefore ensuring the appropriate care was commenced for the initial care problems. Stowlangtoft Hall Nursing Home I54-I04 S24506 Stowlangtoft V232965 050718 Stage 4.doc Version 1.40 Page 10 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 and 10. Individual needs were assessed and care planning was completed therefore ensuring that staff delivered the appropriate care to each resident. Medication policies were in place to ensure safe working practices. EVIDENCE: Two care plans were examined to assess if the residents care needs were identified and the methods of the delivery of care. The home has developed the care planning system based on the Roper, Logan and Tierney model of care. This identifies elements of care appropriate for the residents to be encouraged to aid their daily living. Examples of the plan were communicating, eating and drinking, medication and mobilising. The two care plans that were examined clearly stated the needs for each resident, with the pre admission assessment forming the initial stages for the care plan development. These plans ensured that each member of staff cared for the resident in a consistent way. In addition to the care plan, there was evidence of a mini care plan located inside the resident’s wardrobe stating the care needs for that individual. Stowlangtoft Hall Nursing Home I54-I04 S24506 Stowlangtoft V232965 050718 Stage 4.doc Version 1.40 Page 11 One care plan stated that the resident required hoisting and a manual handling risk assessment was included as part of the plan. The resident was seen and there was evidence that they were unable to move without a hoist and the resident stated that they were unable to move without assistance. Both care plans were updated from the daily progress notes and the plan would be updated when changes occurred. The home meets the requirement that the care plans are kept under review. The health needs assessments for the two care plans was evident. Examples included risk assessments for the prevention of pressure sores, nutritional assessments and that all residents are registered with a General Practitioner. The medication practices were assessed. The lunch time medication round was observed in part, with the trained nurse responsible for the medication checking the Medication Administration Record (MAR) for individual residents before selecting the medication, taking it to the resident, before signing the chart. One controlled drug (CD) was checked against the CD record book, this adhered to the requirement for two staff signatures and corresponded with the recorded amount. One resident managed their own medication and had a small fridge in their room where the Insulin was stored. They maintained daily fridge temperatures and recorded them for examination. The residents drugs were seen to be inappropriately stored on the side of a bedside cabinet. To ensure the correct identity of each trained nurse administering medication, it is recommended to create a record of each person’s signature. Each of the six resident questionnaires returned stated that their privacy was respected. There was evidence of this as staff were seen to knock on bedroom doors before entering and the residents were addressed by their preferred name by staff Stowlangtoft Hall Nursing Home I54-I04 S24506 Stowlangtoft V232965 050718 Stage 4.doc Version 1.40 Page 12 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) 12,13,14 and 15. The home offers daily activities and encourages residents to fulfil their social, cultural and recreational interests. Meals are planned and prepared specifically to meet the needs of all residents. EVIDENCE: The six questionnaires received from the residents and two from the relatives all stated that activities were positive within the home. Evidence of this was seen with the production of the weekly diary of events. The homes activities organiser produces this. A copy of the diary is given to each individual and placed in his or her room, with the opportunity to join an activity if the resident wished to. The diary included events, for example, lunch followed by communion, reminiscing, films and on the day of inspection the activities organiser led four of the residents to the newly formed 1940’s reminiscence room. This area was created for residents to sit in and explore the old material for example books, newspaper and clothing. There are outside events arranged, for example a visit to Lavenham and Bury St Edmunds for shopping and teas. The opportunities for activities is assessed as exceeding the standard and awarded a four. There was evidence that individual residents records and care plans stated the interests of each person. Stowlangtoft Hall Nursing Home I54-I04 S24506 Stowlangtoft V232965 050718 Stage 4.doc Version 1.40 Page 13 The kitchen was visited and three catering staff were seen. The arrangement for meals and mealtimes was positive, with staff coming in on duty at peak times to assist with the preparation and serving of each meal. One member of staff was seen to be preparing the liquidised meals. Each meal was plated with the meat and vegetables liquidised separately, this added to the attractiveness of the meal. The main meal for the day was toad in the hole served with cabbage, broccoli, potatoes and gravy. There were a number of alternative meals requested by the residents, for example, egg, salmon, soup, chicken, fish and salad. All these requests were met, therefore, the residents had their preferred choice. The pudding was rhubarb and custard or an alternative of ice cream. Four residents were seen eating their meals in the dining area with the other residents having lunch in their rooms. One resident stated that ‘there is plenty to eat and we can have a choice.’ There was evidence that all residents had drink in their rooms, with coffee and tea served during the morning and afternoon. The evidence of the menus, choices, preparation and presentation this is assessed as exceeding the standard and awarded a four. Stowlangtoft Hall Nursing Home I54-I04 S24506 Stowlangtoft V232965 050718 Stage 4.doc Version 1.40 Page 14 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 and 18. Arrangements are in place to minimise risk so that the safety and welfare of the residents are promoted. The policies and procedures of the home ensure that residents are safeguarded from abuse and harm. EVIDENCE: There was one complaint received since the last inspection. This was addressed by the home in the required 28-day period and the manager wrote to the relative. The complaints procedure is displayed in the foyer of the home and included as part of the service user guide. Staff are instructed in the complaints procedure during induction for which the nurse manager is responsible. There is a record of the complaint in the homes logbook. The prevention of vulnerable adults training was evident in staff files and the training records. The abuse policy was available for staff and instruction was given during the staff induction programme. Stowlangtoft Hall Nursing Home I54-I04 S24506 Stowlangtoft V232965 050718 Stage 4.doc Version 1.40 Page 15 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) 19,20,22,23,24,25 and 26. The home provides a safe environment to all residents where policies and procedures are in place to protect all those who live there. EVIDENCE: The grounds of the home were seen to be tidy and attractive for the residents and their relatives. The dining room offers residents the opportunity to eat their meals at tables provided with tablemats, condiments and the offer of a glass of sherry prior to eating. Four residents were seen to be eating together in the dining room on the day of inspection and each of them had a sherry and stated how much they looked forward to this. The furnishings in the dining room and the bedrooms were domestic in character and of good quality. Three bedrooms were visited and each of them contained personal possessions and were equipped to ensure comfort and privacy. Each room was carpeted with comfortable seating, curtains and wardrobes. Stowlangtoft Hall Nursing Home I54-I04 S24506 Stowlangtoft V232965 050718 Stage 4.doc Version 1.40 Page 16 The home was assessed as clean and tidy, with no offensive odours apparent. The infection control policy informs staff of the methods for the safe disposal of soiled articles and the laundry was located away from the kitchen area. The laundry therefore was not carried through areas where food was prepared, cooked or stored. The home has four hoists to enable staff to lift and move each resident appropriately. A new hoist had arrived on the day of inspection to replace a broken one. Stowlangtoft Hall Nursing Home I54-I04 S24506 Stowlangtoft V232965 050718 Stage 4.doc Version 1.40 Page 17 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) 27,28,29 and 30. The procedures for recruitment are appropriate and the training and development of staff is positive. The staffing was sufficient in numbers and skill mix. EVIDENCE: The home operates as a care home with nursing therefore each shift is required to be covered by a trained nurse, registered with the Nursing and Midwifery Council. (NMC) The rota evidenced that a trained nurse was on duty on each of the three shifts operated in the home. The trained nurse is responsible for the shift, the care staff and the allocation of the duties, to ensure that all residents receive the appropriate care. The staff rota also indicated that housekeeping and kitchen staff were on duty. There is flexibility within the catering and care staff, with evidence that extra staff will come on duty during peak times. Three care staff were rotered to work from 18.00 throughout the night and finish a shift at 08.00. The manager stated that the staff take regular breaks and it is with the agreement of the members of staff to meet the needs of the residents that the shifts are organised in such a way. The home employs agency staff form time to time and the manager stated that the appropriate checks are completed by the agency prior to the member of staff reporting for duty. These checks include a Criminal Records Bureau (CRB) check and manual handling training. Stowlangtoft Hall Nursing Home I54-I04 S24506 Stowlangtoft V232965 050718 Stage 4.doc Version 1.40 Page 18 The head housekeeper stated that they oversee the catering staff in addition to the housekeeping staff. This person will allocate the housekeeping duties each day and ensure the rooms are cleaned and supplies are provided to do the jobs. Training and development was evident throughout the staff. Examples for the care staff were wound and ulcer care, manual handling, palliative care and pain control. The home has achieved 17.4 of care staff having achieved their NVQ Level 2. The manager stated that four other care staff had applied for their NVQ training over 12 months ago and they are awaiting the allocation of a place to commence their training. The staff induction programme was viewed and found to be relevant. This included sections, for example health and safety, fire prevention, personal hygiene, nutrition and elder abuse. The aims and objectives were stated and referred both to the procedures and outcomes of the training. Recruitment and employment procedures were appropriate and two staff files were examined to check if the appropriate documentation was included. The two files included an application form, two references, terms and conditions and a Criminal Records Bureau (CRB) check. Stowlangtoft Hall Nursing Home I54-I04 S24506 Stowlangtoft V232965 050718 Stage 4.doc Version 1.40 Page 19 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 and 32. There is clear leadership within the home and that ensures residents receive consistent quality care through staff training and communication. EVIDENCE: The manager is a trained nurse, registered with the Nursing and Midwifery Council (NMC). There are clear lines of responsibility within the home. The nurse manager is responsible for the nursing and clinical practices and reports to the registered manager. The housekeeper has the responsibility for a number of domestics and catering with direct line responsibility to the nurse manager on a day-to-day basis. The management approach of the home creates an open, positive and inclusive atmosphere. The housekeeper stated that they have team meetings and discussion includes staffing and provisions. Stowlangtoft Hall Nursing Home I54-I04 S24506 Stowlangtoft V232965 050718 Stage 4.doc Version 1.40 Page 20 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 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION 3 3 x 3 3 2 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x x x x x x Stowlangtoft Hall Nursing Home I54-I04 S24506 Stowlangtoft V232965 050718 Stage 4.doc Version 1.40 Page 21 NO 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 9 and 24 Regulation 23.2 (m) Requirement A lockable space must be provided for one resident who is self medicating. Timescale for action 31st July 2005 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 2 9 Good Practice Recommendations The manager should arrange for a contract to be supplied for each resident placed in the home from social services at the time of admission to the home. It is recommended that a record is created and maintained of each of the trained nurses signatures and kept in the front of the Medication Administration Record.(MAR). Stowlangtoft Hall Nursing Home I54-I04 S24506 Stowlangtoft V232965 050718 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 5th Floor St Vincent House 1 Cutler Street Ipswich Suffolk, IP1 1UQ 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 Stowlangtoft Hall Nursing Home I54-I04 S24506 Stowlangtoft V232965 050718 Stage 4.doc Version 1.40 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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