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Inspection on 23/02/10 for Stowlangtoft Hall Nursing Home

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

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

As soon as the management company took over the running of the home an audit was carried out of all the homes policies and procedures, care practises, staffing arrangements, equipment and the maintenance of the building and an action plan was developed of which, we have been given a copy. Many of the improvements needed have been implemented and action has been taken to improve outcomes for people living in the home. They include the reinstatement of relative and resident meetings, staff meetings have been have taken place and staff supervision is again underway. A selection of surveys have been given to the residents so the management company can get an idea of what changes they would like to see and the staff have had a similar survey. The last relatives meeting had a very good turnout, the lounge was full, and the relatives said they were happy with the changes that had been made. A complaints folder has been set up and staff have been shown how to register them and have been reminded of the complaints procedures. Staff files are being audited to ensure they hold the required documents, training needs are being assessed and training is being provided to enable staff to get their training up to date. The maintenance person is spending more time at the home and has taken on the responsibility of carrying out health and safety checks. He is self employed and has worked at the home for many years and has a good knowledge of the building`s maintenance needs. Colour coded mops are now being used by the domestic staff, this ensures that cross infection is minimised as different mops are used in different areas of the home, there are now different mops for general use, for cleaning the kitchen and moping the toilet floors. Since our last visit to the home it has been inspected by the fire officer, the environmental health officer, the health and safety executive and the Suffolk County Council`s outcome and monitoring team. All of which have made requirements and recommendations that must be complied with. We have seen copies of the reports which all ask for improvements in health and safety in the home. Healthcare Management Solutions are aware of the seriousness of the shortcomings and has already started making the improvements. The outcome and monitoring team also identified that the care plans, the storage and handling of medication and the activities programme all need improvement and the home has already started to implement the necessary changes. We were shown new information sheets to go into the medication folder which, have photographs to identify each person and clearly lists any allergies people may have. Consideration is being given to moving the medication storage facilities to a larger room. Care plans are being updated and redesigned to incorporated recommendations made and risk assessments are being carried out. The environmental health officer found that food wasn`t being stored properly and thatraw food was being stored above cooked food in the fridges, increasing the chances of cross contamination. The officer also noted that there were areas of the kitchen that were dirty and not properly maintained, which made it difficult to maintain good hygiene levels as they couldn`t be cleaned thoroughly. He also asked for regular reviews to be carried out on their hygiene control measures. Among other things, the health and safety executive`s audit identified that people who need assistance with eating have their meals taken to their room early so they can be assisted before everyone else is served. This is good practice, however the meals are taken upstairs on a tray and remain unheated until staff become available to assist people to eat them. This was discussed during our feed back after the inspection and the management consultant has undertaken to purchase a small heated trolley so that the meals can be served hot. During his visit the fire officer issued an enforcement notice in respect of infringements to fire safety legislation that had been identified at a previous visit, before the home was taken into administration, and had not been attended to. Time scales have been set and the fire officer will return to the home to determine whether the work has been carried out. The management company have assured us that work is already going ahead to comply with the notice within the set timescales. When we arrived at the home we found that residents were still not using the communal areas of the home, they are staying in their rooms all day and eat all their meals there. This leads to people becoming isolated and during previous inspections some told us that they felt lonely and wished they could get out of their rooms more often and meet the other residents. Since the random inspection we phoned the home to confirm some details and the assistant manager told us that staff have started to suggest that the residents come down to the lounge more often and that people are beginning to use the communal areas more. They intend to look for ways to encourage people to get out of their rooms more. The home is very cold, there are insufficient heating arrangements, only small areas of the home have central heating and the wall heaters are not sufficiently effective to heat the house properly and are turned off in rooms when not in use. There is also poor insulation throughout the building. Several staff members told us that they and the residents were reluctance to use the passenger lift as it is unreliable and prone to breaking down, the service lift can be used by residents but it doesn`t service all the areas of the home and some people can`t get downstairs at all when the passenger lift is out of action. While we were at the home the lift was undergoing a major refit and was expected to be more reliable once it was done. We have since confirmed with the assistant manager that the lift is in full working order and is in use again. Staff told us that since the home has gone into administration there have been small improvements along with the bigger ones. New bedding and towels have been bought, new commodes are on order and old, unreliable hoists have been replaced. A member of staff told us that, "I feel better about coming to work now."

What the care home could do better:

There have been a lot of improvements made already to the service but there are still areas that need improvement, most of which the acting manager has already identified. Work must continue to comply with requirements made by the various agencies that have visited the home since February, these are primarily around health and safety, care planning and risk assessments. Arrangements need to be put in place to ensure that people get their meals while they are still hot and safe to eat. There is essential work that must be carried out to ensure that the whole home is kept warm and consideration should be given to making improvements to the water supply to ensure that a good water pressure is maintained in all areas, including the bedrooms. Ways must be found to improve the social life within the home to encourage residents to spend less time alone in their rooms.

Random inspection report Care homes for older people Name: Address: Stowlangtoft Hall Nursing Home Stowlangtoft Hall Nursing Home Stowlangtoft Bury St Edmunds Suffolk IP31 3JY zero star poor service 10/12/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Ann Wiseman Date: 2 3 0 2 2 0 1 0 Information about the care home Name of care home: Address: Stowlangtoft Hall Nursing Home Stowlangtoft Hall Nursing Home Stowlangtoft Bury St Edmunds Suffolk IP31 3JY 01359230216 01359233346 iain@stowlangtofthall.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Hilary Anne MacDonald Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Hilary Anne MacDonald,Mr Hector Iain MacDonald care home 37 Number of places (if applicable): Under 65 Over 65 37 0 old age, not falling within any other category physical disability Conditions of registration: Date of last inspection Brief description of the care home 0 37 2 8 1 0 2 0 0 9 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 Care Homes for Older People Page 2 of 11 Brief description of the care home 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 was taken into administration during February 2010 and is being managed by Healthcare Management Solutions whilst decisions are made about the future of the service. Please contact the Manager for details of current fees. Care Homes for Older People Page 3 of 11 What we found: This random inspection was carried out to check that the requirements made at the last key inspection on 10th December 2009 have been complied with. The requirements were focused on care planning, health and safety in the home, meeting peoples health care needs, staffing levels and the management of the home. Two inspectors carried out the inspection, we arrived at the home at 9.40am and stayed until 3pm. While we were at the home we talked to, some of the other staff and some of the residents. We had a look about the home see if the health and safety requirements had been completed and to view the improvements we had been told about. Since that key inspection the home has been taken into administration and Healthcare Management Solutions have been asked by the administrators to manage the home until its future has been decided. Debi Baron is a consultant in the company and is managing the home on their behalf and is assessing the present situation, she works there three days a week and was at the home when we arrived and facilitated the inspection. When the home went into administration the assistant manager left and the management company have appointed the senior nurse as acting assistant manager. She has worked at the home for many years and has a good knowledge of the residents and their needs. The assistant manager runs the home in the absence of the management companys representative and is supernumerary to the rota. In discussions with the consultant and the assistant manager, we were informed that all of the requirements had been complied with, the management consultant had ensured the work was completed as soon as the management company had taken over the running of the home. We saw that the heaters, that had previously caused concern, had been covered and we checked the hot water temperature in three of the bedrooms and one of the bathrooms. We found that the temperature was within the acceptable range but noted that the water pressure was still variable and that the water took a long time to run hot. The fire safety equipment was professionally serviced on 3rd February 2010 and some of the extinguishers were replaced. We were told that the occasion turned into an impromptu training session when the old extinguishers were used to give the staff an opportunity to discharge them and were shown how to use them. A new activities coordinator has been appointed who is in the process of setting up an activities plan. She has started recording what activities take place and has surveyed the residents to get their preferences. The coordinator spends time with residents in their own rooms and is developing life books, she has made the activities room more accessible but it is very cold. We were told that one gentleman goes to the room to use the piano privately. The number of care staff on duty has remained the same since the last key inspection, we were assured that with the better management structure, which was put in place after a review of work practices, time management is better and staff are not as busy as they were and can spend more meaningful time with the residents. Also, domestic staff now Care Homes for Older People Page 4 of 11 do the laundry and some other tasks previously the responsibility of the care staff. What the care home does well: As soon as the management company took over the running of the home an audit was carried out of all the homes policies and procedures, care practises, staffing arrangements, equipment and the maintenance of the building and an action plan was developed of which, we have been given a copy. Many of the improvements needed have been implemented and action has been taken to improve outcomes for people living in the home. They include the reinstatement of relative and resident meetings, staff meetings have been have taken place and staff supervision is again underway. A selection of surveys have been given to the residents so the management company can get an idea of what changes they would like to see and the staff have had a similar survey. The last relatives meeting had a very good turnout, the lounge was full, and the relatives said they were happy with the changes that had been made. A complaints folder has been set up and staff have been shown how to register them and have been reminded of the complaints procedures. Staff files are being audited to ensure they hold the required documents, training needs are being assessed and training is being provided to enable staff to get their training up to date. The maintenance person is spending more time at the home and has taken on the responsibility of carrying out health and safety checks. He is self employed and has worked at the home for many years and has a good knowledge of the buildings maintenance needs. Colour coded mops are now being used by the domestic staff, this ensures that cross infection is minimised as different mops are used in different areas of the home, there are now different mops for general use, for cleaning the kitchen and moping the toilet floors. Since our last visit to the home it has been inspected by the fire officer, the environmental health officer, the health and safety executive and the Suffolk County Councils outcome and monitoring team. All of which have made requirements and recommendations that must be complied with. We have seen copies of the reports which all ask for improvements in health and safety in the home. Healthcare Management Solutions are aware of the seriousness of the shortcomings and has already started making the improvements. The outcome and monitoring team also identified that the care plans, the storage and handling of medication and the activities programme all need improvement and the home has already started to implement the necessary changes. We were shown new information sheets to go into the medication folder which, have photographs to identify each person and clearly lists any allergies people may have. Consideration is being given to moving the medication storage facilities to a larger room. Care plans are being updated and redesigned to incorporated recommendations made and risk assessments are being carried out. The environmental health officer found that food wasnt being stored properly and that Care Homes for Older People Page 5 of 11 raw food was being stored above cooked food in the fridges, increasing the chances of cross contamination. The officer also noted that there were areas of the kitchen that were dirty and not properly maintained, which made it difficult to maintain good hygiene levels as they couldnt be cleaned thoroughly. He also asked for regular reviews to be carried out on their hygiene control measures. Among other things, the health and safety executives audit identified that people who need assistance with eating have their meals taken to their room early so they can be assisted before everyone else is served. This is good practice, however the meals are taken upstairs on a tray and remain unheated until staff become available to assist people to eat them. This was discussed during our feed back after the inspection and the management consultant has undertaken to purchase a small heated trolley so that the meals can be served hot. During his visit the fire officer issued an enforcement notice in respect of infringements to fire safety legislation that had been identified at a previous visit, before the home was taken into administration, and had not been attended to. Time scales have been set and the fire officer will return to the home to determine whether the work has been carried out. The management company have assured us that work is already going ahead to comply with the notice within the set timescales. When we arrived at the home we found that residents were still not using the communal areas of the home, they are staying in their rooms all day and eat all their meals there. This leads to people becoming isolated and during previous inspections some told us that they felt lonely and wished they could get out of their rooms more often and meet the other residents. Since the random inspection we phoned the home to confirm some details and the assistant manager told us that staff have started to suggest that the residents come down to the lounge more often and that people are beginning to use the communal areas more. They intend to look for ways to encourage people to get out of their rooms more. The home is very cold, there are insufficient heating arrangements, only small areas of the home have central heating and the wall heaters are not sufficiently effective to heat the house properly and are turned off in rooms when not in use. There is also poor insulation throughout the building. Several staff members told us that they and the residents were reluctance to use the passenger lift as it is unreliable and prone to breaking down, the service lift can be used by residents but it doesnt service all the areas of the home and some people cant get downstairs at all when the passenger lift is out of action. While we were at the home the lift was undergoing a major refit and was expected to be more reliable once it was done. We have since confirmed with the assistant manager that the lift is in full working order and is in use again. Staff told us that since the home has gone into administration there have been small improvements along with the bigger ones. New bedding and towels have been bought, new commodes are on order and old, unreliable hoists have been replaced. A member of staff told us that, I feel better about coming to work now. Care Homes for Older People Page 6 of 11 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 23 Requirements made by the environmental health report must be complied with. The expectation is that the management of the care home will take immediate action when health and safety failings are identified. 23/04/2010 2 25 23 Steps must be taken to 23/04/2010 maintain the ambient temperature throughout the home at a level that is safe and comfortable for the residents. Some of the bedrooms and most of the communal areas are very cold. Cooked food must be 26/03/2010 transported and stored at the required temperature. Serving food that has been left standing and allowed to get cold is unappetising and is an unsafe practise. 3 38 12 Care Homes for Older People Page 9 of 11 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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