Inspection on 12/02/07 for Stretton Nursing Home

This inspection was carried out on 12th February 2007.

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

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

Other inspections for this house

Stretton Nursing Home 11/07/06

Stretton Nursing Home 13/12/05

Stretton Nursing Home 11/10/05

Stretton Nursing Home 30/06/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Stretton Nursing Home Stretton Nursing Home Manor Fields Burghill Hereford Herefordshire HR4 7RR Lead Inspector Denise Reynolds Unannounced Inspection 12th February 2007 11:30 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 Stretton Nursing Home DS0000062332.V330339.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. Stretton Nursing Home DS0000062332.V330339.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stretton Nursing Home Address Stretton Nursing Home Manor Fields Burghill Hereford Herefordshire HR4 7RR 01432 761611 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) Stretton Care Ltd Post Vacant Care Home 50 Category(ies) of Dementia (50), Dementia - over 65 years of age registration, with number (50), Old age, not falling within any other of places category (50), Physical disability (50), Physical disability over 65 years of age (50), Terminally ill (50) Stretton Nursing Home DS0000062332.V330339.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents` with care needs associated with dementia illnesses may only be admitted to the Home where these are secondary to the person`s care needs. 11th July 2006 Date of last inspection Brief Description of the Service: Stretton Nursing Home provides nursing care to 50 people. A range of registration categories are in place allowing a service to be provided to people with physical care needs, those arising from dementia illnesses and people who have terminal illness. Residents’ whose care needs are associated with a dementia illness are only able to be admitted to the home where the dementia care needs are secondary to any physical disability and care they may require. The accommodation is provided in a single storey building which is situated in a peaceful rural location just outside Hereford. The building is operated as two wings with independent staff teams and separate communal rooms. The accommodation is within shared and single rooms. The home provides a range of equipment for residents’ with physical disabilities. The current scale of fees are from £470.20 - £559.07 per week. Stretton Nursing Home DS0000062332.V330339.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection began mid-morning on the first day and was resumed the following day. This was a key inspection – this is an inspection where we look at a wide range of areas. To help us plan the inspection we looked at pre inspection information requested from the Home some weeks earlier, survey forms received from residents (4), relatives (12) and health and social care professionals (8). During the two visits to the Home care records, staff records and other records and documents were inspected. There was a tour of the accommodation and interviews with six staff, including the manager designate and the deputy manager. Time was spent speaking privately with five residents in their rooms as well as spending time out and about in the home observing what was happening. The inspector also met and spoke with the relatives of four residents during the inspection. Following the previous key inspection in July 2006 there was an unannounced random inspection in November 2007. A random inspection looks at specific things; this one was to follow up concerns about care in the Home that we found when we inspected in July and that arose from complaints we received. This inspection was brief due to the Home having an outbreak of diarrhoea and vomiting. Subsequently there was an unannounced inspection by a specialist pharmacy inspector in January 2007. The reports of the November and January inspections are not available on our website but copies may be requested from the local office. What the service does well: The Home gives prospective service users written information and a written contract to help them make an informed choice about moving there. The manager or deputy does an assessment before offering a place to someone to make sure the Home can meet the person’s needs. Staff try to make life interesting and enjoyable for residents; there is an activities organiser who provides group activities each afternoon and spends some individual time with residents. People told us that the staff are friendly and caring – “ X…receives a lot of really loving care – we feel X is well looked after. They make X very happy here, she feels wanted and cared for. Staff great with us too!” “the nursing staff are excellent – first class” “the care from all staff (nursing, carers, cleaners and laundry) is not only caring but affectionate and loving in a professional way” Stretton Nursing Home DS0000062332.V330339.R01.S.doc Version 5.2 Page 6 “ staff always seem happy and it rubs off” Staff recognise that food and mealtimes are an important part of everyone’s lives and do their best to make sure people enjoy their meals and eat well. Visitors to the Home are made welcome and relatives told us that they feel they can speak to the staff if they think something needs to be improved and that the feel listened to. Staff recruitment is thorough and helps protect residents from unsuitable staff being employed at the Home. The senior staff team is committed to working together to improve the quality of the service. What has improved since the last inspection? What they could do better: The details in some care plans need to be more specific about the care needed and short-term changes to people’s care needs to be included. The provision of fluids has improved since the last inspection but staff still need to make sure they remember to help residents who might forget their drink or are not able to hold their cup. Stretton Nursing Home DS0000062332.V330339.R01.S.doc Version 5.2 Page 7 More work needs to be done to make sure that people who are unable to leave their rooms have things to do to pass the time enjoyably. Further investment is needed in furnishings and the overall environment to improve the surroundings and standard of comfort and safety. Staffing levels do not always enable staff to maintain enough contact with residents or respond promptly to call bells. This was the main area of concern that residents and relatives told us about. A solution needs to be achieved so that keeping bedroom and corridor doors open does not place people at risk if there is a fire at the Home; the service provider is investigating this. The call bell system needs to be improved – residents need to be able to use a call bell wherever they are in the building and staff must be made aware as soon as someone presses their bell. The information from any surveys that the Home does needs to be collated and the findings used to contribute to a review of the quality of the service. 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. Stretton Nursing Home DS0000062332.V330339.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 Stretton Nursing Home DS0000062332.V330339.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, 2, 3, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service provides prospective service users with written information about the Home and a written contract to help them make an informed choice about moving to the Home. The manager or deputy does an assessment before offering a place to prospective residents to make sure the Home can meet the person’s needs. EVIDENCE: The Home has a statement of purpose, service user guide and written contract. The documents would benefit from proof reading and further development in line with guidance from The Office of Fair Trading about care Home documentation. All the survey forms from residents confirmed that they had received a contract and were given enough information before they moved in. One Stretton Nursing Home DS0000062332.V330339.R01.S.doc Version 5.2 Page 10 relative wrote about being given a tour of the Home, with tea and biscuits and the chance to meet staff and speak to residents and other relatives. A social care professional gave an example of a flexible and considerate approach by the Home; this enabled a married couple to stay together. Copies of signed contracts were seen in the care records sampled. Stretton Nursing Home DS0000062332.V330339.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff are working hard to improve the way they respond to changes in residents’ health by having better care plans and more robust systems for checking that people’s care needs are all being met. Significant improvements have been made in how the Home manages medication and pressure area care. EVIDENCE: There are care plans for each person living at the Home. A new format for these has recently been introduced. This is easy to follow and laid out clearly. The care plans contain daily reports by nursing staff and senior care staff that give a picture of how a person has been each day and the care given to them. These main care plans are supplemented by record sheets in residents’ rooms for care staff to record personal care. Information about liaison with health and social care professionals and with families is recorded and easy to find. Overall the care plans have been improved considerably. Stretton Nursing Home DS0000062332.V330339.R01.S.doc Version 5.2 Page 12 There are some areas where further improvements are needed. The plans do not contain any details about why someone has come to the Home. This is information that can be very helpful to staff in the first few days when a person is settling in and is likely to be feeling anxious. Some elements of the plans need to be more specific to make sure they give staff sufficient guidance about the care needed. For example, entries like ‘thick and easy to be used in all fluids ‘ ‘daily oral care’ ‘encourage her to take daily fluids’ and ‘provide clean water daily’ need to be more specific to give staff adequate guidance. There was evidence that the care plans and specific risk assessments are being reviewed regularly. Changes in the level of help needed with things like washing and dressing during illness or after an injury were not sufficiently described in some examples seen. However, a resident this applied to said she is getting the help she needs. Relatives had signed the care plans looked at but it was not clear if the residents themselves have been consulted and involved in deciding what their care plan contains. The Home is working to make sure residents have enough to drink. Jugs of water or squash were seen in every room but although staff were seen giving residents drinks the inspector saw a cold cup of tea in front of one resident who had not been helped to drink it. This suggests that some staff may not be aware of which residents need more help. The feedback in relatives’ survey forms indicated that some of them had felt the need to prompt staff to follow up health problems on occasions. This was an issue that was evident during previous inspections. The improvements found during this inspection will hopefully mean that this will not be a problem in future. Overall, residents, relatives and health and social care professionals were satisfied with the care at the Home. There was information from consultation with relatives and service users that staff are often very busy and that response times to call bells can be slow on occasions. An example of this was observed during the inspection. This issue can be partly explained by the fact that the call bell is difficult to hear in some parts of the building; however, a high proportion of residents are very frail and being cared for in bed which is demanding of staff time. Significant improvements have been made to the recording of the care given in respect of pressure area care. The new records make it easy to track the care given and to check if observations have been acted upon. The information is Stretton Nursing Home DS0000062332.V330339.R01.S.doc Version 5.2 Page 13 kept I a separate wound management folder with a section for each person. The manager designate and deputy decided on this format to make it easier for them to monitor that dressings and wound evaluations are being done. The Home is well equipped with pressure relieving equipment and the deputy manager reviews this monthly. The Home is not accepting new residents with pressure area care needs until the equipment needed is in place. Medication practice had been improved in line with the requirements made during the last key inspection and a random inspection by a specialist inspector in January 2007. There are no outstanding requirements regarding medication. Good practice was observed during this inspection. It was noted that while medication storage is secure, the medication room needs to be cleaned and refurbished as some low surfaces were dusty and a drawer is broken. During the two days all the contacts observed between staff and residents were caring and respectful; residents and relatives spoken to said the staff are very good. This was echoed in the survey forms with comments such as – “ X…receives a lot of really loving care – we feel X is well looked after. They make X very happy here, she feels wanted and cared for. Staff great with us too!” Stretton Nursing Home DS0000062332.V330339.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff work hard to make life interesting and enjoyable for residents. There is room for improvement so that people unable to leave their rooms have things to do to pass the time enjoyably. Staff recognise that food and mealtimes are an important part of everyone’s lives and do their best to make sure people enjoy their meals and eat well. Visitors to the Home are made welcome. EVIDENCE: The part time activity co coordinator provides a range of activities each afternoon. She also spends time individually with residents who do not ant to join in group activities or are not well enough to. The care plans do not contain enough detail about how individual people might like to spend their time. For example, one person’s plan mentions that she likes watching old films but does not go on to set out how staff will make sure she can do this regularly. Stretton Nursing Home DS0000062332.V330339.R01.S.doc Version 5.2 Page 15 From observation it seemed that care staff had limited time to spend talking to residents or to participate in the daily activities. All the information we received from relatives showed that they are made welcome at the Home. During the inspection lots of people were coming and going. One visitor was given something to eat and a cup of tea while staff were providing personal care to his relative. One survey form said – ‘They understand when we are tired or poorly and give us all support’ and ‘we are made to feel welcome there and part of the community’ Another said – ‘ Staff always seem happy and it rubs off’ The cook has recently left and a member of the kitchen staff has just been appointed to replace her. Residents spoken to are happy with the food. Staff were seen giving one to one attention to people needing a lot of help to eat their meal. Those in their rooms were helped first and then the meal was served to those sitting at the table. This meant that everyone had their meal while it was fresh and hot. Staff made the meal sociable and leisurely by talking pleasantly to residents while helping them. No one was rushed even though this meant that it took along time to help some people. Food was nicely presented and for people needing softened or liquidised diets each food item was individually served on the plate so the different colours, tastes and textures could still be enjoyed. Stretton Nursing Home DS0000062332.V330339.R01.S.doc Version 5.2 Page 16 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, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Home has recognised that it needs to improve the way it deals with complaints and is making its arrangements more robust. A programme of training is underway to make sure that all staff are trained to understand adult protection issues and know what to do if they have concerns about an older person’s safety or welfare. EVIDENCE: Three of the relatives who sent survey forms back to us did not know about the Home’s complaints procedure, although most residents and relatives we had contact with know who to speak to if they are not happy with something at the Home. Several people told us that they feel they are listened to seriously when they do this. In recent months the service provider has investigated a number of complaints in relation to situations that were dealt with under the Herefordshire multi agency adult protection arrangements. The service provider and senior staff have been very constructive in their attitude and shown a willingness and desire to learn from these situations. Evidence of improvements was found during a recent pharmacy inspection and during this inspection. Stretton Nursing Home DS0000062332.V330339.R01.S.doc Version 5.2 Page 17 The newly appointed training manager has made adult protection training one of her priorities and the majority of staff have attended an in house course based on the Herefordshire multi agency adult protection arrangements. Adult protection is now also covered in a staff induction package based on the Skills for Care outcomes. Stretton Nursing Home DS0000062332.V330339.R01.S.doc Version 5.2 Page 18 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, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. During the last year some of the décor and facilities in the have been improved. Further investment is needed in furnishings and the overall environment to improve the surroundings and standard of comfort and safety. Systems are in place for the management of health and safety and the prevention of cross infection. EVIDENCE: The laundry is well organised and systems are in place for the management of cross infection. Disposable gloves and aprons are available for staff to use when they are providing personal care. Staff were seen using these. There are hand washing facilities throughout the home, with liquid soap and paper hand towels. The Inspector noted that there was no liquid soap in some bathrooms and toilets. Hand sluicing facilities are still in use for commode pots and Stretton Nursing Home DS0000062332.V330339.R01.S.doc Version 5.2 Page 19 urinals. This can be a potential risk for staff as they may inhale or splash bacteria into their face. In some bedrooms unused picture hooks were still on the walls from where previous occupants pictures had been removed. This is unsightly and indicates that rooms are not redecorated before someone moves in. There are items of old and worn furniture in some parts of the house (for example, chairs with foam poking through the outer covers and scuffed or scratched wooden furniture); a comment about this was made in a relative’s comment card. Some of the beds in use are dated in their style and appearance. A damaged bath panel was noted in one bathroom. A large gap was noted at the bottom of an exterior door suggesting that the wood may be rotting. Throughout the building doors were held open with wooden wedges; this include bedroom doors. This seriously compromises fire safety throughout the building because smoke and flames could spread unimpeded. It is acknowledged that the doors are kept open so that residents in their rooms do not feel cut off or isolated and so that staff can observe as they pass the rooms. There risk assessment regarding this practice has not been reviewed since 2005 and staff were uncertain about whether doors are all closed at night and if so at what time. An immediate requirement was made for the service provider to deal with this issue. He responded immediately and has been in consultation with Herefordshire and Worcestershire Fire and Rescue Service and a fire safety equipment supplier. A previous concern regarding cleaning chemicals being left around the building had been dealt with; the domestic staff are now given a daily allocation of cleaning materials and all stock is kept locked away. A new maintenance man has been employed to work at the Home and was enthusiastic about helping to improve the standard of the accommodation. The level gardens are well maintained and have pleasant rural views. Stretton Nursing Home DS0000062332.V330339.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels do not always enable staff to maintain enough contact with residents or respond promptly to call bells. Arrangements for staff training have been strengthened by the appointment of a training manager. A full training programme is now being developed delivered and monitored to improve the knowledge and skills of the staff team. Staff recruitment is thorough and helps protect residents from unsuitable staff being employed at the Home. EVIDENCE: On the day of the inspection there were 43 people living in the Home; 25 in the area known as the main home and 18 in the area known as ‘The Woodlands’. Staff work in two teams, one in each area. The main home team has one registered nurse and four care staff on duty on all shifts during the day and Woodlands has one registered nurse with two care staff in the morning and three in the afternoons. The manager designate, deputy manager, activity coordinator, training manager and administrator are additional to this except when short staffed when they would assist with the direct care work. Stretton Nursing Home DS0000062332.V330339.R01.S.doc Version 5.2 Page 21 There was evidence that the staffing levels described are not always sufficient. 50 of the survey forms from relatives indicated that there are not always enough staff or that they are too busy – ‘ …. often a long time before bell is answered ….they are kept very busy and not always able to answer promptly’ From observation over two days and discussion with residents and staff the inspector gained the view that staff are indeed very busy and that there is not always enough time to maintain contact with all the residents regularly during the day. This applies particularly to those residents who spend a lot of time in their rooms. The inspector observed an example of a call bell not being answered – it was ringing for about five minutes before a member of staff was free to attend although the inaudibility of the bell in some parts of the building may also have been a contributory factor. Amongst the care staff the number who have done NVQ is low at present with only four staff with NVQ 2 and one who has NVQ 3. Another has done a health and social care course equivalent to NVQ 3. The service provider has demonstrated his commitment to training by employing a training manager for 20 to 30 hours a week. As a result the numbers of staff who have done mandatory training is increasing. This progress is being monitored by the use of a comprehensive spreadsheet that shows which staff have done training and whether they are due for updates. Staff induction training is being improved by the introduction of job specific induction checklists and an induction package based on Skills for Care training requirements. The recruitment records sampled all met the requirements of the relevant regulation. Comments about the attitudes of staff were all positive – ‘ the nursing staff are excellent – first class’ ‘the care from all staff (nursing, carers, cleaners and laundry) is not only caring but affectionate and loving in a professional way’ Staff showed an interest in their work and some were particularly enthusiastic and committed. A number of different nationalities of staff are employed and this was described by some of them as contributing to an overall tolerance and willingness to pull together. Lots of laughter and cheerful chatter was heard during both days of the inspection. A relative commented “ staff always seem happy and it rubs off” Stretton Nursing Home DS0000062332.V330339.R01.S.doc Version 5.2 Page 22 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Steps are being taken to develop management systems that will support all aspects of the running of the Home and enable staff to provide an improved standard of care. A new manager designate has been appointed to lead an enthusiastic and hard working senior team. The management of fire safety needs to be more vigorous to ensure that residents and staff are safe. EVIDENCE: A new manager designate has been appointed since the last key inspection. The previous post holder has stayed at the Home in the post of deputy manager with a lead role in clinical practice. These two staff took joint responsibility for assisting with the inspection. This gave an opportunity to Stretton Nursing Home DS0000062332.V330339.R01.S.doc Version 5.2 Page 23 observe the partnership they are building and the positive way they are working together to improve standards at the Home. The introduction of the additional tier of management in having a deputy together with the appointment of a training manager appeared to be a key factor in the improvements seen during this inspection. The service provider carries out monthly visits to the Home as required but is there more often than this at present. The reports on these visits are very detailed. The manager designate was not aware of the availability of these reports in the Home. The manager designate said that she is impressed with the extent to which he knows the residents and is familiar with their needs and circumstances. A number of residents said that they like him, that he always goes to see them and speaks to them about how they are. Some of the staff spoken to said they feel well supported by the new management team and by the service provider. There was a lot of optimism expressed about the future with staff saying they want to help improve the quality of the service. Surveys of residents and relatives views have been done by the Home but these have not been collated and analysed to help them form an action plan. The Home no longer deals with service users personal finances. Arrangements are being finalised for the finances of the one remaining person they did this for to be transferred to Herefordshire Council. The training manager has put in lace a formal supervision framework and is working through the staff group to ensure they all have regular supervision. This is currently taking the form of direct observation of practice although time is also allowed for discussion about development needs. The manager designate is undertaking a similar exercise to ensure that all the registered nurses receive clinical supervision and appraisal. The pre inspection information sent by the service confirmed that all required annual maintenance and inspection has been done. An electrical safety certificate has been forwarded to CSCI as required following the last key inspection. Infection control procedures at the Home are good and the levels of health and safety related training have been improved since the arrival of the new training manager. Records of accidents have been improved and these are now well organised and easy to cross reference to people’s care records. The fire safety issue referred to in the accommodation section of the report needs to be addressed. In addition, the fire risk assessment for the building needs to be updated. None of the senior member of staff have had fire safety training at an appropriate level. Stretton Nursing Home DS0000062332.V330339.R01.S.doc Version 5.2 Page 24 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 2 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X 2 X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 2 2 2 2 Stretton Nursing Home DS0000062332.V330339.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation 4, 5A Requirement The Statement of Purpose and Service User guide must include all the information set out in Schedule 1 and Regulation 5 of the Care Homes Regulations 2001 and Regulation 5a (Care Homes (Amendment No. 2) Regulations 2003. Timescale of 30/11/05, 14/12/05 & 30/04/06 only partly met. This standard was not assessed at this inspection. The timescale for action was 03/01/07. Care plans must provide enough detail to guide staff in the care each person needs and include information about any shortterm care that is needed. Staff must ensure that help is given to residents who need assistance with drinking. A further review must be undertaken of the condition of the premises & facilities internally and a report showing the outcome and any action plan must be submitted to the Commission. Timescale for action 30/04/07 2 OP7 12 31/03/07 3 4 OP8 OP19 12 23 31/03/07 31/05/07 Stretton Nursing Home DS0000062332.V330339.R01.S.doc Version 5.2 Page 26 5 OP26 13 6 OP22 16 7 OP27 18 8 OP38 23(4) Stained and soiled carpets must be cleaned and/or replaced. This standard was not assessed at this inspection. The timescale for action was 03/01/07. The call bell system must be improved so that residents have access to a call bell wherever they are in the building and staff are made aware as soon as someone presses their bell. The service provider must make sure that the number of staff on duty is enough for them to be able to meet residents’ needs, including responding promptly to call bells. You must comply with Regulation 23 (4) of the Care Homes Regulations 2001 (as amended) in respect of fire safety in the Home. (This relates to updating the fire risk assessment and finding a suitable solution to keeping doors held open.) 31/05/07 30/09/07 30/04/07 16/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP12 OP12 OP33 Good Practice Recommendations The Home needs to ensure that residents are as involved as they can be in the content of their own care plan. The care plans need to include more information about individualised activities or pastimes for residents who are unable, or prefer not to take part in group activities. The information from any surveys that the Home does needs to be collated and the findings used to contribute to a review of the quality of the service. Stretton Nursing Home DS0000062332.V330339.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Stretton Nursing Home DS0000062332.V330339.R01.S.doc Version 5.2 Page 28 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!