Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 13/02/08 for Stubby Leas Nursing Home

Also see our care home review for Stubby Leas Nursing Home for more information

This inspection was carried out on 13th February 2008.

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

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

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

What the care home does well

Stubby Leas offers a genuine commitment to care, with an open and personable approach, led by an Acting Care Manager, who `leads from the front`, which reflects the increasingly confident relationship between care staff and residents. Emphasis goes into involving the residents and their families in the process of care, ensuring a highly personal approach to meeting individual needs. There is evidence that residents are treated with respect, and that they are enabled to make choices concerning their day-to-day lives. Comments made to the inspector and assessor were: " I am really happy to come here as it is very nice", "It`s a nice place, they work very hard to make things nice. They help you and don`t leave you, they see you safe." The staff are committed and enthusiastic, anxious that their residents should be given good quality care. There are improved opportunities for training, and good systems in place to ensure that residents` needs are met. Meals are of a good standard with a sensitive catering approach to meeting needs. The establishment of accountability towards effective assessment, care planning and review of resident`s needs are meaningful in formulating a satisfactory standard of care. This personable attitude and approach to care is appreciated and welcome by residents and visitors alike.

What has improved since the last inspection?

There is evidence that residents and families have been consulted more often than in the past, particularly with regard to daily life and social care activities, resulting in more satisfaction among the residents. One person said: "We are asked what we want", another person said: "If you want something, they`ll do it." Care assessment, planning and review have significantly improved, with an established and sustainable standard that offers a solid foundation for the practice of care. There has also been an improvement in social care activities within the home. The budget for this has been established to provide 25 hours a week activity coordinator, and equipment has been purchased. The physical environment of the home is continuing to improve, with slow progress on what is a huge job to see through. Ground floor facilities have been prioritised, a new fire alarm system installed, and a steady supply of new equipment continues to be ordered.

What the care home could do better:

The Provider and Acting Care Manager have a continuing need to upgrade the services, planning, and general environment to meet the criteria of an expected good standard of care. Particular attention is drawn to Room 1 and all bathrooms and toilet areas. The Home has been without a Registered Care Manager for over five months. A speedy application for Registration from the Acting Care Manager is a requirement.

CARE HOMES FOR OLDER PEOPLE Stubby Leas Nursing Home Fisherwick Road Whittington Lichfield Staffordshire WS13 8PT Lead Inspector Keith Jones Unannounced Inspection 13th February 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Stubby Leas Nursing Home DS0000022378.V352037.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. Stubby Leas Nursing Home DS0000022378.V352037.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stubby Leas Nursing Home Address Fisherwick Road Whittington Lichfield Staffordshire WS13 8PT 01827 383496 01827 383086 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) First Care Ltd Vacant post Care Home 48 Category(ies) of Dementia (48), Dementia - over 65 years of age registration, with number (48) of places Stubby Leas Nursing Home DS0000022378.V352037.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 5 Dementia (DE) - Minimum age 55 years on admission. 48 DE (Dementia) - Minimum age 60 years on admission. Date of last inspection 12th June 2007 Brief Description of the Service: Stubby Leas Care home provides personal and nursing care for up to 48 people suffering with forms of dementia related illnesses. The home is situated in its own grounds on the edge of Fisherwick, a rural hamlet fairly close to the city of Tamworth. Accommodation is provided on three levels, which are accessed, by stairs or a passenger lift. Rooms are provided on all levels of the home with a mixture of single or double rooms, some with en suite facilities. Communal areas are on the ground floor and there is a separate smoking area. The home has a purpose built activity room where service users have the opportunity to maintain their skills and hobbies or to enjoy new interests. The grounds are spacious and there are pleasant country views all round, with space for several cars to park. Stubby Leas Nursing Home DS0000022378.V352037.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means people who use this service experience adequate outcomes. A quality rating is provided throughout the report based on each outcome area for the people who use the service. These ratings are described as excellent, good, adequate or poor based on findings of the inspection. We considered if the information given to us confirmed that customers were presented with the service they needed, and whether the service was of a satisfactory standard to ensure service users’ safety. This unannounced inspection was conducted over one day by one inspector, with the Care Manager (Designate), an ‘expert by experience’ (assessor), nursing and senior care staff. All the Key National Minimum Standards were inspected. CSCI are trying to improve the way we engage with people who use services, so we gain a real understanding of their views and experiences of social care services. We are using a method of working where ‘experts by experience’ are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use a social care service. The term ‘experts by experience’ (assessor) used in this report describes people whose knowledge about social care services comes directly from using them. Four residents were spoken to during the course of the inspection, and discussion took place with three staff members and the Acting Care Manager of the home. The care plans of four residents were seen, and various other documents were inspected. The tour of the home was carried out in a relaxed, courteous and professional manner. The assessor had access to talk with, and share daily life with a number of residents. There were 34 Service Users in residence on the day of inspection, 20 with nursing care needs. Relatives who were present were complimentary of the family approach to care, the freedom they enjoyed and the involvement that the manager and her staff encouraged. Everyone appeared comfortable and at ease with their surroundings. The Acting Care Manager has been in post since October 2007 and is presently in the process of registering with CSCI. The last inspection report was discussed, and it was noted that requirements and recommendations made have been, or are in the process of being attended to. There has been a significant consolidation and improvement in the planning, review and implementation of care standards. There, however, remains a substantial amount of work, and investment required to bring the physical environment, furniture and fabric to a similar standard. Stubby Leas Nursing Home DS0000022378.V352037.R01.S.doc Version 5.2 Page 6 Information gained from the pre-inspection questionnaire identified that current fees are from £328 to £525 per week. This information was correct at the time of this inspection. The reader may wish to contact the service for current information A sample review of the administration confirmed solid practice and an increasingly effective care management. A feedback session was offered at the end of the inspection with open discussion with the Acting Care Manager, which included the verbal report from the expert by experience assessor. The Inspector thanked all concerned for their contribution to a pleasing and constructive inspection. Potential service users and their representatives are able to gain information about the service from the Statement of Purpose and Service User Guide. Our inspection reports can be obtained directly from the provider or are available on our website at www.csci.org.uk What the service does well: What has improved since the last inspection? There is evidence that residents and families have been consulted more often than in the past, particularly with regard to daily life and social care activities, resulting in more satisfaction among the residents. One person said: “We are Stubby Leas Nursing Home DS0000022378.V352037.R01.S.doc Version 5.2 Page 7 asked what we want”, another person said: “If you want something, they’ll do it.” Care assessment, planning and review have significantly improved, with an established and sustainable standard that offers a solid foundation for the practice of care. There has also been an improvement in social care activities within the home. The budget for this has been established to provide 25 hours a week activity coordinator, and equipment has been purchased. The physical environment of the home is continuing to improve, with slow progress on what is a huge job to see through. Ground floor facilities have been prioritised, a new fire alarm system installed, and a steady supply of new equipment continues to be ordered. 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. The summary of this inspection report can be made available in other formats on request. Stubby Leas Nursing Home DS0000022378.V352037.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 Stubby Leas Nursing Home DS0000022378.V352037.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): 1,2,3,4,5 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service, and on the examination of the homes policies, procedures, practices and discussions with management. The Home ensures that prospective residents have the necessary information to enable an informed choice to be made. Aims and objectives, terms and conditions are clearly presented in a way to facilitate easy understanding of services and standards of care. The Home has demonstrated their commitment to promote a partnership of care, to meet the objectives of providing a home to meet individual needs. EVIDENCE: The revised Statement of Purpose, and Service User’s guide represent a satisfactory description of the Home’s aims and objectives, philosophy of care and terms and conditions. It offers residents, and their relatives the Stubby Leas Nursing Home DS0000022378.V352037.R01.S.doc Version 5.2 Page 10 opportunity to make an informed choice about where to live. A readily available stock of up to date documents would be helpful. It is stated in the Statement of Purpose that independence, privacy and dignity are encouraged, with the full involvement of family in all matters concerning the well being of residents. The Statement of Purpose also indicates the terms and conditions, which are discussed with residents and relatives prior to admission. A pre-admission assessment, carried out by the Acting Care Manager or designated deputy, appreciated any special needs of the individual, including cultural, social or personal needs, which are fully discussed and documented. This assessment initiates the process of care, each individual having a plan of care based on personal needs and a daily living process. The Home demonstrated through case tracking, that the assessor explained this information in respect of each individual to ensure a clear understanding is established. The care assessor also makes a judgement as to the suitability of each prospective resident, using the same criteria. There is evidence that the family is kept fully informed of the situation, offering prospective residents, and their relatives, the opportunity to make an informed choice about where to live. Stubby Leas Nursing Home DS0000022378.V352037.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 and 11 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was an examination of four care plans, discussions with residents, staff, and manager, with general observations and examination of the homes medication system. The care assessment and planning system is a well-organised, yet personalised process offering meaningful and valid documentation of care administered. A broad vision of needs is addressed through the care planning process, meeting personal and health needs. It is recognised that this reflects an individual profile of needs, discussed fully with family. The nursing team manage the provision of a secure and safe medicines administration. EVIDENCE: Stubby Leas Nursing Home DS0000022378.V352037.R01.S.doc Version 5.2 Page 12 Care records and case tracking clearly showed that this standard has been well met, establishing a quality process of assessment. The pre-admission assessment represented the foundation for a well-considered and detailed care planning process, in association with Social Services reports if available. A profile of the residents’ social, physical and psychological status offered an individual plan of care, based upon activities of daily living, to be implemented and frequently reviewed. Each residents’ health, personal and social care needs are carefully assessed in an individual plan of care that is reviewed monthly, including residents and relative’s views, to reflect their changing needs. That review is more frequent, dependant upon the individual’s needs and clinical condition. The strength of purposeful planned care lies within the frequency of the review process in monitoring and adapting care profiles. This process is supported by a daily report convention applicable to the individual’s day (and night) events and progress. Risk assessments were carried out on an individual basis and frequently reviewed. Included in the care records were applications of established monitoring systems following a process of goals, care and evaluation models of monthly assessment. Case tracking confirmed the extent that the carefully prepared, and well-recorded care plans were appreciated by residents and relatives alike. The assessor also reflected on the resident’s awareness and engagement in their care planning, notwithstanding their cognitive impairment. Tissue viability, continence, psychological and special needs are assessed and documented, along with nutritional screening, hearing and sight tests as appropriate. The local practice GP service is very supportive; through this service, arrangements are made to provide professional support. A physiotherapist, wheelchair adaptation and dietician had been provided for those residents whose records were examined. Continence is assessed on admission and promoted within the plan of care, and there was evidence that residents’ nutritional needs, and weights were frequently reviewed. Care staff maintain all aspects of residents’ personal care, overseen by the trained nurse on a daily basis. The administration of medicines adheres to procedures to maximise protection to residents. There are no residents taking charge of their own medication at the time of inspection. A random sample of the medication and administration record sheets (MAR) were seen at the inspection, and there were no discrepancies. The storage was secure with satisfactory added security for controlled drugs (CDA). A controlled drug register was examined and found to be in order. Oxygen storage availability was satisfactory. Drugs waiting to be returned to the pharmacist require a more secure holding storage area, and redundant stock should be returned. The ‘anchor’ wire for securing the medicine trolley requires repair. Stubby Leas Nursing Home DS0000022378.V352037.R01.S.doc Version 5.2 Page 13 Visitors are able to see the residents in any of the communal rooms or in the residents’ own bedrooms. Residents spoken to felt that their privacy was respected. It was observed during the inspection that residents were treated with dignity and respect, staff always knocking on doors before entering rooms. There was evidence from staff induction records that all new staff receive training in how to treat residents with respect. The inspector observed the free, courteous interaction between residents and staff, based on a level of confidence of mutual trust and respect. Comments received by the assessor confirmed the warmth of the care atmosphere and daily interactions. Relatives have freedom of visiting, emphasising on the importance of maintaining social contact. Adequate privacy policies exist for all toilet/bathroom areas and bedrooms, although bedroom identifiers were considered poorly presented and of little value for people with dementia. Individual spiritual persuasions were documented and respected at all times. The Inspector and assessor were impressed with the renewed confidence and empathy within the Home of staff, residents and visitors, and the mutual respect that prevailed. Staff were seen to demonstrate a personal rapport with residents, through a respectful, yet friendly discourse. The assessor pointed out “...a huge effort was being made to provide a lifestyle for them (the residents) as comfortable and loving as possible”. Stubby Leas Nursing Home DS0000022378.V352037.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 and 15 The quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There were discussions with residents, staff and examination of records in relation to social activities undertaken and general observations during to course of the inspection. The home had a relaxed atmosphere where people were encouraged to individualised lifestyles. Those who wish to bring in personal possessions are encouraged to do so. EVIDENCE: Discussions with residents and staff identified a relaxed atmosphere in which the residents’ needs were respected. A routine exists to establish a framework for managing the home, not as a regime for residents to comply with, but for a point of familiarity. Several residents exercised their freedom of movement, with the security that there are routine events to the day they could relate to. Stubby Leas Nursing Home DS0000022378.V352037.R01.S.doc Version 5.2 Page 15 The Home has attempted to appoint a part time activity staff member, for twenty-five hours a week, without success as yet. There is a large activity room used spasmodically with care staff involved. A senior carer is presently engaged in facilitating activities, on the day a Valentine’s Day presentation. Those residents’ rooms inspected showed an element of personalisation in the inclusion of belongings, some furniture and general décor. During the course of the inspection staff were observed to interact with residents in a positive and polite manner. The standards of catering offered a satisfactory service, to which residents and a visitor spoken to were complimentary of all aspects of quality. A menu on a four weekly cycle offered a wholesome, varied and suitable choice. A very pleasant lunch was served during inspection, with choices available, served in dining rooms adjacent to the lounge areas. Three meals were provided daily, with hot and cold beverages and snacks available throughout the day. Special diets were accommodated, with the staff making positive effort to engage with residents, and sometimes relatives, to discuss personal preferences. Stubby Leas Nursing Home DS0000022378.V352037.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, 17 and 18 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a Complaints Procedure in place and residents feel that their concerns will be listened to and acted upon. There are procedures in place to assist staff to protect the residents. EVIDENCE: There is a Complaints Procedure in place, but this needs to set out the stages, timescales and process. The Acting Care Manager was advised to establish a single file to accommodate concerns, complaints and allegations separately, each supported with the relevant procedure. Three complaints have been received by the home since the last inspection, each being dealt with effectively and timely. Written information is provided to residents and their relatives, which informs them of how to refer a complaint to the Commission. Several of the residents spoken to during the inspection said “If there was anything wrong I’d tell them”, “Staff listen to you, you can go at any time to the matron.” Discussion confirmed that there is a protocol and response, to anyone reporting any form of abuse, to ensure effective handling of such an incident. Staff induction and in-house training programmes clarified and reinforce the Stubby Leas Nursing Home DS0000022378.V352037.R01.S.doc Version 5.2 Page 17 responsibilities of all staff in their daily contact with residents, especially their privileged position in protecting people from abuse, of all natures. It was acknowledged that abuse is established as a regular feature on the annual training programme for all staff. Stubby Leas Nursing Home DS0000022378.V352037.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): 19,20,21,22,23,24,25,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The location of Stubby Leas is conducive for a care home, situated in a country setting with reasonable access to road links for Tamworth and Lichfield. The physical environment of the home is continuing to slowly improve, but has some way to go to provide a safe and well-maintained environment. There are a number of outstanding issues and it is hoped that these can be resolved speedily. Each of the bedrooms, whether single or double, provided differing levels of furnishing and facilities, across a broad band of quality, but to which each resident has been encouraged to add their personal belongings, furniture and décor as preferred. The standard and presentation of all the toilets and bathrooms were of a poor quality, although clean, uncluttered and odour-free. The good standard of cleanliness has continued to provide a safe environment. EVIDENCE: Stubby Leas Nursing Home DS0000022378.V352037.R01.S.doc Version 5.2 Page 19 Refurbishment and redecoration is continuing at a slow pace, heavily reliant upon the in-house maintenance resources. A programme of developments and routine maintenance has been undertaken on an unstructured way. The Acting Care Manager was requested to establish, with the Provider, an enhanced development plan, and that this programme be forwarded to the Commission. Car parking is limited, the gardens are potentially attractive, and have been made safe for the winter period, although address must be made for residents to enjoy in the forthcoming warmer months. The area around the maintenance workshop is cluttered with redundant equipment, and poses a potential risk due to poor security. This point was raised at the last inspection. Internal access was facilitated with adequate, well-lit and airy corridors, which are in continuing need of decoration and repair. It was acknowledged that the entrance area is scheduled to be redesigned, to offer a secure and pleasant main entry. The refurbishment and re-decoration programme is a continuing feature of concern. Recent up-grades were inspected, and found to be of an adequate standard. Communal areas present much improved, pleasantly furnished areas to accommodate social or reflective needs, in a homely setting. There are four main lounges, which provide a comfortable seating area with a good standard of furnishings. On the day of inspection staff were seen to be deployed in lounges with residents, and actively engaged in interactions. It was felt that supervision was made difficult due to the diverse options of four lounges available. The assessor considered that a lounge area could be redesigned to offer a facility for men, and a room for visitors, or counselling. There are two pleasant main dining rooms, clean and fresh smelling. It was recognised that there are plans to enhance the secondary room with new décor and furnishings, to enhance the ‘homeliness’ of shared facilities. A large activity room has been ‘earmarked’ for a sensory area, with the purchase of some equipment. It was actively use more for staff to prepare materials, rather than resident’s use. There has been work on some downstairs bedrooms to a good standard, although room 1, a double, is of a poor state to an extent that it cannot be used until a refurbishment has taken place. Overall, most bedrooms were seen to be adequately appointed. It is the policy that on bedrooms becoming vacant, that each room is reappraised for redecoration. There has been a continuing process in the purchasing of bedroom and communal furniture, although there still remains some furniture looking worn and in need of replacement. The Acting Care Manager indicated that the remaining needs would be shortly met through the development programme. A complete replacement of the fire alarm system has been completed, a renewal of the call system is underway. It was suggested that the resident name identifier on each bedroom door was of a very poor quality, and did not enhance recognition by people with a dementia condition. The use of labels and notices Stubby Leas Nursing Home DS0000022378.V352037.R01.S.doc Version 5.2 Page 20 in bedrooms is to be reviewed. A 2008/09 development programme is to be drawn up and presented to CSCI, following a full environmental risk assessment by the management. The standard and presentation of all the toilets and bathrooms continued to be of a poor quality of decoration and barely furnished, although clean, uncluttered and odour-free. Urgent attention is needed to secure the desired standard, this includes the quality of fitments and pipe work. The water temperature was within acceptable limits, although a bath thermometer is needed for each bathroom. Toilets are accessible to all and within close proximity to all communal areas. A store cupboard on the main corridor, fixed at head height, containing toiletries was inappropriately situated. There are adequate sluice facilities, each having suitable arrangements to assist in control of infection. Notices regarding chemical handling the areas that store chemicals displayed appropriate COSHH posters and information charts. It was noted that soiled equipment had been stored in the room, albeit temporarily. The domestic services in the Home were seen to be of a good standard. The residents and relatives spoken to, and the assessor remarked that they find the environment very clean, and odour free. There are two variable height beds available, even though there were a number of physically ill residents. It was agreed that the Provider would ensure a minimum of five beds be made available. This had been a recommendation made at the last inspection. The laundry area was clean and well organised; procedures were in place for coping with soiled/infected linen with a provision to minimise handling, and cross-infection. COSHH signs were evident, although in need of renewal with laminate posters. The laundry assistant was advised about keeping soiled and clean linen at a distance. The kitchen was inspected with the cook, and found to present a well equipped and organised area. All fridges and freezers were seen to be used in the appropriate manner, well maintained, and checked daily by the kitchen staff. A cleaning schedule was in place, and found to be accurate, up to date and comprehensive. The room was poorly ventilated, hot and stuffy. There is evidence that the Home’s staff and management have systematically addressed the many problems identified in recent reports. There remain many challenges but there has been a meaningful focus on establishing a safe environment, and evidence of meeting personal care standards. The building complied with local fire service, Environmental Health, and Health and Safety requirements. Stubby Leas Nursing Home DS0000022378.V352037.R01.S.doc Version 5.2 Page 21 Stubby Leas Nursing Home DS0000022378.V352037.R01.S.doc Version 5.2 Page 22 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 and 30 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The overall staffing coverage manages to maintain the expected levels each shift that was inspected, over a three-week period. Discussions with residents and visitors to the home also conveyed a very positive impression of staff conduct. However there is reliance upon agency nursing and care staff working coverage in a time of reorganisation. Nevertheless the Acting Care Manager has acted conclusively to stabilise recruitment, appointment and deployment throughout the workforce. The management have established an effective procedure for interview, selection and appointment of staff. It is recognised that the thoroughness of staff selection has a significant effect upon the provision of care to ensure protection of residents. All staff receive a satisfactory level of training within the home from Registered nurses and external trainers. EVIDENCE: There were 34 residents in the Home on the day of the inspection. Off-duties were provided and examined; staffing levels were seen to be satisfactory. The daily care staffing rota showed adequate balance between Stubby Leas Nursing Home DS0000022378.V352037.R01.S.doc Version 5.2 Page 23 qualifications, skills, experience and numbers to provide a good standard of care. Discussions with staff also confirmed their commitment to providing a quality service, and their awareness of the principles of good practice. The Acting Care Manager works supernumerary, yet helped to cover some shifts on the floor on a regular basis, with a complement of Registered Nurses supported her. Agency coverage has been used to support shortages of both Nursing and care staff, in tandem with overtime and flexible rostering to meet shortfalls. The staffing establishments were examined and found to be satisfactory in meeting the staffing notice. An average coverage was seen to be: 0700 - 1430 - 1 Trained Nurse 7 Carers 1430 - 2130 - 1 Trained Nurse 6 Carers 2130 - 0700 - 1 Trained Nurse 3 Carers This represented an improvement in numbers to facilitate enhanced supervision and monitoring to establish a foundation for further developments of service. Observations of staff on duty conveyed a very positive impression of their competence and care of the residents of Stubby Leas. Four members of staff were interviewed, who confirmed the appropriate staffing levels, conduct and training of staff. It was noted that there are several overseas care staff, who have been appointed to their position after suitable screening, including their ability to communicate effectively. Those spoken with on the day of inspection showed satisfactory standards, and an infectious enthusiasm for their work. Three staff files were examined which showed an improved consistency of general application of procedure in appointing staff. The procedures for recruiting and appointing staff were seen to be appropriate with various stages of the process logically applied. Staff had sufficient evidence of clearance with references, letters of appointment, and contracts, and clear checks are made of CRB and POVA records. The management have produced a progressive training plan, based on personal centred training. Staff induction programmes are well established; very well designed, forming the base upon which in-service supervision and training are planned and achieved. Staff records displayed an account of training that includes the General Social Care Council’s code of conduct, obtained to compliment existing guides. Records were available to demonstrate an on-going process of supervised practice, showing training sessions and appraisals to be a routine feature of staff development. There was evidence to show that a formal supervision process (referred to as appraisal) is in use, although requiring a consistent Stubby Leas Nursing Home DS0000022378.V352037.R01.S.doc Version 5.2 Page 24 approach. The Acting Care Manager emphasised the heavy commitment made by senior staff in offering on-duty practical supervision. A process to cascade the responsibilities throughout the workforce was advised. Stubby Leas Nursing Home DS0000022378.V352037.R01.S.doc Version 5.2 Page 25 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): 31,32,33,34,35,36,37 and 38 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were discussions with the Care Manager (designate), trained Nurses and senior staff, examination of the home policies and procedures with regards to the effective management of the home, general comments, observations during the process of the inspection, and discussions with residents, visitors and staff. EVIDENCE: The Acting Care Manager, Beverley Salt offers a considerable resource of experience and skills, which are reflected in the improving standards of care in Stubby Leas Nursing Home DS0000022378.V352037.R01.S.doc Version 5.2 Page 26 a Home that has had a very volatile 15 months. In this time she has establishing a solid professional policy portfolio that has been implemented, to achieve a high standard of set aims and objectives. A Registered Nurse, with an extensive professional portfolio of practical and managerial experience. There is a requirement for a speedy conclusion to the application for Registration with CSCI. The inspector was nevertheless impressed by the forthright approach, openness and confidence in the observed interactions between, and with staff, relatives and residents. The relationships were seen to be of mutual trust and respect. It is recognised that the Acting Care Manager feels supported in operational matters, and influential in determining the short and long-term planning for the Home. The Provider continues to comply with requirements from recent inspection reports, and day-to-day situations as they arise, and a steady commitment of resources in meeting those requirements. She continues, with the assistance of a qualified professional Operations Director, to hold a high profile presence, on a regular basis, in supportive administration and direction. There is an ongoing, essential need to offer a commitment for continuing development of the environment and services within. The management have developed a formal approach to monitoring quality across a wide range of activities. This includes care risk assessment, care plan review process that is recorded at least once a month, a staff training programme and an environmental risk assessment prevention programme. This includes the setting of objectives, forward planning on short-term and long-term planning, as evidenced in the ongoing arrangements of refurbishment and development of Stubby Leas. Evidence was secured to acknowledge achievements, ongoing and planned objectives. Involved within this process are the views of residents and relatives, confirmed at case tracking, relatives audit and informal discussion. Social Workers’ review meetings are often an avenue for assessing quality. Staff meetings are held regularly. Care plans were drawn up, implemented and reviewed with residents and relatives whenever possible. Case tracking, and informal discussion provided evidence that participation is encouraged. A sample of administrative, maintenance and care records were examined and found to offer an accurate reflection of a service committed to providing a safe and comfortable environment for elderly residents. These included procedures on Code of Conduct, Health and Safety and movement and handling. Service records for the hoists, disposal of drugs and handling of clinical waste were evidenced, including PAT reports. Staff records show that periodic training is held in fire safety, moving and handling, first aid, food hygiene and infection control. Fire safety checks and Stubby Leas Nursing Home DS0000022378.V352037.R01.S.doc Version 5.2 Page 27 checks on fire fighting equipment take place at regular intervals. Accidents were seen to be addressed, risk assessed, actioned and recorded in an effective way, with access to Riddor if needed. No serious accidents have been reported recently. The style of management was seen as by direct observation, and by discussion with residents, relatives and staff, and that a very open and positive attitude prevails, enhancing the Home’s ‘family feel’ and homeliness. There was strong evidence of openness and honesty in speaking with residents, relatives and staff in which day to day events and episodes were freely discussed. On-site inspections offers evidence of a care management increasingly in control, organised and prepared to facilitate meaningful, delegated responsibilities to a care management team, increasingly sensitive to the needs of residents. Stubby Leas Nursing Home DS0000022378.V352037.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 2 1 2 2 2 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X X 2 3 2 Stubby Leas Nursing Home DS0000022378.V352037.R01.S.doc Version 5.2 Page 29 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 2. Standard OP32OP32 OP19 Regulation 8 23(2)(b) Requirement The Care manager is registered with the CSCI. Timescale for action 01/09/08 The registered person must 01/09/08 ensure that all areas of the home have good quality décor. (Previous timescale of 01/09/07 not met). 3 OP19 23(2)(j) All bathrooms and toilets be upgraded, due to the poor state of repair which has the potential to represent a health and safety issue. To redecorate and refurbish room1 with immediate effect, so as to improve basic living standards. 01/06/08 4 OP24 23(2)(b) 01/04/08 Stubby Leas Nursing Home DS0000022378.V352037.R01.S.doc Version 5.2 Page 30 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 OP9 OP19 Good Practice Recommendations Medicines awaiting return to pharmacy be secured in a locked cabinet until disposal. That a full unit risk assessment programme be updated, to enable the management to review safety, and appraise facilities on a regular basis. Corridors needs an appraisal of the décor and fittings, so as to improve general living standards.. Provide a further 3 variable height beds for nursing cases, to provide a minimum option for nursing seriously ill residents. Provide CSCI with a development plan for 2008/09 to demonstrate a commitment to a future service at Stubby Leas. Continue the review of bedroom and communal furniture for repair/replacement, so as to improve general living standards. Ensure that soiled linen coming into the laundry does not contaminate clean linen, in accordance with infection control policies. To make the maintenance section of the garden safe for residents, from redundant equipment and furniture. Provide CSCI with a staff training development plan for 2008/09, to identify needs and resources to effect a suitably trained workforce. Re-site toiletries cupboard off main corridor, so as to minimise risk to people walking down the corridor. Discontinue the use of paper name identifiers, notices and sticky labels on Residents’ bedroom doors and furniture. It is in respect of residents’ dignity and facilitate DS0000022378.V352037.R01.S.doc Version 5.2 Page 31 3. 4. OP26 OP24 5. OP33 6. OP24 7 OP26 8 9. OP38 OP33 10 12. OP38 OP10 Stubby Leas Nursing Home identification of surroundings for people with dementia needs. 14. OP19 All bathrooms and toilets be upgraded, due to the poor state of repair, which has the potential to represent a health and safety issue. Stubby Leas Nursing Home DS0000022378.V352037.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Stubby Leas Nursing Home DS0000022378.V352037.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!