Inspection on 01/06/06 for Elroi Manor Residential and Nursing Home

This inspection was carried out on 1st June 2006.

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

Elroi Manor Residential and... 08/01/09

Elroi Manor Residential and... 19/11/08

Elroi Manor Residential and... 22/07/08

Elroi Manor Residential and... 23/01/08

Elroi Manor Residential and... 15/12/06

Elroi Manor Residential and... 10/01/06

Elroi Manor Residential and... 21/06/05

Elroi Manor Residential and... 25/01/05

Elroi Manor Residential and... 26/04/04

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Claremont Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Suddon House Nursing & Residential Home West Hill Wincanton Somerset BA9 8BP Lead Inspector Stephen Humphreys Key Unannounced Inspection 1st June 2006 09:30 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 Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 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. Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Suddon House Nursing & Residential Home Address West Hill Wincanton Somerset BA9 8BP 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) 01963 33577 01963 31175 Deverill Holdings Limited Vacant Care Home 43 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0), Mental disorder, excluding learning of places disability or dementia (0), Mental Disorder, excluding learning disability or dementia - over 65 years of age (0) Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Persons, not less than 60 years, who require nursing care by reason of progressive mental disorder. Up to five persons in the range 50-60 years, who require nursing care by reason of a progressive mental disorder. Up to 18 places for personal care DE(E). Up to 29 places for nursing care only in the categories DE, MD, DE(E) and MD(E). Registered for a total of 42 places in categories DE, MD, DE(E) an MD(E). Room 10Q must only be occupied by a person who is independently mobile, has a low risk of falls and can manage their personal care needs independently. The person admitted to this room must meet this criteria when they move in. This must be evidenced through the pre-admission assessment and monthly reviews. Should the persons needs change during their stay a multi-professional and service user/representative review must be held to determine the adequacy of the accommodation to meet their needs. 10th January 2006 Date of last inspection Brief Description of the Service: Suddon House is situated in pleasant rural location, approached by a long private drive. The home is approximately one mile from Wincanton town centre. The home is secure with the main doors controlled by keypads. Suddon House has a large garden, which is semi-secure, with two large patio areas approached by patio door from two lounges. The home is spacious with rooms connected by corridors, two dining rooms, conservatory/lounge and three other lounges. Bedroom accommodation is provided on two floors. The home provides care for older people with dementia who require nursing care or personal care only. Service users have access to all areas of the home whilst staff are allocated each shift to the service user groups, nursing or personal care only. Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection was informed officially shortly after this inspection that a new owner had acquired Suddon House. Any reference to the registered provider in this report refers to the now previous management. The registered provider will be required to produce an improvement plan with timescales that will be agreed with the Commission for Social Care Inspection. Timescales for completion of the requirements will be entered into the inspection report before being available to the public. This was the first key inspection of Suddon House Nursing Home following the introduction by The Commission for Social Care Inspection of the Inspecting For Better Lives methodology. As of April first 2006 all inspections will be unannounced visits. This inspection was carried out on the 1st June 2006. Three inspectors undertook the inspection over one day. At the time of this inspection there were 28 residents, accommodated at Suddon House. 17 nursing and 11 residential. Due to the concerns identified from the January inspection a voluntary stop on admissions was agreed by the provider. No new residents have been admitted to the home recently. The inspection included a tour of the home, speaking with residents, staff, the home manager and observing staff interactions and practices. A case tracking exercise was carried out and all statutory records were reviewed. Commission for Social Care Inspection surveys were sent out to service users and other professionals who have contact with the home. Eight of the ten service user surveys were returned, all appeared to be completed by a relative, this can be expected due to the nature and cognitive abilities of the residents. The last full inspection of Suddon House Nursing Home was carried out in January 2006. The outcomes of this inspection identified major shortfalls in meeting the Care Homes for Older Peoples National Minimum Standards. The Commission for Social Care Inspection has carried out monitoring visits to Suddon House to review and assess how the registered provider has progressed towards meeting the standards. Monitoring visits were carried out on the 14/02/06, 13/03/06,11/05/06, and 17/05/06. Two meetings have been held with the directors of Deverill Estates Ltd, the owners of Suddon House, and action plans had been agreed to enable the registered provider to improve the standard of service delivery and to come up to the level expected in the national minimum standards. Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 6 Since the last inspection an inspector from the Commission for Social Care Inspection has investigated one complaint. The complaint was upheld. The National Minimum Standards were introduced in 2002 and providers of care services have therefore had four years to work towards meeting or exceeding those standards. The Commission for Social Care Inspection is very concerned that four years after the introduction of the national minimum standards that the level of service delivery at Suddon House does not meet the standards. The shortfalls in the main related to basic care of people with dementia. All of the care homes for older people national minimum standards were reviewed except for standard 6. Suddon House does not provide intermediate care. The outcome from this inspection identified very little progress in the standard of service delivery and in meeting the agreed action plans. Immediate requirement notices were issued at this inspection to improve the administration of medicines and to ensure the recruitment and selection procedures are followed correctly. During the course of the last six months two vulnerable adult meetings were held between Commission for Social Care Inspection and social services as part of the monitoring exercise of the home by the regulation authorities. What the service does well: What has improved since the last inspection? The providers have made some improvements to the internal environment of the home through decoration and new furnishings. At this inspection the interaction between staff and residents was more noticeable. The manager has arranged appropriate training in dementia care for nursing and care staff. The manager has introduced a new care planning record system in an attempt to introduce a person centred care philosophy. Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 7 What they could do better: Choice of Home: The statement of purpose needs to be updated to include how the care is delivered to meet the individuals basic and complex nursing care needs. The statement of purpose needs to be available in the home for people to read. A copy of the service user guide needs to be available to all residents in the home. Whenever prospective residents or their relatives or representatives are shown round the home they should be given a copy of the service user guide. The manager should also provide a copy to prospective residents whenever they are visited in their own environment. The terms and conditions need to be reviewed to include the rights and obligations of the service user and registered provider identifying who is liable if there is a breach of contract and also state what is considered as a breach of contract. Periods of notice need to be made clear in the contract. The needs assessment of prospective residents needs to be detailed and include all identified basic and complex care needs. As mentioned above the statement of purpose needs to state how the home can meet the resident’s needs through the use of research based procedures and advice from nurse specialists. Health & Personal Care: The residents care plan needs to become a working record that sets out the actions for staff to enable the residents care needs to be met. The care plan needs to be regularly evaluated and updated to identify the current state of and needs of the resident. Staff in the home need to be more pro-active towards meeting resident’s health care needs. There is a need for all nursing staff to receive training in administration of medicines procedures. Staff should be aware of and seek specialist advice to care for residents who need palliative care. Daily Life and Social Activities: The activities and entertainment for residents should include activities that are stimulating to the individual resident. The home manager could improve the service delivery by ensuring that all staff members are involved in the development of an activities programme. Knowledge of resident’s capabilities and interests should be included in the types of recreation and entertainment provided. The activities co-ordinator should be offered the opportunity to receive specific training to work with people with dementia. Complaints and Protection: The complaints procedure must be robust and followed whenever a complaint or a concern is notified to the home. The registered person must ensure through training and at supervision that staff understand the procedures for reporting an incident involving a vulnerable adult. Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 8 Environment: The internal and external areas of the home are in need of maintenance, repair or replacement. Windows are not draft proof, locks on bedroom doors are not considered to be suitable to promote the independence of people with dementia. Shared rooms should have suitable screening to ensure privacy and dignity at all times. The bedrooms should be suitably fitted with adequate electrical sockets to accommodate all the equipment needed to meet the resident’s comfort and care. The tables and chairs in the dining rooms are showing signs of wear and tear and need to be replaced or repaired. A programme should be identified to replace the old fixed height beds with variable height beds suitable for nursing purposes. The lighting in corridors should be reviewed to ensure residents with poor eyesight could maintain their independence and walk about safely. Appropriate signage suitable to guide people with dementia to their rooms and bathrooms should be installed. Bedroom doors should be painted to make them homely. Laundry equipment must be repaired or replaced to ensure an adequate service is available. House keeping should include high dusting procedures ensuring good infection control procedure. Staffing: The information required to be kept by the employer does not appear to be robust which indicates that policies and procedures may not have followed at all times. Communication between management all is lacking, as was apparent when the administrator left the home. The staff recruitment and selection procedure must be followed and the statutory records kept on each member of staff are complete. There must be adequate experienced staff and competent staff on duty at all times and increased whenever there is a need based on individual risk assessments. The registered person can improve the resident’s safety and protection by carrying out formal staff supervision regularly and recording agreed personal objectives or development plans with staff members. The staff induction-training programme needs to be improved so that it meets the skills for life standards. Management and Administration: The registered provider must ensure the home has a registered manager. The registered person must introduce a quality assurance system into the home that can measure the service outcomes. Policies and procedures need to be updated to include NICE and SCIE guidance on dementia care. Staff supervision needs to be introduced for all members of staff and conducted regularly through out the year. The standard of record keeping needs to be improved and the registered person must ensure all statutory records are kept up to date and available for inspection. The financial records kept to account for extra payments made by residents for personal items does not appear robust and should be strengthened to protect residents from abuse. 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. Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 9 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 Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 The quality in this outcome group is poor. Residents and relatives do not always receive the information available from the home to make an informed choice on whether the home can meet their individual care needs. EVIDENCE: The statement of purpose and service user guide do not give clear relevant information about the services offered. A copy of the service user guide and statement of purpose was reviewed post inspection. To improve these documents they need to detail how the welfare of residents with complex needs will be met. In discussion with one of the registered nurse’s she said that she does show prospective residents/relatives around the home. She said she was unable to provide a copy of the service user guide to relatives because it was locked in the office. The registered nurse said that the relatives did not get an opportunity to speak to staff when being shown round but they were shown an empty room. Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 11 Six of the eight service user surveys returned recorded that they felt they had received enough information by looking round the home. Three surveys returned recorded that they were certain they had received a contract. Two said they had not received a contract. The registered person must ensure that all residents receive and agree the terms and conditions of residence. A copy of the homes’ terms and conditions was reviewed post inspection. To meet the standard fully the terms and conditions need to include the rights and obligations of the service user and provider to determine who has breached the contract. As there have been no recent admissions to the home a discussion with the homes manager and case tracking of care records was carried out to evidence the quality of the pre-admission needs assessment. Referrals were received from social services and private clients. All new residents receive a preadmission needs based assessment based on the activities of daily living model of care. In carrying out the case tracking exercise reviewing accident reports and reviewing the care plans it was clear that the pre-admission needs assessment did not always identify the complex needs of residents. The needs assessments lacked detail in assessing specialist needs such as sensory abilities. There was no evidence to indicate that the assessment was linked to the skills and experiences of the staff groups. Staff were observed during the day interacting with residents. The routines were based on task orientation with very little emphasis on promoting independence. The majority of nursing staff in the home are registered general nurses who have had little training and experience in caring for people with dementia. Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 The quality of this outcome group is poor. Residents cannot be assured their individual care needs will be properly assessed by an experienced nurse or met through a detailed working care plan. There are areas of practice that have the potential to place residents at risk of harm. EVIDENCE: Each resident has a care plan, however the care plans are not working records. A review of care plans was part of the case tracking exercise. Six care plans were reviewed in detail. Assessments are based on the activities of daily living model of care and include personal care, moving & handling, nutrition and falls assessments. There was no evidence of relative or representative involvement in the development or evaluations of the care plan. Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 13 The six care plans reviewed lacked detail in most areas with only brief descriptions of care needs and actions to meet them recorded. One care plan had personal care identified as ‘ bath when required’, there were no actions to inform staff on how to meet any dementia care needs. The daily hygiene sheet recorded dates of baths. The daily record evidenced the resident had received a weekly bath. The care plan recorded ‘bath when required’ therefore the action does not correspond with the care plan instruction. The risk assessment on falls was detailed however there was no review carried out on the date identified. No reviews were carried out with regards to the moving & handling and tissue viability assessments. The evidence shows that staff do not follow the care plan or place importance on monitoring residents welfare. One of the care plans examined included the resident’s life history, which is always very helpful to staff caring for persons with dementia. The continence assessment was not comprehensive enough to provide carers with clear actions to meet the identified need. The care plan recorded that the resident needed to be ‘hoisted on to the toilet by two carers’, the assessment did not identify the type of hoist needed or why. ‘Risk of aggression’ was identified, the care plan recorded ‘3 members of staff are required at all times when attending to this resident’. There disparity is clear in the needs assessment between the continence plan and the behavioural plan. The action also included the need for staff to observe, monitor and record behavioural patterns. No records of the monitoring processes could be found. Good practice requires care plans to be reviewed monthly to ensure the care plan is reflective of the residents present state. The last review date was recorded as December 2005 and staff confirmed they were still following this care plan. It was clear that staff do not follow the instructions in the care plan. Another of the care plans reviewed found that the needs assessment recorded that there was a need ‘to assist and encourage independence and decision making’ however, the care plan does not identify how this need will be met. The moving & handling assessment records that the resident is immobile, but does not identify the type of sling needed when the resident is moved using the hoist. The last review recorded was in January 2006, this further suggests that staff do not follow the care plan and do not evaluate the residents care needs to determine the correct intervention. A record of GP and other professional’s visits was included. Very little accounts of social care where found in any of the care plans reviewed. One of the care plans included a record of a fall. There was a corresponding accident record but no record of any action taken by the manager to indicate the risk assessment had been reviewed with appropriate actions for staff to try and reduce the possibility of the resident having another fall. The continence assessment indicates continent. The daily statement records ‘pad wet at bedtime’, this would indicate that the original needs assessment has changed, Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 14 however, there was no supporting assessment in the care plan to suggest incontinence had occurred. Risk assessments regarding falls, tissue viability and nutrition had been recorded during this residents stay in the home. The manager has started to introduce a new care plan record system into the home. One of the new care plans was reviewed as part of the sample. The care plan recorded the daily living and needs assessment from the previous care plan. The needs based assessment did not appear to have been updated to identify the resident’s present physical and mental state. The care plan identified a need for ‘regular turning’ and recorded the type of hoist sling and other equipment needed by staff to carry out this action. The wound care plan was very descriptive and up to date. The local pharmacist carried out a pharmacy inspection on the 24th May 2006. The outcome of this inspection identified major shortfalls in the medicines procedure. The report identified that staff involved in the medicine procedure need training. The Commission for Social Care Inspection inspector carried out a review of the requirements made by the pharmacist and found that variable doses were not always recorded efficiently. External creams were not risk assessed or the administration being recorded appropriately. Other requirements to ensure safe administration and recording of medicines had been done. During the inspection the registered nurse was observed to administer medication to a resident. She did not follow the procedure as it was written. An immediate requirement notice was issued to improve the administration of medicines to ensure the safety of the residents. Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The quality in this outcome group is poor. The life style created in the home is task oriented and a limited activity programme. The home provides a varied, mainly home made diet but may not always be balanced and nutritious. EVIDENCE: The inspectors noted that on some residents files there was a record of activities, however, these were primarily talking to residents, walking with a resident inside the home or looking at photos. The care files in some instances recorded residents interests such as classical music but this did not seem to be taken into account when planning or providing activities. There is an activities programme attached to the notice board in the main corridor. It shows planned activities for two weeks including weekends. Carers were asked about activities at weekends, one said they sometimes take place but in the main there are no activities. ‘Relatives visit at weekends’. The activities were not identified to meet the needs or capabilities of the residents. One the day of the visit two carers in the nursing lounge were observed with residents. One was stroking a lady’s hand and one was just Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 16 chatting. At this time there were thirteen residents in the lounge, the television was on, seven residents were asleep and none where watching or interested in the television. On the residential side one carer was observed to be looking at photos with a resident. Mostly the interaction between staff and residents is supervisory. It is a slight improvement to observe staff interacting with residents. To move forward staff need to receive specific training in carrying out social therapies with people with dementia. The staff spoken to stated that clergy visited the home but were unsure of the religious denominations or needs of residents to arrange for them to continue with religious observance if they so wished. There are two dining rooms each has seating for up to 13 people. During this visit several residents were observed to receive their meals sitting in the lounge. Carers serve the meals. There were no residents on special diets other than pureed meals for those with swallowing difficulties. Two residents received diabetic diets. There was a choice of two dishes on the day either lamb chops or Leek and bacon bake. Two carers were observed to be serving residents in the nursing lounge. They both had on blue gloves and aprons, they were observed to be assisting the resident, asking them their meal choice and then going to the hot trolley and serving the meal. As a matter of good practice and preservation of dignity the person serving the meal onto the plate need only wear blue protective gloves. One resident was observed to not eat the main dish. She was not offered any alternative or desert or a drink. Eventually a carer returned to give the resident Yoghurt. All residents were offered or given orange squash. There was no other choice. The menus are built on a four-week cycle. The menus on display in the dining room and notice boards were not current. There are occasions when the meals produced are not on the planned menus. Desert of fruit salad is canned; no evidence of any fresh fruit or vegetables was seen in the kitchen stores on the day of the visit. The inspector was told that the regular cook was off and did not place the food order. The cook was unaware of the calorific value of the daily menu or the particular dietary needs of older people with dementia. Food seen during the monitoring visits and the inspections was nicely presented and looked appetising. Snacks are provided during the day with drinks up till when residents go to bed. As part of the case tracking weight records were checked. Not all records were up to date. Supplements had been prescribed for residents with a weight loss. Monitoring of food intake was not as robust as would be expected. Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 17 The homes statement of purpose and brochure encourages residents and their representatives to maintain contact and to visit the home whenever possible. No visitors came to the home on the day however the survey results recorded that relatives felt welcomed and were greeted respectfully by staff. Residents are able to bring personal possessions into the home by arrangement at the time of admission and within space constraints of their private room. Residents accommodated at the home are unable to manage their own financial affairs safely. In the main relatives or representatives have a power of attorney or other court directive that enables them to legally take charge of the resident’s finances. Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 The quality in this outcome group is poor. The home does not always take concerns seriously to ensure the protection of service users from potential risk of abuse. EVIDENCE: Since the last inspection in January 2006 the Commission for Social Care Inspection has investigated one complaint at Suddon House. The investigation into this complaint was carried out because the registered person failed to respond to the complainant. An inspector from the Commission for Social Care Inspection carried out the investigation and upheld the complaint. During a recent monitoring visit to Suddon House the inspectors were made aware of another letter received by the manager informing her of concerns regarding the standard of care in the home. The inspectors were again concerned that the manager and registered person had not taken the concerns seriously and had not responded by following the homes complaints procedure. Following a meeting between Commission for Social Care Inspection officers and the providers the home manager was required to carry out an investigation and to respond appropriately to the complainant. Inspectors from The Commission for Social Care Inspection have been monitoring the protection and safety of residents at each visit to the home. The outcome from case tracking residents during the last two monitoring visits and issues brought to the attention of the inspectors by staff using the whistle blowing procedure have resulted in actions being taken by the Commission for Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 19 Social Care Inspection and Social Services to protect residents well-being. Vulnerable adult meetings were held between The Commission for Social Care Inspection and Social Services. The outcome of these meetings was the agreement to provide Community Psychiatric Nurse (CPN) support to the home on a weekly basis. CPN’s from the Community Mental Health Team have visited the home and carried out assessments and provided support to nursing staff in meeting the resident’s care needs. The registered provider agreed to a voluntary stop on admissions to enable actions to be put in place and specific areas to be addressed to ensure the safety and protection of residents. During monitoring visits and at this inspection accident records were checked and resident’s case tracked to ensure their needs were being met. As part of the preparation for this inspection comment cards were sent to professional groups for their comments on the quality of service delivery. Comments received back were in the main positive about the care delivery, however, comments of concern related to a lack of basic care needs not always being met. The Commission for Social Care Inspection is working closely with the provider on these issues, however, is considering taking enforcement action on this home. Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22,23,24,25,26, The quality of this outcome group is poor. Although some redecoration has been carried out on the home the internal environment is not homely. EVIDENCE: Following the last inspection the providers have put a lot of effort into ensuring the home is clean and tidy. The malodours apparent when entering the home have almost been eradicated. Observations during a tour of the home identified only minor urine odours from the corridor and bedroom areas. The home was generally clean especially the lounges. The dining rooms are furnished with wooden floors and furniture. There are three tables and seating for thirteen persons in the nursing dining room. Three chairs had at least one of the skies damaged and the tables were stained. The serving hatch woodwork was dirty and in need of painting. The window frames were not draft proof as were many of the windows through out the home. The bedroom doors Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 21 are bear and plain with poor signage to identify the person’s room. Locks on the bedroom doors are Yale type locks and could not be opened from the outside by a resident. The doors are kept permanently locked, requiring each member of staff to hold a master key to enter the rooms. To make the rooms accessible and to promote independence in the residents the locks on the doors should be changed. There is no visible indication that the environment has been developed to promote independence or to support people with dementia. Signage is poor. People who walk about are unable to locate toilets or their own bedrooms unaided. Lighting in the main corridor is just adequate but needs to be improved. The day of the inspection was very hot with an outside temperature in excess of 75F. The central heating in the home was on in parts that made some areas stifling although all windows and conservatory doors were open. The heating is run from three systems in the home that are not centrally controlled and give off varying degrees of heating. There was no evidence of a planned programme of maintenance for the home. Most of the fixtures and fittings need replacing due to being broken or worn. In one bedroom the equipment needed for the care and comfort of the resident was plugged into an extension lead because there was not enough electrical outlet sockets in the room. Use of the extension lead is not good practice especially as the lead trailed over the screen put in place to provide privacy for the residents who shared this room. No risk assessments were found to sustain this practice. Most resident’s bedrooms appeared to have some degree of personalisation. One relative survey commented on the dowdy ness of the room. One bedroom smelt of damp. None of the residents commented on their rooms. Residents have access to the rear garden through the conservatory, but this wasn’t being used a lot. There was very little seating and shade in the garden or on the patio for residents. The patio paving is uneven and would prove difficult for residents to walk on safely. No risk assessment on this area was found. The roof tiles above the conservatory door appeared to be loose and in need of replacement. Aids and equipment are provided through out the home. The pressure relieving mattresses are of good quality; new profile beds are evident although only a few have been bought. Bedrails all had appropriate protectors attached. Lifting hoists were being used and maintained as required. Two domestic staff were on duty at the time of the visit and one laundry lady. One of the drying machines had been broken for two weeks seriously limiting the amount of laundry being completed. Cleaning chemicals were being stored in a locked storeroom, however there was a clear plastic spray bottle Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 22 containing yellow liquid that had an unreadable label. The sluice room did not have suitable racking to hold clean bedpans. Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The quality in this outcome group is poor. Residents cannot be assured they are safe or competent and skilled staff will meet their care needs. EVIDENCE: The results of the resident surveys returned (all completed by relatives) suggested that relatives felt that staff provided all the care and support needed to meet the resident’s needs. However only 50 commented that staff were available when they were needed and only 50 felt that staff listened to them and acted on what they said. Monitoring visits to Suddon House were carried out at various times. One visit was in the evening, one very early morning. At each visit staff were observed carrying out their duties and their interactions with residents. Discussions with staff on a one to one were also held with the inspectors. The outcome of the observation exercises was that staff did not interact very well with resident’s only two carers were observed to interact in a person centred manner. Staff were observed when assisting residents with their meals to be talking to each other in their first language, other staff when assisting residents with meals were observed to be watching television. Staff were observed to approach residents with a view to carrying out a care need without speaking or explaining to the resident the task. Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 24 On more than one occasion inspectors observed poor manual handling practice. This was immediately brought to the manager’s attention. Inspectors also observed poor administration of medication practice for which an immediate requirement notice was issued. Duty rotas were reviewed for a period of three weeks. It was evident that some staff work excessive hours in the home. This was confirmed in discussions with staff members. Inspectors also found evidence that staff were turning up late for a shift because they were working elsewhere. There was no evidence to indicate that the providers supported or encouraged the development of a competent staff group that understood the needs of people with dementia. Training provided appears to be very limited and not focused on the needs of the staff group. Training specific to the care of people with dementia has been reactionary following meetings with the registered provider. Staff confirmed they had received fire safety, food hygiene and manual handling training. Poor manual handling techniques were witnessed on more than one occasion. This questions the standard of the training provided and the competency of the staff. A pharmacist from the local pharmacy carried out an inspection of the medicines and administration procedures on the 24th May 2006. A requirement from this was that staff needed training. An immediate requirement notice was issued for other major shortfalls in the medicine procedures. Staff records checked included all the required checks to be carried out by the employer and information on employees recorded. Supervision records were included in the individuals file. Supervision records identified a need for specific training in communication, dementia and person centred care. The providers have been reactionary following the monitoring visits and following meetings with Commission for Social Care Inspection in relation to providing specific training for staff to care for people with dementia. The manager has arranged for training to be provided by Yeovil College. Up to the time of the monitoring visit on the 17th May 2006 nine staff had completed the dementia training and another eight had commenced with another nine about to enrol. Unfortunately there was no evidence to support any change from staff who had completed the training. There was no evidence to suggest that persons with complex needs were being met through specific evidence based person centred care. Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 25 At the time of this visit staff spoken to said they felt things had improved since the new owner took over. Staff felt more optimistic. During the inspection staff were observed to be interacting better and talking to residents. Two carers were observed to be sitting with residents looking at photos. Another member of the care staff said they had received training on abuse, however the inspector was not convinced that the carer’s understanding was sufficient enough to take appropriate action to report an incident if it occurred. Comments received from visiting professionals suggested that staff were not delivering basic care mainly due to poor understanding. Many of the staff group are from overseas. The inspectors spoke with two domestic staff, who were from overseas. They were not able to confirm clearly the actions to take on hearing the fire alarm. Staff induction training needs to be improved to meet the skills for life standards. One new carer said they were given a copy of the daily routines to follow as their induction. In discussion with the manager she recognises the need for cultural understanding amongst staff groups too improve, along with communication with residents. Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37,38 The quality in this outcome group is poor. Residents cannot be assured the home is run in their best interests. EVIDENCE: The manager is a qualified nurse and has worked in the home for some time, previously as the deputy manager. The manager appears to have had very little support from the registered provider in trying to improve the standard of service delivery in the home. The manager has attempted to meet the requirements from all meetings and monitoring visits to the home. In an attempt to move the service delivery forward the manager has now introduced weekly staff meetings, has set up a staff training programme, Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 27 introduced limited staff supervision and is reviewing the care plan system. She is attempting to do everything herself which is perhaps to optimistic without support. Staff spoken to felt the introduction of the staff meetings has dealt with some of the conflicts that have developed. The manager also acknowledges that there are cultural issues that need to be ironed out to promote a quality service. The philosophy of care in the home is task orientated and does not promote independence in the residents. There are no quality assurance systems in the home. No clinical or management audits are carried out to ensure the safety of the residents. Case tracking of residents who sustained falls showed a lack of good record keeping and management in identifying appropriate action plans. Satisfaction surveys are sent to relatives by the home annually, however, evidence was seen that suggests that no action is taken by the registered person from the comments received back. (see complaints). A review of resident’s financial records was attempted from the records available on the day. Unfortunately the administrator who was responsible for keeping these records had recently left and no one was aware of how she kept the records. From the records it appeared that all residents were charged a regular monthly sum for toiletries. The charge appeared to be a blanket charge across the board. The inspectors were unable to determine whether this was an acceptable way of providing toiletries to residents given that most individuals use toiletries to their personal liking. No audit trail of the toiletries could be tracked back to individuals. The terms and conditions of residence do not include a charge for toiletries as noted in paragraph 2 – Fees or in paragraph 4 – Leisure and other Activities. The inspectors will review this issue further with the new management at a later visit. The chiropody file showed that all residents are seen at least once per month for treatment. The financial records showed that all residents paid for their chiropody and hairdressing. One resident was invoiced for chiropody treatment for May, but was not seen during that time, staff said they would be seen next time the chiropodist visits. Staff personal files were reviewed. Two files recorded supervision interviews and recorded agreed needs. There was no record to suggest that the manager had taken any action to enable the staff member to meet their personal development needs. Three members of staff spoken to said they did not receive any form of official supervision. They all said that they would go to the manager if they had a problem. Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 28 One staff file checked did not contain all the information required to be kept by the employer on each member of staff. Staff spoken to said they were aware of and read the homes policies and procedures, however the inspectors observed instances of bad practice, which was evidence that staff did not follow correct procedures, or safe practices. At least three instances of poor manual handling practices were observed. Poor infection control practice was observed. Inspectors found soiled linen on one bed. Health and safety practices in the home are poor. Domestic staff were observed to have a trailing electrical wire across a corridor where residents walk. Hot water temperatures are recorded monthly and the incidents reportable to Commission for Social Care Inspection under regulation 37 have improved since the last inspection. Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 1 1 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 1 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 2 18 1 2 2 2 2 3 3 2 2 STAFFING Standard No Score 27 1 28 X 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 1 1 X 2 1 1 1 Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 30 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 (1)(b) Schedule 1 Requirement The registered person must produce a statement of purpose and service user guide that is up to date and includes all the services provided to the resident group, including how services will be delivered to persons with complex needs. The registered person must provide to all residents a copy of the terms and conditions of residence. The registered person must carry out a needs based assessment on each prospective resident identifying all physical and mental health care needs. The registered person must ensure the assessment of need is reviewed and takes into account changes in the resident’s wellbeing. The registered person must be able to demonstrate the homes capacity to meet the dementia care and other specialist needs of residents admitted to the home. The registered person must DS0000003292.V290847.R01.S.doc Timescale for action 30/07/06 2 OP2 5(1)(b) 30/07/06 3 OP3 14(1)(a) 30/07/06 4 OP3 14(2)(a) (b) 30/07/06 5 OP4 14,12(1) 30/07/06 6 OP4 18(1)(a) 30/07/06 Page 31 Suddon House Nursing & Residential Home Version 5.1 7 OP7 15 (1) 8 OP7 14 (a)(2) (b) 9 OP7 13 (4) 10 OP7 15 (2) 11 OP7 15 (1) 12 OP8 12 (1)(a) 13 OP9 13 (2) 17 (1)(a) 14 OP9 18 (1)(a) (c)(i) 15 OP10 18 (1) ensure that staff have the appropriate skills and experience to care for persons with dementia. The registered person must ensure that the residents care plan sets out in detail the actions taken by care staff to meet all of the individual’s health care needs. The registered person must ensure the individuals care plan identifies all appropriate actions for staff to follow to deliver the care needed. The registered person must ensure the individuals care plan includes relevant up to date clinical guidance from NICE and SCIE. The registered person must ensure that the individuals care plan is reviewed and updated to reflect the changing needs of the resident. The registered person must ensure the individuals care plan shows evidence of resident or their representatives involvement. The registered person must ensure residents personal hygiene is carried out as required. The registered person must ensure staff who are involved with medicines in the home adhere to the procedure for receipt, storage, administration and disposal at all times. The registered person must ensure nurses carrying out the medicines procedure are competent and receive training as necessary. The registered person must ensure that staff treat residents with respect especially when DS0000003292.V290847.R01.S.doc 30/07/06 30/07/06 30/07/06 30/07/06 30/07/06 30/07/06 02/06/06 30/06/06 30/07/06 Suddon House Nursing & Residential Home Version 5.1 Page 32 16 OP15 16 (2)(i) 17 OP15 16 (2)(i) 18 OP15 17 (2) schedule 4 (13) 19 OP16 22 (3) 20 OP18 13 (6) 21 22 23 OP24 OP24 OP24 23 (2)(b) 16 (2)(c) 16 (2)(C) 24 25 OP26 OP26 16 (2)(k) 23 (2)(c) assisting to eat meals. The registered person must ensure that the menu offers a choice of wholesome and nutritious meals and is available in a suitable format for residents to read. The menu on display in the home must be current. The registered person must ensure residents receive a wholesome and nutritious diet that includes fresh foods. The registered person must ensure all records of food provided to residents are completed in detail to establish the nutritional state of the resident. The registered person must ensure all complaints; concerns and allegations are investigated within the homes procedure. The registered person must ensure that all staff are aware of and understand how to implement the vulnerable adults procedures. The registered person must ensure the home is kept in good repair externally and internally. The registered person must repair or replace the damaged dining room chairs and tables. The registered person must review all furnishings and fittings in resident’s bedrooms and repair or replace as necessary. The registered person must keep the home free from offensive odours. The registered person must repair or replace the broken dryer. 30/07/06 30/07/06 30/07/06 30/07/06 30/07/06 30/07/06 30/07/06 30/07/06 30/07/06 30/07/06 Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 33 26 OP27OP30 18 (1)(2) (3)(4) The registered person must assess the competency of the staff groups with regards to skill and experience to care for persons with dementia. The registered person must ensure that at all times there are suitably qualified and competent staff on duty. The registered person must ensure all new staff receive an adequate induction training that meets the skills for life standards. The registered person must ensure the cook is appropriately qualified to provide a nutritious balanced diet to residents with dementia. 30/07/06 27 OP30 18(1) 30/07/06 18 (1)(c)(i) 28 OP32 29 30 OP33 OP36 31 OP37 32 OP38 The registered person must provide catering staff with opportunities to update their knowledge and skills. 9 (2)(b)(i) The registered person must ensure the management of the home communicates clear leadership to meet the aims and objectives of the home. 24 (1) The registered person must establish a system to review the quality of care in the home. 18 (2) The registered person must ensure that staff supervision is carried out with all staff groups and formally recorded in their individual files. 17 (1)(a) The registered person must ensure that all records kept are accurate and up to date to ensure the efficient running of the home. 13 (5) The registered person must ensure staff carry out appropriate and legal manual handling practices. DS0000003292.V290847.R01.S.doc 30/07/06 30/07/06 30/07/06 30/07/06 30/07/06 Suddon House Nursing & Residential Home Version 5.1 Page 34 33 OP38 13 (3) 34 OP38 13 (6) The registered person must 30/07/06 ensure staff carry out procedures regarding the disposal of foul or infected linen correctly. The registered person must 30/07/06 ensure staff carry out their duties being aware of health & safety requirements. Staff must not leave trailing leads across corridors. The registered person must ensure staff do not put residents at risk of harm or injury through poor practices. The registered person must ensure domestic staff use chemicals in appropriately labelled bottles only. 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 OP1 OP2 Good Practice Recommendations The registered person should ensure the statement of purpose and service user guide is displayed and available in the home to present and prospective residents. The registered person should ensure the terms and conditions of residence includes the rights and obligations of the service user and provider to determine who has breached the contract. The registered person should ensure the pre-admission needs based assessment identifies the complex needs of residents and their specialist needs with regards to sensory abilities. The registered person should ensure prospective residents or their relatives have an opportunity to meet and talk to staff during a visit to the home. The registered person should introduce appropriate DS0000003292.V290847.R01.S.doc Version 5.1 Page 35 3 OP3 4 5 OP5 OP11 Suddon House Nursing & Residential Home 6 7 8 9 OP12 OP12 OP15 OP15 10 OP17 11 12 13 OP19 OP22 OP22 14 15 16 OP33 OP34 OP35 palliative care practices to support residents with deteriorating conditions. Activities should be appropriate to the capabilities and interests of residents. Activities staff should be given the opportunity to learn and provide appropriate social care to persons with dementia. The registered person should ensure there is a choice of drinks available to residents at meal times and during the day. The registered person should ensure that staff complete fully all residents fluid and food intake monitoring charts and that the results are evaluated to ensure the dietary and nutritional needs of the resident are met. The registered person should ensure residents with dementia have access to advocacy services. The opportunities should be recorded in the individuals care plan. The registered person should introduce a routine programme of maintenance and repair or replacement of fixtures and fittings. The registered person should replace all bedroom door locks to those that are suitable for people with dementia in regards to maintaining independence. The registered person should review the décor in the home and the lighting in the main corridors taking into consideration recommendations by NICE and Alzheimer’s Society on environments for people with dementia. The registered person should provide support and advice to the manager on setting up and carrying on a quality assurance system. The registered person should review and improve the financial records regarding residents extra payments. The registered person should ensure that all financial records pertaining to resident’s payments are maintained satisfactorily. Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 36 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Suddon House Nursing & Residential Home DS0000003292.V290847.R01.S.doc Version 5.1 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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