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Inspection on 10/01/06 for Elroi Manor Residential and Nursing Home

Also see our care home review for Elroi Manor Residential and Nursing Home for more information

This inspection was carried out on 10th January 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.

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

What the care home does well

The home produces a clearly written statement of purpose that gives some of the information required in the National Minimum Standards to prospective residents, their families and funding authorities about the services that the home provides. All resident`s relatives or solicitors are given a clearly written contract and financial agreement detailing the terms and conditions of residency at the home, although this lacks some information about complaints. The manager or deputy manager assessed all residents before they were admitted to the home to ensure that the home could meet their assessed needs. Prospective residents had the opportunity to visit the home or meet staff wherever they are living before making a decision about residency. Residents are encouraged to maintain contact with their families, friends and representatives and they are made welcome into the home by staff. They are informed of their rights to access information held about them by the home and are able to bring personal possessions into the home by arrangement on admission. The catering staff ensure that all residents have a cake on their birthday and special party teas have also been provided on request with relatives being invited into the home to share that occasion. The cook endeavours to provide home cooked meals including cakes and puddings. POVA First checks were in place on all staff files checked. Staff spoken to said they were supported and encouraged to attend training courses and that the home paid them to attend and also paid the course fees. The training matrix showed that several staff had attended training courses in 2005 on various topics including abuse, continence care, infection control and dementia awareness. An NVQ training programme was in place and 31% of staff had qualified to NVQ level 2 or above so far. Residents` financial interests were partially safeguarded by the home and supported by good recordkeeping. The home has adequate insurance and accounting procedures in place. Records were stored securely in the nurses` office. The majority of staff has undertaken training in infection control.

What has improved since the last inspection?

What the care home could do better:

The statement of purpose required minor revision to meet the National Minimum Standards. The home`s brochure should be amended to provide up to date information about the home. A service users guide written in plain English must be developed to provide information for prospective residents and their families/representatives. The contract required minor amendment to the information about complaints to ensure that complainants are made aware that they are able to contact the Commission for Social Care Inspection at any stage of a complaint. Whilst the contract stated what room the resident was to occupy during the inspection two residents had been moved to temporary alternative rooms without discussion, knowledge or consent of their relatives. The home must consult with residents and their families/representatives if there is any planned or unplanned move to another private room. The pre admission document should be amended to include all the topics detailed in standard 3.3 of the Care Homes for Older People National Minimum Standards to ensure that all aspects of prospective residents care, social and health needs are assessed and can be met by the home prior to admission. The registered person must provide specialist information and clinical guidance to staff on the care of older people, dementia and other physical conditions so as to meet the assessed needs of residents currently living at the home. Systems must be developed systems to ensure that all staff are familiar with residents care plans and are able to demonstrate how residents assessed needs will be met. Residents, relatives and representatives must be involved in the care planning and review process and care plans updated regularly as necessary to reflect current needs. Systems must be developed and put in place to monitor and record the fluid and food intake of residents at nutritional risk. Care plans should detail residents pressure care needs and positional change charts completed to record pressure relief care given to those at risk of developing pressure sores. The inspectors observed during all the visits that many of the residents were unkempt and had a dishevelled appearance, with an inadequate supply of personal toiletries and a lack of attention by staff to their personal hygiene.Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 8The term bedrails should be adopted as more appropriate than `cot sides` when caring for adults. Risk assessments for bedrails should be reviewed and updated regularly. Residents must have access to all national healthcare professionals such as dentists and opticians regularly to ensure that their health needs are met. The home must develop a programme of stimulating and appropriate activities within and outside the home suitable for the needs of residents and give very serious consideration to employing a designated activities coordinator to ensure that residents` social needs are met. The registered person must ensure that the catering staff are provided with accredited training and research and reference material on the dietary needs of older people with dementia to enable them to provide a healthy balanced diet to meet the assessed needs of residents. The menu should be reviewed to reflect seasonal changes. Communication between care staff and catering staff must improve to ensure that residents` dietary needs are properly assessed and met to reduce the risk of weight loss and associated problems. The home should promote the rights of residents and their relatives/representatives to access local advocacy service if they wish to obtain independent advice and support. The complaints procedure must have a clear statement to direct the complainants that they are able to contact the Commission for Social Care Inspection at any stage of a complaint. Polices and procedures on restraint and managing physical and verbal aggression must be developed and training on challenging behaviour provided for all staff. Furniture must be provided in all areas of the home that is suitable and that residents who are able to get up at will without assistance have the freedom to do so. The finance policy should make clear that staff should not accept gifts from residents or assist with the making of or benefit from residents wills. A planned programme of maintenance and renewal must be in place and furnishings and fittings must be of reasonable quality. Residents must be given the opportunity to move from shared rooms to a single room if one becomes available. Lighting in all areas must be on at all times throughout the day and sufficiently bright. Sufficient equipment for moving and handling and bathing must be provided. The laundry floor should be readily cleanable to reduce the risk of infection and instructions for staff on infection control and how to use the laundry equipment should be available. Bins provided in the laundry should be foot operated, lined and covered.The home must ensu

CARE HOMES FOR OLDER PEOPLE Suddon House Nursing & Residential Home West Hill Wincanton Somerset BA9 8BP Lead Inspector Sue Hale Announced Inspection 10.00a 10 & 11th January 2006 th 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.V277886.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.V277886.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.V277886.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. 21st June 2005 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.V277886.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced and took place over the course of two days. One inspector and a regulation manager undertook the first day’s inspection; one inspector, a regulation manager and the pharmacy inspector undertook the second day’s inspection. The inspectors spoke to the registered person, several members of staff, several residents and visitors to the home. The inspectors examined the personal files in detail of four residents and three recently employed members of staff. Policies and procedures and other documents related to the running of the home were examined. Monitoring visits to the home were undertaken on the 19th of December 2005, 22nd of December 2005 and the 30th of December 2005. This report contains findings and observations made on the 30th December 2005. During the period in which the additional monitoring visits referred to above have taken place, enforcement notices have been issued in relation to the risk of entrapment presented by bed rails, the failure of the call system to work effectively and a failure to provide adequate personal care. The National Minimum Standards were introduced in 2002 and providers of care services have therefore had three years to work towards meeting or exceeding those standards. It was of very serious concern that three years after the introduction of the standards so many requirements were identified, the majority of which were related to basic care of older people. Two meetings have been held with the directors of the home and they are making efforts to work towards addressing the outstanding requirements and recommendations. What the service does well: The home produces a clearly written statement of purpose that gives some of the information required in the National Minimum Standards to prospective residents, their families and funding authorities about the services that the home provides. All resident’s relatives or solicitors are given a clearly written contract and financial agreement detailing the terms and conditions of residency at the home, although this lacks some information about complaints. Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 6 The manager or deputy manager assessed all residents before they were admitted to the home to ensure that the home could meet their assessed needs. Prospective residents had the opportunity to visit the home or meet staff wherever they are living before making a decision about residency. Residents are encouraged to maintain contact with their families, friends and representatives and they are made welcome into the home by staff. They are informed of their rights to access information held about them by the home and are able to bring personal possessions into the home by arrangement on admission. The catering staff ensure that all residents have a cake on their birthday and special party teas have also been provided on request with relatives being invited into the home to share that occasion. The cook endeavours to provide home cooked meals including cakes and puddings. POVA First checks were in place on all staff files checked. Staff spoken to said they were supported and encouraged to attend training courses and that the home paid them to attend and also paid the course fees. The training matrix showed that several staff had attended training courses in 2005 on various topics including abuse, continence care, infection control and dementia awareness. An NVQ training programme was in place and 31 of staff had qualified to NVQ level 2 or above so far. Residents’ financial interests were partially safeguarded by the home and supported by good recordkeeping. The home has adequate insurance and accounting procedures in place. Records were stored securely in the nurses’ office. The majority of staff has undertaken training in infection control. What has improved since the last inspection? The way in which beds are made and the quantity and quality of bedding has improved since the 19th December 2005. The majority of radiators in residents’ rooms are now working. As recommended in the previous report all chemicals are now stored securely, all high risk areas are kept locked. The flowing hot water temperature in the water outlet tap identified in the immediate requirement given on the 22nd December 2005 has had thermostatic regulators, appropriate valves fitted and hot water now flows at or near 43°C. Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 7 Residents’ monies held for safekeeping is kept individually as recommended in the last report. All bedrooms had locks fitted and access to the staff accommodation was locked as required in the previous report at the time of this inspection. What they could do better: The statement of purpose required minor revision to meet the National Minimum Standards. The home’s brochure should be amended to provide up to date information about the home. A service users guide written in plain English must be developed to provide information for prospective residents and their families/representatives. The contract required minor amendment to the information about complaints to ensure that complainants are made aware that they are able to contact the Commission for Social Care Inspection at any stage of a complaint. Whilst the contract stated what room the resident was to occupy during the inspection two residents had been moved to temporary alternative rooms without discussion, knowledge or consent of their relatives. The home must consult with residents and their families/representatives if there is any planned or unplanned move to another private room. The pre admission document should be amended to include all the topics detailed in standard 3.3 of the Care Homes for Older People National Minimum Standards to ensure that all aspects of prospective residents care, social and health needs are assessed and can be met by the home prior to admission. The registered person must provide specialist information and clinical guidance to staff on the care of older people, dementia and other physical conditions so as to meet the assessed needs of residents currently living at the home. Systems must be developed systems to ensure that all staff are familiar with residents care plans and are able to demonstrate how residents assessed needs will be met. Residents, relatives and representatives must be involved in the care planning and review process and care plans updated regularly as necessary to reflect current needs. Systems must be developed and put in place to monitor and record the fluid and food intake of residents at nutritional risk. Care plans should detail residents pressure care needs and positional change charts completed to record pressure relief care given to those at risk of developing pressure sores. The inspectors observed during all the visits that many of the residents were unkempt and had a dishevelled appearance, with an inadequate supply of personal toiletries and a lack of attention by staff to their personal hygiene. Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 8 The term bedrails should be adopted as more appropriate than ‘cot sides’ when caring for adults. Risk assessments for bedrails should be reviewed and updated regularly. Residents must have access to all national healthcare professionals such as dentists and opticians regularly to ensure that their health needs are met. The home must develop a programme of stimulating and appropriate activities within and outside the home suitable for the needs of residents and give very serious consideration to employing a designated activities coordinator to ensure that residents’ social needs are met. The registered person must ensure that the catering staff are provided with accredited training and research and reference material on the dietary needs of older people with dementia to enable them to provide a healthy balanced diet to meet the assessed needs of residents. The menu should be reviewed to reflect seasonal changes. Communication between care staff and catering staff must improve to ensure that residents’ dietary needs are properly assessed and met to reduce the risk of weight loss and associated problems. The home should promote the rights of residents and their relatives/representatives to access local advocacy service if they wish to obtain independent advice and support. The complaints procedure must have a clear statement to direct the complainants that they are able to contact the Commission for Social Care Inspection at any stage of a complaint. Polices and procedures on restraint and managing physical and verbal aggression must be developed and training on challenging behaviour provided for all staff. Furniture must be provided in all areas of the home that is suitable and that residents who are able to get up at will without assistance have the freedom to do so. The finance policy should make clear that staff should not accept gifts from residents or assist with the making of or benefit from residents wills. A planned programme of maintenance and renewal must be in place and furnishings and fittings must be of reasonable quality. Residents must be given the opportunity to move from shared rooms to a single room if one becomes available. Lighting in all areas must be on at all times throughout the day and sufficiently bright. Sufficient equipment for moving and handling and bathing must be provided. The laundry floor should be readily cleanable to reduce the risk of infection and instructions for staff on infection control and how to use the laundry equipment should be available. Bins provided in the laundry should be foot operated, lined and covered. Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 9 The home must ensure that suitably qualified catering staff is employed at all times and available to supervise trainees to ensure that the quality of food served is maintained and the appropriate recording and other tasks in the kitchen are completed. The home must ensure that newly qualified staff is offered appropriate advice and support and that staff left in charge of the home are suitably qualified and experienced. The acting manager should be allocated supernumerary hours to ensure that the home is well managed and that there is sufficient time to complete management tasks. The homes recruitment and selection process must be improved, standard interview questions should be developed to ensure that the homes equal opportunities policy is adhered to and records kept of interviews. Recent photographs of staff and evidence of qualifications claimed kept on their staff file. Records of satisfactory CRB enhanced disclosures should be kept on staff files to ensure the protection of residents. The home’s application form and reference request form need amending to ensure they are in line with current good practice. The home must ensure that a structured induction programme that meets Skills for Care standards is in place for all new members of staff and completed within six weeks of the commencement of employment. The home must increase the number of care staff qualified to NVQ level 2 or above to ensure that the staff team is qualified to provide a good standard of care. The home must establish systems to monitor the quality of care provided and seek the views of stakeholders, including relatives, and collate the results. These should be included in the service user guide. The registered person must conduct regular monitoring visits and produce a record of such visits and share this information with the acting manager and the Commission for Social Care Inspection as required by Regulation 26 of the Care Standards Act 2001. A formal supervision policy must be developed to include all the recommended topics to ensure that all staff are formally supervised to ensure that their practice is appropriate and to a good standard. The home must provide the Commission for Social Care Inspection with an up to date business and finance plan. In view of the complex needs of residents accommodated at the home daily records should be kept of their health, welfare, personal care and nursing delivered by staff. Personal information about residents should be kept on their individual file not collectively, in line with the requirements of the Data Protection Act 1998. Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 10 Polices and procedures must be produced along with risk assessments on safe working practices to ensure the safety of staff and residents. All staff must undertake training in fire safety and the fire risk assessment of the premises must be up dated. Equipment used at the home by staff and residents such as hoists and portable appliances must be properly maintained and serviced to ensure that they are safe for use. All relevant certificates such as hard wiring must be obtained to ensure that the premises are safe for residents. Adequate supplies of accident books should be available to ensure that they do not run out. Staff should record any treatment given after an accident had occurred. Up to date infection control policies and procedures must be developed to ensure that suitable arrangements are in place to prevent risks to the health of residents and staff. Adequate arrangements should be put in place to reduce the risk of Legionella. A call system that staff are familiar with and suitable for the needs of residents must be in place and regularly checked and serviced to ensure that it works. All staff should receive mandatory training in manual handling to ensure that residents are assisted with moving and handling in a safe manner. 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.V277886.R01.S.doc Version 5.1 Page 11 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.V277886.R01.S.doc Version 5.1 Page 12 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. (Standard 6 is not applicable to this service) A statement of purpose was available, although it did not contain all the required information, and gave details about the services offered at the home. A service user guide was not available. All residents have a financial agreement and contract detailing the terms and conditions of their stay at the home, this required minor amendment to the information about complaints. All residents were assessed by a qualified member of staff prior to moving into the home but the assessment did not cover all the recommended topics. The home offers a specialist service to residents with dementia but relevant clinical guidance and information on the care of older people, dementia and other physical conditions such as multiple sclerosis was not available for staff. Prospective residents and their families are able to visit the home and meet staff before making a decision about residency. Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 13 EVIDENCE: The home produces a written statement of purpose, which is given with a brochure to prospective residents and their families on enquiry. The statement of purpose does not contain all the information required in the national minimum standards and whilst it refers to the homes service user guide this document was not available and staff spoken to were unaware if one had been produced. The homes brochure did not contain all the information required to be included in a service user guide and needed to be updated. All residents are given a financial agreement and a contract of the terms and conditions of residency at the home after the four-week trial period and some of these were seen on residents files checked with evidence that others had been sent to relatives and solicitors but not returned. The contract required minor amendment. The room that was to be occupied by the resident was identified but two residents had been moved to another room on a temporary basis without the knowledge or consent of their relatives or representatives. In one case this had meant a resident moving into a room that was already occupied. There had been no discussion with the resident or their relatives as to their feelings or consent to this. In both cases residents’ clothing had not been moved into the temporary rooms and in one case was seen to be strewn on top of the bed in the resident’s own room. The statement of purpose states that prospective residents are assessed by a manager or in their absence by the deputy manager to see if their care needs can be met by the home before they are admitted and these were in place on residents files checked. The home uses a pre admission assessment document that did not cover all the topics detailed in standard 3.3 of the Care Homes for Older People national minimum standards. There was no evidence on residents files checked or by observation of the daily routine of the home over a period covering five separate visits to the home that the registered person is able to demonstrate the homes capacity to meet residents assessed needs. There was no evidence from observation of materials available to staff and in discussion with them (staff) that the registered person provided staff with information on specialist or clinical guidance in relation to the care of older people with dementia and /or other physical conditions such as diabetes, and multiple sclerosis. A training matrix completed in November 2005 was checked that showed that many staff had not completed mandatory or specialist training that would be required to give them the skills and experience to deliver the services that the home offers. However, some staff spoken to said whilst they did not have Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 14 access to reference material they were supported to attend training course paid for by the home. The statement of purpose advises and encourages prospective residents and their relatives to visit the home before making a decision about residency. Due to the specialist nature of the care required by prospective residents it would not be possible for them all to visit the home before admission so the manager or deputy visits them at their own home, or wherever they are living whenever possible, to meet them before they enter the home. The statement of purpose states that admissions are only arranged following assessment so emergency admissions would not be undertaken. Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 15 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. The care planning and review system does not include residents and their relatives and does not meet the standard expected of a home caring for vulnerable adults. Medication management in the home has improved although there are areas of practice that have the potential to place residents at risk of harm. EVIDENCE: All residents personal files checked had a care plan, however the amount of detail in them varied and none covered all the topics recommended in the Care Homes for Older People National Minimum Standards to ensure that all of residents health, care and social needs are fully met. None of the staff spoken to were fully aware of the detail in the care plans case tracked, for example, two care plans detailed that the residents were at nutritional risk and noted that regular snacks between meals should be given. This had not been done and care and catering staff were unaware of this assessed need. Care plans checked contained information noting that residents’ weights should be regularly checked but this had not always been undertaken. Some residents Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 16 were nursed and cared for in bed, positional change charts were checked and whilst care plans detailed that positional changes should take place 2/3 hourly there was no written evidence that this had been carried out by staff. There was no record of fluid/ food intake kept for residents who are nursed or cared for in bed to ensure that they received sufficient fluid or food to ensure that their assessed nutritional needs are met. Whilst there was some evidence of reviews, care plans had not been updated to reflect current needs. There was no evidence that residents and relatives/representatives had been involved in the care planning or review process. A system was in place to ensure that all residents had a toilet bag kept in the communal bathrooms. Not all toiletries had been returned to the bags after use and were on shelving (some unlabeled) or in residents’ rooms. The inspectors checked toilet bags and the majority did not contain a sufficient range of toiletries to meet residents needs including toothpaste and toothbrushes. Steradent was seen to be available and accessible by residents presenting a risk of ingestion by residents. Throughout the visits inspectors observed that many residents were unkempt, their hair appeared greasy, unwashed and in some cases had not been brushed or combed. The inspectors observed hairbrushes, combs, razors both disposable and electric and toothbrushes in communal bathrooms that were unlabelled and in many cases dirty and unfit for use. There was very little written evidence on any care plans checked that staff maintained residents’ personal hygiene, and no evidence that residents oral hygiene was maintained. On six resident’s files checked over a period of 5 weeks there was only one record that residents had been assisted to have a bath or shower. Pressure mattresses and cushions were provided for those at risk of developing pressure sores. However, some staff spoken to was unaware of how to accurately assess for appropriate equipment and no reference material was available to them to check if the equipment provided was appropriate for the individual. One member of staff spoken to said that district nurses were often asked to undertake assessments for pressure care equipment. Risk assessments in relation to bed rails were in place on files checked but these lacked detail and on one file contradicted information recorded in a later risk assessment of pressure equipment provided. The training matrix indicated that 12 members of staff had completed training on continence care and a member of staff spoken to said that they were aware of good practice and that a toileting programme was in place for some resident’s, although this was not recorded on individual care plans checked and there was no reference materials for staff on the management of continence. Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 17 Staff spoken to said that an optician did not visit the home and that residents only had optical checks if they wore glasses on admission. Staff also stated that residents did not see a dentist regularly but that arrangements were made if a resident was experiencing dental problems. Records were seen that indicated that residents saw the chiropodist but it was noted that these were kept communally and not in residents individual files. All resident were registered at a local GP practice and a GP spoken to during the inspection said that they had no concerns about the quality of care offered at the home, although there were significant differences in the validity of ‘home’ visits requested by different staff and some were thought to be unnecessary. Medication was seen to be stored securely in the medication room. An up to date medicines reference source is available in the medication room. Hand written entries on the Medication Administration Record (MAR) charts were mostly signed by two people although many of them were not dated. Application of creams is not recorded on the MAR charts and for those residents who have charts within their car files to record the application of creams these are often incomplete and do not always record the name of the person to whom the cream is to be applied or the name of the cream being applied. Although there is a “Homely remedies” list signed recently by the GP there is not a complete record for the receipt of these medicines into the home and some products in this container had evidence of having had the dispensing labels removed. For those service users prescribed medication to be administered “when required” no clear guidelines were available either with the MAR charts or in the service user’s care plan to indicate when these should be administered. Residents were able to use the homes telephone to make or receive calls with a nominal charge made for outgoing calls. Residents preferred name was recorded in their individual files and was used by staff. A GP spoken to said that some medical visit took place in residents’ own rooms but that others took place in communal areas. Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 18 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 home does not provide stimulating activities suited to the needs of residents. The home encourages residents’ families and representatives to maintain contact. Residents are supported to have some control over their lives and their private environment. The home provides a varied, mainly home made diet but systems to monitor those at nutritional risk are not in place. EVIDENCE: The statement of purpose and brochure state that the home offers a ‘wide range of activities’ however, there is no structured activities in place or a member of staff designated solely to organise and undertake stimulating social activities within and outside the home. During the course of the monitoring and inspection visits the only activity observed to take place was an outing to a local play that was attended by 15 residents. There were no activities programme displayed of any future events within or outside the home. Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 19 On some files checked there was a detailed life history of residents obtained by the key worker talking to the residents’ family and friends, although this did not inform the activities offered or provided to individuals. The inspectors noted that on some residents files checked there was a record of activities these were primarily talking to residents, walking with a resident inside the home and on one occasion shopping. 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. The activities that were recorded had not taken place regularly and on one file the last entry was 24th December 2005. 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. The homes statement of purpose and brochure encourages residents and their representatives to maintain contact and to visit the home whenever possible. The inspectors observed that visitors came to the home throughout the day and were treated with respect by staff and made to feel welcome. 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 would be unable to manage their own financial affairs and families or representatives deal these with. The statement of purpose informs residents’ families/representatives of their rights to access information held about them by the home. There was no information available in the brochure or statement of purpose on how to access local advocacy services. The home has a 4-week rotating menu that changes yearly and is drawn up by the chef. The chef stated that this was currently under review and would be amended in the near future. The chef was unaware of the calorific value of the daily menu or the particular dietary needs of older people with dementia. The chef was unaware of any infection control policies and procedures that may relate to food safety or kitchen routines in the home. Reference material on diet and nutrition was not available to staff. The kitchen was seen to have a good supply of dried, tinned and frozen foods with fresh vegetables available. The chef stated that fruit was not often available as when it has been ordered in any quantity previously it has been unused and thrown away. The home provides three main meals daily with the main cooked meal served at lunchtime and lighter snacks available at teatime. The chef stated that food was available in the kitchen for staff to access to provide residents with supper. The food seen during the monitoring visits and the inspections was nicely presented and looked appetising. The provision for residents who have soft Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 20 diets was less varied and was prepared earlier in the day and reheated which may affect the nutritional content of the meal. The inspectors noted that in two care plans checked it was recorded that the residents weight and dietary intake should be monitored, the care plan recommended that snacks were made available and given to the residents between meals. However, none of the staff spoken to were aware of the specific dietary needs that had been noted and no snacks had been provided by the catering staff as they had not been requested to do so. One residents care plan checked noted that prior to admission that she was a vegetarian, the chef and staff spoken to were unaware of this and the resident had been served meat since her admission. However, a member of staff checked with a colleague and stated that the resident had on occasion requested meat so she was now given meat whenever it was served. There were no records kept of individual residents dietary and fluid intake despite the care plan stating in at least two cases that they were at nutritional risk. The chef told the inspectors that several residents were on soft diets and two residents were on diabetic diets and that sugar free alternatives were available and provided as necessary. There was no record of meals served and the chef was unaware of the requirement to do so in order to be able to monitor residents’ dietary intake. Staff were available to assist with helping residents to eat and drink at mealtimes. Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 21 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 home has a complaints policy but this is not fully detailed in information produced about the home. The home does not promote the rights of residents to access independent advocacy services. The policies and procedures do not protect residents from the risk of abuse. EVIDENCE: The home had a complaints policy and procedure that detailed the timescales in which complaints would be dealt with. The home had received one complaint since the last inspection that had been partly substantiated and resolved with the complainant. The statement of purpose tells readers that residents have the right to access advocacy services but does not include details on how to do this. The home does not have an advocacy policy to give staff information about residents’ rights or details of how to contact local advocacy services, this is despite the vulnerability of residents accommodated at the home due to their impaired mental capacity. The homes adult abuse policy was developed in 2001 and had not been updated in line with current good practice guidelines, it did not give advice or information to staff on what to do if an allegation of abuse was received and a Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 22 member of staff spoken to was unaware of the correct procedure. The home did not have a copy of No Secrets or the Somerset Safeguarding Vulnerable Adults policy. The training matrix showed that up to November 2005 that 16 staff had completed training on adult abuse. The medication policy had been recently amended and was up to date and available in the nurse’s room. All the homes policies and procedures that were available to staff were dated 2001 and did not reflect current good practice advice or the requirements detailed in the Care Homes Regulations 2001 and the National Minimum Standards. The home did not have a policy or procedure in place for staff on how to manage physical and verbal aggression by residents despite the specialist needs of residents accommodated at the home. Staff were not provided with training on managing challenging behaviour. The home did not have a finance policy precluding staff from accepting gifts from residents or precluding them from assisting in or benefiting from residents wills. The home did not have a detailed policy and procedure for staff on the use of physical restraint that included Department of Health guidance. Some residents were observed by inspectors during the visits to be sat on domestic sofas and chairs that were too low and which they could not get out of without assistance from staff. All new staff files checked had POVA checks in place to ensure that staff were suitable to work with vulnerable people. Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 23 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, 21, 22, 23, 24, 25 & 26. The environment is generally shabby with a continued need for improvements in the decor, furnishings fittings. The home does not offer a clean, comfortable environment for residents. Arrangements for bathing are unsatisfactory. The home was generally clean except for the kitchen but several areas of the home had an offensive odour. EVIDENCE: A maintenance log was available in which the ongoing programme of redecoration was recorded, however many entries were noted that insufficient time was available for completion. There is evidence of water ingress in several rooms on walls and ceilings. Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 24 During the monitoring and inspection visits several areas of the home including residents private rooms were noted to need cleaning due to black damp marking and cobwebs particularly in window frames and recesses. The nursing dining room wall was observed to be very dirty with food and drink staining on the walls by the access to the kitchen servery. The call system was tested by the inspectors on several occasions during the 10th and 11th January 2006 and no occasion did the system work correctly. Many residents’ rooms did not have calls systems in place and some residents’ rooms had pull cord systems that could present a risk of strangulation given the particular needs of residents living at the home. The positioning of beds in some residents rooms meant that the call system was not accessible. There was no evidence on residents’ files checked that they had or were able to make a decision to occupy a shared room and this had been made by relatives/representatives. There was no evidence that residents occupying shared rooms were given the opportunity to move to a single room if one became available. In some shared rooms the lighting did not allow for discreet lighting to be provided for an individual should they require care or intervention in the night. The inspectors noted that two residents had been moved to another room on a temporary basis without the knowledge or consent of their relatives or representatives. In one case this had meant a resident moving into a room that was already occupied. There had been no discussion with the resident or their relatives as to their feelings or consent to this. In both cases residents clothing had not been moved into the temporary rooms and in one case was seen to be strewn on top of the bed in the residents’ own room. In one room the resident needed moving and handling equipment and the use of this intruded into the other resident’ space. The positioning of the additional bed also meant that access to the ensuite toilet was not possible for the original occupant of the room (who was able to use this independently). All residents’ private rooms had locks on them that ensured that only staff and individuals could enter their private rooms. Access to the staff accommodation was locked to ensure residents could not enter it unsupervised. All bedrooms have domestic style furniture, some of which is shabby and require replacement due to wear and tear. Some of the furniture in the communal areas was shabby and not suitable for residents needs (please refer to standard 18), one chair was seen to be very worn with the arms ripped and interior padding exposed. Many carpets throughout the home were stained and required cleaning and/or replacement, with carpets in two private rooms being ill fitting and leaving gaps around the room. A number of bins were broken or were not foot-operated, and some residents’ rooms did not have any bins. Paper debris was observed during the visit on the 19th December 2005, Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 25 on top of a resident’s wardrobe (the room had no bin), the debris was still in situ on the 30th December 2005. The quality of bed linen was variable, with some linen and blankets very thin although it was noted that several new quilts had been purchased after the inspection on the 19th and 22nd December 2005 in order to provide residents with sufficient bedding in cold weather. Residents were able to bring in personal possessions within space constraints and able to personalise their rooms, however, some rooms were noted to be quite bare. Adjustable beds were available including a specialist bed, the bed in question had been recalled by the manufacturer and the MHRA in November 2005 but a decision had been made by the previous manager to continue to use it. This was drawn to the attention of staff and the registered person on the 19th December 2005 but it was in use by a resident until the 5th January 2006 following an enforcement notice issued by the Commission for Social Care Inspection. The home has sufficient bathrooms/shower room for residents, however not all are in use or have assistance equipment and on the 30th December 2005 not all were useable. One bathroom/toilet upstairs was being used to store continence pads and the toilet, sink and bath were inaccessible. An immediate requirement was issued on the 22nd December 2005 in relation to water outlet temperatures that were too hot and could present a risk of scalding to staff and residents. During the visits the inspectors did not see any evidence that residents had been assisted to bath or shower. Sluices were provided separately to bathing and shower areas. There were two hoists being used in the home both of which required servicing which was carried out on the 11th January 2006, following which one hoist was taken away for repair. The registered person state that other hoists were available and stored and would be brought over to the home immediately for use by staff. There were insufficient storage areas on the ground floor residential areas and the hoist needed for one resident had to be moved from one end of the home to the other when it was required by staff. Many areas of the home required decorating due to marked walls, paintwork and missing wallpaper. The wallpaper in the staff toilet on the nursing corridor was ripped and dirty, and the flooring in poor condition. Please refer to standard 7 in relation to the use of toilet bags in bathrooms. The home has gardens that are kept tidy and accessible to residents although they are not secure and residents would need to be accompanied by staff to use them safely. Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 26 An environment health officer inspected the home on the 10th December 2006 and a number of requirements and recommendations were made, a further visit will be undertaken by them to check compliance. The fire officer had planned to visit the home on the 16th January 2006. The home has a range of communal rooms available for residents requiring residential care and one large room available for residents requiring nursing care. There are two dining rooms, with some residents having their meals at their chair and some who are bedfast in their private rooms. The lounges and dining rooms have views over the garden and nearby countryside. Lighting is domestic but in many areas is dim and insufficiently bright, it was noted that during the visits several lights, including on the 30th December 2005, a whole section of the upstairs corridors, rooms and bathrooms were not working or the bulbs required replacement. (Staff were unaware of this until it was pointed out by the inspectors). The lighting in corridor areas and the entrance lobby was not always on resulting in several areas of the home being dimly lit. Pipe work is covered but in many areas it has been done in such a way as to significantly restrict the heat flow, there are also several areas of piping exposed that was hot to the touch and where radiator controls had been removed the piping was pointed and could present a risk to residents. The laundry areas of the home were sited so that they were separate from facilities where food is stored prepared and served. The home has three laundry rooms that contain washers and dryers. The washing machines had programmes to wash foul laundry at appropriate temperatures although there were no written instructions in the laundry for staff to follow on how to use the machines or at what temperature to wash items at. The small laundry had an area of flooring that was permeable and could not be adequately cleaned so as to reduce the risk of infection. The main laundry had a hand washing sink available for staff although on some visits there were no towels or soap available and on the 11th January 2006 the sink was dirty and had not been used for some time. There were two bins available in the laundry, one of which had no lid and the other was not lined, neither of which were foot operated. During the monitoring visits on 19th December 2005, 22nd December 2005, 30th December 2005 and the inspections on 10 and 11th of January 2006 several residents’ rooms smelt of urine and on some occasions of faeces, with evidence of faeces on carpets in some residents’ private rooms. Please refer to standard 38 in relation to infection control. Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 27 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. There are sufficient numbers of staff on duty to ensure that residents are kept safe and physical needs are met. The recruitment and selection process at the home does not protect residents. The induction training programme could not be verified, the home provides foundation training. EVIDENCE: Rotas examined showed that the numbers of staff on duty met the guidance of the previous regulator. The inspector noted that a qualified member of staff was undertaking their preceptorship but had been left in charge of the home on several occasions and was working 53 hours a week whilst the acting manager was on leave. The inspectors noted that during the visits qualified staff left in charge of the home had no management experience or training. The rotas for 21st January 2006 did not record any supernumerary time for the acting manager in which to undertake the management of the home. There was one qualified cook and a trainee employed, this had reduced from two trained chefs plus a trainee when a member of staff left but was not replaced. The qualified cook was therefore working long hours and the trainee was left in charge of the kitchen unsupervised on two days a week. Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 28 The inspectors examined the files of three recently employed members of staff. Files contained application forms, two written references, two files contained copies of the homes grievance and disciplinary procedures, two files contained job descriptions and terms and conditions of employment. All new staff files checked had POVA checks in place to ensure that staff were suitable to work with vulnerable people. Staff files did not contain evidence of qualifications stated by applicants on their application form, a recent photograph, evidence of identity, no evidence of induction training or the completion of mandatory training, only one file contained a record that a satisfactory enhanced CRB disclosure had been received. There was no evidence that the home had copies of the General Social Care Council’s code of conducts or that staff had been given their own copies, staff spoken to confirmed that they had not been given copies. There was no evidence on staff files checked that they had undertaken an induction or completed mandatory training. There was no evidence that nurses undertook an induction. The training matrix confirmed that two of the members of staff concerned had not completed any mandatory training or been asked to produce evidence that they had current certificates obtained elsewhere. The member of staff responsible for providing moving and handling training stated that all current members of staff had received training but that confirmation of this and certification was dealt with by the previous manager. The training matrix provided by the home on the day of the inspection confirmed that the other member of staff had competed fire safety and basic food hygiene since starting at the home. There were no training records available other than the matrix and the inspectors were unable to confirm if the training programme provided by the home was to Skills for Care standards. The registered person stated that they were committed to providing good training opportunities for staff and a member of staff spoken to confirmed that they had attended three external training course during the last year and that the home had paid them to attend and also paid the course fees. Evidence was seen in the nurses’ diary that some members of staff were booked to attend a training course on the administration of medicines in January 2006. The training matrix showed that staff had attended various courses in 2005 including dementia awareness, continence care, infection control and abuse. The home employs 7 qualified nurses, 22 carers and 7 domestic staff. The training matrix provided by the home on the day of the inspection showed that 7 staff had achieved NVQ 2 or above with a further one person registered on an NVQ 2 course and four people registered on NVQ 3 courses. The home’s statement of purpose states that the home actively encourages’ all care assistants to achieve NVQ 2 as a minimum’, however, the current numbers of Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 29 qualified staff mean that only 31 of the care staff team are qualified to provide a good standard of care. The inspectors noted that the chef had not undertaken any training in the nutritional needs of older people and that there was no reference material available on the dietary needs of older people particularly those with dementia who are known to be at nutritional risk. Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 30 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): 33, 34, 35, 36, 37, & 38. (31 and 32 were not assessed)_ The home is not managed in the best interest of the residents. The home had financial procedures in place including appropriate insurance cover. Residents’ finances were well managed and their interests safeguarded. Staff did not receive regular supervision of their practice. The health, safety and welfare of residents and staff are not promoted. EVIDENCE: The home had a questionnaire that it used to canvass the opinion of relatives of residents about the quality of the service provided at the home but the Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 31 results were not collated and there had been none received since the last inspection. The views of stakeholders in the community were not sought on the service the home provided. There was no evidence of a development plan for the home based on a cycle of systematic planning. The policies and procedures were dated 2001, were out of date and showed no evidence of having been used regularly. The home has not taken action within agreed timescales to implement requirements made in previous inspection reports. The registered person is not in day to day charge of the home but had not undertaken any visits under Regulation 26 of the Care Homes Regulations 2001 to monitor the standard of care provided at the home. The home had a valid insurance certificate on display and the registered person stated that it included cover for business interruption although the schedule was not available for inspection. The registered person stated that the home had a business and finance plan but that this was not available as it was under review. The home employs external auditors to provide accounting support. The home kept small amounts of some residents’ monies and records relating to three residents were checked and found to be correct. Records were kept on income and expenditure and monies were kept separately. Records and receipts are kept of anything handed over to staff for safekeeping and secure facilities provided for their storage. Residents and staff records are stored securely and the statement of purpose tells residents and their relatives of their rights to see information held about them by the home. The inspectors examined several residents personal files, it was noted that although all files contained a ‘daily record sheet’ these were not consistently completed by day or night staff and there were gaps of several days in some cases where no records had been made about the residents health, welfare or the care given by staff to ensure that resident’s care, health and social needs were met. The inspectors noted that personal and medical information was kept about individual residents in the nurses’ diary and collectively for some recording systems such as chiropody records. There was no record on the two of the three staff files checked that staff received regular formal supervision of their care practice. One qualified member of staff had had an appraisal/supervision in November 2005 a month after starting work at the home. Food Safety/hygiene During the monitoring visit on the 30th December 2005 the inspectors noted that many areas in the kitchen including the tiling were dirty. It was also observed that appliances including the milk dispenser, the hot water dispenser, the underside of the freezer lid and the handles of the upright freezer were Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 32 dirty and required cleaning. The pantry light was missing and the pantry floor covered in water because the back door had been left open when it was raining, the pantry area contained electrical appliances. Two flip top bins containing foodstuffs were dirty and two bins containing foodstuffs were uncovered. On the visit undertaken on the 11th January 2006 it was noted that the kitchen had been cleaned, bins replaced and the light fitting in the pantry was working. There was no record of temperature check of fridges or freezers and the chef said that he was unaware of the need to do this until advised by an environment health officer on the 10th January 2006. The chef stated that food temperatures were checked before food was served but this was not recorded so could not be verified. The inspectors observed that some food stored in the fridge was not labelled and dated to ensure that it was discarded within appropriate timescales if not used. Food was also stored incorrectly in the fridge presenting a possible risk of food poisoning risk. Fire safety On the visit undertaken on the 30th December 2005 it was noted that the fire extinguishers had not been serviced, one in the small laundry since 2002. The extinguishers were being serviced during the inspection on 11th January 2006. The training matrix supplied by the home showed that six members of staff had not undertaken fire safety training. The homes fire safety risk assessment was dated 7th July 2004 and stated that it should be reviewed yearly. The fire pack available in the office contained out of date information about residents and staff. It contained information about the location of water stopcocks, listed electrical boxes and the location of oil and gas tanks. There was no evidence that regular up to date checks were made of the fire alarms, the last recorded check was 4th November 2005 in the nursing hallway and the 24th August 2005 in the residential hallway. There was no evidence that the fire alarm had been serviced recently and the administrator made arrangements during the inspection visit for this to take place on 16th January 2006. Call systems The call system was tested by the inspectors on several occasions during the 10th and 11th of January 2006 and no occasion did the system work correctly. Many residents’ rooms did not have calls systems in place and some residents’ Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 33 rooms had pull cord systems that could present a risk of strangulation given the particular needs of residents living at the home. The positioning of beds in some residents rooms meant that the call system was not accessible. Infection Control The home had a policy on infection control but it was noted that it was incomplete (pages missing), lacked detail and was not up to date. The training matrix showed that 24 staff had competed training in infection control. First Aid There was first aid box prominently sited and available to staff. Radiator/room temperatures The temperatures of rooms varied and in some cases radiators were not on and rooms were very cold. Immediate requirements to improve the temperatures were given on the 19th December 2005 and some improvements were noted on subsequent visits. However, not all the radiators at the home seem to work at the same time and some bathrooms and corridor areas remain cold. At the visit on the 19th and 22nd December 2005 the bedding in residents’ rooms was insufficient for the needs of the residents and immediate requirements were given to rectify this. It was noted on the visit on 30th December 2005 that more bedding had been purchased, and spare bedding used to make sure that residents were warm enough when in bed. Wheelchairs/Moving and handling/Electronic scales All wheelchairs had been recently serviced but were all due to be returned to the maintenance centre despite advice given to staff wheelchairs were being used without footplates. It had been decided that pins would be fitted to chairs to prevent the removal of footplates due to the risk of injury to residents. The member of staff nominated to take responsibility for undertaking moving and handling training stated that all current staff had completed training course and had up to date certificates, however, this could not be verified via training records. It was recorded in the staff meeting minutes of the 14th October 2005 that some staff had been moving residents using the hoist on their own contrary to good moving and handling requirements. Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 34 Hoists The bath hoist was due for service on August2005 but this had not been carried out. The two mobile hoists were serviced on the day of the inspection (11th January 2006) and one was taken away for maintenance work to be carried out. The registered person stated that there were other hoists that had current service certificates available and these would be moved to the home. Water temperature The water outlet on the baths, showers and sinks were not checked regularly to ensure that water was delivered at or near to 43° to reduce the risk of scalding. The water temperature in one outlet was found to be 66° on the visit of 22nd December 2005 and an immediate requirement given to ensure the registered person took action to reduce the risk of scalding to residents and staff. Electrical safety The hard wiring certificate was not available but was thought by the administrator to have been issued in 2001. However, on checking records at CSCI it was noted that this was undertaken in 2002. There was no current PAT testing certificate available, the administrator made arrangements for this to be undertaken on 16th January 2006. COSSH Information was available in the office on cleaning products used in the home. There was no information available or risk assessments on safe working practices for staff to follow to ensure that they followed appropriate health and safety advice. Accident book The accident book was readily available for staff in the nurses’ office. Entries were not completed sequentially. Some accidents had been recorded on loose sheets of paper during a period where the home did not have as supply of accident books. Entries in the accident book were checked with entries in residents’ files that were being case tracked, and it was evident that not all entries recorded treatment given when accidents had occurred. Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 35 Window restrictors There were restrictors in place on the majority but not all of the windows in residents’ private rooms. Equipment servicing There were records to show that the lift, and boilers had been serviced. Legionella There was no evidence that Legionella testing or sampling been undertaken. The administrator arranged during the inspection for this to be undertaken on the 20th January 2006. Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 36 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 2 2 1 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 1 18 1 1 2 2 1 2 2 1 1 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 2 3 1 2 1 Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 37 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)(c), 6 Schedule 1 (2)(3)(14) (16) Requirement Timescale for action 28/02/06 2 OP1 3 OP2OP23 5(1)(2), 6, Schedule (4)(2) 12(4)(a) 4 OP4 12(1) The statement of purpose must contain: - the relevant qualifications and experience of the registered provider. - the size of all rooms in the home. - the complaints procedure. - the qualifications held by staff working at the home. The registered person must 28/02/06 ensure that a service users guide is developed that meets the Care Home Regulations 2001. The registered person must 28/02/06 consult with residents and their relatives/representatives if changes to private accommodation is proposed or made. They must ensure that if residents move to another room even if this is temporarily, that their clothing is taken with them. The registered person must 28/02/06 provide relevant specialist and clinical guidance for staff on conditions related to ageing, dementia and other physical conditions. DS0000003292.V277886.R01.S.doc Version 5.1 Suddon House Nursing & Residential Home Page 38 5 OP7 12(1)(4) 6 OP7 13(4)(c) 7 OP7 15(2)(b) (c) 8 OP7 12(1), 16 (2)(i) 9 OP7OP8 12(1) 10 OP8 12(1) 13(1) 18(1)(a) (c)(i) 11 OP8 The registered person must ensure that the care plans set out in detail the action to be taken by staff to meet residents assessed needs. The registered person must ensure that all staff is familiar with individual residents assessed needs. (Previous timescale of 30/08/05 not met). The registered person must ensure that all residents have a risk assessment in relation to falls on admission and as necessary thereafter. (Previous timescale of 30/08/05 not met). The registered person must ensure that all care plans are reviewed regularly and updated as necessary. This should be undertaken with residents and their relatives /representatives. (Previous timescale of 30/08/05 not met). The registered person must ensure that fluid /food intake charts are in place and completed for all residents assessed to be at nutritional risk. This is to ensure accurate monitoring of this identified care need. The registered person must ensure that positional change charts are in place and completed for all residents who are cared for in bed and at risk of pressure sores to ensure accurate monitoring of this care provision. The registered person must ensure that all residents have access to an optician and dentist regularly. The registered person must ensure that staff is trained in how to asses for the risk of pressure damage, what type of DS0000003292.V277886.R01.S.doc 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 Suddon House Nursing & Residential Home Version 5.1 Page 39 12 OP8 13(4)(c) 15(1)(2) (b) 13 OP9 13(2) 14 OP10 12(4)(a) 15 OP12 16(3) 16 OP12 16(2)(m) (n) 17 OP15 12(1)(a), 16(2)(i), 18(1)(a) 18 OP15 Schedule 4(13) equipment to use to reduce risk and how to use the equipment. The registered person must ensure that risk assessments for bedrails are reviewed and updated regularly and that all action indicated by these assessments is carried out promptly. (Previous timescale of 30/09/05 not met). The registered person must ensure that arrangements for the recording, handling, safekeeping and safe administration of medicines is made. The registered person should ensure that all health and medical visits and treatment take place in residents’ own rooms or in a private room designated for this purpose. The registered person must ensure that residents’ wishes in relation to religious observation are ascertained and arrangements made accordingly for them to do so. Staff must be familiar with this to ensure residents’ needs are met. The registered person must ensure that a stimulating programme of activities suitable for the needs of the residents is put in place. The registered person must ensure that reference materials are available on the dietary needs of residents currently accommodated at the home to ensure that the menu meets their nutritional needs. They must ensure that the care and catering staff is aware of residents assessed nutritional needs and that they are met. The registered person must ensure that records are kept of DS0000003292.V277886.R01.S.doc 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 Page 40 Suddon House Nursing & Residential Home Version 5.1 19 OP18 12(1)(a), 13(6) 20 OP18 13(6-8) 13(4)(c), 18(1)(c) (i) 21 OP18OP20 16(2)(c), 23(2)(h) 22 OP19 23(1)(a) 2(b)(d) 23 OP19 23(2)(b) (d) 23(2)(n) (p) 23(2)(j) 24 OP20 25 OP21 26 OP22 23(2)(l) food provided for residents in sufficient detail as to be able to determine if individual residents diets are satisfactory. The registered person must develop a robust abuse awareness and protection policy and procedure that reflects the guidance in ‘No Secrets’ and the Somerset Multi Agency ‘Safeguarding Vulnerable Adults’ policy, and gives clear guidance to staff on what to do should an allegation be received. The registered person must develop policies and procedures on the use of restraint and managing verbal and physical aggression. The registered person must also ensure staff are trained in managing challenging behaviour. The registered person must ensure that furniture provided for seating in communal areas is appropriate for the needs of the residents and does not restrict their movement. The registered person must ensure that the home is well maintained and provides a safe and comfortable environment for residents. The registered person must ensure that a planned programme of maintenance and renewal is in place. The registered person must ensure that sufficiently bright lighting is provided at all times in all areas including corridors. The registered person must ensure that all bathrooms are fit for use and not used as additional storage areas for other items e.g. bulk quantities of continence pads. The registered person must DS0000003292.V277886.R01.S.doc 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 Page 41 Suddon House Nursing & Residential Home Version 5.1 27 OP22 16(1)(2) (c), 23(2)(n) 28 OP23 12(1)(a) (b) 23(1)(a) (2)(e)(f) 23(1)(a) (2)(e)(f) 29 OP23 30 OP23 12(1)(a) (b) 23(1)(2) (a) 31 OP24 12(1) 32 OP26 16(2)(k) 33 OP26 13(3) ensure that adequate storage facilities are provided in the residential ‘wing’. The registered person must ensure that an adequate number of hoists and assisted bathing equipment is available for use in the home to meet the assessed needs of the service users. The registered person must ensure that all residents occupying shared rooms are given the opportunity to move into single accommodation if the opportunity arises. The registered person must ensure that residents sharing a room can individually have their needs met by doing so, or are making a positive choice. This refers to the need for individual access to en-suite facilities and the provision of low-level lighting to reduce disturbance to service users during the night. The registered person must ensure that in shared rooms the layout ensures that there is room for access for staff and any necessary equipment. They must assess each shared room to ensure that it is suitable and provides sufficient lighting and screening to provide residents with individual privacy and dignity. The registered persons must ensure that requirements, recommendations made by equipment manufacturers and the MHRA is adhered to. The registered person must ensure that all areas of the care home are free from offensive odours. The registered person must ensure that the floor of the small laundry is readily cleanable. DS0000003292.V277886.R01.S.doc 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 Suddon House Nursing & Residential Home Version 5.1 Page 42 34 OP27 18(1)(a) (2) 35 OP27 18(1)(c) (i) 36 OP27 18(1)(a) 37 OP28 18(1)(a) 38 OP29 19(1)(c) Schedule 2 (1) (4) (7) 18(1)(a) (c)(i) 39 OP15OP30 40 OP33 24(1-3) 41 OP33 24(1-3) 25(1)(2) (a, c) Foot operated flip top bins must be available in all areas where personal care and laundry is provided. (Previous timescale of 30/09/05 not met). The registered person must ensure that suitability qualified catering staff are employed at all times to provide supervision for catering trainees. The registered person must ensure that all qualified staff left in charge of the home are suitably qualified and experienced. The registered person must ensure that the acting manager is supernumerary to the number of qualified staff on the rota. The registered person must ensure that at least 50 of care staff are qualified to NVQ level 2 or above. The registered person must ensure that when employing staff all documentation is obtained and verified if required to do so by the regulations. The registered person must ensure that the chef is qualified to provide a balanced diet that meets the need of residents accommodated at the home. The registered person must establish and maintain systems for reviewing and improving the quality of care provided at the home and supply to the Commission for Social Care Inspection a copy of the report. The registered person must produce a development plan for the home based on a systematic cycle of planning. They must also produce and send to the Commission for Social Care Inspection an up to date business and financial plan. DS0000003292.V277886.R01.S.doc 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 Suddon House Nursing & Residential Home Version 5.1 Page 43 42 OP33 12(1)(a) 24(1-3) 43 OP33 10(1) 12(1)(a) (b) 44 OP33 10(1-2), 12(1)(a) (b) 26(1)(3) (4)(5) 45 OP33 46 OP36 18(2) 47 OP37 17(1-3) Schedule 3((k)(m) 13(4)(c) 48 OP38 49 OP38 13(4)(b) (c), 23(2)(c) 50 OP38 18(1)(c) (i) The registered person must seek the views of residents’ families, friends and stakeholders in the community about the quality of the service provided. The registered person must ensure that relevant up to date policies and procedures are in place for staff reference and training, and that these are reviewed and updated regularly. The registered person must ensure that action is progressed by the home on requirements identified in CSCI reports. The registered person must undertake formal monthly visits to the home in accordance with this regulation and a written report of these visits must be supplied to the Commission for Social Care Inspection. The registered person must ensure that all staff receives regular formal supervision of their care practice. The registered person must ensure that daily records are made of each resident’s health; care and social care needs and how these have been met. The registered person must ensure that the fire risk assessment is updated to comply with the requirements of Somerset Fire and Rescue Service. The registered person must ensure that all equipment at the home is properly maintained and serviced, including the call system and fire alarm. They must also ensure that all portable electrical appliances are serviced at the required intervals and are safe for use. The registered person must ensure that all staff receives DS0000003292.V277886.R01.S.doc 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 Page 44 Suddon House Nursing & Residential Home Version 5.1 51 OP38 12(1), 13(4)(c) 52 OP15OP38 12(1) 13(4)(c) 53 OP26OP38 13(3) 54 OP22OP38 12(1), 13(4)(c) 23(2)(c) 55 OP38 13(4)(c) (5) 56 OP38 13(3)(4) 23(4) 57 OP38 13(4) 58 OP38 13(4) training on fire safety. (Previous timescale of 30/09/05 not met). The registered person must provide a written statement of the policy, organisation and arrangements for maintaining safe working practices. The registered person must ensure that records are kept of temperature checks of food and refrigeration equipment in the kitchen. The registered person must ensure that detailed up to date infection control policies and procedures are developed for staff to use. The registered person must ensure that a working call system suitable for the need of residents accommodated at the home is in place and that staff are familiar with how it works. The registered person must ensure that all staff are trained in moving and handling and updated regularly to maintain their skills and meet the changing needs of the service users. (Previous timescale of 30/10/05 not met). The registered person must ensure that the electronic sit on scales are calibrated annually to ensure that are fit for use. (Previous timescale of 30/09/05 not met). The registered person must ensure that regular checks are made of all water outlets to ensure that hot water temperatures do not exceed 43C in areas accessible to service users and that the legionella checks are completed and up to date. (Previous timescale of 30/09/05 not met). The accident book must be DS0000003292.V277886.R01.S.doc 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 Page 45 Suddon House Nursing & Residential Home Version 5.1 59 OP38 23(1)(a) (2)(b)(c) (p) completed in line with manufacturers recommendations and the Data Protection Act. The heating system at the home must be in full working order at all times and be able to provide a sufficiently high level of heat throughout the home. 28/02/06 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 Refer to Standard OP1 Good Practice Recommendations In view of the care needs of residents accommodated at the home the registered person should reconsider the statement of purpose comment that in regard to alcohol ‘residents will normally make their own arrangements’. The information about complaints in the statement of purpose and residents contracts should make clear that complainants are able to contact the Commission for Social Care Inspection at any stage of a complaint. The pre admission document and care plans should cover all topics detailed in standard 3.3. of the national minimum standards. The registered person should develop an advocacy policy and include the details of how to access local advocacy services. These details should be included in the service users guide, brochure and complaints policy. The term ‘cot sides’ should be replaced by bedrails as more appropriate for an adult care home. Fluid and food intake charts should be kept for residents deemed to be at nutritional risk. It is recommended that when an entry is hand written onto the Medicines Administration Record chart that this is signed and dated by the person making the entry and it is then checked and countersigned by a second person. It is recommended that for all mediations prescribed to be administered “when required” that clear guidelines are available to indicate the prescriber’s instructions and ensure that the service user receives consistent treatment. The registered person should give urgent consideration to DS0000003292.V277886.R01.S.doc Version 5.1 Page 46 2 OP1OP2OP 16 OP3OP7 OP1OP14O P16OP17 3 4 5 6 7 OP8 OP8OP15 OP9 8 OP9 9 OP12 Suddon House Nursing & Residential Home 10 OP15 11 12 OP18 OP18 13 14 15 OP19 OP24 OP26 16 17 18 OP29 OP29 OP29 19 20 OP29 OP29 21 22 OP30 OP2OP33 employing a designated activities organiser. The life histories should be developed for all residents to help develop appropriate activities. The cook should ensure that residents who require a soft diet are offered the same choices and variety as other residents. This should not be reheated. The menu should change at least twice yearly to reflect seasonal changes. The registered person should obtain a copy of the Department of Health’s guidance No Secrets and the Somerset Safeguarding Vulnerable Adults policy. The registered person should develop a finance policy that makes clear to staff that they should not accept gifts from residents and that they should not assist in the making of or benefit from residents wills. The registered person should ensure that the staff toilet on the nursing corridor is redecorated and the flooring replaced. The registered person should undertake an assessment of all bedding to ensure that there is sufficient quantity, and it is of good quality and fit for purpose. The registered person should ensure that written instructions (in appropriate languages) are available for staff in the laundry on how to use the machines and at what temperatures items should be washed. Bins used in the laundry should be lined and covered. All care staff should be given their own copies of the General Social Care Council code of conduct. The staff file checklist should be further developed to cover all the information required in the Care Homes for Older People national minimum standards. The staff application form should be amended to make clear that jobs within the home are exempt from the Rehabilitation of Offenders Act and to make clear that applicants should put their current or last employer as a reference. The homes reference request form should be updated and the request to provide information about known convictions removed. The registered person should develop standard interview questions to ensure equality of opportunity for applicants and keep written records of interviews. The registered person should obtain references from applicant’s current or last employer if at all possible. The registered person should explore any gaps in employment with job applicants and record the findings. An induction programme for nurses should be developed. The results of quality surveys should be published in the service user guide. DS0000003292.V277886.R01.S.doc Version 5.1 Page 47 Suddon House Nursing & Residential Home 23 OP36 24 25 26 27 28 OP8OP37 OP38 OP38 OP38 OP26OP38 A formal supervision policy should be developed. Supervision should cover all the topics detailed in standard 3.3 of the national minimum standards. Formal supervision should take place at least 6 times a year. The registered person should ensure that records are kept in manner that meets the requirements of the Data Protection Act 1998. All opened food and stored food should be dated and labelled. Daily temperature checks should be recorded of the fridges and freezers Risk assessments should be undertaken on all safe working practices. The accident book should be completed in line with manufacturers recommendations. The registered person should ensure an adequate supply of accident books. The registered person should ensure adequate arrangements are in place to reduce the risk of Legionella. Suddon House Nursing & Residential Home DS0000003292.V277886.R01.S.doc Version 5.1 Page 48 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.V277886.R01.S.doc Version 5.1 Page 49 - 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. 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