Inspection on 15/12/06 for Elroi Manor Residential and Nursing Home

This inspection was carried out on 15th December 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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

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

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

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

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

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

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

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

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

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOMES FOR OLDER PEOPLE Suddon House Nursing & Residential Home West Hill Wincanton Somerset BA9 8BP Lead Inspector Stephen Humphreys Unannounced Inspection 15th December 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 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 manager (if applicable) Type of registration No. of places registered (if applicable) 01963 33577 01963 31175 Deverill Holdings Limited Sarah Ambridge 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.V323212.R01.S.doc Version 5.2 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 14 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 43 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. 1st June 2006 Date of last inspection Brief Description of the Service: Suddon House is a care home registered to accommodate and provide personal and nursing care services for up to forty-three service users. Up to thirty-eight over the age of sixty years. Conditions have been agreed to enable up to five persons over the age of fifty years to be admitted depending on their care needs. Suddon house is approximately one mile from Wincanton town centre set in its own grounds with pleasant views onto surrounding farmers fields. The home is approached by a long private drive off the main road in West Hill. The home has two entrances with the main entrance to the front of the property. The second entrance is to the side. There is ample car parking to the front and side of the home. The main entrances are kept locked at all times for security of the home and the service users. There is a bell on the front door for visitors to make staff aware they are there. Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 5 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. Suddon House has a large garden, which is semisecure, with two large patio areas The home provides nursing and personal care for older people with dementia and other mental health needs. Service users have access to all areas of the home. The home provides twenty-four hour nursing care by registered nurse’s who are experienced in mental health and general nursing. Care staff are experienced in delivering personal care. The fees for the service at the time of this inspection are £538.34 - £741.56 per week. Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This is the second key inspection of Suddon House Nursing Home using the Inspecting for Better Lives methodology introduced by the Commission for Social Care Inspection in April 2006. The inspection methodology used by the Commission for Social Care Inspection enables the inspector to make a judgement on the quality of the service delivery based on the outcomes for residents. Two inspectors visited the care home and assessed all of the key older persons national minimum standards and had detailed discussions with residents, staff and the homes manager. The registered provider Mr Oozageer was also in the home and attended the feed back session at the end of the site visit. The trigger for this key inspection was to review the progress made in the delivery of the services to persons with dementia. During the site visit the two inspectors were able to spend time talking to staff and service users. A tour of the home was made and one inspector reviewed the quality of the furnishings in the bedrooms. The inspector was able to have a discussion with two relatives during the day. Lunch was observed along with some care practices and the administration of medicines. The lead inspector for this care home sent out written service user survey questionnaires and comment cards to visiting health care professionals prior to the site visit. The comments received back were very positive about the service delivery and how helpful the manager was to them. Since the last key inspection in June 2006 the registered provider and manager have made considerable changes and improvements to the overall service delivery in this home. The registered provider is working towards more improvements in the next six months. The manager has introduced changes in care practices that have benefited service users. Specific person centred care training has been delivered to staff which was observed during the inspection. The outcome of this inspection was very pleasing and reassuring with measurable benefits to service users. Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? The internal and external environment of the home has been extensively refurbished. The roof to the old part of the home is being replaced. Internally all the corridor carpets have been replaced and all the rooms have been redecorated. New flooring has been put down in the area of the main entrance. New bedding and linen has been purchased along with cutlery and tablecloths. The overall standard of record keeping and care plans has improved. Staff moral has improved along with the integration and quality of care delivery. Residents appeared to be well dressed and clean. Activities have been introduced to provide stimulation and help to maintain resident wellbeing. Care practices observed were based on good dementia care practices. Residents are being offered choices at meal times. The manager has rewritten the statement of purpose and service user guide. The manager has completed three units of the registered manager award. Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4. Quality in this outcome area is adequate. Prospective service users will be provided with a service user guide prior to them entering the care home. Service users will receive a contract that is reflective of the Office of Fair Trading report - guidance on terms and conditions for care homes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager provided the inspector with an up to date and rewritten statement of purpose and service user guide. A copy of both documents was taken away by the inspector to be reviewed. Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 11 The service user guide is not routinely provided to service users in the home. The manager has only recently introduced the practice of providing a copy of the service user guide to prospective service users and relatives. A review of the statement of purpose by the inspector found it to be a detailed document with all the necessary information to meet the national minimum standard. Once the manager finalises the statement of purpose and service user guide they will then be made available in formats suitable to the capabilities of the service users e.g. in large print, on a video / DVD disc or on audio tape. The manager is also proposing to have the service user guide available in each service users room. The inspector reviewed three contracts of private service users and three issued by the social services. The registered provider is currently using the contract issued by the previous owners. The inspector highlighted two conditions in the contract that appeared to be unreasonable and discussed them with the registered provider. The registered provider should revisit the terms & conditions to ensure the contracts reflect the Office of Fair Trading report – guidance on terms and conditions for care homes. The manager has admitted approximately ten new service users in the last four months. The inspectors discussed the referral and assessment of prospective service users with the manager. Referrals were received from social services and private clients. All new residents receive a pre-admission needs based assessment based on the activities of daily living model of care. The inspector was able to review six care plans of recently admitted service users. The care needs assessments were detailed using the activities of daily living model of care however there was no linkage of the care needs to enable a person centred care approach. None of the service users could recall being visited by the manager prior to coming into the home. There was no evidence seen in any service user file that indicates a confirmation from the registered provider that the care home can meet their care needs. The registered provider is encouraged to inform prospective service users in writing their care needs can be met by the home. Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 12 Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. Quality in this outcome area is good. Service users can be assured that they will have a care plan that reflects their care needs. Service users needing palliative care cannot be assured that their care plan will be as comprehensive to identify all the end of life care needs. Service users can be assured they will be treated with respect and dignity at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector reviewed six care plans at this inspection. Three care plans of service users who had recently been admitted into the home and three of service users who required high dependency care. Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 14 The inspector reviewed the three service users needing high dependency care in detail to assess the level of service delivery. The manager has reviewed the care planning process since the last inspection. The manager or her deputy carries out all the pre-admission assessments. The assessments are based on the activities of daily living model of care and include personal care, moving & handling, nutrition and falls assessments. A record of the assessment along with the social workers assessment was filed in the care plan. A detailed plan of care is then made from the identified care needs to make up the care plan. The care plans reviewed showed a big improvement in the standard of recording to make the care plan a working record which clearly benefits the service users well being. Care plans of the recently admitted service users contained all the necessary information including risk of falls and nutritional needs however the personal and nursing care needs were more task orientated than person centred. There was no clear evidence of relative or representative involvement in the development or evaluations of the care plans. Evaluations appeared to be “no change” which is not specifically outcome related. The daily hygiene sheet recorded dates of baths and other personal care tasks. The inspector was able to observe care staff carrying out some of the personal care needs recorded in the care plans. One of the service user care plans reviewed recorded a need for increased fluids however the nutritional assessment did not highlight this need or include a link to the recorded weight loss. The service users fluid charts were completed however there was no clear evidence to show that the registered nurses are using the information to promote person centred care. The benefit to service users of having a person centred care plan is that all the identified needs should be linked with appropriate interventions and outcomes. The manager is encouraged to continue developing person centred care plans. The inspector was able to review in detail three service users who were being nursed in bed due to their frailty. The inspector visited each service user in their room. Each service user was warm and comfortable in new profile beds that are variable height. Each had a pressure relief mattress. Due to their current state of frailty it was difficult to talk to the service users. However one service user was able to say they were comfortable. One service user had a grade 2 pressure sore that was being cared for by the district nurse. Wound care records were checked. There were fluid, intake / Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 15 output charts and position change charts in each of the rooms being completed each time care was given. The inspector found that the care plans of the three service users were lacking in consistency and evaluation of the care needs. As stated above the main shortfall is that the care plans do not link all the care needs together to ensure a holistic approach. There was no evidence to show that the link between the wound, nutritional state and weight loss had been identified with appropriate care and monitoring. Fluids and food are recorded as given, wound care was appropriate and weight loss recorded but there was no evidence to suggest that the nurses had linked all the information together to evaluate the service users current state of wellbeing. Another service user was in need of continuous pain management. This was discussed with the registered nurse in charge. The controlled drugs were checked for this service user and found to be correct. The registered nurse’s followed the prescribed procedure and the dispensed controlled drugs were disposed of correctly. There was no specific pain management care plan. It is good practice to have a risk assessment associated to pain management procedures. There should be a record of the behaviours or expressions used by the service user to communicate to the registered nurse that they are or are not in pain. One of the care plans included a record of a fall. There was a corresponding accident record but no record of any action taken by the manager to indicate the risk assessment had been reviewed with appropriate actions for staff to try and reduce the possibility of the resident having another fall. The inspector discussed palliative care practices and recommended the Gold standards framework be introduced for service users needing high dependency care and pain management. The care plans of the three service users have improved and reflected the current state of the service user but need to be more person centred. During the inspection the registered nurse was observed to administer medication to a service user. The registered nurse appeared to follow the procedure as it was written. The inspector checked the medication policy including the storage, receipt, administration and disposal of the medicines. A random check of service users medications was carried out. All the medications checked were found to be correct against the medicine administration record. Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 16 During the tour of the home the inspectors observed that all service users were well dressed and clean. Staff were observed to speak to service users using their preferred name, as recorded in the care plan. The interactions between staff and service users have greatly improved. Staff were seen to be respectful and providing explanations when assisting the service user. The staff have received training in person centred care and dementia care practices since the last inspection. The inspectors were pleased to observe good dementia care practices have been introduced into the home. As stated above there is a need for the manager to introduce palliative care and recognised end of life care procedures. The inspectors were able to conclude from their observation of care practices and the care plans that the service users were receiving the care they needed however the care plans lacked specific end of life care. Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 – 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, Quality in this outcome area is good. The lifestyle in the home has improved to meet service user expectations. Service users can be assured of homely and nutritious meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager said that the registered provider has provided more money for activities. The activities programme was displayed on the notice board. The inspectors observed a group of service users busy making Christmas cards with the activities co-ordinator during the visit. The hairdresser visits the home and a price list was displayed in the entrance area. The activities co-ordinator records the outcome and benefits of the activity for each service user in their care plan. Six service users recently went to the theatre for entertainment. Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 18 Staff organised a Halloween party this year, which was a big success. The manager also produces a homes newsletter for relatives and service users. Comments from service users included “I am able to take part in all activities and go out and about with friends” The inspector spoke with two relatives during the visit to the home. They were very happy with the improvements the new registered provider has made. They said “the manager is very friendly and approachable”, “ there has been a big improvement in the place”, “I’m pleased that they keep us in touch with what goes on”. The manager has introduced regular relatives meetings, which are fairly well attended. The mealtime procedures have improved. Staff were observed to explain to the service user what they wished to do. The lunch tables were properly laid with condiments and table decorations in the nursing end. Staff were observed to take the plated meal options to the service user and ask them their choice. This is good dementia care practice and benefits the service user because they can see the meal and make an informed choice. A list is displayed for the cook of dietary requirements and other lists for staff of who requires plate guards and assistance. The meals produced appeared wholesome and were liked by the service users. Service user comments on the meals included “The food’s not cooked to my liking”; this was one service user about the meat. “The plates are always cold”, “Generally the food is good”, “We get drinks and snacks and a drink before bed at 9’0’clock”. The cook has attended food hygiene training and a supervisory development course. The cook said “there is more money now for food”. Some new equipment has been bought to replace the old equipment. Two minor points were observed in the kitchen, the ceiling could benefit from painting and the door handle on the cooker was broken. The manager is inviting relatives to have Christmas lunch in the home this year if they wish. This is an improvement that benefits the service users lifestyle and promotes a homely environment. To promote good dementia care practices further the cook and other ancillary workers should be included in dementia care training. Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 19 Another good practice introduced by the manager is to ensure all service users receive a wholesome meal. Service users who walk about are supported to eat where they may be in the home and not expected to sit at the tables. The inspector observed fresh vegetables in the kitchen store. The records of fridge and freezer temperatures are recorded as required. Risk assessments have been developed but not dated. To promote good practice further a record of meals served to individuals should be kept. This should link to the nutritional needs in the service user care plan. The dietician is visiting in January 2007 to review the menus. The inspector sat with a group of service users in the residential wing who said “There is always a choice of meals so therefore always something that we like”. Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 – 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is good The registered person takes all concerns and complaints seriously to ensure the protection of service users from potential risk of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During monitoring visits and at this inspection accident records were checked and service users case tracked to ensure their needs were being met. As part of the preparation for this inspection comment cards were sent to professional groups for their comments on the quality of service delivery. Comments received back from GP’s and visiting social and health care professionals were very positive about the care delivery. Comments included “ a vast improvement under the new management” The inspector reviewed the homes complaints procedure. Copies are displayed in the home and included in the statement of purpose and service user guide. Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 21 The Commission for Social Care Inspection has not received any serious concerns or complaints about the service delivery since the new registered provider took over. Staff moral is good and the workforce stable. Staff motivation is very good and the introduction of recognised dementia care practices has improved the lifestyle in the home. Staff are aware of the homes whistle blowing procedure and what actions to take if an incident of abuse occurred. Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26. Quality in this outcome area is good Service users can be assured of a warm and well-maintained environment. Service users accommodation is homely and equipment suitable to meet the nursing needs of all service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Following the last inspection the providers have put a lot of effort into ensuring the home is clean and tidy. The malodours apparent when entering the home have been eradicated. The home was generally clean especially the lounges. The dining rooms are furnished with wooden floors and furniture. There are three tables and seating Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 23 for thirteen persons in the nursing dining room and three tables and seating in the residential dining room. The inspector pointed out that two of the chairs needed cleaning as they had food debris ingrained and needed a good cleaning. New flooring has been put down in the main entrance and carpets through out the corridors and bedrooms have been replaced. New linen and bedding along with cutlery and tablecloths have been acquired. New profile nursing beds and pressure mattresses have been bought. Externally the roof of the old building is being replaced along with windows and repairs to the conservatory are planned. During the tour of the bedrooms and communal rooms items were highlighted to the manager that are in need of repair or replacement. The registered provider said that a planned programme of repair and replacement of furnishings and fittings would start in the New Year. The inspector visited the laundry. Infection control procedures were in place. Gloves and paper towels were available for staff. Two domestic staff were on duty at the time of the visit and one laundry lady. Cleaning chemicals were being stored in a locked storeroom. The sluice room did not have suitable racking to hold clean bedpans Washing machines were suitable to deal with foul and dirty items. Two dryers where in place and working. The floor was clean but the walls had cobwebs on. There has been no changes to the bedroom doors which are bear and plain with poor signage to identify the person’s room. Locks on the bedroom doors are Yale type locks and could not be opened from the outside by a service user. The doors are kept permanently locked, requiring each member of staff to hold a master key to enter the rooms. To make the rooms accessible and to promote independence in the service user the locks on the doors should be changed. Most service user bedrooms appeared to have some degree of personalisation. None of the service users commented on their rooms. Service users have access to the rear garden through the conservatory. Aids and equipment are provided through out the home. The pressure relieving mattresses are of good quality; new profile beds have been bought with only a few more needed to complete the total replacement of beds in the home. Bedrails all had appropriate protectors attached. Lifting hoists were being used and maintained as required. . Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 24 Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30, Quality in this outcome area is good Service users can be assured that competent and skilled staff will meet their care needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector discussed staffing issues with the manager and individual staff members during the visit. The manager gave copies of the duty rotas to the inspector. The inspector reviewed the rotas and confirmed that the staff on duty were on the rota. The staffing level of seven carers and one registered nurse are maintained during the day with one registered nurse and three carers on night duty. One carer covers a twilight shift each day. The manager has recruited two registered mental nurse’s recently who have experience of caring for elderly persons with mental health problems. Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 26 There has been an improvement in the staff working schedules and only one carer now has additional employment. The manager continues to study for the registered managers award. The noticeable improvements observed by the inspectors was that staff interacted better with service users. They made eye contact and were talking to them. Carers said, “communication is much better between staff, we work as a team”. “Money is available for activities, the piano has been tuned and children are coming in to sing carols, things have improved here” “We are paid to attend mandatory training now” and we feel we can put forward our opinions and ideas at the staff meetings. Staff moral has improved. Comments from relatives included” most of the staff I have met tried to do their best, but I think they were handicapped, I am pleased with the improvements I have seen”. “The staff are very friendly and caring”. “Staff do not speak in their own language which helps to create better team work”. The manager has developed a staff training matrix and individual training records for the staff. The matrix and files were reviewed. Mandatory training is being carried out. Staff have attended Dementia specific training since the last inspection. It is hoped the registered person will continue to encourage the staff to develop their individual skills in dementia care. The results of the service user surveys returned (all completed by relatives) suggested that staff provided all the care and support needed to meet the service user needs. The inspector checked the staff files of the three most recently employed persons. All the required information and security checks were received before the staff commenced employment. References were received from last employers however the reference requests are based on character. The inspector discussed improving the information requested from referees to include competency and skills especially for registered nurses with the registered person. Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 27 The inspector spoke to the new registered mental nurse on duty.The registered nurse felt that the induction training was adequate and sufficient providing the necessary information about the home polices and procedures. The registered nurse was aware of the on-call system and who to contact if an untoward incident occurred. The registered nurse commented, “It’s the friendliness here and the relaxed approach” “ everything is geared towards the service user”. The comments and observations of the inspectors provided sufficient evidence to conclude that skilled and competent staff cared for service users. Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,36,37,38. Quality in this outcome area is good Service users will benefit from a changed ethos introduced into the home. The manager is experienced and runs the home for the benefit of the service users This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is a registered nurse with many years experience of caring for older persons in care homes. Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 29 Comments received from staff include “the homes manager is very good, always available and friendly”. “She is always available, treats all staff the same, spends time on the floor with staff and service users” “ The manager is visible” Comments from social care professionals include “the manager made my client welcome and helped them settle into the home” The evidence gathered during this inspection has shown that the changes made by the registered provider and manager have improved the well being of the service users. Service user monies held by the home were checked. Each service user had a sealed envelope kept secure in a locked cabinet. Records were checked for credit and debit. Receipts were checked against the records all were correct. The manager has set up a supervision protocol for staff starting with an appraisal. A record of each supervision session is kept secure. The quality assurance system is being developed further. Monthly medicine audits and satisfaction surveys are completed and analysed. The registered person intends to introduce further elements of a quality system in the future. Statutory maintenance records were checked. The fire logbook and hot water temperature records were not completed satisfactorily. The registered provider will discuss these issues with the maintenance person. Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 x X x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 3 3 x x 3 3 2 Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 OP2 Good Practice Recommendations The registered provider should revisit the terms & conditions to ensure the contracts reflect the Office of Fair Trading report - guidance on terms and conditions for care homes. The registered person should ensure good practice and develop a risk assessment associated to pain management procedures. The registered person should introduce the Gold standards framework for service users needing high dependency care and pain management. The registered person should promote good practice further and record meals served to individuals linked to the nutritional needs in the service user care plan. The registered person should make the rooms accessible DS0000003292.V323212.R01.S.doc Version 5.2 Page 32 2 OP7 3 OP8 4 OP15 5 OP24 Suddon House Nursing & Residential Home 6 7 8 OP26 OP26 OP29 9 10 OP30 OP38 and promote independence of the service user the locks on the doors should be changed to dementia friendly types. The registered person should that the dining room chairs are cleaned as they had food debris ingrained on them. The registered person should ensure the laundry walls are cleaned regularly. The registered person should review the reference request for referees to include competency and skills especially for registered nurses. The registered person should include the cook and other ancillary workers in dementia care training. The registered person should ensure the fire logbook is completed correctly. Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Suddon House Nursing & Residential Home DS0000003292.V323212.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!