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Inspection on 21/06/05 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 21st June 2005.

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

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

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

What the care home does well

The home provides a secure environment suitable for people with dementia care needs with space to move around freely. Service users benefit from accessible gardens with pleasant rural views. The home has a robust recruitment and induction procedures that protects service users from the risk of abuse. The home offers a varied menu of home cooked and nutritional meals. Lunch and tea, seen during the inspection, was appetising and plentiful.

What has improved since the last inspection?

Seven requirements and five recommendations were raised at the last inspection. Four of these requirements have been actioned and one partly addressed. Three of the recommendations have been actioned. The manager/provider now ensures that a POVA First check and two references are received for all new employees prior to starting work. Regular room audits are carried out to check bedrails and other equipment that is provided in bedrooms. Additional adjustable beds have been purchased to provide for the needs of service users requiring nursing care and assistance in bed. The small laundry room has been thoroughly cleaned and additional shelving provided. The management of medicines has improved and is now mostly satisfactory. A new reception area and quiet room have been created, improving the communal areas for service users and their visitors. Staff have improved access to training with a significant number of staff attending different courses.

CARE HOMES FOR OLDER PEOPLE Suddon House West Hill Wincanton Somerset BA9 8BP Lead Inspector Sue Burn Unannounced 21 June, 2005 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 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 D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Suddon House Nursing and Residential Home Address West Hill, Wincanton, Somerset, BA9 8BP Telephone number Fax number Email 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 Ltd Mrs Tina Mandy Marshall Care Home with Nursing 41 Category(ies) of see below registration, with number of places Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Elderly persons of either sex, not less than 60 years, who require nursing care by reason of a progressive mental illness/disorder. 2. Up to five persons of either sex, in the range 50-60 years, who require nursing care by reason of a progressive mental illness/disorder. 3. Up to 17 places for personal care DE(E). 4. Registered for a total of 41 places in categories DE, MD, DE(E) and MD(E). Date of last inspection 25 January 2005 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 three 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 or mental health needs 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 D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out as part of the planned annual programme of inspections. 2 inspectors carried out this unannounced inspection over one day. The last inspection was announced and took place on 25 January 2005. The manager was not available for this inspection and the administrator and nurse in charge assisted inspectors in her absence. Feedback was given to Paul Deverill, one of the company directors, at the end of the inspection. 39 people were living in the home. 23 people were receiving nursing care and 16 were receiving personal care only. Visitors spoken to confirmed that they are satisfied with the care provided, staff are kind and they find the home is more organised than a year ago. One visitor commented particularly on the benefits of the key worker system that has been introduced since the last inspection, where staff are allocated to service users to support them and their families. Service users able to express a view indicated that they are happy at the home, however a number less able to give their views appeared bored and had little interaction with staff during the day, some service users felt that there was not a lot to do. Observations made throughout the day confirmed that the interactions and stimulation available to service users was variable. Some staff engaged and chatted to people appropriately, others spent long periods of time in the lounge without interacting with service users other than to provide drinks or ensure that they stayed safe in the lounge. Most service users were free to move around the home as they wished and there was open access to the garden. Lunch and tea were observed and looked plentiful and appetising having been freshly prepared by the cook. A tour of the premises was made, care in the home observed and a range of records was inspected, including care records. 8 staff, 28 service users and 2 visitors were spoken to. Inspectors saw all service users. Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 6 What the service does well: What has improved since the last inspection? Seven requirements and five recommendations were raised at the last inspection. Four of these requirements have been actioned and one partly addressed. Three of the recommendations have been actioned. The manager/provider now ensures that a POVA First check and two references are received for all new employees prior to starting work. Regular room audits are carried out to check bedrails and other equipment that is provided in bedrooms. Additional adjustable beds have been purchased to provide for the needs of service users requiring nursing care and assistance in bed. The small laundry room has been thoroughly cleaned and additional shelving provided. The management of medicines has improved and is now mostly satisfactory. A new reception area and quiet room have been created, improving the communal areas for service users and their visitors. Staff have improved access to training with a significant number of staff attending different courses. Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 7 What they could do better: Care plans - require improvement to contain more detail of service users’ assessed needs and planned interventions to direct staff to provide consistent and person-centred care. These plans should all be reviewed regularly in consultation with service users/representatives. Social and psychological needs – the home no longer has a dedicated activities organiser and care staff are unable to meet the social needs of service users. Records examined did not indicate what social stimulation people were offered on a regular basis. During the inspection inspectors unobtrusively observed staff, particularly during the afternoon. All interactions were kindly but limited with staff either engaged in ‘tasks’ or ‘supervising’ the room. Some service users stated that there was not a lot to do and others indicated that they were bored and lacked stimulation through their behaviour. Records examined contained variable information about people that would help guide the provision of activities; some had life histories, but not all. Records did not record how and what social activities service users had been offered or taken part in. The provider’s have been asked to address this to enable all service users to benefit from positive social interaction suited their capabilities and needs. Care plans examined did not detail sufficient information about service users’ psychological and behavioural needs to support staff to offer objective and consistent approaches to individual needs. This should be addressed with the care plans. Moving and handling – during the inspection inspectors observed moving and handling practice with 2 service users that either did not follow the plan of care or used techniques that could cause injury/discomfort to the service users and staff. The home has a range of pressure relieving devices that were seen in use, some cushions were worn and in need of replacement. Some service users, at risk of pressure damage were sat for long periods of time without being assisted to change their position. The manager has been required to ensure that all service users are assisted to move and change position in ways that are consistent with their level of assessed risk and the instructions in the care plan. Environment – some areas of the home require attention to the décor and furnishings and few of the bedrooms have suitable locks to offer service users the opportunity to lock their doors. The provider has been required to ensure that all damaged furniture and fittings are maintained and the décor, windows that cannot be opened and the need for locks are addressed, as well as continued refurbishment to meet the standards. On the day of inspection the shower room and two of the bathrooms were not fit to be used and the provider has been required to make arrangements to reinstate these facilities as a matter of urgency. An Immediate Requirement was issued to ensure that the bath hot water outlet was maintained at a safe temperature to minimise the risk of scalding to service users. Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 8 Control of Infection - A number of bins in areas where service users are assisted with personal care were broken or were not foot operated flip top bins and hand wash facilities are not provided in the laundries. Suitable bins and hand wash facilities in these areas to maintain satisfactory standards of hygiene. Inspectors have also required the provider to ensure that the milk cooler in the kitchen is replaced or repaired where it has become rusty. Staffing – sufficient numbers of staff are on duty to meet the needs of service users. However inspectors have again raised concerns at long hours worked by some staff, which the manager has been asked to review to ensure that staff do not become overtired. The deployment and/or training and development of staff requires addressing to ensure that service users are able to participate in stimulating and social activities, as detailed above. Management and Health and Safety –The home manages small amounts of personal money on behalf of some service users. Inspectors identified that two systems are being used to record the management of this money and amounts held for each person could not be clearly identified. The manager has been required to review the systems and storage in use to ensure that a clear and secure system is implemented. During the inspection both laundry rooms and the staff accommodation were left unlocked. This posed a potential risk to service users who may enter these areas. The providers have been required to ensure that all chemicals are stored securely and high risk areas, such as the laundries, sluice and staff accommodation are kept locked at all times to ensure the safety of all service users. A significant gap was found on one bed where a bedrail was in use, which presented a serious entrapment risk. The provider rectified this before the end of the inspection. Inspectors were concerned that staff that had fitted and used these rails had not recognised the risk to the service user. The manager has been required to ensure that all staff are trained in the safe use of bedrails and that a full risk assessment and consultation with service users/families are carried out when bedrails may need to be used. Please contact the provider for advice of actions taken in response to this Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 9 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 10 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 Standards Statutory Requirements Identified During the Inspection Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 11 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 standard(s) 3. All service users needs have been appropriately assessed prior to moving into the home. EVIDENCE: Inspectors examined 2 care records for service users recently admitted to the home. The home has an adequate assessment format, that is completed by the manager or assessing nurse before the person moves into the home, to determine individual needs. The records confirmed that the home obtains additional information from other professionals and family members involved, where appropriate. Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10. There is no clear and consistent care planning system in place to adequately provide staff with the information and direction they need to satisfactorily meet service users’ needs. Some staff have a good understanding of service user needs as demonstrated by the positive relationships that have developed. Personal care is provided in the home in such a way as to protect service users’ privacy The system of medication management is satisfactory. EVIDENCE: Individual care plans are maintained for service users and suitable documentation is in place to support assessments and care plans, including dependency, mental health, moving and handling and nutrition. 6 care records were examined. Not all service users had fully completed assessments that could be used to develop relevant care plans. For example, it could not be evidenced that moving and handling assessments had been fully completed in 2 of the records seen and pressure risk assessments for 3 of the Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 13 service users’ records examined. Nutrition assessments were not always fully completed, including where service users were identified as having significant nutritional and dietary needs. Service users did not always have their weight monitored as determined in the plan of care and there was no evidence of action taken where significant weight loss had been identified. Nutritional screening and weight monitoring was not systematic. Risk assessments seen were not adequately detailed and lacked evidence of bedrail assessments and consultation with service user/families regarding their use. The plans did not contain sufficient detail to direct staff as to how service users’ psychological needs should be met and observation by inspectors indicated that strategies are not always in place to support staff to meet these needs. These needs include communication, relationships, stimulation and socialisation and behaviours that are difficult for others. The plans drawn up to reflect service user night time nights showed clearer direction and regular review. The manager must ensure that all care plans have been drawn up from comprehensive assessments and detail clear strategies to guide staff in the care and support of all service users and all aspects of their health and welfare. Plans did not evidence that service that service users or their families had been consulted in drawing up or reviewing the plans and a number of planned reviews were overdue. This consultation should be in documented and the plans reviewed regularly, usually monthly. The home has a range of pressure relieving devices and mattresses and cushions, which were observed in use. Not all people at risk of pressure damage had regular positional changes during the day and one person was observed sat in a wheelchair without a cushion for over 2 hours when a specific alternating pressure cushion was required, this practice increased the risk of discomfort and pressure damage. Some cushions seen were worn and would not provide the protection from pressure damage that they were designed for and should be replaced. Two service users were observed to be assisted using moving and handling techniques that could cause injury and/or discomfort to the service user and/or staff. One service user had the use of a hoist indicated in their care plan, which was not used, and the other person was not weight bearing and was not assisted appropriately. This person’s needs were not fully documented in their care plan. Medication management was mostly satisfactory and storage arrangements were suitably organised. The administration of medication requires review to ensure that medication in blister packs is locked away when the trolley is left unattended to minimise risk to service users. Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 14 All personal care was provided in private and service users had medical consultations in their rooms during the inspection. Most people looked well kempt although a number had on torn items or buttons that were missing from their clothing. All staff should be reminded to ensure that people are not assisted to wear clothing that is in need of repair. Staff were observed knocking on service users doors and treating people kindly, some staff were observed paying particular attention to the person that they were key worker for and demonstrating their knowledge of the person’s individual preferences. Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15. Service users benefit from a flexible daily routine and access to all areas of the home and garden. Some staff have a good understanding of service user needs as demonstrated by the positive relationships that have developed. Some staff are not able to engage appropriately with service users to promote the development of relationships, stimulation and occupation. Service user benefit from identified and personalised bedrooms reflecting their own preferences. The arrangements for meeting the psychological and social needs of service users are poor. Arrangements for service users to maintain contact with family and friends are good. Dietary needs of service users are well catered for with a home cooked, varied selection of food available that meets service user needs. EVIDENCE: Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 16 Service users are able to get up and retire as they wish; breakfast time is protracted to accommodate people who wish to get up later. People are free to move around the home as they wish and have access to the garden with seating. The home is currently arranging pastoral support within the home with local churches. Staff engagement with service users was markedly variable during the inspection; the detail of this was discussed with Paul Deverill, one of the directors at the end of the inspection and the manager the following day. Some staff demonstrated skilled interventions,when relating with service users, appropriate to their needs. Other staff did not appear to be able or wish to encourage service users to socialise or engage in activity that would be meaningful to them. For a period of 2 hours during the afternoon, whilst staff were present in one of the lounges, they did not interact with service users other than to ‘supervise’, provide drinks or assist them to the toilet. Some service users’ behaviour indicated that they were bored and lacking stimulation, others spoken to felt that there was not much to do. The manager must ensure that all staff understand the appropriate ways to communicate effectively with people with dementia and make proper provisions to ensure that the social and psychological needs of service users are met; this may include supporting the staff with training and leadership and dedicated time set aside. Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 17 Some care records contained life stories, which are helpful in developing activities to reflect individual capabilities, interests and preferences, particularly where service users may not be able to express these readily, and should be developed for all service users. Care plans should record individuals’ involvement in social and recreational activity to enable this to be monitored and reviewed to ensure that individuals’ social needs are being met. The home has introduced a key worker system that was reported by one visitor and staff spoken to as working well enabling care staff to gain greater insight into the background and needs of service users. Visitors are made welcome in the home whenever they choose to visit. Bedrooms were personalised to reflect the service users’ preferences and orientation cues to bedrooms have been developed to help guide each person to their own room. Lunch and tea were observed and the cook had freshly prepared a meal suitable for the hot weather on the day, having varied the menu to take account of this. A choice was offered to service users who were able to eat a ‘normal’ diet and the food looked and smelt appetising. The provision for service users’ requiring a soft/pureed diet was less varied and prepared earlier in the day and then reheated. This may affect the nutritional content of the food and should be freshly prepared as needed. Staff were available to assist those people who needed help. Some staff need further guidance in communicating and assisting people to ensure that the service user is offered all the meal and has a full explanation and necessary equipment, e.g. plate guards as they are being helped. This will support their enjoyment of the meal and help ensure that all take a full meal. All service users had access to drinks in their bedrooms and drinks were available in lounges. Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 The recruitment and training procedures carried out ensure that people are protected from the risk of harm or abuse. Arrangements for complaints are satisfactory. EVIDENCE: Staff records examined confirmed that POVA and CRB checks are obtained prior to an employee starting work. Where there have been any difficulties with the CRB system affecting these checks the manager has sought CSCI advice. Abuse awareness is included in induction and 16 staff received abuse awareness training in November 2004. The complaints procedure is displayed in the home. CSCI have not received any complaints about the home since the last inspection. Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 19 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 standard(s) 19, 20, 21, 23, 24, 25, 26. The environment is improving with refurbishment in some areas. The home remains shabby in parts with a continued need for improvements in the décor and comfort of the home. Service users do not have access to sufficient suitable bathing facilities. The standard of cleanliness continues to improve with most areas clean and hygienic. EVIDENCE: The home has a range of communal rooms available for use by visitors and service users, all overlooking the garden. The large garden is accessible and has seating areas for service users to enjoy, a number of service users, who were able to use the garden independently used the garden during the inspection. Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 20 A programme of redecoration and refurbishment is underway. The provider confirmed that this is not a planned programme but areas are decorated as needed. Few of the bedrooms have suitable locks to offer service users the opportunity to lock their doors. The provider has been asked to address this for the past 2 years. It is required that suitable locks be fitted that allows service users choice. A pleasant quiet room and an improved reception area have been created since the last inspection. The lounges are large and pleasant with views over the open countryside. Additional adjustable beds have been provided. Service users have been provided with additional side tables to enable them to manage drinks safely and independently. There is a continued requirement for these developments to continue as a number of areas remain shabby and in need of attention and redecoration and some furniture required replacement or attention to fix broken parts (see below), which was discussed with the provider at the end of the inspection. The door to the staff accommodation has been fitted with a lock since the last inspection but was not locked, which could allow service users to enter an unsupervised and unregistered area of the home, which may place them at risk. This must be kept locked at all times. Most bedrooms in the nursing ‘wing’ of the home do not have locks. Two service users spoken to were not satisfied with this arrangement and wanted a lock on their door to prevent people entering. Suitable locks must be sourced as soon as possible to ensure that individual needs can be met. This has been a requirement since 2002. All bedrooms have domestic style furniture; a number of these items require maintenance. One wardrobe required urgent attention as it was badly broken and also required securing to the wall to prevent risk of injury to service users or staff. One bedroom requires attention where there is a lack of storage and the service user’s belongings are stacked in black sacks or piles in the room. Not all windows can be opened, including in some upstairs bedrooms, this must be addressed to ensure that rooms can be naturally ventilated as needed. Some of the downstairs rooms had window openings that need to be reviewed to ensure that the safety, security and comfort of service users is maintained. The home has sufficient bathrooms/shower for service users, however not all were useable on the day of the inspection. One bath hot water outlet Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 21 temperature exceeded 50C. An Immediate Requirement was issued to regulate the temperature to safe level to minimise the risk of scalding to service users. The shower room could not be used as the showerhead was missing. Another bathroom had a sign on the door indicating that it was out of order. This left two bathrooms that could be used for 39 people, only one of which is an assisted bath. It is required that action is taken to ensure that all bath/shower rooms are available for use. Most areas were suitably clean and the general standard of cleanliness has improved throughout the home. Two rooms require attention to rectify malodours; the administrator confirmed that specialist air fresheners were on order. A number of bins were broken or were not foot operated flip top bins. These bins must be replaced to ensure the prevention of cross contamination from items used in personal care. The kitchen was clean and organised. The milk cooler had areas that were rusting and requires repair or replacement to maintain hygiene standards in the kitchen. One of the fridges was in need of defrosting. The laundry facilities have been improved and the residential laundry was clean and better ordered. Staff hand washing facilities are required for both laundries to minimise the risk of cross contamination as advised by Somerset Health Protection unit in the guidance for care homes published in 2005. A system has been developed to ensure that all service users have a toiletry bag. Not all toiletries had been returned to the bags, which could lead to loss or sharing of items. The manager should take steps to ensure that the system is maintained or reviewed to minimise the risk of shared toiletries. Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30. There are sufficient numbers of staff on duty to ensure that service users are kept safe and physical needs are met. The home is not fully meeting the social and psychological needs of service users. The recruitment procedures are robust and protect the service users from the risk of abuse and ensure that suitable staff are recruited. The arrangements for staff induction are satisfactory with new staff clear about their roles. Systems for staff training are being developed. EVIDENCE: Rotas examined showed that the numbers of staff on duty in the met previous Somerset Health Authority and Somerset County Council Guidance which was adequate to meet the needs of current service users. 3 domestic and 2 kitchen staff and the administrator supported the care team on the day of the inspection. Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 23 Due to the specialist nature of the service offered the home would benefit from the recruitment of a further RMN to support the team, particularly during holidays, sickness and other absences, where one nurse worked in excess of 70 hours for 2 of the weeks examined. This was also noted at the previous inspection in January 2005. 4 care staff worked in excess of 70 hours per week during all of the 4 weeks rotas examined and 1 of these staff also worked for 16 days continuously. This is not considered to be good or safe practice and staff may become overtired in a demanding working environment, which is not in the best interests of service users. This concern was also raised at the last inspection, where some staff were working in excess of 60 hours per week. The manager should ensure that these staff do not work excessive hours and have the opportunity for reasonable rest periods and time off. There are no longer any specific staff arrangements for the provision of activities and the provision of activities and recreation are incorporated into the role of the care staff. Through observation and records it was evident that the care staff are unable to undertake this role effectively and are in need of direction, training and resources to achieve this. Staff are recruited after all the appropriate checks have been received and well-organised files are maintained. The manager must ensure that these files also contain the information detailed in Schedule 2. Care and domestic staff receive an induction programme that is linked to the TOPSS standards. It is recommended that an induction programme be developed for nursing staff. Since her appointment in September 2004 the manager has implemented a number of training courses for staff and the training records were examined. The home has 3 in-house moving and handling trainers and most staff have received moving and handling training. 6 support staff have not received this training and are required to do so. 3 senior staff are undertaking a supervisory management course. One member of staff has NVQ2 in Care. There are 21 care staff indicated in the training records provided. 4.7 of care staff have achieved NVQ in care. One person is undertaking NVQ2 and 6 are undertaking NVQ3 in Care, with 5 due to start NVQ2 in June 2005. The manager must ensure that all staff receive training in dementia awareness and person-centred care to equip them to support service users social and psychological needs. The manager is advised, as at the last inspection, that RGNs should be supported with relevant dementia care courses to enable them to develop their skills, awareness and leadership in this specialist area. The cook has completed his NVQ in catering at college. The training records indicated that not all staff that handle food have received relevant food hygiene training, this is required. Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 24 Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 35, 37 and 38. The home is satisfactorily managed and the manager is developing systems to support the development of the home. Staff would benefit from clearer day-to-day leadership to enable them to develop their practice with regard to the specialist needs of the service users. Personal monies are not effectively managed. Health and safety arrangements are not adequate. EVIDENCE: Mrs Marshall has implemented training and development for staff and feedback from visitors was that the home is more organised and they are able to approach the manager and her staff. Mrs Marshall is undertaking the Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 26 Registered Manager’s Award and has over 20 years experience in both nursing and education. Staff feedback indicated that the team get on well. A newsletter is published regularly for the benefit of service users, visitors and staff. As detailed in ‘Daily Life and Social Activities’ some staff lacked direction regarding meeting the day-to-day social and psychological needs of service users. The manager needs to address ways to support and direct these staff on each shift where service user communication needs are more complex. Small amounts of personal money are held by the home when requested by the service user or their family. The management of this money was inspected. The home has 2 record keeping systems for monies, which could not be used to satisfactorily identify the amounts held for each person. The system in operation requires review to ensure that monies held are auditable, reconciled regularly and storage is adequately secure. The detail of this was discussed with the manager following the inspection. Service user and other confidential records are stored securely and the records examined were well ordered. Service users and their families (where appropriate) are able to see their records on request. The home has a nominated member of staff to co-ordinate health and safety matters in the home. During the inspection both laundry rooms and the staff accommodation were left unlocked. This posed a potential risk to service users who may enter these areas. The providers have been required to ensure that all chemicals are stored securely and high risk areas, such as the laundries, sluice and staff accommodation are kept locked at all times to ensure the safety of all service users. During the inspection a range of records was examined and observations made to ensure that the health and safety of service users was being well managed. These included; Fire – Most staff receive fire safety training regularly. The training records indicated that 5 staff require update training in fire safety and there have not been any fire drills in the past year, which are strongly recommended as detailed in the publication ‘Fire Safety. An employer’s guide’ published by HSE. Evacuation procedures are clearly displayed. Fire systems are checked each month and serviced as required. Hoists – all have been serviced in the past 6 months as required. Bedrails and bedrooms – A comprehensive monthly room audit is conducted. Rails are checked. A significant gap was found on one bed during the inspection. This gap presented a high risk of entrapment. The provider rectified the problem before the end of the inspection. Inspectors were concerned that staff had not identified this problem when fitting and using Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 27 these rails. Inspectors could not identify risk assessments and consultation with service users/representatives for those who have bedrails fitted. A comprehensive document was available but not evidenced in care records examined. The manager must ensure that all staff are instructed in the safe fitting and use of bedrails. All service users who have bedrails fitted must have a documented risk assessment, which should include evidence of consultation with service users and/or their representative. PAT testing – completed 27.4.05. Medical – there were no records to confirm that the electronic scales have been calibrated, this is required annually. Medical equipment should also be checked annually to ensure that it is fit for use. Hot water temperatures – the outlets to the baths and shower had not been checked since 13.4.05. These checks must be carried out at least monthly to ensure that the temperature is maintained close to 43C by the thermostatic valves. Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 2 1 x 3 2 2 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 3 3 x x 2 x 3 1 Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 29 yes Are there any outstanding requirements from the last inspection? 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 7 8 Regulation 12(1) Requirement Timescale for action 30.8.05 2. 8 12(1)(a) 13(5) 3. 12 16(2)(n) The manager must ensure that all care plans have been drawn up from comprehensive assessments and detail clear strategies to guide staff in the care and support of all service users in all aspects of their helath and welfare. They should include: - Nutrition - Behavioural management - Risk assessments, including the use of bedrails - Psychological and social needs. Care plans must evidence consultation with service users/representatives and be reviewed as determined in the plan. on receipt The manager must ensure that of report all service users at risk from pressure area damage are fully assessed and assisted to change position as necessary. Safe systems for moving and handling service users must be maintained and be consistent with the plan of care. The manager must ensure that 30.9.05 all staff understand the appropriate ways to Version 1.30 Page 30 Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc 4. 19, 20, 24, 25 13(4) 23(2) 5. 21 23(2)(j) 6. 26 13(3) 7. 30 18(1)c 8. 35 Schedule 4-9(a)(b) 12(1) communicate effectively with people with dementia. Proper provision must be made to ensure that the social and psychological needs of service users can be met. The programme of redecoration and refurbishment must be continued and must include: - the provision of suitable locks to bedroom doors - fixing all damaged furniture and ensuring that it is safe to use - provision of adequate storage in the identified bedroom - ensuring all bedroom windows can be opened and that those on the ground floor do no open too wide as to compromise security. The identified bath hot water outlet temperature must be regulated to close to 50C. All bathrooms must be fit to use. The missing showerhead must be replaced and the other downstairs bathroom brought back into use. Foot operated flip-top bins must be available in all areas where personal care and laundry is provided. Staff handwashing facilities must be provided in the laundries. The manager must ensure that all staff receive direction and training in dementia awareness and person-centred care to equip them to support service users social and psychological needs. Al staff who handle food must receive food hygeine training. The outstanding staff must receive moving and handling training. An auditable and secure system of managing personal monies must be implemented. monitoring at each inspection 30.7.05 (furniture) Immedaite Requireme nt hot water and 30.8.05 bathrooms 30.9.05 30.10.05 30.8.05 Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 31 9. 38 13(3)(4) 23(5) The following health and safety issues require action: - the temperature of all hot water outlets to baths/showers msut be checked at least monthly to ensure that it is maintained close to 43C - all staff must be instructed in the safe fitting and use of bedrails and all service users must have a documented risk assessment for their use as detailed in this report (on receipt of this report) - all chemicals must be stored securely to comply with COSHH regulations 2000 (Immediate Requirement) - all high risk areas must be kept locked at all times, including staff accomodation, the sluice and both laundries - the scales require calibration and the medical equipment requires checking/servicing annually to ensure that they are fit for use - the identified staff must receive fire safety update training on receipt of report and 30.9.05 fire training and equipment RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 7 9 10 12 Good Practice Recommendations Care plans should be reviewed monthly with service users/representatives. Blister packs should be locked away whenever the trolley is left unanttended. Staff should be reminded to ensure that service users are not assisetd to wear clothing that is in need of repair. The life histories should be developed for all service users to help develop appropriate activites. Key workers should be supported to take this role. D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 32 Suddon House 5. 6. 15 27, 30 7. 8. 30 The presentation and provision of the soft diet should be reviewed to ensure that it is varied, nutritious and is not reheated. An additional RMN should be recruited to support the specialist provision at the home. The RGNs should receive training in relevant dementia care courses and a nurse induction programme be developed. The manager should review the working hours of those care staff working over 70 hours per week to ensure that they receive adequate time off and are not overtired. Suddon House D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 Page 33 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier 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 D53 - D02 S3292 Suddon House V234360 210605 Stage 4.doc Version 1.30 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. 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