Please wait

Please note that the information on this website is now out of date.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

Inspection on 22/07/08 for Elroi Manor Residential and Nursing Home

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

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

Visitors are welcome at the home at all times. People spoken with were happy with the quality of the food served in the home. One relative described the meals as "tasty, tender and full of flavour." The food seen by the inspectors was well presented and portion sizes were adequate. At the time of the inspection two people were being nursed in bed. Both appeared clean and comfortable. There was documentation in place to show that people were being assisted to change position regularly to reduce the risk of pressure damage. Appropriate pressure relieving equipment was in place. Medication was being well managed and records of medication administration were clear and correctly signed.

What has improved since the last inspection?

Since the last key inspection there has been some improvements to the environment. All areas have been thoroughly cleaned and some areas have been redecorated. The call bell system has been re-instated so that people can summon assistance when required. Bedroom doors are no longer locked to prevent people accessing their rooms during the day. However the unsuitable locks have not yet been replaced with locks and handles that are suitable for people who have a dementia. Some basic signage has been put in place. Low level lighting has been put in place in bedrooms to prevent light disturbance when people are being assisted during the night. The practice of people sharing rooms without making a positive choice to do so has ceased.

CARE HOMES FOR OLDER PEOPLE Suddon House Nursing & Residential Home West Hill Wincanton Somerset BA9 8BP Lead Inspector Barbara Ludlow Unannounced Inspection 10:15 22nd & 23rd July 2008 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.V365823.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.V365823.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 registered manager (if applicable) Type of registration No. of places registered (if applicable) 01963 33577 01963 31175 suddon.house@virgin.net Deverill Holdings Limited Vacant Care Home 43 Category(ies) of Dementia (29), Dementia - over 65 years of age registration, with number (43), Mental disorder, excluding learning of places disability or dementia (29), Mental Disorder, excluding learning disability or dementia - over 65 years of age (29) Suddon House Nursing & Residential Home DS0000003292.V365823.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) and 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 person`s 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. 23rd January 2008 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 people. 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 people who live there. The home has ample communal space and outside areas that can be accessed with the support of staff. Bedroom accommodation is provided on two floors. Suddon House Nursing & Residential Home DS0000003292.V365823.R01.S.doc Version 5.2 Page 5 The home provides nursing and personal care for older people with dementia and other mental health needs. 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 provider stated that the fees for the service at the time of this inspection are £625.00 to £845.00 per week. Suddon House Nursing & Residential Home DS0000003292.V365823.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. This inspection was carried out over a two-day period by two inspectors. During this time the inspectors met with people living, working and visiting the home and were able to observe care practices. A tour of the building was carried out and some records were viewed. Prior to the inspection the home completed an Annual Quality Assurance Assessment (AQAA.) This was poorly completed and gave only minimal information about the home and plans for improvement. 5 Relatives/carers completed questionnaires prior to the inspection and some of their comments have been incorporated into this report. Since the last key inspection two random inspections have been carried out and copies of these inspection reports are available on request. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: Visitors are welcome at the home at all times. People spoken with were happy with the quality of the food served in the home. One relative described the meals as “tasty, tender and full of flavour.” The food seen by the inspectors was well presented and portion sizes were adequate. At the time of the inspection two people were being nursed in bed. Both appeared clean and comfortable. There was documentation in place to show that people were being assisted to change position regularly to reduce the risk of pressure damage. Appropriate pressure relieving equipment was in place. Suddon House Nursing & Residential Home DS0000003292.V365823.R01.S.doc Version 5.2 Page 7 Medication was being well managed and records of medication administration were clear and correctly signed. What has improved since the last inspection? What they could do better: There is currently no registered manager at the home. There is a lack of leadership and direction leading to poor staff morale and inconsistencies in care practices. Records viewed were poor in quality. Care plans were varied in format and daily recordings gave a very limited picture of the person. Some assessments in respect of nutrition and tissue viability were not correctly completed and contradicted other parts of the care plan. Plans of care in respect of wound care were not kept with the care plan and other information was recorded on communal charts. Therefore there was no one document that gave a holistic picture of the individuals’ abilities and needs. Staff working in the home appeared kind and polite but were very task focussed and demonstrated limited knowledge in working with people who have a dementia. Although basic physical healthcare needs are being met there is very limited social stimulation or emotional support for the people who live at the home. Staff training is mainly video based and not specific to the people who live at Suddon House or their needs. Suddon House Nursing & Residential Home DS0000003292.V365823.R01.S.doc Version 5.2 Page 8 The home was not able to demonstrate how people were assisted to make choices about their day-to-day lives and routines. There are some organised activities in the home but these are very ad hoc and again it was unclear how people made choices about activities. Although improvements have been made to the building it is still not an enabling environment for the people who live there. Some basic signage has been put in place but there are no other points of reference or interest to encourage people to move around independently. There are no appropriate bathroom facilities on the first floor so anyone living upstairs has to use the facilities on the ground floor. There are no separate hand washing facilities in the laundry or sluice room. At the time of the inspection staff spoken with said that they were working long hours to cover for people who had left the home and not been replaced. Staff said that they were becoming tired and this was contributing to low morale amongst the staff. 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.V365823.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.V365823.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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. At the last key inspection (23/01/08) this outcome group was judged as adequate. There have no admissions since the key inspection. EVIDENCE: Since the last key inspection the statement of purpose and service user guide has been up dated. The statement of purpose is not in line with the care Homes Regulations 2001 Regulation 4 Schedule 1. The service user guide is not in an accessible format for the people who live at the home. Suddon House Nursing & Residential Home DS0000003292.V365823.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are adequate but do not reflect a complete picture of peoples’ abilities and needs. Privacy and dignity could be compromised by the systems in place. The physical healthcare needs of people are met at the home. EVIDENCE: The home is currently in the process of updating all care plans to ensure that they are person centred and give accurate guidance for staff to follow. The inspectors viewed a sample of 4 care plans. These care plans were in various formats. Assessments in respect of nutrition, tissue viability and moving and handling had been completed. Not all gave clear guidance and Suddon House Nursing & Residential Home DS0000003292.V365823.R01.S.doc Version 5.2 Page 12 some assessments in respect of tissue viability were not accurately scored meaning that the risk was understated. Guidelines in respect of nutrition and assistance required with eating and drinking were inconsistent. For example the care plan for one person stated that they had a poor appetite but this was later described as adequate in the tissue viability assessment. The plan of care also stated that dietary intake needed to be monitored but there were no details of how this should be monitored and no records for food or fluid intake. Three further care plans were examined for wound care management. The records for these are not kept with the main care plan but held together in the treatment room. There was no cross reference between the two plans of care meaning that it was difficult to monitor how all aspects of care were managed for the individual. There was evidence that wounds were improving and also evidence of the involvement of healthcare professionals outside the home. There is a communal bowel movement record chart on the wall in the main office. This information is not included in individual care plans and therefore does not contribute to holistic care. Neither does it promote the privacy and dignity of people living at the home. Staff write daily reports on all people living at the home. The quality of these was poor and did not give a clear picture of the persons’ day-to-day care. For example one person had been given additional pain relief but there was no mention of this, or the reason for it being administered, in the daily records. Also concerns were raised with the nurse in charge about the language used in daily reports. Throughout the second day of the inspection the inspectors monitored the care being given to people who were being nursed in bed. These people appeared clean and comfortable. There was evidence that they were being assisted to change position regularly and that food and fluids were being appropriately given. There is appropriate secure storage for all medicines. All medication is administered by trained nurses. The inspectors viewed the Medication Administration Records (MARs) and found them to be satisfactory. Photographic identification was used and all administrations were signed for. Controlled drugs were checked and records kept corresponded with stocks held. Since the last key inspection the practice of people sharing rooms without making a positive choice to do so has ceased. There is still no evidence in care plans that people are being given a choice about the gender of the staff who assist with their intimate personal care. Suddon House Nursing & Residential Home DS0000003292.V365823.R01.S.doc Version 5.2 Page 13 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 adequate. This judgement has been made using available evidence including a visit to this service. Dining rooms have been thoroughly cleaned and now provide a pleasant environment. There is limited social stimulation for people who are not able to initiate activities for themselves. Visitors are always welcome at the home. EVIDENCE: Care staff stated that, with the exception of people being nursed in bed, everyone is assisted to get up, washed and dressed by 11am. The inspectors observed that people in the main communal lounge during the morning appeared tired and many were asleep. Suddon House Nursing & Residential Home DS0000003292.V365823.R01.S.doc Version 5.2 Page 14 At the time of the inspection the activity worker was not at the home and care staff were responsible for providing social stimulation. The inspectors observed that people who were able to occupy themselves were watching TV, reading and chatting. There was some interactions between staff and people living at the home, this included staff playing a ball game with some people, nails being attended to and chatting. A member of staff remains in the main lounge to supervise and assist people, this was observed at this, and the previous random inspection. A record of activities is maintained. The inspector viewed this record and noted a small variety of activities are offered including ball games, puzzles and music. Visitors are always welcome in the home. Visitors spoken to stated that they can visit at anytime. Care plans did not show that people had been consulted on their preferences and gave no evidence of how choices were made. Activities appeared to be ad hoc and again there was no evidence of how people made choices about the things that they joined in with or declined. Since the last inspection dining rooms have been thoroughly cleaned and made more inviting. Tables were laid and drinks were available. On both days of the inspection there was a choice of meal that people were able to see. The food looked appetising and portion sizes were ample. The inspectors noted that high calorie snacks were offered to two people between meals and there was evidence of prescribed nutritional supplements being given. One relative who was assisting someone to eat, they stated that the food was “tasty, tender and full of flavour.” The days’ menu was written on a board in the dining room. The writing was not easy to read and there were no pictures. Suddon House Nursing & Residential Home DS0000003292.V365823.R01.S.doc Version 5.2 Page 15 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 adequate. This judgement has been made using available evidence including a visit to this service. Staff are aware of how to recognise abuse but are not all familiar with the local policy. There is a complaints procedure in place that relatives/advocates know how to use. EVIDENCE: The home has a complaints procedure and there is evidence that complaints are investigated. A recent complaint concerned a lack of supervision in the main lounge and this is being investigated by the provider. The company have identified in their AQAA that they plan to “make the complaints process more complete by providing written response.” 5 relatives/advocates completed questionnaires prior to the inspection. All answered YES to the question “do you know how to make a complaint about the care provided by the home if you need to.” The inspectors spoke to 9 staff in private. Staff said that they had received video training about how to recognise abuse. All staff spoken to demonstrated an awareness of types of abuse and what to do if they witnessed any abusive Suddon House Nursing & Residential Home DS0000003292.V365823.R01.S.doc Version 5.2 Page 16 behaviour. Long standing staff had received training in how to work with people who display behaviours that challenge. Staff were aware of the whistle blowing procedure and the ability to take serious concerns outside the home. At the last inspection it was highlighted that staff need to be made aware of the Somerset policy for safeguarding vulnerable adults. At this inspection it was unclear, by speaking with the provider and a trained nurse, whether or not this document was available to all. At the last key inspection bedroom doors were locked meaning that people did not have unrestricted access to their private space. Bedrooms are not now routinely locked and it was stated that the home is looking into providing locks and door handles that are easier for the people who have a dementia to use. Suddon House Nursing & Residential Home DS0000003292.V365823.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made to the environment but it still does not provide an enabling environment for the people living there. The home was clean and fresh. EVIDENCE: The inspectors toured the building looking at communal areas and a sample of bedrooms. There have been considerable improvements to the environment since the last key inspection and more recent random inspections. Areas have been Suddon House Nursing & Residential Home DS0000003292.V365823.R01.S.doc Version 5.2 Page 18 thoroughly cleaned and some rooms have been redecorated. The home was clean and fresh with no unpleasant odours detected. The call bell system has been re-instated to ensure that people are able to contact a member of staff when they require assistance. The system was tested and staff responded very promptly. The standard of furnishing in bedrooms is basic in style and design and some people do not have bedside cabinets to put drinks or lamps on. However bedside lamps and other low level lighting has been made available in personal rooms to minimise light disturbance at night. There is a variety of communal areas, a large main lounge, two smaller lounges, a conservatory and two dining rooms. The grounds around the house are not safe for people to access independently. Bedrooms are located on two floors and there is a passenger lift. There is an assisted bathroom and a level access shower on the ground floor. There are no appropriate assisted bathing facilities on the first floor meaning that people living upstairs have to come downstairs for a bath or shower. The bathrooms upstairs would benefit from refurbishment. The baths were in poor condition and the rooms were in need of decoration. The home provides care to people who have a dementia and since the last inspection some signage has been put in place to assist people to orientate themselves. The provider and maintenance person gave evidence that they are considering incorporating up to date research in providing environments that promote independence for people who have a dementia. These measures have yet to be put in place. Equipment is in place to meet the physical needs of people, this includes adjustable beds with integral rails and pressure relieving equipment. Throughout the home hand washing facilities were seen and some staff stated that they had received video training in infection control. The home has two laundry rooms and a small dryer room. Neither laundry room has a wash-hand basin. In the main laundry the Belfast sink was accessible for staff to wash their hands. One sluice room was seen, again there were no separate hand washing facilities, and the room itself required a thorough clean. Suddon House Nursing & Residential Home DS0000003292.V365823.R01.S.doc Version 5.2 Page 19 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 poor. This judgement has been made using available evidence including a visit to this service. Staff are not skilled to meet the specialist physical and emotional needs of the residents. A large number of staff have left which has led to excessive hours and low morale in the staff team. EVIDENCE: At the time that the AQAA was completed (12/07/08) the home employed 6 qualified nurses and 15 carers. 4 members of the care staff team (26 ) have a National Vocational Qualification (NVQ) in care at level 2 or above, 1 member of staff is working towards this award. In addition to this the home employs 8 ancillary workers. The inspectors viewed the duty rotas for the previous month. There is a trained nurse on duty at all times. Between 7am and 8pm there are 5 carers on duty and overnight there are three carers. Staff spoken to stated that they were currently working long hours and many shifts to cover for staff that have left and for those on holiday. Rotas seen confirmed this and it was evidenced that staff had worked up to 16 days without a day off. Some staff living on site Suddon House Nursing & Residential Home DS0000003292.V365823.R01.S.doc Version 5.2 Page 20 stated that they chose to work extra shifts. Other staff said that they found the hours very tiring and this was resulting in low staff morale. Video training packages are used for the bulk of staff training including, manual handling, abuse awareness, food hygiene, infection control and fire safety training. Very few of the staff have received training specific to the needs of the people living at the home. 3 members of the care staff team stated that were currently undertaking a distance-learning course in the care of people who have a dementia. 3 care staff said that they had already received training in dementia care. Some staff stated that they had received training about challenging behaviour in the past. The most recently appointed member of staff was originally employed in another home owned by the same provider. This file was seen and contained a completed application form and evidence that the person had been checked against the Protection Of Vulnerable Adults (POVA) register and had undergone a Criminal Records Bureau (CRB) check. Written references had been obtained. There is no formal management system in place to check the registration status of employed nurses. This issue is being addressed outside the routine inspection. Staff were observed to be polite and kind in their interaction with those living at the home. However the majority of interactions were task focussed. Some relatives/carers who completed questionnaires complimented the staff on their patience and caring attitude. Suddon House Nursing & Residential Home DS0000003292.V365823.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 35, 37 & 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is drifting and lacks purpose and direction. Staff do not receive adequate training to promote the health and safety of people living at the home. There is a lack of respect for monies and very personal possessions belonging to people at the home. EVIDENCE: Suddon House Nursing & Residential Home DS0000003292.V365823.R01.S.doc Version 5.2 Page 22 There is currently no registered manager for the home. There is a manager in place who was not available at the time of this inspection. The deputy manager was seen on day two of the inspection and was due to leave employment at the end of the week. At the time of this inspection the home was being managed by the proprietor who is a registered nurse. The current management arrangement is resulting in a lack of leadership and direction for the home. The negative impact of this was apparent upon staff and relatives visiting the home. A registered nurse is taking a clinical lead within the home but is not supernumerary. Quality assurance was not assessed at this inspection due to the difficulties in management being experienced. The proprietor stated that they do not act as an appointee or power of attorney for anyone living at the home. They also stated that they did not hold monies in respect of anyone although at the last key inspection personal monies were seen and records and monies held correlated. It became apparent that some personal monies were being looked after by the home. Money was securely stored but records of these were not available until the second day of the inspection. On the second day records were provided. These showed that valuables were also being held for safekeeping, on request these valuables, and others not recorded, were produced. Assurances were given by the proprietor that this would be dealt with as a matter of urgency. The records held for money, valuables and some personal care records were poorly completed, not up to date and would not meet the standard required by the Data Protection Act. There is no formal system for managing and monitoring staff recruitment and employment records. Since the last key inspection the statement of purpose and service user guide has been up dated. The statement of purpose is not in line with the care Homes Regulations 2001 Regulation 4 Schedule 1. The service user guide is not in an accessible format for the people who live at the home. Some health and safety improvements have been made since the last inspection. This includes re-instating the call bell system, repairs to the environment and the testing of fire safety equipment. The AQAA gave no indication of when equipment had been serviced or checked. These records were inspected and showed that appropriate checks had been carried out on fire safety equipment, the lift, hoists and portable electrical appliances. Staff spoken with stated that they had not recently received any training in fire safety in relation to Suddon House. Staff had viewed fire safety videos. A quote for fire safety training to be provided by an outside facilitator was seen and the proprietor stated that this training would be arranged. Suddon House Nursing & Residential Home DS0000003292.V365823.R01.S.doc Version 5.2 Page 23 The only manual handling training available to staff is by video and again not specific to the needs of Suddon House. The inspectors observed that many people require moving and handling expertise. It is therefore strongly recommended that all staff receive practical training and up dating in this area to promote best practice. Accident records were not viewed but the proprietor stated that falls have decreased significantly in the last month. Certificates of registration and insurance are displayed. Suddon House Nursing & Residential Home DS0000003292.V365823.R01.S.doc Version 5.2 Page 24 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 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 2 2 2 x x x 2 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 x x 1 x 1 1 Suddon House Nursing & Residential Home DS0000003292.V365823.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 (1) Requirement The registered person must ensure that the statement of purpose is reflective of the services offered in the home and that it contains all the information required. (Previous timescale of 31/03/08 and 30/04/08, not met) 2. OP7 12 (1) (3) 15(2) The registered person must ensure that care plans are fully reflective of service users needs and wishes. Previous timescale not met (30/04/08) 3. OP12 16 (2) m The registered person must ensure that all service users have opportunities to take part in social activities and receive social stimulation. Previous timescale not met (30/04/08) 31/08/08 15/09/08 Timescale for action 30/10/08 Suddon House Nursing & Residential Home DS0000003292.V365823.R01.S.doc Version 5.2 Page 26 4. OP14 12 (2) (3) The registered person must ensure that service users are given opportunities to make choices. Evidence seen did not support that this requirement was met. 30/04/08 31/08/08 5. OP22 23(2)(n) The registered person must ensure that suitable adaptations are in place to promote the independence of service users. This includes the provision of clear signage in the home and other orientation adaptations and cues. This also includes the provision of door locks that are suitable for the individual service user. Not met at this inspection. Previous date 30/04/08 30/09/08 6. OP30 18(1) The registered person must 31/08/08 ensure that all staff receive up to date training appropriate to their roles and that records are maintained of all training undertaken. Not met at this inspection. Previous date 24/04/08 7. OP33 24 (1) The registered person must establish and maintain a system for reviewing and improving the quality of care, which includes consultation with service users and/or their representatives. This was not assessed at this inspection, previous date 30/04/08. 31/08/08 Suddon House Nursing & Residential Home DS0000003292.V365823.R01.S.doc Version 5.2 Page 27 8. OP27 18(1) (a) The registered person must ensure that there is sufficient staff working at the home as is appropriate for the health and welfare of service users. This was not met at this inspection, by 30/04/08 This refers to staff working excessive number of consecutive shifts, without a day off. 31/08/08 9. OP2 Schedule 4(8)17(2) The registered person must ensure that all residents are given a terms and conditions of residency which makes clear any charges they are liable for. This was not fully met by 09/06/08 31/08/08 10. OP8 12(1) 11. OP10 12(4)(a) 12. OP29 18(1)(a) 13. 14. 15. OP31 OP32 OP35 12(1)(a) 12 (5)(a) 12(5) 16(2)(l) 17(2) Care plans must give full and accurate information about the health care needs of the individual. All information must be held together or clearly cross referenced. The registered person must ensure that all staff promote and respect the privacy and dignity of individuals in their care. There must be a system in place for checking nurse registration and re-registration with the Nursing and Midwifery Council There must be clear leadership and clear lines of accountability in the home. The registered person must maintain good professional relationships with staff The registered person must ensure that service users DS0000003292.V365823.R01.S.doc 31/08/08 31/08/08 31/08/08 11/08/08 11/08/08 31/08/08 Page 28 Suddon House Nursing & Residential Home Version 5.2 Schedule 4 (9) 16. 17. OP37 OP38 17(1)(2) Schedule 3 and 4 13(4)(c) personal belongings are treated with respect. Any items held must be securely stored and accurate records be maintained. All written records must be accurately maintained, up to date and securely stored. Staff must receive health and safety training that is appropriate to Suddon House and the needs of the people that live there. 31/08/08 30/09/08 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 OP30 Good Practice Recommendations The registered person should include the cook and other ancillary workers in dementia care training. Recommendation carried over from previous two inspections. 2. OP9 The registered person should ensure that there are protocols in place for the administration of ‘as required’ medication. Recommendation carried over from previous inspection. 3. 4. 5. OP18 OP36 OP37 The registered person should ensure that all staff are familiar with the Mental Capacity Act and its practice. All staff should receive regular formal, recorded supervision. The registered person should ensure that all policies and procedures are up dated in line with current good practice guidelines. Recommendation carried over from previous inspection. Suddon House Nursing & Residential Home DS0000003292.V365823.R01.S.doc Version 5.2 Page 29 6. OP24 All residents should have access to a lockable space to store valuables or personal possessions in their private rooms. Recommendation carried over from previous inspection. 7. OP19 Serious consideration should be given to installing blinds on the conservatory ceiling. Serious consideration should be given to how the temperature in there can be regulated. The registered person must ensure that hand washing facilities are available in the sluice and laundrys. All staff should have access to the Somerset Safeguarding Vulnerable Adults policy. Everyone living at the home should have unrestricted access to safe outdoor space. 50 of care staff should hold a national Vocational Qualification in care. 8. 9. 10. 11. OP26 OP18 OP20 OP28 Suddon House Nursing & Residential Home DS0000003292.V365823.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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.V365823.R01.S.doc Version 5.2 Page 31 - 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!