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Inspection on 23/01/08 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 23rd January 2008.

CSCI found this care home to be providing an Poor service.

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

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

All prospective service users have their needs assessed before moving into the home. The first month of a persons stay is considered a trial period to ensure that the home feel able to meet the persons needs and that the service user is happy with the service offered. The home provides nursing and residential care. At the time of this inspection two people were being nursed in bed. Both people were seen by the inspectors, they were clean and comfortable and had appropriate pressure relieving equipment in place. There was evidence that staff were assisting them to change position regularly to further reduce the risk of skin damage. Visitors are made welcome in the home and the inspectors observed that visiting families were given refreshments. The food in the home is of a good quality and well presented. People were assisted with meals in a discrete and dignified manner. Staff spoken to felt that there were always adequate numbers of staff on duty.

What has improved since the last inspection?

Since the last inspection the provider has made some investment into the building. For example; the roof at the rear of the building has been replaced, the heating has been up graded and door guards linked to the fire alarm system have been fitted on many doors.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Suddon House Nursing & Residential Home West Hill Wincanton Somerset BA9 8BP Lead Inspector Jane Poole Unannounced Inspection 09:40 23 January 2008 rd 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.V355489.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.V355489.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.V355489.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. 15th December 2006. Date of last inspection Brief Description of the Service: Suddon House is a care home registered to accommodate and provide personal and nursing care services for up to forty-three service users. Up to thirty-eight over the age of sixty years. Conditions have been agreed to enable up to five persons over the age of fifty years to be admitted depending on their care needs. Suddon house is approximately one mile from Wincanton town centre set in its own grounds with pleasant views onto surrounding farmers fields. The home is approached by a long private drive off the main road in West Hill. The home has two entrances with the main entrance to the front of the property. The second entrance is to the side. There is ample car parking to the front and side of the home. The main entrances are kept locked at all times for security of the home and the service users. There is a bell on the front door for visitors to make staff aware they are there. The home is spacious with rooms connected by corridors, two dining rooms, Suddon House Nursing & Residential Home DS0000003292.V355489.R01.S.doc Version 5.2 Page 5 conservatory/lounge and three other lounges. Bedroom accommodation is provided on two floors. Suddon House has a large garden, which is semisecure, with two large patio areas The home provides nursing and personal care for older people with dementia and other mental health needs. Service users have access to all areas of the home. The home provides twenty-four hour nursing care by registered nurse’s who are experienced in mental health and general nursing. Care staff are experienced in delivering personal care. The manager stated that the fees for the service at the time of this inspection are £625.00 to £900.00 per week. Suddon House Nursing & Residential Home DS0000003292.V355489.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 stars. 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 by two inspectors over a period of 9.5 hours. During this time the inspectors were able to speak with staff and service users, tour the building, observe care practices, discuss issues with the recently appointed manager, sample the food and view records. Prior to the inspection the previous manager had completed an Annual Quality Assurance Assessment (AQAA) 13 members of staff and 8 health and social care professionals completed questionnaires in July 2007. The inspectors were given unrestricted access to all areas and were made welcome in the home. What the service does well: All prospective service users have their needs assessed before moving into the home. The first month of a persons stay is considered a trial period to ensure that the home feel able to meet the persons needs and that the service user is happy with the service offered. The home provides nursing and residential care. At the time of this inspection two people were being nursed in bed. Both people were seen by the inspectors, they were clean and comfortable and had appropriate pressure relieving equipment in place. There was evidence that staff were assisting them to change position regularly to further reduce the risk of skin damage. Visitors are made welcome in the home and the inspectors observed that visiting families were given refreshments. The food in the home is of a good quality and well presented. People were assisted with meals in a discrete and dignified manner. Staff spoken to felt that there were always adequate numbers of staff on duty. Suddon House Nursing & Residential Home DS0000003292.V355489.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The home is not well maintained and many areas seen by the inspector were in need of thorough cleaning to create an acceptable environment and promote good infection control practices. The décor and furnishings in the home are in a bad state of repair. The building has not been adapted to enhance independence for people who have a dementia. There is no clear signage in the home or points of reference to enable service users to orientate themselves. All bedrooms doors are locked with yale type locks which are not appropriate to the needs of the service user group. This greatly reduces peoples’ freedom of movement. Privacy is not respected. Service users are not able to spend time alone in their bedrooms without consulting with staff so that they can be let into their personal rooms. Some rooms are shared by people who have not chosen to do so and there is no consultation with service users about this practice. Shared rooms have inadequate screening, which further compromises privacy. Many service users are unable to fully express their views and some have limited verbal communication. The inspectors saw no evidence that staff are offering choices about how people spend their day, activities that they take part in or even the food that they eat. There is limited social stimulation for people who are unable to initiate activities or conversations. There are no protocols in place for the use of ‘as required’ medication which many lead to inconsistent practice. There is limited information about how people who are unable to express themselves verbally may indicate that they are in pain or discomfort and require pain relief. The care plans do not clearly identify all up to date needs are not being fully evaluated to ensure their effectiveness. Some of the policies and procedures in the home have not been up dated to reflect current best practice or local guidelines and therefore they give misleading information to staff. Suddon House Nursing & Residential Home DS0000003292.V355489.R01.S.doc Version 5.2 Page 8 The inspectors have also highlighted areas in respect of health and safety that require improvement. These include poor fire safety practices and general poor maintenance within the home, which potentially places service users at risk. It was noted that two window-panes were cracked with sharp edges exposed and that wardrobes were not always secured to walls and therefore posed a risk of toppling forward and causing injury. The call bell system in the home has been de activated so service users are unable to summon help. 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.V355489.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.V355489.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All prospective service users have their needs assessed before being offered a place at Suddon House to ensure that the home is able to meet their needs. The service user guide is not appropriate for the service user group. Intermediate care is not provided. EVIDENCE: The home has produced a new statement of purpose, which incorporates the service user guide. This is a fairly weighty document that is not appropriate as a service user guide for the service user group. Suddon House Nursing & Residential Home DS0000003292.V355489.R01.S.doc Version 5.2 Page 11 Some information in the document is not fully reflective of the service offered or the philosophy demonstrated at the time of this inspection. All service users have their needs assessed before being offered a place at the home. The inspector saw copies of pre admission assessments in individual care plans. One care manager, who completed a questionnaire prior to the inspection, praised the pre admission assessment process. They stated that the home took time to talk with relatives to gain a holistic picture of the prospective service user before offering a place at the home. All service users have a contract with the home. This states that the first four weeks of a person’s stay is a probationary period for both the home and the service user. During the first 4 weeks only one weeks notice is required to terminate the contract, after this point a calendar months notice is required. Suddon House Nursing & Residential Home DS0000003292.V355489.R01.S.doc Version 5.2 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. 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. All service users have a care plan but these need to be further developed to ensure they give details of individuals’ wishes and provide clear guidance for staff. Service users privacy is not respected. There are no protocols in place to ensure that people receive ‘as required’ medication at appropriate times or that staff are administering this in a consistent way. EVIDENCE: Everyone living at the home has a care plan. The inspector viewed 5 care plans in detail. Suddon House Nursing & Residential Home DS0000003292.V355489.R01.S.doc Version 5.2 Page 13 All contained assessments of need from which care plans had been created. The care plans covered many areas of daily life but there was limited information about likes and dislikes or preferred routines. In some instances care plans did not reflect current practice in the home. For example staff stated that one service user was taken to their room after lunch each day for a rest on their bed. This was not documented in the care plan. In other instances the care plans did not give clear guidance for staff. Two stated that food and fluid charts were to be completed but gave no indication on what was considered to be an adequate diet and therefore no measures were in place if an adequate diet was not taken. Care plans were being reviewed on a regular basis but many had not been changed for over a year. The reviewer had written ‘no change’ or ‘continues to be effective.’ There was however no evidence to show how the effectiveness of the plan was being monitored. Assessments in respect of tissue viability, nutrition and moving and handling are carried out for all service users. However these were not clearly linked to care plans. The nutritional assessment for one person whose weight had reduced significantly had not been changed since November 2006. There is always a qualified nurse on duty and all appointments with healthcare professionals outside the home are recorded. At the time of this inspection two people were being nursed in bed. They were sharing a room with no adequate screening between the two beds. There was no evidence that either person had requested to share a room. Staff stated that the service users relatives had agreed to this but there had been no consultation with the service users themselves. Both people being nursed in bed appeared clean and comfortable. Pressure relieving equipment was in place and they were being assisted to change position on a regular basis. The radio was on in the room but unfortunately it was not quite tuned to a station so was quite distorted. The staff write daily records in respect of each person and these focus on physical needs and interventions. Charts are also completed to show when people have received assistance with personal care such as washing and dressing. The inspectors observed that some service users were not well presented, many had not had their hair brushed or styled and some peoples’ clothes had food stains on. At least two service users in the communal areas did not have slippers or shoes on. Staff stated that personal care is always carried out in private, either in the privacy of bedrooms or communal bathrooms. The home employs both male and female staff but there was no evidence in care plans that people were given a choice about the gender of the person who assisted them with intimate personal care. Suddon House Nursing & Residential Home DS0000003292.V355489.R01.S.doc Version 5.2 Page 14 All bedrooms are locked meaning that service users do not have unrestricted access and have limited opportunities to spend time alone. Suddon House Nursing & Residential Home DS0000003292.V355489.R01.S.doc Version 5.2 Page 15 A generic risk assessment in care plans states “Unless on bed rest the residents must remain in the supervised areas.” Very few service users at the home have a key to their room and therefore have to ask staff if they wish to go to their room. The home cares for people who have a dementia and many are unable to verbally communicate their wishes or needs. All rooms have the same lock so anyone with a key can open any room. The statement of purpose states “ Service users are entitled to ‘private’ accommodation (ideally in single rooms subject to availability), which they can call their own, which they can use as and when they wish and to which they can invite guests. This implies choice about the nature of the room or space (eg furnishings) and ability to lock the room and to have a secure place for personal belongings” This is not the current practice in the home and therefore very misleading for anyone moving to Suddon House. The home uses a Monitored Dosage System (MDS) for all medication. There is appropriate storage for medication, including controlled drugs. The Medication Administration Records, (MARs) are audited on a monthly basis by the deputy manager. The inspector looked briefly at the MAR charts. Controlled drugs were checked and stocks held correlated with records kept. There are no protocols in place for medication that is prescribed on an ‘as required’ basis and therefore no guidelines for staff detailing under what circumstances it should be given. Many people who are prescribed pain relief would be unable to verbally communicate when they needed the medication but there are no individual guidelines to state what behaviours may indicate pain or discomfort. The medication fridge was above the recommended 2 – 8 degrees and had been for some time. Staff continued to record daily temperatures between 19 and 28 degrees, which is not appropriate for the storage of medication. Suddon House Nursing & Residential Home DS0000003292.V355489.R01.S.doc Version 5.2 Page 16 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. The food in the home is of a good quality and well presented. Service users are not offered choices about how they spend their day and there is limited social stimulation. EVIDENCE: As previously stated care plans do not give details of people likes, dislikes or preferred routines, although one care plan seen stated that the person liked to stay in bed. The staff stated that everyone, except those being nursed in bed, is expected to have breakfast in the dining room. There was no evidence that all service users were able to make this choice. Many of the care plans seen had good life histories of the person, giving details about their interests and lifestyles but these did not appear to be incorporated into care plans. There is an activity timetable on the notice board in the corridor and a dedicated worker is employed for two hours a day from Monday to Friday. Suddon House Nursing & Residential Home DS0000003292.V355489.R01.S.doc Version 5.2 Page 17 A member of staff stays in the main lounge but on the day of inspection this person sat with one service user and there was very limited social interaction for other people in the room. During the morning there were 13 people in the main lounge; over half were asleep. There was music on but no interaction. A member of staff stated that a person comes in to play the piano on occasions and some service users enjoyed a sing along. There is a smaller lounge at the other end of the building and during the inspection some people were watching television and another was reading. The activities timetable is not clearly displayed and the inspectors were unable to ascertain how people were assisted to make choices about the activities that they took part in. Staff have not received training about the Mental Capacity Act or how to assist people with limited capacity to make decisions Two service users stated that they are able to have visitors at anytime and the inspector observed that one service user was being visited by their family. The visitors were made welcome and provided with refreshments. A hairdresser visits the home regularly and a price list was displayed on the notice board. A member of the local clergy also visits the home and offers communion. There are two dining rooms in the home and the inspectors observed lunch being served. Both dining rooms are poorly furnished and uninviting. One dining room is locked when meals are not being served. In one of the rooms there was a Christmas decoration on the wall and holly leaves drawn on the menu board. This does not assist people with a dementia to orientate themselves to the time of year. There was no choice of main meal and service users were not offered a choice of vegetables or condiments. Service users were assisted with their meal in a discrete and dignified manner. The quality of the food was good and well cooked. Since the last inspection the home has introduced a new three-week menu, a copy of which was given to the inspectors. The menu displayed on the notice board at the home was out of date but each day the staff write the days menu on a notice board in the dining rooms. The new menu shows a good variety of meals but there is no choice for service users except about the pudding they have at lunch-time. Suddon House Nursing & Residential Home DS0000003292.V355489.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 17. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Systems in place do not adequately protect service users from abuse. Staff are not aware of the correct procedures to follow if an allegation of abuse is made. EVIDENCE: The home has a complaints procedure, which is included in the statement of purpose and in the contract. The home maintains a complaints log but the inspectors noted that one complaint written in the communication book had not been entered into the log. There was no written evidence of how the complaint had been dealt with or whether the complainant was satisfied with the outcome. The home does not have an up to date copy of the local ‘Safeguarding Vulnerable Adults’ policy and procedure. The homes own policy on recognising and reporting abuse is not consistent with the local multi -professional policy and gives misleading advice. The whistle blowing policy gives contact details for the previous home-owners who are no longer involved in the running of the home. Suddon House Nursing & Residential Home DS0000003292.V355489.R01.S.doc Version 5.2 Page 19 Al 13 staff who completed questionnaires stated that they were aware of the homes policy on protecting vulnerable adults and how to report abuse. Staff need to be made aware of the Somerset policy to ensure that they are acting in line with up to date guidelines and practices. The inspector viewed the recruitment files of four recently employed members of staff. Three staff had started work in the home before two written references had been obtained. All staff had been provisionally checked against the Protection Of Vulnerable Adults (POVA) register before they began work but there was no evidence that they had been supervised in the home before full clearance against POVA and the Criminal Records Bureau (CRB) had been obtained. Senior staff in the home were not aware of their duty, or the procedure to follow, in reporting staff to the POVA register. As previously stated service users are not able to freely access all communal areas of the home or their personal rooms. Suddon House Nursing & Residential Home DS0000003292.V355489.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 & 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home requires refurbishment to bring it to an acceptable level for service users. Many areas seen were not clean and there were inadequate measures in place to prevent the spread of infection. The home has not been adapted to meet the needs of the service user group. EVIDENCE: Suddon House is a large older style house that has been extended over the years to provide accommodation for up to 43 service users. There are 33 Suddon House Nursing & Residential Home DS0000003292.V355489.R01.S.doc Version 5.2 Page 21 single rooms and 5 doubles. Service user accommodation is located over two floors and there is a passenger lift between. The home is located in a rural location with far reaching views across open land. The home is fitted with a fire detection and emergency lighting system. Records of regular tests of this equipment were not available at this inspection. The call bell system in the home has been removed and replaced by walkietalkies for staff. This means that there is no way for service users to summon assistance. All areas of the home seen by the inspectors were poorly maintained and in need of refurbishment and redecoration. There are two dining rooms and a selection of communal seating areas. The quality of furnishings in communal areas is poor and does not provide a homely environment. In one dining room the wooden doors leading to an outside area were rotten at the bottom allowing a strong draft to come into the room. There was a selection of chairs that did not match and required cleaning. There was also a sideboard in this room that contained items including incontinence pads and a set of unnamed false teeth in a glass of water. Walls and skirting boards were dirty and required cleaning or painting. In the conservatory there was a wicker chair that was broken, one pane of glass was cracked with a sharp edge, the windows were dirty and the sills were in need of painting. In the main lounge the furniture is sparse and the general appearance is not homely. The inspectors were given a master key which enabled them to view a sample of bedrooms. Furnishings were generally old and of a poor quality. Very few rooms had bedside lights and the main light switches were not accessible from the bed. This means there was no accessible light for people getting up in the night. Many rooms did not have bedside cabinets meaning that people could not have drinks by them when in bed. Some rooms did not have a comfortable chair. In one room there was no light in the en-suite and the chair had a large rip in it. One room had a broken chest of drawers. The inspectors found lightweight wardrobes that were not secured to the wall and were at risk of toppling forward causing possible injury to service users or staff. (An immediate requirement was issued to ensure all wardrobes were checked and secured within 24 hours.) Bed linen was of a poor quality and very thin for the time of year. One sheet seen had a tear in it. Suddon House Nursing & Residential Home DS0000003292.V355489.R01.S.doc Version 5.2 Page 22 Rooms seen were generally untidy and some smelt unpleasant. Some rooms have en suite facilities and there are communal toilets, bathrooms and shower rooms around the home. One shower room seen, which was obviously still in use for service users, was also being used for storage, as well as the shower and shower chair there were four dinning room chairs, two patio chairs, a blanket and a vest on the floor. There were no suitable hand-washing facilities and the sink and toilet were dirty. Other communal bathrooms seen were in need of thorough cleaning and redecorating to bring them to an acceptable standard for people to use. There are two laundries in the home providing adequate washing and drying facilities. In one laundry the sink is inaccessible and there are no hand washing facilities. The main kitchen in the home is also in need of upgrading. The door had fallen off of one cupboard, the freezer was rusty and dented and the lid did not stay open without being held. An environmental health officer visited the home in October 2007. A requirement was issued for the home to redecorate the ceiling and outside wall within two months. At the time of this inspection this work had not been undertaken. The manager stated that there is a refurbishment plan for the home but this is not written down. The front entrance has been decorated and work has begun on the corridors. In one corridor names and numbers have been removed from bedroom doors and they have been undercoated in preparation for painting. Staff stated that it has been over a month since this was done. The home provides care for service users who have a dementia but the environment has not been adapted in any way to meet their needs. There is very limited signage and no points of reference around the building to assist people to orientate themselves and maintain independence. All bedroom doors have yale type locks which can only be opened from outside with a key and are not suitable for people with a dementia. As previously stated bedroom doors are kept locked. The whole home was untidy and in need of thorough cleaning. There were unused incontinence pads on window sills in communal areas, floors required cleaning or hovering, curtains were hanging off rails, there were cobwebs in many areas and furniture was in a poor state of repair. There was no liquid soap in bedrooms or any communal area for staff or service users to wash their hands with. An immediate requirement was issued for soap to be provided within 24 hours. Suddon House Nursing & Residential Home DS0000003292.V355489.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 17, 18, 29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are no records of staff training in the home. Staff work in a task centred rather than person centred way. Staff recruitment procedures do not adequately protect service users from abuse. EVIDENCE: There are 28 members of the care staff team, this is made up of 6 trained nurses, 21 carers and 1 bank nurse. 7 members of the care staff team have a National Vocational Qualification (NVQ) in care at Level 2 or above. Staff spoken to on the day of the inspection felt that there were always sufficient numbers of staff on duty. The duty rotas seen showed that in the mornings there is one trained nurse and 6 carers and in the afternoon there is one trained nurse and 5 carers. Overnight there is one trained nurse and 3 carers. All ancillary hours and the managers’ hours are in addition to this. Suddon House Nursing & Residential Home DS0000003292.V355489.R01.S.doc Version 5.2 Page 24 The inspectors viewed the recruitment records of 4 recently appointed members of staff. As previously stated they did not contain all items required by the Care Homes Regulations 2001. Some staff had started work before two written references had been obtained and there was no evidence that staff were being fully supervised between being appointed with a provisional POVA check and the home receiving a full CRB check. New staff are not given a copy of the General Social Care Council code of conduct. Staff spoken to stated that they had received training in moving and handling, fire safety and dementia care. However there was no written evidence of this in the home and therefore no way to ensure that everyone had up to date statutory training certificates. Some staff stated that training consisted of watching videos and completing questionnaires. 11 of the 13 staff who completed a questionnaire said that they had received an adequate induction when they began work in the home. The manager stated that all new staff undertake an induction programme but again there were no records of this. Staff observed on the day of the inspection spoke to service users in a friendly manner but appeared quite task centred in their work and there was very limited social interaction between staff and service users when tasks were not being performed. As previously stated life histories have not been incorporated into care plans and therefore there are no clear guidelines for staff to provide appropriate social interaction and assist people to make choices and decisions. Suddon House Nursing & Residential Home DS0000003292.V355489.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 & 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The current manager is not registered with the Commission for Social care Inspection. There are no formal systems in place to seek the views of service users and ensure that the home is run in line with their wishes and needs. Practices in respect of fire safety are poor and potentially place service users at risk. EVIDENCE: Suddon House Nursing & Residential Home DS0000003292.V355489.R01.S.doc Version 5.2 Page 26 There is currently no registered manager at the home. A new manager was appointed in November last year who stated that he will be applying to the Commission for Social Care Inspection to be registered. In addition to the manager there is a deputy manager who also acts as the trained nurse when on duty. The deputy has no hours allocated for management but oversees the day to day care in the home including care plans and will be organising and co-ordinating staff training. The home holds staff meetings to share information and ideas. There are no meetings for service users or their representatives and therefore no formal systems for service users to influence the running of the home. The inspectors discussed with the manager the need to set up formal quality control systems to ensure that service users and other interested parties are consulted about their views on the quality of care offered. There are no records of up to date supervision sessions for staff. The home does not act as an appointee or power of attorney for anyone living at the home. Small amounts of personal money is held for safekeeping to ensure that people have access to cash for personal items and services such as toiletries and hairdressing. Records are kept of all money held and transactions made. The inspectors viewed a sample of these and found that records correlated with monies held. Fire procedures in the home are not clear. The fire log showed no evidence that alarms had been tested since August 2007. (Staff stated that the tests may be recorded elsewhere but additional records were not available at this inspection) The homes fire risk assessment had not been up dated since 2006 and was not in line with new regulations. There was no evidence that all staff had received up to date training in fire safety. An immediate requirement was issued to ensure that the fire alarms and emergency lighting system was tested within 24 hours of this inspection. One fire extinguisher had come off the wall and was sitting on the floor in a downstairs corridor. There was no clear procedure for how staff should respond in the event of a fire at night and the possibility of the building needing to be evacuated. The inspector saw servicing records of equipment in the home. All lifting equipment is currently being serviced annually by outside contractors, it is recommended that this be increased to 6 monthly. The portable electrical appliances in the home were last tested in January 2007 and now need to be re-tested. There is no landlords gas safety certificate in the home. Suddon House Nursing & Residential Home DS0000003292.V355489.R01.S.doc Version 5.2 Page 27 All accidents are recorded and the deputy manager sees all records on a monthly basis to establish any recurring patterns relating to accidents. Records show that there are a high number of falls in the home. Care plans are not changed to reflect individuals recorded falls. The inspector sampled the policies and procedures in the home and found that many required up dating in line with current good practice and local guidelines and contacts. There is an up to date certificate of insurance and registration displayed in the home. Suddon House Nursing & Residential Home DS0000003292.V355489.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 1 1 1 1 x 1 1 1 STAFFING Standard No Score 27 2 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 1 x 3 1 2 1 Suddon House Nursing & Residential Home DS0000003292.V355489.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP26 Regulation 13(3) Requirement The registered person must ensure that there are suitable hand-washing facilities for staff and service users including the provision of soap in bedrooms and communal areas. Immediate requirement issued The registered person must ensure that fire alarms and emergency lighting is tested regularly and records of tests maintained. Immediate requirement issued The registered person must ensure that all wardrobes are stable and secured to the wall where necessary to prevent the risk of them falling forward and causing injury. Immediate requirement issued The registered person must ensure that the statement of purpose is reflective of the services offered in the home. The registered person must ensure that care plans are fully DS0000003292.V355489.R01.S.doc Timescale for action 24/01/08 2 OP38 23 (c ) 24/01/08 3 OP38 13(4) 24/01/08 4 OP1 4 (1) 31/03/08 5 OP7 OP8 12 (1) (3) 15(2) 31/03/08 Suddon House Nursing & Residential Home Version 5.2 Page 30 6 OP10 12(4) 7 OP12 16 (2)[m] 8 OP14 12 (2) (3) 9 10 OP16 OP18 17 (2) Sch 4 11 13 (6) 11 OP18 13 (7) 12 OP19 23 (1) [a](2) [b] 12 OP22 23 (2) [n] reflective of service users needs and wishes. They must also be reflective of current physical and mental health care needs and give clear guidelines in respect of nutrition. The registered person must ensure that the home is conducted in a way that respects the privacy of service users. This includes ensuring that service users have unrestricted access to their private rooms and ensuring that adequate screening is provided in shared rooms. The registered person must ensure that all service users have opportunities to take part in social activities and receive social stimulation. The registered person must ensure that service users are given opportunities to make choices. The home must maintain an accurate record of all complaints made. The registered person must ensure that all staff receive up to date training in the correct procedures for recognising and reporting abuse The registered person must ensure that service users have access to all communal areas of the home and personal rooms unless reasons for restrictions are recorded in care plans and agreed with service users and/or their representatives. All areas of the home must be kept in good repair. A refurbishment plan including timescales must be forwarded to CSCI. The registered person must ensure that suitable adaptations are in place to promote the DS0000003292.V355489.R01.S.doc 31/01/08 31/03/08 28/02/08 28/02/08 31/03/08 31/03/08 31/03/08 30/04/08 Suddon House Nursing & Residential Home Version 5.2 Page 31 13 OP22 14 OP24 15 OP25 16 OP26 17 OP26 18 OP29 19 OP30 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. 16 (2) [ c] The registered person must ensure that service users are provided with equipment, which enables then to contact staff in the home. 16 (2) [c] The registered person must provide adequate bedroom furniture for all service users including curtains and bedding and screening where appropriate. 23 (2) [p] The registered person must 13 (4) ensure that there is suitable lighting in all bedrooms and ensuites. 16 (2) The registered person must [j][k] ensure that there are satisfactory standards of hygiene in the home and all areas are free from offensive odours. 13 (3) The registered person must ensure that suitable arrangements are made to prevent the spread of infection in the home. This includes providing appropriate hand washing facilities for service users, staff and visitors and providing training for staff in infection control. 19(1) Sch The registered person must 2 ensure that no person commences work in the home until all items listed in Schedule 2 of the Care Homes Regulations have been obtained and authenticated. 18 (1) The registered person must ensure that all staff receive up to date training appropriate to their DS0000003292.V355489.R01.S.doc 31/03/08 30/04/08 28/02/08 15/02/08 15/02/08 15/02/08 28/02/08 Suddon House Nursing & Residential Home Version 5.2 Page 32 20 OP33 24 (1) 21 OP38 12 (1) roles and that records are maintained of all training undertaken The registered person must 31/03/08 establish and maintain a system for reviewing and improving the quality of care, which includes consultation with service users and/or their representatives. The registered person must 28/02/08 ensure that the home is conducted so as to promote the health and welfare of service users. This includes regular testing of fire safety equipment, training staff in fire safety, securing fire extinguishers to walls and ensuring there is a clear procedure for staff to follow in the event of a fire at night. 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 OP15 Good Practice Recommendations The registered person should promote good practice further and record meals served to individuals linked to the nutritional needs in the service user care plan. Recommendation carried over from previous inspection. The registered person should that the dining room chairs are cleaned as they had food debris ingrained on them. Recommendation carried over from previous inspection. The registered person should ensure the laundry walls are cleaned regularly. Recommendation carried over from previous DS0000003292.V355489.R01.S.doc Version 5.2 Page 33 2 OP26 3 OP26 Suddon House Nursing & Residential Home inspection. 4 OP30 The registered person should include the cook and other ancillary workers in dementia care training. Recommendation carried over from previous inspection. The registered person should ensure that there are protocols in place for the administration of ‘as required’ medication. The registered person should ensure that all staff are familiar with the Mental Capacity Act and its code of practice. Communal areas should promote a homely atmosphere. Bedrooms should only be shared by service users who have made a positive choice to do so. 50 of care staff should have a National Vocational Qualification in care at level 2 or above. 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. All lifting equipment in the home should be tested on a six monthly basis. 5 6 7 8 9 10 11 12 OP9 OP18 OP20 OP23 OP28 OP36 OP37 OP38 Suddon House Nursing & Residential Home DS0000003292.V355489.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Regional Office 4th floor, Colston 33 33 Colston Avenue BS1 4UA Bristol 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. 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