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Inspection on 21/06/06 for Sue Ryder Nursing Home

Also see our care home review for Sue Ryder Nursing Home for more information

This inspection was carried out on 21st June 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

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

This inspection found the overall quality of the nursing care and support offered to residents was to an excellent standard. The care provided was found to be within a risk assessment framework, and was recorded within each person`s plan of care. Residents` needs and wishes were recorded demonstrating that residents` were consulted about decisions and choices that affected their lives. A number of residents received PEG feeds (nutrition via a tube), and records confirmed they were being closely monitored. A number of reported medication errors checked, demonstrated that nursing staff take these seriously, appropriately report incidents, and try to prevent these from occurring again. Current medication procedures were detailed.Life style and leisure opportunities were widely available for residents so the social needs of individuals were being properly met. This was confirmed by feedback received from residents, relatives and staff. Due to the high quality provided by the home within these areas, these 2 standards were assessed as "standard exceeded". Residents and relatives commented that staff were always cheerful and considerate, and believed the home was a very caring place. The home was found to be clean and mostly well maintained. Staff employment and recruitment records were checked and found appropriately in place, and staff training and supervision continued. The management of the home continued to be responsive and inclusive to the needs of residents.

What has improved since the last inspection?

Since the last inspection, a small number of requirements including the provision of a moving and handling assessment, appropriate Criminal Bureau (CRB) record checks, and a broken bath panel have been resolved. The home had requested an extra bathroom on the first floor to be converted into a single bedroom. This request was to allow a double bedroom to be converted onto a single room, and so better meet the needs of the residents. The new bedrooms were inspected and were considered suitable for purpose.

What the care home could do better:

While it was noted the home provided an excellent service for residents, a small number of issues required attention including the provision of nutritional and fall risk assessments, ensuring that all medication records are signed for, and that some damaged woodwork is repaired. The medication policy must be updated. Two residents identified with challenging behaviour, must have their care management reviewed. Recommendations were made around the storage of surplus equipment, the provision of personal profiles, the deployment of staff, and ensuring that all staff had received supervision.

CARE HOME ADULTS 18-65 Sue Ryder Nursing Home The Chantry Chantry Park, Hadleigh Road Ipswich Suffolk IP2 0BP Lead Inspector Kevin Dally Unannounced Inspection 21 & 22nd June 2006 10:00 st Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 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 Sue Ryder Nursing Home DS0000024508.V300879.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 Adults 18-65. 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. Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sue Ryder Nursing Home Address The Chantry Chantry Park, Hadleigh Road Ipswich Suffolk IP2 0BP 01473 295200 01473 231397 louise.fawkes@suerydercare.org 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) Sue Ryder Care Mrs Joanne Marshall Care Home 29 Category(ies) of Physical disability (27), Physical disability over registration, with number 65 years of age (2) of places Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 The home may also care for two service users, as named in the letter dated 18 August 2004 (from Jayne Stevens, Regulation Manager, to Mrs J Marshall, Registered Manager) who have physical disabilities and who are over the age of 65 years. 1st August 2005 Date of last inspection Brief Description of the Service: The Chantry is situated in a large old mansion house located in the grounds of Chantry Park. The house is owned by the Local Authority and managed by the Sue Ryder Care Group. It is registered for 27 younger adults with physical disabilities and for 2 residents with physical disabilities over 65 years of age. The home specialises in providing nursing care for people who have a neurological condition, such as acquired brain injury or chronic neurological disease. The building has been significantly adapted to provide for the needs of its residents. There is adequate space for wheelchair users, a large physiotherapy room with suitable equipment, a Snoezelen for relaxation therapy, and a large day centre area. Service users who are wheelchair bound are able to access the expansive and well-maintained grounds of the park. The home has 19 single rooms and 5 double rooms. There is a large reception hall and dining room, and a number of large lounges. There is a programme of activities, and the home has its own wheelchair accessible minibus. The weekly current scale of charges is £755 to £1300 per week. Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Sue Ryder Nursing Home provides care for up to 29 residents with specialised nursing care needs. This unannounced inspection was undertaken over two days, on the 21st and 22nd June 2006, and Louise Fawkes came in and was present for part of the first day of the inspection. This was a key inspection that assessed the core standards relating to younger adults. The report has been written using accumulated evidence gathered prior to and during the inspection. This inspection focused on the outcomes for residents around the nursing care provided and the medication practises of the home. Due to a number of reported medication errors over the past year, the home’s medication procedures and systems for monitoring these incidents were checked. Additionally residents’ care plans, risk assessments; accident and incident reporting and nursing assessments were checked for evidence of good record keeping and management monitoring. The meals provided were checked and the environment was assessed. The complaints book and quality assurance systems were checked. Residents, relatives and staff provided additional feedback about the service provision and how residents’ care needs were met. Comment cards were received from 8 residents, 9 relatives, and 8 staff members. Two staff members’ records were checked, and staff training and supervision practises were examined. The home’s revised medication policy was reviewed. The inspection found that of the 34 National Minimum Standards inspected, the home fully met 29 standards, with 5 being partially met. Three standards, “meeting needs”, “lifestyle”, and “leisure activities” were assessed as “standards exceeded”. What the service does well: This inspection found the overall quality of the nursing care and support offered to residents was to an excellent standard. The care provided was found to be within a risk assessment framework, and was recorded within each person’s plan of care. Residents’ needs and wishes were recorded demonstrating that residents’ were consulted about decisions and choices that affected their lives. A number of residents received PEG feeds (nutrition via a tube), and records confirmed they were being closely monitored. A number of reported medication errors checked, demonstrated that nursing staff take these seriously, appropriately report incidents, and try to prevent these from occurring again. Current medication procedures were detailed. Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 6 Life style and leisure opportunities were widely available for residents so the social needs of individuals were being properly met. This was confirmed by feedback received from residents, relatives and staff. Due to the high quality provided by the home within these areas, these 2 standards were assessed as “standard exceeded”. Residents and relatives commented that staff were always cheerful and considerate, and believed the home was a very caring place. The home was found to be clean and mostly well maintained. Staff employment and recruitment records were checked and found appropriately in place, and staff training and supervision continued. The management of the home continued to be responsive and inclusive to the needs of residents. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 Quality in this outcome area is excellent. Residents can expect to have their needs and aspirations assessed prior to admission and know whether or not the home is able to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Comment cards received from residents revealed they had usually received sufficient information about the home, before moving in. The Statement of Purpose and Service User Guide checked included relevant information for residents about the service provided. Residents’ records checked contained new care needs assessments that had recently been redeveloped by the Sue Ryder organisation. The assessments included 8 areas of identified care needs including physical and psychological needs, and these were found to be very detailed care assessments. Care plans are developed using this information. Needs assessments were found in place for the records checked. Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 9 Sue Ryder Nursing Home is a specialised service for younger people with complex physical disabilities. The staff group comprises of around 18 Registered Nursing staff, 2 qualified part time neurological Physiotherapists and two Physiotherapist assistants who are trained to meet the specialised needs of the service user group. Staff spoken with and records checked revealed that staff continued to receive good training that was appropriate to the needs of the residents. The premises were spacious, wheelchair friendly, and all floors accessible by the lift. The home included a Physiotherapist’s room with specialist equipment, a Snoezelen for sensory stimulation and relaxation, and the day centre, so enabling staff to offer a range of programmes and activities for residents. One resident spoken with confirmed they received regular physiotherapy as part of their weekly care programme, and another resident confirmed they regularly accessed the day centre. From the information gathered it was clear that the home was able to meet the specialised needs of the service user group. Due to the high quality of the specialised services offered, this standard was assessed as “exceeding the standard”. Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 Quality in this outcome area is good. Residents can expect to have their care thoroughly planned and regularly updated, so reflecting their care needs and wishes. Furthermore, they can expect to be enabled to make decisions about their life and be consulted on matters within the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Sue Ryder organisation had recently redeveloped new care plans, which assessed eight areas of physical and psychological needs of residents. Three residents’ care plans checked were found to be very detailed, and included the care and support required from staff. Care plans had been regularly monitored and updated. Care records also provided specialised assessments including pressure area and manual handling risk assessments, weight charts, activity records, and physiotherapy assessments. Nutritional assessment forms were provided in the records but 2 of 3 forms had not been completed. This was because the home was still considering which model of nutritional care would be adopted to identify these needs. However, nutritional guidance had been provided by staff and recorded within their care plans under the section, “eating and drinking”. Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 11 This was discussed with the management and it was agreed that nutritional assessments would be completed without delay. One resident’s fall risk assessment had not been completed, which was required. Residents spoken with during the inspection confirmed that life at the home and the quality of the care provided was very good. They confirmed they were consulted about their lives and life within the home and were able to make their own decisions. Residents had regular meetings where home issues could be discussed and referred to the management for action. The manager also met with a residents’ committee group where various home issues were raised and discussed. Questionnaires received from residents confirmed the majority (6) felt they could “usually or always” make decisions about what to do each day. Two residents stated “sometimes”, and 1 stated “never”, but did not explain why. One resident spoken with confirmed they were supported by the home to access various activities outside the home. For example walking in the park in their wheelchair. The resident stated they would let staff know when they were going, and could do so unattended. This positively demonstrated that residents’ rights were considered, and were supported to take risks within a risk assessment framework. Residents’ questionnaires received confirmed that all residents thought, “they could do what they wanted to do”, either during the day, in the evening, or at the weekend. Comments included, “yes I feel I can do what I want do to a certain degree”, and “I spend a lot of time on my own in the afternoon and evenings”, and “sometimes I attend church or spend the day with my relatives”. One resident stated they “cannot go fishing or hunting”. Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17. Quality in this outcome area is excellent. Residents can expect to have opportunities for personal development, participate in activities within the local community, and be consulted about their daily life and routines. Relatives and friends can expect to be made welcome when visiting the home. Residents can expect to receive meals that are nutritious and balanced, which met their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents continued to have very good access to leisure or exercise opportunities including access to the home’s physiotherapy department, the snoozelum for sensory stimulation and relaxation, the day centre for activities, or trips outside the home. The day centre provided interesting and varied activities for residents and day centre attendees. Residents could also join one of the many planned outdoor excursions provided or join in on one of the home’s many social activities or evenings. Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 13 One resident spoken with stated they had access to trips out to Felixstowe beach, the local shopping centre, and walks within the park. Further, they had access to the day centre, which provided activities that met their needs. For example, woodworking, which they thought was a really good session. A full time activity person was employed to assist individuals pursue personal goals, and achieve local and community based activities, and 2 qualified part time neurological Physiotherapists and 2 assistants were employed to assist residents undertake key daily exercises. A number of resident activities were displayed on the notice board and these opportunities were included a church service, a social evening, woodworking at the day centre, and the residents’ meeting. Residents’ spoken with confirmed they were able to maintain links with their family or friends. One resident confirmed their relative visited frequently and they could spend time in private if required. Comment cards received from 9 relatives stated that staff and management welcomed them at the home anytime. Staff spoken with confirmed that residents had good work and leisure opportunities. The records checked included helpful information around residents’ personal activities, including occupational therapy and activities, relevant exercises, and a weekly activity event calendar. The care plans checked reflected the resident’s needs and wishes in relation to their personal development, social and activity needs and daily routines. Records entitled “pen pictures”, had yet to be completed, which was recommended. The menu choice showed that residents were provided with a balanced, varied, and sufficient diet with good meal choices. A number of residents spoken with confirmed the meals were to their liking, were enjoyable and varied with good alternative choices. The meal on the day of the inspection was Braised Beef or Vegetable Lasagne with potatoes, and vegetables. The dessert was steamed pudding. The tea menu was a burger in a bun, soup and a roll or fruit and yoghurt. The meal was appetising, smelt and looked good. The dining room was pleasant, spacious and clean and residents were seen to be enjoying lunch and one another’s company. Menu records received also revealed the home was about to change the menu, subject to the residents’ approval. Some residents relied on PEG feeds, (feeding via a tube). The procedure was documented within their care plans with instructions and the necessary amounts of feed required. Weight charts were in operation so weight losses and gains could be closely monitored. Some more vulnerable individuals were seen being assisted by staff with their meal. This was undertaken in a dignified and caring manner. Residents’ views of the meals of the home included the following comments. “They are nice meals. I am not a big eater but the meals are good”, and Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 14 “There is plenty of choice, and you can have what you want. “My favourite meal is Bacon Lorraine Quiche or the ploughman’s lunch”. Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. Residents can expect to receive good quality personal and healthcare support. Residents can usually expect to receive appropriate assistance with their medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents’ records checked showed that residents were asked about their personal care and preferences, and their personal needs were reflected in care plans. Healthcare needs had also been assessed and records revealed that health problems were addressed and regularly monitored. Residents’ spoken with stated they were very happy with their care, and the staff group. Comment cards received revealed that residents were “usually or always” treated well by staff. Comments included “The staff are 1st Class”, and “I like this place, its nice”, and “I enjoy being here”. “I am looked after well”. Alternatively one resident stated, “Sometimes I have to wait for care after lunch and in the evening”. Residents and staff spoken with confirmed that staff maintained privacy and respect by knocking on doors before entering, and by the use of screening in double rooms. One resident confirmed they had the opportunity to choose their own personal clothing each day and care was provided in a sensitive manner. Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 16 The accident records checked revealed there had been around 30 accidents since the last inspection. Accidents were monitored by the home, and these were discussed with registered staff at monthly meetings, to ensure staffs’ awareness of the problems. Additionally, staff had reported around 33 separate incidents, which mainly related to 2 residents with challenging behaviour. Problems identified revealed these residents could become violent, could hit staff, or grab them by the wrist. The records revealed that some staff had sustained minor injuries from these individuals. This was discussed with the manager who confirmed that one resident had had challenging behaviour for as long as they had been at the home. These incidents had been monitored and discussed at the home’s quality improvement meetings by the home. In order to deal with this, staff had been were trained to manage challenging behaviour, including breakaway techniques, but sometime, even this training had not always worked. In view of these issues, the home was required to reassess the way in which these two residents challenging behaviour was managed. The home has been adapted with aids and equipment to meet the specialised needs of the residents, including hoists and shower trolleys. The home also had physiotherapy treatment plans. One resident spoken with confirmed that there was access to professional staff including their Doctor, the Chiropodist, the Dentist and the resident Physiotherapist when required. During the past 16 months, the home had appropriately reported a number of medication errors to the CSCI. Today’s inspection focused on the home’s medication policy and procedures, the systems for monitoring incidents, and progress being made towards the reduce of similar incidents. During the period January 2005 to April 2006 the home reported 6 incidents that related to medication practices. Five of these incidents resulted in medication being incorrectly administered by nursing staff to residents. Of the 5 incidents, 3 had occurred by agency staff, and 2 by staff from the home. All incidents had been thoroughly investigated, and where necessary, changes made to try to prevent similar incidents from reoccurring. For example new agency nurses now receive induction at the home, prior to undertaking any work. Much work has also been undertaken by the home to review and rewrite medication procedures, and a new medication policy document has been produced for staff guidance. The manager has also discussed issues with the trained staff, and at clinical meetings. Medication auditing and monitoring now regularly takes place, and a procedure is in place for promptly dealing with any unsigned medication records. Due to the large volume of medication used by residents, the home has now changed the medication system to blister packs for greater efficiency and safety. The home also plan to offer registered staff Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 17 an updated medication training to ensure they are aware of the new procedures. It was evident that the home takes all errors very seriously, and encourages staff to come forward, in the event that an error is made. This is not only to ensure resident safety, but was also to more effectively determine why an error occurred, and how that it may be prevented in the future. An audit was undertaken of the home’s medication policies and procedures and which included checking the way in which medication was administered to residents, checking the home’s ordering procedures, storage areas, record keeping, Controlled Drugs cabinet and register, the disposal of mediation, and the new medication policy for the home. The systems found in place were very thorough and well audited, with an audit trail in place. One resident’s medication records checked had not been signed for and which was required. Although the home had some guidelines, medication policy checked did not include local guidance for staff around the administration of medication within PEG feeds, which was required. Discussion with a number of the registered staff confirmed they were aware of the recent medication incidents. Staff revealed that their greatest concern was the number of interruptions that can occur, when undertaking the medication rounds. These also could correspond with meal times, which were busy times. After hours or weekends could also a problem when there was usually no administration support to answer doors or the telephone. These concerns were discussed with the manager who agreed to further discuss at the next nurses team meeting. Policies and procedures were in place for the control and administration of medication. On the day of inspection medication was appropriately stored and administered by a qualified member of staff. The staff member also demonstrated a sound knowledge about how medication was ordered and disposed of, and how stock was controlled. The medication was transported in a lockable trolley, and records checked were accurate and up to date. Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. Residents can expect to have their complaints taken seriously and acted upon. Resident’s safety, including by recruitment checking and staff training can be expected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy that included appropriate details about the stages of the complaint process and the timescale for response. The procedure stated that a complaint will be acknowledged in writing within 2 days and a full response and outcome will be provided within 20 days. The home had received two recorded complaints since the last inspection. The complaints log detailed the nature of the complaint, the investigation undertaken and the action taken as a result, including the outcome of the complaint. After investigation, one complaint had been resolved, and one was awaiting a response from the complainant. One of the complaints was quite extensive, and the manager had provided a detailed response to this. Residents and relatives’ questionnaires revealed that most people knew about the complaints procedure and who to complain to if they are not happy. One resident stated, “If unhappy, I will complain”. On the day of inspection two residents, spoken with revealed they felt safe at the home and felt confident they could talk to someone, if they had any concerns. Staff training records included abuse awareness and staff spoken with confirmed they had an awareness of Protection of Vulnerable Adults (POVA) procedures. Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 19 Two staff employees’ records checked included Criminal Bureau Record checks (CRB) and Protection of Vulnerable Adults (POVA) checks. Both staff members’ records included 2 reference checks, and an identity check. Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30, Quality in this outcome area is good. The size and style of the building and the need to provide extensive, often large equipment, does not lend itself to creating a homely environment. However, the home is generally well maintained, comfortable and safe. Residents can expect the home to be clean, hygienic and odour free. They can also expect to have the aids and equipment to meet their individual needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Chantry is a large old mansion house located in the expansive grounds of Chantry Park. It has been significantly adapted to provide for the needs of the residents, and there is plentiful space for wheelchair users. Residents can easily access the near-by grounds of the park. The home has 19 single rooms and 5 double rooms. There is a large reception hall, a number of lounges and large newly extended dining room. The buildings fixtures, fittings and general décor are in a practical style for residents and are appropriate to the style of the mansion. Most of the areas checked were generally well maintained. Although safety boards protected the lower walls of the hallway areas, protruding decorative wood had been damaged by wheelchairs in a number of areas. Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 21 Since that last inspection the home requested that an extra bathroom on the first floor be converted into a single bedroom. This was to allow a double bedroom to be converted onto a single room, and so better meet the needs of two residents. As the home already had three other suitable bathing facilities on the same floor, it was agreed that the variation could be made. The new bedrooms were inspected and were considered suitable for purpose. A number of additional residents’ rooms were checked and provided suitable furniture, fixtures and fittings, and many included residents’ personal items. Some rooms were found cluttered including various items of equipment, which did not lend to a homely environment. Specialist equipment, aids and adaptations were found throughout the home to meet the needs of the residents including shower trolleys, lifts and hoists. Call systems were available in residents’ bedrooms and hot water tap temperatures checked were around 43 degrees Celsius, so within safe limits. The home was found to be clean, hygienic and odour free. The bathrooms, toilets and bedrooms seen were provided with liquid hand wash and paper hand towels. Residents and staff confirmed the home was maintained in a clean and hygienic state. The pre-inspection questionnaire stated that a laundry refit was planned from July 2006. Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35,36 Quality in this outcome area is good. Residents can expect to have their needs met by appropriately trained staff but during busy periods staff cover may not always be sufficient. Staff are supervised and supported to ensure complete residents safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Discussion with staff and rota checks confirmed the home continued to maintain a minimum of 2 trained nurses on duty for each shift in addition to 6 support workers in the mornings, 4 in the afternoon and 2 at night. The home also employs domestic, kitchen and maintenance staff, day centre and activity staff, a receptionist, and a physiotherapist and 2 assistants. On the second day of the inspection, the manager and head of clinical care were also on duty. Questionnaires received from 9 relatives/visitors confirmed they felt there were usually sufficient numbers of staff on duty. Staff feedback received indicated that residents’ needs had become more challenging recently. As stated at the last inspection, staff thought ratios needed to be reviewed at certain times, usually in the mornings, and around meal times. Staff also stated that if care staff were sick, and a replacement unavailable, this put particular pressure on staff to meet needs. This was discussed with the manager and it was agreed that the placement of staff during the day would be reviewed. Currently there were 5 care staff vacancies, but all positions had been recruited to. Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 23 Two staff members’ recruitment records were checked and suitable recruitment and employment procedures were found to be in place. Both employees’ records included Criminal Bureau Checks (CRB), identity checks, 2 written references for each employee, a declaration of health status, and a contract of employment. One nurse’s records revealed the home had checked their Professional Identity Number (PIN) with the Nursing and Midwifery council, (NMC) and this was current. Staff training records checked and the home’s 2006 Training and Development Plan confirmed that staff receives good training to meet service users’ needs. Staff confirmed they had received appropriate training including challenging behaviour, protection of vulnerable adults, first aid, moving and handling, fire training, Multiple Sclerosis and Infection Control. The manager confirmed there are 25 support workers, with 14 having obtained an NVQ 2, and three have obtained an NVQ 3. Two are currently working towards NVQ 2, with three working towards NVQ 3. Therefore 60 of support workers have obtained an NVQ in care”. From the records checked and staff spoken with confirmed they usually received regular supervision, personal support and staff meetings. Feedback from 1 staff member stated they had not had supervision since January 2006. Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,42 Quality in this outcome area is good. Residents can expect the home to be inclusive and open, and have their views considered by the management. They can also expect a safe environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is a registered nurse, and has a Diploma in Management, and has managed the Chantry for around 6 years. The management team were found to be open and inclusive about the running of the home, which included the provision of regular resident and staff feedback meetings. The notice board revealed that the residents’ meeting was planned for the following week. The manager also met with a smaller group of residents, to discuss any future plans for the home, and receive their views. The quality assurance systems were checked which revealed the home had undertaken an annual survey of residents in March 2006 and October 2006. Relatives views are also sought. Feedback was compiled into a quality improvement plan and action would be taken to deal with any issues raised. Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 25 The home also ensured that accidents and incidents were recorded and monitored, and any complaints investigated. A number of quality assurance forms were checked and which evidenced service user feedback. Residents’ views included, “staff are always friendly to me but some of the staff can be a bit abrupt”, and “I have never had to complain yet”, and “I saw people cared for in other homes. I can honestly say none are of the same standard of the Chantry”. “care at the home is first rate”. At the time of the inspection, the provider had only forwarded one Regulation 26 visit report to the CSCI during the past 6 months. This was discussed with the manager who stated the provider’s representative had been unwell during this period, and the reason that most had not been provided. The company should therefore identify an appropriate person to ensure that Regulation 26 reports are undertaken. Since the inspection the CSCI has received the June 2006 report. Records confirmed that staff had received appropriate health and safety training including moving and handling training, food hygiene, fire safety and life support training. There is always a minimum of two qualified nurses on duty. Hot water tap temperatures tested did not exceed 43 degrees Celsius, so remained within safety limits. Records of routine temperature testing had been maintained. The accident book was checked which recorded 33 accidents since the previous inspection. The management has monitored these. Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 4 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 x LIFESTYLES Standard No Score 11 4 12 3 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 x 3 3 2 3 x 3 x Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 27 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. 2. 2. Standard YA6 YA6 YA18 Regulation 17(1)(a) Sch 3(3)(m) 13 (4) (a)(c) 12(1)(a) (b) 13(2) 13(2) Requirement Nutritional assessments must be undertaken without delay. Timescale for action 31/07/06 A falls risk assessment for 1 15/07/06 resident must be completed. The home must review the 15/07/06 management of two residents with challenging behaviour. One resident’s medication records must be signed for. Medication policy must include local guidance for staff around the administration of medication within PEG feeds. Decorative woodwork must be repaired in the hallways. Regulation 26 visit reports must be forwarded to the CSCI on a monthly basis. 06/07/06 31/07/06 3. 4. YA20 YA20 5. 6. YA24 YA39 23(2)(b) 26 31/07/06 31/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 28 No. 1 2 3. 4. 5. 6. Refer to Standard YA11 YA26 YA32 YA33 YA36 YA39 Good Practice Recommendations Residents’ personal background profiles (pen pictures) should be completed. Surplus equipment in resident’s rooms should be removed or stored to provide a more homely environment. The home should consider how it proposes to ensure that 50 care staff will achieve an NVQ care qualification. The manager should review staff placements particularly during busy periods. The manager should ensure all staff receive supervision at regular intervals. The company should identify an appropriate person to ensure that Regulation 26 reports are undertaken. Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Sue Ryder Nursing Home DS0000024508.V300879.R01.S.doc Version 5.2 Page 30 - 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. 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