Inspection on 01/03/07 for Summer Lane Care Home

This inspection was carried out on 1st March 2007.

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

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

Other inspections for this house

Summer Lane Care Home 06/11/08

Summer Lane Care Home 19/11/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Summer Lane Care Home Diamond Batch Worle Weston Super Mare North Somerset BS24 7AY Lead Inspector Catherine Hill Unannounced Inspection 1st March 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Summer Lane Care Home DS0000068380.V326316.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. Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Summer Lane Care Home Address Diamond Batch Worle Weston Super Mare North Somerset BS24 7AY 01934 529190 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) Summer Lane Care Home Ltd TBA Care Home 90 Category(ies) of Dementia - over 65 years of age (45), Old age, registration, with number not falling within any other category (45) of places Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate in the Balmoral Suite up to 45 people in category OP, who require nursing care, of whom up to 5 may be 60 - 64 years of age. May accommodate in the Waverly Suite up to 45 people in category DE(E) who may require nursing care of whom up to 5 may be 60 - 64 years of age. Date of last inspection Brief Description of the Service: Summer Lane Nursing Home is a purpose-built home that opened in September 2005. It has recently changed ownership and management. The home is in a residential area close to local facilities and the M5 motorway. Weston-super-Mare town and the seafront are a few miles way. Summer Lane is comprised of two units: Balmoral on the ground floor which caters for older people with general nursing needs, and Waverley on the first floor which caters for people with nursing needs due to their dementia. Each unit is divided into clusters of bedrooms around smaller lounges and kitchendiners. A spacious lounge leading off the foyer is used for entertainments and meetings. There is a large central garden. Downstairs bedrooms on the inner side of the square all have French windows facing onto this garden. Downstairs bedrooms on the outer side of the home have French windows leading on to small patio areas and a secure walkway around the outside of the building. There is also a large enclosed garden at the back of a property for use by people on the upstairs wing. This wing has a spacious patio roof garden which is accessible from the activities room. A local GP provides a weekly surgery at the home as well as additional health care support needed. A Consultant Psychiatrist also visits the Waverley wing on a regular basis. Fee levels range between £467 and £625. Fees exclude hairdressing, chiropody, newspapers and toiletries. Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over two visits made by two inspectors on each occasion. Each visit took between six and seven hours. Between them, inspectors spoke with 24 residents, 5 relatives, and 25 staff. A number of health and social care professionals passed on comments to CSCI prior to these visits. One of these professionals was particularly impressed with how the home is coping with current staff shortages, and with the recruitment programme and development plans for existing staff. Another person passed on the comments of relatives of a resident who died recently. They said that staff were absolutely brilliant throughout this persons final days, and made large numbers of visiting family welcome. Another professional was impressed by the quality of care and of care records. One of the inspectors spent two half-hour periods in the morning in the lounges of the Waverley wing, observing the care being given by staff. She then looked at the records of some of the residents, comparing her observations with these people’s care records and the staff’s understanding of their content. Inspectors looked in particular depth at the care and experiences of six residents. They sampled records, including: • the Statement of Purpose • pre-admission assessments • care plans, some in the old-style format and some in the new format being introduced by the home • risk assessments and other documentation that supplements care plans • records relating to pressure areas and their treatment • records relating to falls and their management • medications • menu records • the staff rota • staff recruitment and training records • records relating to staff supervision • records of residents cash held by the home for safekeeping • fire precautions testing and training. What the service does well: A recurring theme from conversations during this series of visits was that the new provider is unstinting in allocating resources to improve residents quality Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 6 of life. Staff felt well supported and actively encouraged to aim for the highest possible standards. The atmosphere in the home is very positive. Some really good relationships have developed between staff and residents. All the residents who inspectors spoke with made positive comments, such as “the staff are excellent”, “I am well looked after”, and “I can do what I want when I want”. One person said, “they are always there when I need them”. Visitors are given a warm welcome and encouraged to be as involved as they would like. Menus are kept under review and residents are regularly consulted about them. Residents made comments like the food is good and said they liked the daily choices offered. Chefs are very flexible and will provide other alternatives to suit individual tastes. One resident said, if you don’t like something they’ll change it. The environment is very attractive, well laid out, and furbished to a high standard. What has improved since the last inspection? The staff team has achieved remarkable improvements since the last inspection. The atmosphere in the home is livelier and happier. Inspectors met some residents and relatives who had given their views at earlier inspections, and these people were more satisfied with the quality of service than before. Staff went about their duties with a sense of purpose, and paid real attention to residents and their visitors. Staff were more aware of residents’ needs and viewpoints, and took care to promote their dignity. Overall, the organization of tasks and the management of the home is more effective. Quality monitoring systems are being redesigned and better used. Delegation of tasks to staff is being done more effectively, and there are now more staff around at all times of day. Staff are more accessible and spending more social time with residents. Routines are more flexible. Manual handling practice generally complied with the guidelines. Health- and social- care professionals praised the standards of care. Residents on the Waverley wing seemed calmer and more at ease, and were more engaged with people around them. There are more activities going on, and these are better suited to the needs of all the residents. Private information is kept confidential. Records are more streamlined and more useful. Medications practice has improved in some respects. Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 7 Infection-control practice has greatly improved, and suitable equipment is much more readily accessible to staff. More staff have had training in the needs of people with dementia. Inspectors saw a lot of staff-resident interactions and were really impressed with the skill with which staff dealt with some difficult situations. Staff unfailingly treated residents with warmth and respect. A second nursing station has now been provided in the Waverley wing. This allows staff on duty to divide into two teams and to provide care more individually. It provides floor cover more evenly, rather than all staff clustering together in the office at certain times of day. 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 Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 8 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Summer Lane Care Home DS0000068380.V326316.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 Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives get plenty of information before making a decision to move into the home. The home gathers lots of information about the needs of prospective residents with dementia, and is taking steps to gather better information about the general nursing care needs of other people. EVIDENCE: The new owners are redrafting the home’s Statement of Purpose. In the interim, they have produced an action plan to address the most urgent issues affecting the running of the home. Inappropriately placed residents have been moved to new placements. Keypad doors have been fitted at two points across the corridors in the Waverley wing to create a natural division into two units. The rooms of the frailer and more vulnerable people with dementia are Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 11 on one side, and rooms for the people who require more intensive behaviour management input are on the other. Residents are in the process of changing rooms so that people with similar needs share the same half of the wing. This is being done gradually, with the permission of the residents or their representatives. So far, this appears to be working well. The number of accidents has dramatically reduced, residents generally looked much calmer and interacted better with each other, and no-one seemed distressed by the presence of the new doors. Three relatives said they had received good information and reports about the home and this had influenced their choice. People are able to visit as often as they need to before making the decision to move in for a trial period. The residents files sampled each contained pre-admission assessments. Inspectors commented in the last report that the assessment’s focus on mental health and dementia issues makes it particularly useful for residents coming into the Waverley wing but the format does not contain enough detail on general nursing care needs to be adequate for people coming into the Balmoral wing. The assessment documentation is in the process of being changed to more fully reflect the physical and nursing needs of all prospective residents. A care plan is drawn up, based on the information in the pre-admission assessment. One recently admitted resident said that the care was “excellent”, and a relative said the staff were “very attentive, kind and caring and fully meet their needs”. The care practices seen during this inspection showed that staff were fully aware of the residents’ needs as stated in their assessments. Those residents files sampled included letters confirming that a service can be offered, contracts, and copies of terms and conditions. The home does not provide intermediate care. Summer Lane Care Home DS0000068380.V326316.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, 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents care needs are much better documented and are being well met. Staff are treating residents as respected individuals, and are quickly responsive to changing needs. Medications practice has been tightened up since the last inspection but still requires further urgent improvements to ensure peoples safety. EVIDENCE: Each resident’s records have been streamlined, and essential information was much more accessible. Care plans seen at the last inspection were not very person-centred and individualized, but these records are currently being updated. Many residents have new care plans that are much easier to understand, which link needs and goals to action plans, and which show clear short-term and longer-term aims. The acting manager is planning a staff meeting to explain how to use this new format. Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 13 Care plans addressed a broad range of issues, such as social inclusion and the monitoring of mental health. The deputy manager on the Waverley wing has recently completed a training course on person-centred dementia care, and is putting what she has learnt into practice. All care plans showed how the resident or a relative had been involved in drawing them up. Care plans contained well-formulated risk assessments for Manual Handling, Falls, Nutrition and Pressure Area care. None of the residents who inspectors met on the Balmoral wing had any pressure sores, and this was confirmed by the care notes. One bedridden resident said that staff looked after his bottom well and he had never had any bedsores. Several people on the Waverley wing have wounds that require dressing. Each person has their own prescribed dressings, and specialist advice is sought where necessary. Some of the files sampled included consent from a relative for issues such as photographs, blood taking and bedrails; some others contained consent from the resident themselves. Consent for use of recliner (bucket) chairs had not been obtained from residents or their relatives. This is particularly important in order to protect residents from potential restraint against their wishes. Inspectors discussed the issue of consent with senior staff in the light of the new Mental Capacity Act. It is recommended that the managers of both wings attend training in order to understand the implications of this Act regarding people who are unable to give their own consent. One person cannot give or withdraw consent on behalf of another, so if residents are unable to give consent on their own behalf, they should be consulted as far as practicable and a Best Interest meeting held between those people who can advocate on the persons behalf. This might include relatives, health care professionals, and the homes own staff. The frequency of invasive procedures such as blood tests or monitoring blood sugar levels was discussed. The deputy manager of the Waverley wing is going to find out how often blood tests are needed so that residents are not subjected to them unnecessarily. Daily records were up to date and generally written in a respectful manner. However, the tone and type of language used in some of the records made by some night staff indicated that not all actions may be done in the best interests of a resident, but to provide an easy option for the staff. The deputy manager of this wing intends working some night shifts in the immediate future, leading by example of good practice in order to raise the standard of service. Care plans referred to a weekly shower or bath. One resident said they had a full wash on other days of the week. This person was not aware of being able to ask for another bath or shower in the week. It was a requirement of the last inspection that residents must be able to have a bath or shower more often than once a week if they wish. Many of the people inspectors met during Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 14 the current inspection commented on the flexibility of routines. As staffing levels increase and residents become more aware that they have a say in the support they receive, this issue will hopefully be resolved. One inspector reviewed the medication with the deputy manager of the Waverley wing. Some records and stock medications tallied, but the records could not be reconciled with the amount of medication found in the drug trolley and drug cupboard. Monitored Dosage System medicines and Controlled Drugs have been administered accurately, but not the medication in the manufacturers’ containers. The deputy manager of the Waverley wing will be discussing this failure in professional practice with the nurses and instigating a tighter stock control system, which will be spot-checked and monitored closely to identify any failures. Another inspector reviewed the medication with the deputy manager of the Balmoral wing. Regular medication audits are not undertaken on this wing, either, and it was not possible to clearly trace all medication received, administered and disposed of. This is very poor practice and potentially puts residents at risk. Fridge temperatures for medicines fridges are recorded weekly, and all refrigerated products are marked with the date they are opened. These good practices will help to promote effective stock control. Hand-transcribed prescriptions were seen, only some of which had been signed by two members of staff. Good practice guidance should be followed to provide the recommended safeguards for residents. There were some unexplained gaps on the Medication Administration Record charts. Variable dose prescriptions do not show which amount was administered at any one time. No homely remedies were seen on the Medication Administration Record Sheets. The Homely Remedies policy is straightforward and regularly reviewed, but it is not clear whether it has been signed by residents GPs to demonstrate their agreement with it. No stocks of homely remedies were available should the need arise. An inspector found poor practice regarding the storage of medicines, which potentially put residents at risk. Concerns were raised with staff in charge at the time. The morning medication routine complied with good practice guidance. However, the round took so long to complete that medications due at 8.30 a.m. were still being given out at 10.30. This is poor practice, especially for medications that should be given at set times of day. The two nurses on duty give out medications simultaneously on one half of their wing, which should Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 15 reduce the amount of time taken to complete the round. But the nurses are often distracted from this by other tasks. A consultant psychiatrist regularly visits Waverley to review the residents. This helps provide continuity of care, and gives staff valuable extra support. Residents are on minimum medication, and very few residents have any night sedation. The intervention and support from the consultant psychiatrist has meant that prescribing of antipsychotics, antidepressants and sedative medication has been kept to a minimum. The trained staff at the home have all received information and professional guidance regarding covert medication. There are no residents who are selfmedicating. Equipment for use with inhalers appeared not to have been cleaned for some time. This ought to be washed at least twice weekly to prevent the spread of infection and to ensure the full dose is delivered. Some residents and relatives commented that dental services were lacking. The home has still not been able to obtain the services of a visiting dentist. Two relatives said they felt residents would benefit from some regular physiotherapy input, but had been advised this was only available privately. The manual handling practice seen during these visits had significantly improved from earlier inspections, but one inspector saw two staff lifting a resident by putting their arms underneath the person’s arms. This put both the resident and staff at risk of injury. The acting manager intends reminding all staff of the importance of following the manual handling practice they have been taught. This will help protect the safety of residents and staff. Concerns were raised at the past two inspections about the attitude and practice of some staff, although other staff demonstrated excellent awareness of residents needs and feelings. The approaches by staff to residents that inspectors saw during this series of visits were without exception kind, considerate, and appropriate. All the residents spoken with felt that staff are kind and caring, and respect their dignity and privacy. Confidential information about residents is no longer displayed on the office whiteboards, and the visiting chiropodist now sees individual people in the privacy of their own bedrooms. A key worker system is in place, helping to clarify responsibilities and to enable stronger relationships to develop between staff and residents. All the residents spoken with made positive comments, such as “the staff are excellent”, “I am well looked after”, and “I can do what I want when I want”. One person said, “they are always there when I need them, although sometimes I may have to wait a bit for them to answer the bell”. Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 16 One of the residents gave the inspector a good example of how a significant change in his life had immediately triggered staff to give him extra input. A professional who visits the home passed on to inspectors the comments of the family of a resident who recently died: the family said that staff had been absolutely brilliant during this persons final days, were kindness itself, and nothing had been too much trouble, including catering for large numbers of visitors. Very frail people being nursed in bed had suitable equipment and looked well cared for. Fluid charts showed that staff are being conscientious about ensuring each person gets regular fluids. Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are a lot of activities and entertainments, and something of interest is laid on every day but the schedule of activities does not fully meet the needs of bed-bound residents. The attitude of staff and the provision of wellequipped kitchenettes around the home help to ensure that visitors feel welcome. Residents are getting a greater degree of choice and control in their daily lives. Menus are well balanced and flexible, and residents are very satisfied with the quality of meals. EVIDENCE: There was a marked difference in the homes atmosphere during this series of visits. All of the staff went about their duties cheerfully, treated residents with warmth and respect, and readily engaged with the inspectors. Residents seemed calmer, happier, and more engaged with their surroundings. One of the inspectors spent time in two of the lounges on the Waverley wing during the morning. Plenty of staff came into the lounges for short periods, Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 18 and spent a lot of time interacting with the residents. The quality of staff input had a strong impact on residents wellbeing. One lady, left her own devices, quickly became distressed and aggressive, and staff dealt with this in a particularly skilful and positive way. Before long, this lady was chatting with the person next to her and laughing. Staff gave each person lots of positive reinforcement, drew them into whatever was going on, and warmly reassured them if they became upset. Different staff dealt with some potentially difficult situations calmly, creatively and with great respect for the person. The activities organiser and some staff set up a few simple games. Several of the residents became really animated, and spontaneously interacted with other people. There was a lot of laughter, which spread to those people who werent joining in the game. At other points, different staff came in to take people away for help with personal care or to distribute hot drinks. In each case, staff gave clear explanations to people and offered them a choice. Occasionally a resident got up to go for a walk around. While staff were evidently alert to this, no-one tried to prevent her and staff simply made sure she was safe. When she returned, she was greeted warmly and invited to rejoin the group. Many of the residents were still getting up when inspectors arrived to do this series of inspection visits. Most people have breakfast on trays in their rooms and then get washed and dressed at a leisurely pace afterwards. Notices are placed around the home about regular and one-off activities or entertainments. Some sort of event is planned for the morning and afternoon every day of the week. Activities are not always taking place, due to current staffing issues, but residents described regular opportunities to go on local trips out or to join in planned activities at the home. There is a wide range of planned activities, including regular music or film afternoons, World News discussion, pot planting, manicures, outings to local places of interest, shopping trips, arts and crafts sessions, aromatherapy and reminiscence. Care staff also regularly take residents from the Waverley wing for one-to-one strolls around the sensory garden. Each wing has its own activities organizer, who arranges a programme of daily activities. The activities organizers have compiled a social history of each person, identifying their previous interests and including relevant details of their earlier life. Information is also kept on what each person can and cannot do, to help activities organizers plan events. They keep a record of the activities each person participates in. Some residents records showed long gaps between activities over recent months. This appears to coincide with one of the organizers being off long-term. As staffing levels increase, it is likely that care staff will be able to undertake some activities in the organizers absence. One resident’s social life has recently significantly changed. The organizers had been quick to increase their input to this person. Activities organizers are insured to take residents out in their cars. A minibus has also been booked for local outings every week or so. The home is trying to Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 19 get the use of a minibus with a wheelchair lift so that more residents can use this. Many of the more able residents made comments like “we have plenty of choice and variety.” However, three residents and two relatives said that the bed-bound residents often get very bored, and some stimulation needs to be provided for these people. Activities organizers are not restricted in what they book, so this should be easy to address after consultation with the less mobile residents. Visitors came and went throughout the day in a very informal manner. They said that staff are always welcoming and always make it possible for them to take their relative out if they wish to. Visitors are also able to have meals with residents. Four of the residents on the Balmoral wing spoke of the recent residents meeting and how helpful it had been. They were aware that there is a notice of dates for future meetings and felt it was good to be included in the home in this way. Waverley has orientation boards with written information about the day. It might be more helpful to some residents if this was also presented in a pictorial form. Dining areas looked welcoming. Small tables and a variety of dining rooms allow residents to dine in a more personal atmosphere. Staff helped residents to eat with tact and consideration. Staff giving one-to-one support sat alongside the person and chatted easily with them and other people at the table. Residents made comments such as the food is good and said they liked the daily choices offered. One resident said, if you don’t like something they’ll change it. A choice of high tea or a wide selection of sandwiches is available every teatime. Staff see each person on a daily basis to ask about their choices for each meal, then hand this information to the chef so that he can plan his work. The inspector looked at some of these records, which showed a reasonable range of alternatives on offer, and that staff are flexible about suggesting something different if none of these suits. Chefs try to accommodate any special requests, and the head chef talks to residents about the meals as often as he can. There is a four-weekly menu but chefs change some meals to avoid it becoming too repetitive. Copies of the menus are kept in each kitchen area of the dining rooms so that residents or visitors can see them. Photographs of the meals being served that day may help some of the residents on the Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 20 Waverley wing to make an informed choice. All deserts are home-made, as are most of the main savoury dishes. At least one of the vegetables at each meal is fresh, and the quality of ingredients is good. Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples concerns are taken seriously and responded to. Residents are well protected from abuse. EVIDENCE: CSCI has received no complaints since the new owners took over the home. Comments made by residents, relatives and professionals at the time of this inspection revealed that the new owners are actively encouraging people to air their views. Many people gave the inspectors examples of how this had led to change for the better. Forms are kept at the reception desk for any comments or suggestions that residents or visitors might like to make anonymously. The home has a copy of the ‘No Secrets’ in North Somerset guide in the medications room. Staff interviewed were familiar with the Adult Protection policy and knew the procedure that should be followed, if abuse were suspected. Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The environment is exceptionally well-designed and pleasant, indoors and outdoors, and improvements have begun on the sensory garden. EVIDENCE: Residents live in a purpose-built well maintained home. The home is divided into two units: Balmoral on the ground floor that caters for older people with general nursing needs, and Waverley on the first floor that caters for older people with dementia. Each is designed so that a group of a dozen or so bedrooms is serviced by a lounge and a dining room. All bedrooms are at least 12 square metres and have an ensuite toilet. There are no double rooms but several adjoining rooms have an internal connecting door that allows them to be used as a double bedroom with private lounge by couples who choose to Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 23 share. Many residents said how much they liked their rooms. All bedrooms are equipped with safety locks, and new residents are now routinely offered a key to their own front door as well as their patio door. In addition to these facilities, there is a variety of communal rooms, including an activities room, a hair-dressing room, and a large function room. Ground floor bedrooms each have French windows onto either the large central garden or an individual small garden plot beside the outer perimeter walkway. There is a large roof garden leading off the activities room on the upstairs wing, which now has some large raised pots planted with attractive Spring flowers. There is an enclosed central garden with level walkways leading across and around it. A large water sculpture forms the centrepiece of this garden, and there are teak deck chairs and tables with parasols for use in the summer. Hanging baskets have been fixed to the fence around the outside of the building to improve the outlook of the rooms that face outwards. There is a large fenced garden at the very back of the home that has been set aside for use by residents of the Waverley wing. A sensory garden is being created here, and it is planned to include some raised flower-beds and possibly a PVC greenhouse so that residents can get involved with gardening. Corridors have been made interesting by the inclusion of seating areas and long windows, and furnishings are of an exceptionally high standard. Themed areas have been created in the corridor recesses of the Balmoral wing, and interesting artwork has been acquired for the walls of the Waverley wing. Several clocks have also been acquired for the communal areas of this wing, helping residents to know what time of day it is and what meal they can expect next. A number of small lounges and dining areas allow a range of activities, such as watching TV or conversing in small groups. Kitchenettes in each dining area are well equipped, so visitors can help themselves to a hot drink and staff can serve residents meals in these areas. There are bathrooms and toilets within easy reach of all other rooms. Residents have a choice of which type of bath or shower to use. The temperature is controlled at source for all the hot water outlets, and this was routinely tested until recently. It was recommended at the last inspection that water temperature should be tested before residents get into the bath or shower, but the record sheets seen at todays inspection indicated that this is still not being done. In general, infection control practice seen during this inspection was an improvement on the practices seen at the last inspection. Staff the inspectors spoke with showed a good awareness of how to maintain a clean and hygienic environment. Alcohol gel and protective equipment is easily accessible to staff, and there are plenty of hand-washing facilities. Any unpleasant odours Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 24 were quickly resolved, and all areas were kept clean and fresh. Communal toiletries are no longer used: each resident now has their own toiletries. One staff member now has responsibility for cleaning the kitchenette areas, and the overall state of these had greatly improved. In one of the dining areas, there were baked beans on the ceiling, probably from a domestic disaster. Staff were aware of this, and were waiting for someone with a ladder to clean the ceiling. COSHH (Control Of Substances Hazardous to Health) safety data sheets on the chemicals in use around the home are kept in the sluice room, where staff can quickly access them. The new supplier of cleaning chemicals provides these in 5-litre containers, which staff pour into other containers for mixing. Staff were not using protective safety glasses to do this. The inspector suggested that manually operated dosage pumps should be fitted to these containers so that staff can dispense from them safely. Inspectors commented at the last inspection that hoists and wheelchairs needed a thorough cleaning. A lot of this equipment seen during these current inspection visits was still dirty. Discussion with staff revealed that no one has clearly delegated responsibility for keeping this sort of equipment clean. The acting manager intends to address this. Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels have been steadily increasing and are meeting residents needs much better. Staff recruitment practice and training promote residents safety and wellbeing. EVIDENCE: The current rota indicated that there is a minimum of two registered General nurses and five care staff on duty during the day. There are more usually seven care staff on during the day. At night, there is a minimum of two registered nurses and three care staff. The acting manager plans to increase staffing levels on the Waverley unit to two nurses and nine care assistants during the day, and two nurses and five care assistants at night. The rota showed one occasion shortly before this inspection when there had only been one nurse on duty at night. The inspector advised that this is insufficient, despite the fact that neither wing is fully occupied at present. Staff and the acting manager independently confirmed that staffing levels no longer fall this low: when there is a shortage of care staff, some of the nurses cover these shifts. Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 26 At the moment, there are only two cleaners on each wing in the mornings. More applicants are being interviewed, though, and it is intended to increase the number of cleaners to three on each wing in the mornings and one on each wing for several hours in the early evening. If it proves necessary, an extra cleaner will be employed for the evening shift. The home employs a hospitality team who welcome and greet visitors to the home. The home has no maintenance person at present. The manager told the inspector that two new maintenance people had been appointed and would be starting work in the next few weeks. At present, the rota is only done two weeks in advance and there is no predictable pattern to it. The inspector suggested that a basic rota is drawn up, and that actual rotas are done at least four weeks in advance. This would make it easier for staff to plan their off duty. In practice, staff use a diary to request days off. Staff are being deployed better than at previous inspections. Senior staff were clear about where staff were needed at different times of day, and care staff understood how to balance the expectations of their role. Staff were distributed around the building more evenly, and there were very few occasions during these visits when there were no staff around for more than a few minutes at a time. If residents became distressed or needed prompt help, a staff member was quickly on hand. Staff recruitment records showed that checks are done thoroughly before people start work in the home. There is a core group of staff that has worked in the home since it opened, but otherwise staff turnover is still very high. Hopefully, the staff team will start to stabilize as the recent changes begin to take full effect. The home has recently recruited a number of new carers who will be going through an induction, which includes an assessment of competence at the end of each training element. Several of the existing staff commented that the new staff being recruited have a good attitude and show ability for this sort of work. Many people said they work well as a team. A number of staff from overseas are employed at the home and form part of the close-knit team. Staff and residents said their presence brought a breadth of experience and interest to the home. Staff felt that the increased staffing levels are giving them more time to talk to the residents. However, there are still times when the home is short-staffed and the team cannot fully meet residents social and psychological needs. The current recruitment drive will hopefully resolve this. One of the residents commented that he feels safe because the staff are so good, and many other people said how nice the staff are. Staff approached residents with directness, openness and consideration. Each of the residents with whom inspectors Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 27 spoke said how nice the staff are, and many people gave examples of particular instances of kindness. An individual training and development plan is now being created for each member of staff. This is based on any gaps in their previous training schedule, issues arising from one-to-one supervision, and the needs of the resident group. At the time of the last inspection, all but two of the nurse-qualified staff on the Waverley wing were RGNs (Registered General Nurses) rather than RMNs (Registered Mental Health Nurses), which would normally be required for this client group. The home is seeking to employ more RMNs. In the meantime, several of the nursing staff have been doing an intensive dementia training course. Training has always been plentiful and regular since the home opened, but has not always been translated into practice. It is recommended that new staff spend some time after their induction training working alongside a mentor from the senior staff to help ensure that they are able to apply what they have learnt to their daily practice. Two staff are employed solely in the companys training department. They both hold NVQ Assessor qualifications, and one person is about to complete the Internal Verifiers award, which will enable the whole NVQ process to be done in-house. The other trainer is about to complete the Registered Manager’s Award and is undertaking a course to qualify in giving Safeguarding Adults training to other staff. Both trainers do regular observational audits of staff practice in the home to ensure that training has been properly understood, and to help them plan future training courses. They use a variety of training methods to ensure that staff have every opportunity to increase their understanding. The trainers have drawn up an action plan for new staff induction training, with well-designed schedules that specify when each element of the training should be completed. These schedules show how each training element links to the National Minimum Standards and to Common Induction Standards. The training schedules also explain the desired outcome of each element of training, so that senior staff carrying out the training are clear what it aims to achieve. One staff member holds NVQ 4. The company hopes that the nurses in overall charge of each unit will undertake the Registered Manager’s Award in the near future. It is also intended that senior staff will all complete NVQ 3. Nine staff already hold NVQ 2, and three other people are currently taking this course. One member of staff has NVQ 3, and another person is currently taking this qualification. Detailed spreadsheets are kept on each persons training. Any training needs are highlighted, and records also show the date when refresher training will be Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 28 due. Statutory training courses are laid on over several sessions to enable all staff to attend. Training records show that staff have had regular updates on first aid, food hygiene, manual handling, abuse awareness, fire instruction, health and safety, and infection control. Staff also have periodic training in care-related subjects, such as Principles of Care, dementia awareness, communication, death and dying, stroke awareness, catheter care, and training sessions on specific medical conditions, among other topics. A large group of staff did a challenging behaviour course in February this year. Feedback about this course - to the trainers and to the inspectors - was very positive. The skilled and kind way that staff dealt with difficult situations during these inspection visits indicated that this training has been really useful. More of this training is planned in the near future. In-house training is provided in an area next to the hair-dressing room. This is a temporary arrangement, but the inspector recommended that some sort of sound- and sight- proof partition is installed so that confidentiality is ensured at times when the hair-dressing room is being used. Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The culture of the home has improved dramatically. People are being much more involved in the decisions that affect them, and are showing a stronger commitment as a result. Although some management systems are still in their infancy and there is not yet a registered manager, the home is being well run and the interests of its residents are being put first. EVIDENCE: Summer Lane Care Home Ltd, headed by Dr Ravi Sondhi and Dr Salma Uddin took over ownership of the home in November 2006. Sue Williams took over as acting manager in February 2007. The new owners held a series of Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 30 consultation meetings with staff and other stakeholders, and produced an action plan to address the urgent issues. Good progress has been made in implementing this. The culture in the home has become much more open and positive, and the various groups of people associated with the home are much happier. External professionals consulted prior to the inspection visits made many positive comments about the service. The residents and relatives inspectors met during these visits also felt things are really improving. Inspectors also spoke with many of the staff during these visits. Although staff have been through a period of uncertainty, they are beginning to see improvements. Staff were more forthcoming and relaxed, and this showed not only in their approach to the inspectors but in their interactions with residents. Many people said how much happier they now are. They also showed a much greater awareness of the expectations of their role. Several staff told inspectors that morale has greatly improved. People generally felt that their efforts and achievements are being noticed and appreciated, and that any criticism is constructive. Staff felt more involved in decision-making and better informed. Staff were also much clearer about the management structure and who they should go to if they have problems. Several staff told inspectors about the way their own areas of responsibility have been redefined and how this has lead to greater clarity and more job satisfaction. Comments were made to the inspectors from a number of sources that the new owners have a strong commitment to improving life for everyone associated with the home, and have been unstinting in their efforts to achieve this. Despite the many communication systems in place at the time of the last inspection, communication was poor. These systems have been redesigned, the new owners have held regular meetings with the staff to exchange views and ideas, and overall communication has greatly improved. The trainers have recently rewritten the supervision policy. Some of the staff files showed that they had had one formal supervision session in recent months. The acting manager is aware that staff should have supervision at least every two months, and is in the process of setting up a system to ensure regular supervision for each person. The deputies in charge of each wing are responsible for supervising the nurses, and the nurses in turn do the formal supervision of care staff. Staff comments showed that the system is going well, but supervision sessions are not always being recorded. There was a little uncertainty around how this should be done, and the acting manager is still working on this with the senior staff. Staff are finding supervision sessions very supportive and useful. Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 31 The cash records of four of the people who inspectors case-tracked were checked. These were clear and included receipts for any expenditure. Records of cash expenditure were checked against other records, such as hairdressers and chiropodists appointments, and against the cash held. In all cases, these records tallied. The routine reports that the home is required to make to CSCI about anything affecting the wellbeing of residents indicate that there are less accidents and incidents happening to residents. This was borne out by those residents records sampled during these inspection visits, and by the homes own incident log. There is a range of fire procedures for different groups of staff, residents, and visitors, and for separate areas of the home, such as the kitchen. The fire risk assessment identifies high-risk rooms, and the frequency for staff fire training. Individual risk assessments have been drawn up on those residents who wish to keep their bedroom doors open at night. Fire precautions equipment testing has lapsed over the past couple of months. Fire alarms, fire extinguishers, and emergency lighting must all be checked with the prescribed frequency. Hoists and other lifting equipment are all checked at least every six months. Most of the staff hold a current first aid certificate, and further training is planned for other staff over the next few months. First-aid boxes on the Balmoral wing have been sorted out and now contain the items they should do. But the contents of the first-aid boxes on the Waverley wing were variable. First-aid boxes for staff that meet health and safety requirements must be provided. Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 32 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 3 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 4 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 2 Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 & 17 Requirement An accurate record must be kept of all medicines and the date on which they were administered. This particularly refers to: • The lack of administration records for medications in the manufacturers boxes in the Waverley wing, • Inaccurate records of Controlled Drug administration in the Balmoral wing, • Unexplained gaps on the Medication Administration Record charts, and • Variable dose prescriptions not showing which amount was administered at any one time. Suitable arrangements must be made for safekeeping and administration of medications. This particularly refers to • Medications storage facilities being unlocked and unattended, and • Medications not being given out at the time they Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 34 Timescale for action 13/03/07 2. OP9 13 13/03/07 3. OP38 12 & 23 4. OP38 13 & 23 are due. Fire alarms, fire extinguishers, and emergency lighting must all be checked with the prescribed frequency. First-aid boxes must contain the correct equipment prescribed by health and safety legislation, and no other equipment. 13/03/07 13/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP9 Good Practice Recommendations The deputy managers of both wings should attend training on the new Mental Capacity Act. Medications records and practice should be improved by taking the following actions: • Two members of staff should sign any handtranscribed prescriptions. • Residents GPs should be asked to sign the Homely Remedies policy to demonstrate their agreement with it. • Stocks of homely remedies should be kept available in case they are needed. • Equipment for use with inhalers ought to be washed at least twice weekly to prevent the spread of infection and to ensure the full dose is delivered. Bed-bound residents and their relatives should be consulted about what entertainments they would like, and suitable activities laid on. Water temperature should be tested before residents get into the bath or shower. Suitable equipment should be supplied to ensure staff safety when using hazardous chemicals. Hoists and wheelchairs should be routinely cleaned. New staff should spend some time after their induction training working alongside a mentor from the senior staff to help ensure that they are able to apply what they have learnt to their daily practice. DS0000068380.V326316.R01.S.doc Version 5.2 Page 35 3. 4. 5. 6. 7. OP12 OP25 OP26 OP26 OP30 Summer Lane Care Home 8. OP30 Some sort of sound- and sight- proof partition should be installed in the training area next to the hair-dressing room so that confidentiality is ensured at times when the hair-dressing room is being used. Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Summer Lane Care Home DS0000068380.V326316.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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