Inspection on 23/11/05 for Summerfield Nursing Home

This inspection was carried out on 23rd November 2005.

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

Other inspections for this house

Summerfield Nursing Home 08/03/07

Summerfield Nursing Home 09/05/05

Summerfield Nursing Home 30/11/04

Summerfield Nursing Home 29/06/04

Summerfield Nursing Home 09/02/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Summerfield Nursing Home 23 Christchurch Road Cheltenham Glos GL50 2NV Lead Inspector Peter Still Unannounced Inspection 23rd November 2005 12:45 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 Summerfield Nursing Home DS0000016594.V257281.R01.S.doc Version 5.0 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. Summerfield Nursing Home DS0000016594.V257281.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Summerfield Nursing Home Address 23 Christchurch Road Cheltenham Glos GL50 2NV 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) 01242 519913 Mr Keith Coghill Mrs Laraine Coghill Linda Aitken Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability (3) of places Summerfield Nursing Home DS0000016594.V257281.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Managers Award is to be commenced within 2005. Date of last inspection 9th May 2005 Brief Description of the Service: The home provides 30 places for older people who require nursing care and 3 places are available for those under the age of 65 years who have a physical disability. The home operates at less than 30 people since the home has a policy of ensuring accommodation can be single occupancy. Situated on one of Cheltenham’s main roads it is close to bus routes and other amenities. Accommodation is provided over 4 floors all reached by a shaft lift. Both single and double rooms are available if requested with 9 single rooms having ensuite facilities. On the ground floor there is a large lounge/dining room with conservatory area. To the front of the house is an attractive low maintenance garden with non–slip ramp to the front door. The back garden is predominantly lawn with ample car parking to the side. Summerfield Nursing Home DS0000016594.V257281.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over 4 hours. The proprietor and registered manager were present throughout and supported the inspection process. 5 residents and 3 relatives were specifically spoken with and gave praise for the care provided. One relative said that nothing could be improved and the care staff give is excellent. The atmosphere was relaxed and organised and staff were attentive to residents needs. The environment was clean and warm. Bedrooms had a ‘hospital’ feel and the proprietor acknowledges this but says the focus of the home is to ensure the physical well being of residents. A tour of the building was conducted and a number of records were reviewed. What the service does well: What has improved since the last inspection? The manager should be praised for her hard work to respond to a number of issues raised within the last inspection report. The care planning system has been a key task, which the manager has worked on to provided a comprehensive approach. Summerfield Nursing Home DS0000016594.V257281.R01.S.doc Version 5.0 Page 6 A new pre admission document had been produced to comply with a previous requirement. The manager has improved the range of activity and stimulation for residents. Further specialist beds have been purchased to improve the comfort and health care of residents. The provider has supported the manager in ensuring she has sufficient supernumerary management time. What they could do better: The proprietor says he has a policy of not providing a variety of social and recreational activities for the home since it is not the focus. However, the manager provided evidence of a range of activity important in ensuring residents are stimulated. The proprietor may wish to hear more about this from his manager to understand how she is promoting the standard to enrich the quality of resident’s lives. A structured staff supervision system must be put in place to ensure staff are formally supported to do their work and provided with appropriate and accountable management. Some fire doors were found not to close fully and need adjustment. The practice of propping open the fire doors of residents bedrooms, may put residents at risk and alternative arrangements should be discussed with the Fire Prevention Service. The new pre-admission document will need review once it has been used to see where improvements can be made. The refurbishments planned will enhance the environment for residents. The manager must continue to encourage staff to complete their NVQ training. A management tool to provided a simple overview of staff training might be helpful. Summerfield Nursing Home DS0000016594.V257281.R01.S.doc Version 5.0 Page 7 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. Summerfield Nursing Home DS0000016594.V257281.R01.S.doc Version 5.0 Page 8 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 Summerfield Nursing Home DS0000016594.V257281.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The new pre admission assessment document will need review to ensure residents needs can be met. EVIDENCE: A new pre admission document had been produced, which complies with a requirement of the last inspection. It will need review once it has had a chance to be used to ensure it meets the requirements it was designed for, ensuring resident’s needs would not be overlooked. A copy of the new document was provided for CSCI files and is a one sided A 4 paper. It is likely that the layout will not be found to be fully satisfactory. A date of production for all documentation with date for review of the template document can be helpful in ensuring a homes documentation systems are up to date and in line with current best practice. Summerfield Nursing Home DS0000016594.V257281.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 A comprehensive new care plan system ensures needs can be identified clearly to ensure good delivery of care. EVIDENCE: The manager should be commended for working very hard to establish a comprehensive care planning system. It was considered that the manager had thought through the points from the last inspection and had responded very well to the improvements in practice. 3 care plans were reviewed. The daily care file had been improved since the last inspection to include all key aspects and was considered to be wellorganised, clear and easy to reference. The files included: Numbered nursing needs with alphabetical nursing instructions; monthly review, which was up to date and risk assessments for moving and handling. A register of specialist individual equipment had been transferred to make the file more manageable. The manager holds an archive file, ensuring only current documentation is easily available to staff, within a smaller file. Staff hold the daily care file during the day for completion and to ensure clarity between staff shifts on a daily basis. Since the last inspection the manager had changed the daily care file layout to provide more space for care staff recording to ensure greater thoroughness. Staff complete a daily statement for each resident, which was found to be up to date. Staff considered the new approach to be working well. Summerfield Nursing Home DS0000016594.V257281.R01.S.doc Version 5.0 Page 11 The manager is a member of the local community tissue viability group, which meets monthly. This was considered to be a valuable use of the managers time and it was also noted that the number of residents with pressure sores at the home had reduced to two and that both people were very close to being healed successfully. This is a great achievement and much to the credit and professional dedication of the staff team. Further indexing of documentation may be helpful. Summerfield Nursing Home DS0000016594.V257281.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 A wide range of activity and stimulation for residents is enriching quality of life. Family and supporters of residents are encouraged to visit. The diet of residents was considered to be good. EVIDENCE: The provider said that he makes it clear on admission that the provision of activities is not a priority at Summerfield and this was noted at the last inspection, following a resident saying they were bored. However at this inspection, the manager was clear in understanding the importance of activity and stimulation for residents and had made improvements since the last inspection and wishes to explore further ways of enhancing resident’s lives. Residents are supported individually in terms of their needs and wishes for stimulation and activity. One resident visits the gym each week; 2 volunteers visit 3 residents and talk to others; a local student was about to start a work placement and will carry out non personal tasks including flower arranging; 1 resident was observed to be enjoying a sensory light; The proprietor arranges for an entertainer to visit every Thursday; a volunteer continues to read to one resident and the manager works hard to ensure residents retain their past hair Summerfield Nursing Home DS0000016594.V257281.R01.S.doc Version 5.0 Page 13 dresser or chiropodist. This provides good evidence that the home is run in the best interest of residents rather than the ease of management for staff. 3 relatives gave high praise for the care at the home and said they were welcomed to the home. The diet was considered to be good and residents and relatives reinforced this view. Two special diets were being catered for and the menu was on a board in the dining room. On the day of inspection chicken and roast potatoes had been served. Summerfield Nursing Home DS0000016594.V257281.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Residents are protected by staff that have training in adult protection and are listened to, where issues are expressed. EVIDENCE: A protection of vulnerable adults alerters guide had been given to each member of staff and posted up on the staff notice board. Staff undertaking their NVQ training, have a module, which includes adult protection. A leaflet concerning making a complaint was in resident’s bedrooms. 3 relatives said they have no complaints and were aware of how to make a complaint or raise a concern. Five residents said they would be listened to if they had a concern and spoke of going to the manager. No recent complaints had been recorded. Summerfield Nursing Home DS0000016594.V257281.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23, 26 The home was clean and the standard of décor and furnishings was good, with equipment to meet resident’s needs; adjustment of fire doors and an assurance that all bedrooms have window restrictors will ensure safety. Planned refurbishment will improve some areas. EVIDENCE: Some fire doors were found not to close fully and an audit and steps must be undertaken to ensure all fire doors close effectively. The proprietor told the inspector, that two fire officers had said bedroom fire doors could be wedged open as long as staff were present on the same floor. This was unusual guidance from fire officers and following the inspection, the fire prevention service told the inspector that they do not provided this guidance. They said that fire doors must not be wedged open and that the provider can make contact to discuss alternative arrangements. Summerfield Nursing Home DS0000016594.V257281.R01.S.doc Version 5.0 Page 16 The environment was maintained to good standards and specialised equipment was available. Some of the bedrooms look clinical in style and the proprietor said he was supportive of any residents and families, who wish to personalise bedrooms. The manager had bought colourful knee rugs as a way of softening the look in bedrooms and to provide a little more homeliness for some residents. Other bedrooms were personalised. The last inspection noted the purchase of a number of specialist profiling beds and the proprietor has continued to purchase these. The beds were finished in a light beech colour, helping to soften the look of bedrooms. A missing radiator cover to bedroom 9 was dealt with immediately following the last inspection. Bedroom 12 was a vacant room and found not to have a window restrictor, which could mean that a resident may be able to fall from the window. A requirement will be made to complete an audit of all bedroom windows to ensure they have effective window restrictors and not to admit a person to room 12 until the window is made safe. The call bell plate and wiring in bedroom 15 had been pulled from the wall by a resident and was repaired whilst the inspection was taking place. The call bell system for the home although working, was not fully satisfactory in its operation and it was understood that it would be replaced. The sink unit in bedroom 8 is to be replaced within three weeks and the first floor bathroom was also due to be refurbished. Summerfield Nursing Home DS0000016594.V257281.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 30 A settled team of staff, who are well supported by their managers, provide good care to residents and skills will improve when NVQ qualification has been achieved. EVIDENCE: The manager was considered to be very effective in her position and working hard to make improvements to the general running of the home. The manager says her deputy particularly supports her, and that the staff team were working well together. There was a good mix of older and younger members of staff, bringing a range of skills and experience to the home. The standard to ensure a minimum of 50 of staff hold an NVQ Level 2 award, or higher was not met and a requirement will be made for the manager to support staff to complete their training. The current position was that 3 staff hold NVQ Level 3 and 10 were undertaking NVQ level 2. The proprietor should be commended for supporting a member of staff to be a training officer for the home. This was considered to be an excellent approach. The manager was also using the member of staff as a mentor for staff to support their NVQ training and was another positive step. The new training officer had completed the manual handling assessors course on 04/10/05 and will be able to cascade training through the home. All staff will be provided with their own training portfolio, which will be available for inspection in a few months. Summerfield Nursing Home DS0000016594.V257281.R01.S.doc Version 5.0 Page 18 A recommendation will be made for the manager to have a staff training matrix, which will provided senior managers with an immediate management overview of all training for each member of staff. This could provide detail with dates of past, current and future training and a list of all training the manager considers important. It would also provide a trigger for reinforcement training. An external company had provided some training but the content was not considered satisfactory and the manager plans to undertake some training in house. Summerfield Nursing Home DS0000016594.V257281.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 36 The manager has taken good steps since the last inspection to move practice forward. A misunderstanding concerning the last inspection report had meant that staff supervision was not been properly implemented and action will be required so that residents can be protected by staff that are adequately supervised. EVIDENCE: The manager said she feels supported by the proprietor and that he listens to the issues she raises. The provider should be commended for acknowledging that the manager needed additional supernumerary time to undertake her duties and said that she can have whatever time she needed. The manager said that she now does have sufficient time to commit to the management and development of the home. The requirement for the home to have a structured staff supervision system had unfortunately been confused with the need to develop staff in terms of Summerfield Nursing Home DS0000016594.V257281.R01.S.doc Version 5.0 Page 20 their NVQ training, which was under way. This had resulted in non-compliance with Standard 36. This Standard says that staff should have supervision at least six times a year, which should cover such things as: all aspects of practice; philosophy of care in the home and career development needs. Good and formally recorded supervision is a fundamental task and helpful training materials and courses are available if the manager needs further support to establish staff supervision. Staff work alongside each other but this does not provided opportunity for a designated time, formally, for each member of staff. The requirement will be repeated. The last inspection noted that certificates for fire and manual handling training would be inspected at this inspection and the records were seen. The fire training record was dated October 2005 and 35 staff had attended. The proprietor will be communicating with the lead inspector for the home in the near future about plans to extend the property and increase numbers, which will have an impact on the statement of purpose for the home. Residents and relatives spoken with gave high praise for the care provided and the manager was observed to provide a good example, focusing on individual residents in a caring and sensitive way. Summerfield Nursing Home DS0000016594.V257281.R01.S.doc Version 5.0 Page 21 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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 X X X 2 X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X 2 X X Summerfield Nursing Home DS0000016594.V257281.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP19 Regulation 13 (4) (a) Requirement Complete audit on all bedroom windows to ensure adequate window restrictors are in place to prevent people from falling from windows. Bedroom 12 must not be used until the window is made safe. Bedroom fire doors must not be propped open. All fire doors must be compliant with the requirements and guidance of the fire and rescue service. The manager must continue to support staff undertaking their NVQ training to ensure compliance with the standard. A formal structured and recorded staff supervision system must be developed, which also offers opportunities for professional development. (Previous timescale of 1st August 2005 not met) Timescale for action 19/12/05 2 3 OP19 OP19 13 (4) (a) 13 (4) (a) 19/12/05 19/12/05 4 OP28 19 (5) (b) 29/04/06 5 OP36 18 (2) 01/04/06 Summerfield Nursing Home DS0000016594.V257281.R01.S.doc Version 5.0 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP30 Good Practice Recommendations It is recommended that the manager has a simple staff training matrix to use as a management tool when considering the training for the home and for individual staff. The pre admission document should be reviewed, once it has been used to consider improvements to it. 2 OP37 Summerfield Nursing Home DS0000016594.V257281.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Summerfield Nursing Home DS0000016594.V257281.R01.S.doc Version 5.0 Page 25 - 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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