Inspection on 09/05/05 for Summerfield Nursing Home

This inspection was carried out on 9th May 2005.

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 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 23/11/05

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 Gloucestershire GL50 2NV Lead Inspector Janice Patrick Announced 9 May 2005 10:00am 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 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 D51_D03_s16594_Summerfield_V183301_090505_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Summerfield Nursing Home Address 23 Christchurch Road Cheltenham Gloucestershire GL50 2NV 01242 519913 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Keith Coghill and Mrs Laraine Coghill Mrs Linda Aitken Care Home with Nursing 33 Category(ies) of Old Age not falling within any other category registration, with number (33) of places Physical Disability (3) Summerfield Nursing Home D51_D03_s16594_Summerfield_V183301_090505_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 26th & 30th November 2004 Summerfield Nursing Home D51_D03_s16594_Summerfield_V183301_090505_Stage 4.doc Version 1.30 Page 5 Brief Description of the Service: The Home provides 30 places for older people who require nursing care and 3 places are availble for those under the age of 65 years who have a physical disability. Situated on one of Cheltenhams main roads it is close to bus routes and other amenities. Accomodation is provided over 4 floors all reached by a shaft lift. Both single and double rooms are availble with 9 of the single rooms having ensuite facilities. On the ground floor there is a large lounge/dining room with a conservatory area. To the front of the house is an attractive low maintaince garden with a non-slip ramp to the front door. The back garden is predominantly lawn with ample car parking to the side. Summerfield Nursing Home D51_D03_s16594_Summerfield_V183301_090505_Stage 4.doc Version 1.30 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over 6.25 hours by one inspector. The Proprietor and Registered Manager were present throughout and very open to the inspection process. 6 service users, 4 care staff and 1 external health care professional were specifically spoken to. Several other service users were met with briefly. Several records were read during the inspection process. The Home was organised and running smoothly. Service users appeared relaxed and were having they’re needs met. The environment was clean, warm, airy and maintained to its usual high standard. The environment does have a ‘hospital’ feel to it, particularly in the bedrooms. The Registered Manager although very competent and hard working, is struggling to achieve some of the changes needed in some of the main systems such as care planning and staff supervision, due to a lack of managerial supernumerary hours. What the service does well: Summerfield meets the needs of a diverse group of service users well. The care staff support and encourage individuals in a kind and respectful manner. Service users are free to make choices. The qualified nurses have good clinical knowledge and work alongside external health care professionals frequently to maintain a good level of nursing and medical care and review. The Home is maintained to a high standard and all areas are accessible to all service users. Staff look smart, are friendly and act professionally. Summerfield Nursing Home D51_D03_s16594_Summerfield_V183301_090505_Stage 4.doc Version 1.30 Page 7 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. Summerfield Nursing Home D51_D03_s16594_Summerfield_V183301_090505_Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Summerfield Nursing Home D51_D03_s16594_Summerfield_V183301_090505_Stage 4.doc Version 1.30 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 standard(s) 2 & 3 Irrespective of how their care fees are met, service users and their representatives receive a contract that makes them aware of what has to be paid, when and what the amount includes. The lack of a written format for pre admission assessments may result in service users’ needs being overlooked and therefore not met. EVIDENCE: The provider has said that all service users are given copies of the Home’s terms and conditions prior to or just after admission. Those paying their fee privately sign a contract which includes terms and conditions. Those receiving contribution by a funding authority sign the joint contract between the authority and the Home and receive separate terms and conditions. An example of an invoice was seen, clearly stating the Registered Nurse Care Contribution (RNCC) due. One recently admitted service user had a good understanding of what he was paying for. Summerfield Nursing Home D51_D03_s16594_Summerfield_V183301_090505_Stage 4.doc Version 1.30 Page 10 The Manager goes to see all service users prior to admission, unless they are geographically miles away. Additional information from Social Workers, other health care professionals and family members is taken into account. The lack of a structured format for this process makes it hard for the Manager to demonstrate that all care needs have been assessed prior to admission and to ensure these are passed onto the admitting nurse and ultimately included in the care planned. Summerfield Nursing Home D51_D03_s16594_Summerfield_V183301_090505_Stage 4.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 & 9 The health needs of service users are well met with evidence of good multi disciplinary working taking place, but some needs are not adequately identified in the written care plan which may lead to confusion in the delivery of care. The systems in place for medication administration and recording demonstrate that service users are protected against poor practice. EVIDENCE: Staff follow a written guide on a daily basis, informing them of the care services basic needs. They return this signed, to the Nurse in Charge at the end of each shift. Service users have said that their care needs are being met. However, in some cases the documented care plan is not demonstrating how those needs are to be met. It was discussed in the last inspection that the current documentation does not help this process and that the lack of format for the initial assessment maybe hindering the identification of these needs. The Manager has decided to change the system. A visiting Physiotherapist spoke highly of the staff and said that service users are always ready for her visit and that staff adhere to her advice and are well able to identify when they need to make a referral. Summerfield Nursing Home D51_D03_s16594_Summerfield_V183301_090505_Stage 4.doc Version 1.30 Page 12 The medication system was organised and records of administration, ordering and medical review were maintained well. Qualified nurses are updated in the use of all relevant additional methods of drug administration. A General Practitioner was carrying out a routine review at the time of this inspection, which involved a medication review. One service user requires his medication to be given at consistent, set times and he was able to confirm that this is being carried out. Summerfield Nursing Home D51_D03_s16594_Summerfield_V183301_090505_Stage 4.doc Version 1.30 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 14 Links with the community are able to support and enrich service users’ social and educational needs and for those who do not use the community links, the Home appears to meet their social and recreational needs. EVIDENCE: 5 service users agreed they have the freedom to mix or remain in their bedroom. It was clear that several prefer a routine, one couple preferred to go down to the lounge mid morning onwards, allowing for a relaxed start to their day. Another said he preferred to remain in his bedroom watching the television. One younger service user has been able to continue attending college during his short stay at the Home. A member of staff explained that another very elderly service user finds her bed more comfortable so she is helped back after lunch. No one spoke of being particularly bored during the day, but the provider makes it very clear on admission, that the provision of activities is not a priority at Summerfield. An external entertainer visits the Home regularly and short activities, such as manicures and quizzes are organised by the care staff, but for some service users who do not have visitors and who are dependant on staff for their interaction, this is limited. Each week a volunteer reads stories and chats to some service users on a one to one basis. Summerfield Nursing Home D51_D03_s16594_Summerfield_V183301_090505_Stage 4.doc Version 1.30 Page 14 2 of the service users confirmed that they manage their own monies and others had family to help. Summerfield Nursing Home D51_D03_s16594_Summerfield_V183301_090505_Stage 4.doc Version 1.30 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Staff awareness of Adult Protection and Adult Abuse issues have been increased, therefore offering more protection to vulnerable service users. EVIDENCE: Since the last inspection the Manager has ensured that each member of staff has received an ‘Alerter Guide’ on Adult Protection and Adult Abuse. This information includes who to contact for advice in such a situation. The updated information now needs to be incorporated into the Home’s Policy and Procedures. Use of the ‘Whistleblowing’ procedures were also discussed. 2 members of staff were able to explain their understanding of the guidance. Staff that complete their NVQ Training in Care automatically cover this subject. Service users confirmed that they felt safe and well treated in the Home. Summerfield Nursing Home D51_D03_s16594_Summerfield_V183301_090505_Stage 4.doc Version 1.30 Page 16 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 standard(s) 19, 22 & 25 The standard of the décor and furnishings are high providing service users with the equipment they require and a safe environment. EVIDENCE: The environment is maintained to high standards and specialised equipment is available. Some of the bedrooms lack the sense of a domestic setting and present a ‘hospital’ style setting. Others have been personalised by the service user with items of furniture and other affects. The provider demonstrated that the Home complies with all health and safety requirements and 2 staff spoken to had a good understanding of these issues. 13 new profiling beds have been purchased since the last inspection. Specialised moving and handling equipment is available including a ceiling mounted hoist. All equipment, including systems carrying the main utilities, are checked and serviced. Radiators are partially covered and some risk assessments have been completed to identify risks on an individual basis, for those at risk of falling. It has been recommended in the past and again in this report that the radiator is fully covered to include the area at the top where the heat is felt. Summerfield Nursing Home D51_D03_s16594_Summerfield_V183301_090505_Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29 & 30 Recruitment practice has improved with the provider aware of what is required when employing future staff to ensure the safety and protection of the service users. EVIDENCE: The files of 4 staff were seen. Many staff have worked at the Home for several years and have proved their trustworthiness despite being taken on, in some cases, without references. Criminal Record Bureau (CRB) clearances have subsequently been carried out. The Home has not recruited any new staff for sometime now apart from one carer who left after one shift. According to the Manager, all appropriate recruitment procedures were carried out (staff file not seen at this inspection). Both the provider and the Manager are fully aware of the criteria that must now be met before recruiting any further new staff. An external trainer will now provide induction training for future recruits. This is in the form of a booklet that contains several areas of care and is signed off when the candidate is competent. A decision was taken to put all longstanding staff that have chosen not to move onto NVQ training, through this. Several workbooks were seen and discussed at this inspection. Summerfield Nursing Home D51_D03_s16594_Summerfield_V183301_090505_Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 36 & 38 The Manager has a good understanding of the areas in which the Home needs to move forward and now must identify how these are to be implemented. Staff supervision does not identify individual development needs and offer a route for staff to add to their knowledge and awareness; this may result in a lack of improvement in the quality of care provided. The Home is run in a manner that aims to safe guard the health and safety of the service users, staff and those that visit. EVIDENCE: Since the last inspection the Commission for Social Care Inspection (CSCI) has registered the Manager as ‘fit’ to manage Summerfield. There are several large systems still to organise and maintain, however, without designated time this will not be accomplished. This was discussed with the provider, who will ensure that added supernumerary time will be made available to achieve these. Summerfield Nursing Home D51_D03_s16594_Summerfield_V183301_090505_Stage 4.doc Version 1.30 Page 19 A requirement was made in the last inspection report for a structured staff supervision system to be organised. This has still not been developed. Staff confirmed that senior staff and qualified nurses work alongside them, but the opportunity for a designated time to discuss developmental needs is not available. Since the last inspection the provider has attended an update in Fire Training, a Fire Training schedule has been devised and updated training has begun. An attendance record was seen. One domestic said that she had received relevant training to her role. Training in Manual handling has been updated and one service user was aware of a moving belt always being used by staff, to move his wife from an armchair into a wheelchair. Certificates for this Fire and Manual Handling training were to follow, the Inspector will expect to see these and certificates for any other trainings in staff files during the next inspection. The Manager has confirmed that First Aid Training is to be explored soon. Summerfield Nursing Home D51_D03_s16594_Summerfield_V183301_090505_Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 x COMPLAINTS AND PROTECTION 3 x x 4 x x 3 x STAFFING Standard No Score 27 x 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 3 x x x x 2 x 3 Summerfield Nursing Home D51_D03_s16594_Summerfield_V183301_090505_Stage 4.doc Version 1.30 Page 21 Yes 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 3 Regulation 14 Requirement The Registered must be able to demonstrate that all the care needs of a service user have been identified and can be met prior to admission. The care planning system must demonstrate how all the needs of a service user are to be met and reviewed. A structured supervision system must be developed offering each member of staff, ongoing professional development opportunities. Certificates and a record of training attended must be kept in each individual staff file. Timescale for action 1/7/05 2. 7 15 1/8/05 3. 36 18(2) 1/8/05 4. 38 17 Schedule 4(6)(g) 1/8/05 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 3 18 Good Practice Recommendations That the assessment carried out prior to admission be in a written format and meet the criteria, at least of 3:3 of this standard. That the new information contained in the Alerters Guide D51_D03_s16594_Summerfield_V183301_090505_Stage 4.doc Version 1.30 Page 22 Summerfield Nursing Home 3. 4. 25 29 5. 6. 31 36 be incorporated into the Homes Adult Protection Procedures. That all radiators are fully covered or changed to low surface temperature style. That the providers copy of the staff members CRB be shredded thus meeting Data Protection Guidelines, but retaining the top third containing name, address and clearence number which should be placed in staff file. The Manager should have extra supernumerary hours allocated on a perminant basis, in order for her to be able to fulfil her Registered Manager responsibilities. That set time is afforded for all staff to receive supervision that meets with the criteria laid down in this standard. An individual written record should be kept of this. Summerfield Nursing Home D51_D03_s16594_Summerfield_V183301_090505_Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 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. 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