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Inspection on 21/06/05 for Summerhill Nursing & Residential Home

Also see our care home review for Summerhill Nursing & Residential Home for more information

This inspection was carried out on 21st June 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents spoken to liked the staff team and spoke well of them and said they felt that "staff listened" and "were interested in them". They felt the manager and staff worked hard for them. The home provided a comfortable, well furnished, maintained homely atmosphere for residents and visitors. The home organised and provided a varied activities programme to appeal to different groups of residents and discussion groups with the University of the Third Age locally. Staff were aware of the needs of residents and worked well with relevant health care professionals to maintain an appropriate service for residents. Care plans are detailed and have an emphasis on the individual resident and their choices and preferences and were clear and up to date. The home promoted a learning culture evident in the support given to staff to analyze and learn from their mistakes as in a recent medication incident. The staff on duty at the inspection responded positively to the inspection process.

What has improved since the last inspection?

Care plans had been improved to make sure that they were up to date and had all necessary information included for staff. Staff felt that since the new manager had been in post opportunities for training and development had improved. Odour on one area of Windermere suite had been a problem at the last inspection and this had been effectively dealt with to make the environment better for residents and staff. Requirements and recommendations made at the last inspection on medication practices had all been met and improvements made to systems.

What the care home could do better:

The home must make sure all suites are able to store medicines that need cold storage in separate, secure refrigerators, not in the suite domestic refrigerator. The home had information on services for prospective residents but should include more information on the dementia care and services it provided given the number of residents with this. A resident spoken with wanted to have more responsibility for administering their own medication and the home should assess this to try to achieve more control over this for the resident within the restrictions of their condition.

CARE HOMES FOR OLDER PEOPLE Summerhill Nursing & Residential Home East View Kendal Cumbria LA9 4JY Lead Inspector Marian Whittam Unanounced 21 June 2005 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. Summerhill Nursing & Residential Home F58 F10 s6157 summerhill v229273 210605 ui stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Summerhil Address East View Kendal Cumbria LA9 4JY 01539 726000 01539 727254 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) Care First Care Homes LTD (BUPA Care Services) Helen Elizabeth Askins Care Home 71 Category(ies) of OP - Old Age registration, with number DE(E) - Dementia, over 65 years of places PD - Physical Disability DE - Dementia Summerhill Nursing & Residential Home F58 F10 s6157 summerhill v229273 210605 ui stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 71 service users to include: - up to 38 service users receiving nursing care in the categories of OP(21) and DE(E)(17) - up to 31 service users in the category DE(E) (Dementia over 65 years of age) - up to 37 service users in the category of OP (Older people not falling within any other category) - up to 1 service user in the category DE (Dementia under 65 years of age) - up to 2 service users in the category PD (Physical disability under 65) 2. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 13th December 2004 Brief Description of the Service: Summerhill is a care home with nursing registered to provide nursing, residential care and personal care for up to 71 residents. The home is divided into 4 suites as follows: Buttermere for general nursing care, Windermere for nursing care of service users with dementia, Grasmere for high dependency personal care with mental health needs and Thirlmere for those with personal care needs only. The home is in a residential area of the market town of Kendal and close to the shopping areas, banks, libraries and general amenities. The home has mature and well-tended gardens, including a secure walled garden for Windermere suite. It has patio and seating areas for service users that overlook the town. There is a large car park to the front of the building. The home is on two floors these can be reached by a passenger lift or by stairs. There are attractive dining and communal areas for service users on each suite and all service users have single bedrooms with en suite facilities. The home has its own kitchen and laundry facilities. Summerhill Nursing & Residential Home F58 F10 s6157 summerhill v229273 210605 ui stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was on 21st June 2005 The morning and early afternoon was spent looking around the home, talking with residents in the lounges and in their own bedrooms, speaking to the staff, the activities coordinator and the senior nurse on duty and also looking at care plans, medicine records and documentation that was available in the absence of the manager. Policies and procedures and records were looked at in the afternoon. What the service does well: What has improved since the last inspection? Care plans had been improved to make sure that they were up to date and had all necessary information included for staff. Staff felt that since the new manager had been in post opportunities for training and development had improved. Summerhill Nursing & Residential Home F58 F10 s6157 summerhill v229273 210605 ui stage 4.doc Version 1.30 Page 6 Odour on one area of Windermere suite had been a problem at the last inspection and this had been effectively dealt with to make the environment better for residents and staff. Requirements and recommendations made at the last inspection on medication practices had all been met and improvements made to systems. 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. Summerhill Nursing & Residential Home F58 F10 s6157 summerhill v229273 210605 ui stage 4.doc Version 1.30 Page 7 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 Summerhill Nursing & Residential Home F58 F10 s6157 summerhill v229273 210605 ui stage 4.doc Version 1.30 Page 8 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) 1,2,3,4 and 5. Residents had information about the home and services available before admission so they could make an informed choice. A detailed assessment and care planning system and information from other agencies was in place to provide staff with the information they need to meet resident’s needs when they come in. EVIDENCE: Information was available about the home for prospective residents and their families in the statement of purpose and service users guide so they knew what services the home could provide. These were provided for all residents and were displayed in the foyer. However, given the number of residents with dementia the home should provide more information on the dementia care and services they provide and underlying philosophy they promote in their statement of purpose and residents guide. Individual care plans showed that new residents needs had been assessed in detail before and following admission and their individual care plans developed from this. The home manager or senior staff did an individual assessment of Summerhill Nursing & Residential Home F58 F10 s6157 summerhill v229273 210605 ui stage 4.doc Version 1.30 Page 9 needs to ensure that the home could meet them before residents came to live there. Where appropriate other care agencies and professionals were involved in providing information and making assessments of the needs to be met. Summerhill Nursing & Residential Home F58 F10 s6157 summerhill v229273 210605 ui stage 4.doc Version 1.30 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 standard(s) 7,8,9 and10. The systems in place provide staff with the information they need to satisfactorily meet resident’s needs. The health needs of residents are being satisfactorily met with evidence of good multi disciplinary working to meet assessed needs. The systems for the administration and recording of medicines are satisfactory to meet resident’s medication needs. Personal support was being offered in a way that promoted and protected resident’s dignity and independence. EVIDENCE: All residents had an individual plan of care setting out their health, personal and social care needs. Any changes identified at evaluation had been incorporated into care plans and needs assessments and the plans were resident focused. One resident said “ I have been on 2 units since I moved here and in both the staff have been brilliant, I cannot speak highly enough of them, they know my needs very well”. However one resident said they would like to have more responsibility for giving their own medication although they realised this might be difficult with their condition. This should be assessed to try to give them more control where possible in administering their medicines. There was evidence of prompt referral to health care and services and working well with other agencies and the actions taken following their involvement. Summerhill Nursing & Residential Home F58 F10 s6157 summerhill v229273 210605 ui stage 4.doc Version 1.30 Page 11 Medication procedures and records suggested that resident’s needs are being monitored and met. A recent incident where staff did not follow procedure has been investigated and actions taken by the home to retrain and raise staff awareness about what they did wrong. Although procedures and records were satisfactory, there was a suite where medicines that need cold storage were kept in the general refrigerator. These medicines must be stored in a separate and secure refrigerator. Residents spoken with said their privacy was respected and felt their dignity upheld. Observation during the inspection suggested that resident’s dignity was being maintained when receiving care and being assisted and independence and choice was being promoted. Summerhill Nursing & Residential Home F58 F10 s6157 summerhill v229273 210605 ui stage 4.doc Version 1.30 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 standard(s) 12,13,14 and 15. A full and varied programme of organised activities was provided that took into account residents preferences and capabilities. Choices about daily life and routines, contacts with family, friends and the local community were being promoted and maintained according to the residents recorded wishes. Dietary needs are well catered for with a varied selection of nutritious food that meets resident’s special dietary needs and individual choice. EVIDENCE: The home had 2 activities coordinators who provided a range of advertised group and one to one activities and entertainments, discussion groups, social and religious events. Resident’s former hobbies and interests and ‘life maps’ were recorded and individual abilities and capabilities were being given consideration in planning and carrying out the activities. Residents told the inspectors that they could chose to take part or not as they preferred and one showed us their artwork done in the craft sessions and said “ there is plenty to do if you want to”. On the day of the visit there was a garden party in the secure garden for residents, staff, family and friends as well as the local community. Summerhill Nursing & Residential Home F58 F10 s6157 summerhill v229273 210605 ui stage 4.doc Version 1.30 Page 13 Residents said that they could come and go as they pleased, take their meals where they preferred and see who they wanted to. Several of those spoken with thought the quality of the food provided was “excellent”, some others thought it was “ very good” and a small number spoken with felt the food was “alright”.” All agreed there was a choice of food each day and that there was plenty to eat and drink. The menus, displayed in the foyer, showed a nutritious diet. Summerhill Nursing & Residential Home F58 F10 s6157 summerhill v229273 210605 ui stage 4.doc Version 1.30 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 standard(s) 16 and 17 The home has a satisfactory complaint system that both residents and staff were aware of. Residents felt confident that the manager would listen to them and act on any concerns effectively. EVIDENCE: The home had a clear complaint procedure, displayed and made available throughout the home and in service user rooms. There is a complaints logging system that records all complaints received and the details of the investigation its outcomes and the actions taken and is linked to quality assurance system. Information on advocacy was provided for residents in the home and obtained for anyone who asked, although care plans indicated most people had family members to act on their behalf. The home used a ‘permission to use restraint consent form for bed rails following a risk assessment. Summerhill Nursing & Residential Home F58 F10 s6157 summerhill v229273 210605 ui stage 4.doc Version 1.30 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 standard(s) 19, 20, 21, 22, 23, 24 and 26 The decoration and furnishing in the home was of a good standard. with evidence of regular maintenance and decoration. The home provided a clean, comfortable and homely environment for residents to live in and had the equipment they need to promote mobility and independence. EVIDENCE: The home is well maintained with regular, planned maintenance and a good standard of décor throughout that provides a clean, tidy and homely environment for residents. The home had satisfactorily dealt with an odour problem in one area found at the last inspection that improved the environment for everyone. The lounge and dining areas were comfortable and well furnished with good lighting. Outside the large gardens are attractive, well kept and have seating for residents. Residents said that they used the garden a lot in the summer months, and enjoyed them. Summerhill Nursing & Residential Home F58 F10 s6157 summerhill v229273 210605 ui stage 4.doc Version 1.30 Page 16 Resident’s bedrooms seen by the inspector had a high standard of décor, and furnishings with ensuite toilets. Many residents had brought some of their own possessions in and this made their bedrooms more personal and homely for them. There is a range of equipment, nursing beds and adaptations in the home to help residents make the most of their independence and to get about the home. Summerhill Nursing & Residential Home F58 F10 s6157 summerhill v229273 210605 ui 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) 27 The numbers and skill mix of nursing and care staff on the rotas and on duty during the visit were adequate to be able to meet resident’s needs. EVIDENCE: Staff rotas and observation during the visit suggested that the home had a stable staff group providing continuity for residents and enough staff on duty to provide adequate nursing and care during the day and night. Staff spoken with enjoyed their work and morale was good. Staff spoke about the good opportunities for training on offer to them. Residents said that staff and management were “caring” and “friendly” and “ “staff are very easy going”, one said “staff come pretty promptly when you ring”. Summerhill Nursing & Residential Home F58 F10 s6157 summerhill v229273 210605 ui 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, 32, 33, 35 and 36 The manager is well supported by senior staff in providing clear leadership, supervisions and planning in the home and this is communicated to residents and staff. Systems for resident consultation and involvement are effective and quality monitoring systems and reviews are in place to promote residents interests. Procedures and practices are in place which safeguard resident’s financial interests. EVIDENCE: Staff confirm that formal and daily supervision was in progress and regular staff meetings allowed staff feedback as well as internal reviews of policies and procedures, audits and information sharing. Residents spoken to said their views and opinions were asked for and acted upon to affect the way the service is run and had been given satisfaction surveys. They confirmed they saw the manager most days and felt happy to raise issues with her and that Summerhill Nursing & Residential Home F58 F10 s6157 summerhill v229273 210605 ui stage 4.doc Version 1.30 Page 19 the home had residents meetings. One resident said they had asked to change rooms and this had been done promptly. The home’s administrator handled the payment of fees and any service user spending monies, with their permission or their families. Transactions were documented and kept on computer and receipts given. Summerhill Nursing & Residential Home F58 F10 s6157 summerhill v229273 210605 ui 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x 3 3 3 x x 3 x x Summerhill Nursing & Residential Home F58 F10 s6157 summerhill v229273 210605 ui stage 4.doc Version 1.30 Page 21 No 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 (2) Requirement Medicines requiring cold storage must be stored in a separate and secure refrigerator. Timescale for action 30.6.05 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. Refer to Standard OP1 Good Practice Recommendations More detailed information on the dementia care and services provided and the philosophy of care underlying this should be included in the statement of purpose and residents guide. An assessment should be undertaken to find ways to allow the resident who wishes to self administer their medication to do this where possible given their condition. 2. OP9 Summerhill Nursing & Residential Home F58 F10 s6157 summerhill v229273 210605 ui stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith, Cumbria CA11 9BP 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 Summerhill Nursing & Residential Home F58 F10 s6157 summerhill v229273 210605 ui stage 4.doc Version 1.30 Page 23 - 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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