CARE HOMES FOR OLDER PEOPLE
Summerhill Nursing & Residential Home East View Kendal Cumbria LA9 4JY Lead Inspector
Marian Whittam Unannounced Inspection 09:30 6 February 2006
th 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 Summerhill Nursing & Residential Home DS0000006157.V255558.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. Summerhill Nursing & Residential Home DS0000006157.V255558.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Summerhill Nursing & Residential Home Address East View Kendal Cumbria LA9 4JY 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) 01539 726000 01539 727254 askinsh@bupa.com Care First Care Homes Limited (BUPA Care Services) Mrs Helen Elizabeth Askins Care Home 71 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (31), Old age, not falling within any other of places category (37), Physical disability (2) Summerhill Nursing & Residential Home DS0000006157.V255558.R01.S.doc Version 5.0 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 usres in the category PD (Physical disabilities under 65 years of age) The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 21st June 2005 2. Date of last inspection Brief Description of the Service: Summerhill is a care home with nursing registered to provide nursing and residential 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 on site. Summerhill Nursing & Residential Home DS0000006157.V255558.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was on 6th January 2006 by 2 inspectors over 5 hours. The morning was spent looking around the home, talking with 17 residents in the lounges and in their own bedrooms, speaking to the staff, the senior nurse on duty and the registered manager. Residents care plans, medicine records and documentation on the day to day running of the home and policies and procedures were looked at. All areas of the home were seen during the inspection. What the service does well: What has improved since the last inspection?
The Requirement and recommendations made at the last inspection on medication practices have all been promptly met and procedural reviews have been done. Policies and procedures have been updated to ensure the home works in line with recent changes to the arrangements that affect the disposal of medicines in care homes (nursing).
Summerhill Nursing & Residential Home DS0000006157.V255558.R01.S.doc Version 5.0 Page 6 The home continues with its ongoing maintenance and redecoration programme for bedrooms and communal areas to improve the environment for residents. The home has taken on a third activities coordinator to improve activities at weekends in addition to during the week, with a particular emphasis on musical recreation for residents. 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 DS0000006157.V255558.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Summerhill Nursing & Residential Home DS0000006157.V255558.R01.S.doc Version 5.0 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 the following standard(s): 1,3 and 4 Residents have information about the home before admission so they are able to make an informed choice. A detailed assessment and care planning system is in place to provide staff with the information they need to satisfactorily meet resident’s needs. EVIDENCE: Information is available about the home for prospective residents and their families in the statement of purpose and service users guide so they know what the home can provide. An information/welcome pack is provided for all residents in their rooms. All residents have an individual plan of care and resident’s needs had been assessed in detail before and following admission and their individual care plans developed from this. The home manager or senior staff do an individual assessment of needs to ensure that the home could meet them before residents came to live there. Social services management plans have been obtained where appropriate. Care plans and records indicated relevant care agencies and professionals are involved in providing information and making assessments of the needs to be met on admission. This was evident for one
Summerhill Nursing & Residential Home DS0000006157.V255558.R01.S.doc Version 5.0 Page 9 resident where the speech and language therapist had provided an assessment and plan for staff to follow. Summerhill Nursing & Residential Home DS0000006157.V255558.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, 9 and 10 The care planning provides staff with the information they need to meet resident’s healthcare personal and social care need. However wound management records require improvement to ensure consistent care. The systems for the administration of medicines are satisfactory to meet resident’s medication needs. EVIDENCE: All residents have an individual plan of care, based on assessments and setting out their health, personal and social care needs. Changes identified at evaluation are incorporated into care plans and needs assessments and the plans are resident focused. However wound assessment and management planning was absent from more than one resident’s care plan where daily notes identified a dressed wound. There were no records of the wound type, the dressing regime and progress of the wound and evaluations. This must be planned for according to relevant clinical guidelines and information stated for staff of the actions to take and evaluation of progress and effectiveness. There is evidence of timely referral to health care services and working with other agencies and the actions taken following their involvement.
Summerhill Nursing & Residential Home DS0000006157.V255558.R01.S.doc Version 5.0 Page 11 Medication procedures and records are satisfactory and subject to review. However to promote resident safety on administration those medicines prescribed by the doctor as variable, 1 or 2 tablets, should have the dose administered recorded. Residents spoken with said their privacy was respected and felt their dignity upheld. Observation during the inspection, including moving and handling, suggested that resident’s dignity was being maintained during care and independences promoted. Summerhill Nursing & Residential Home DS0000006157.V255558.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 and 15 A full and varied programme of well organised activities is provided that take into account residents individual preferences, capabilities and cultural and religious expectations. Dietary needs are well catered for with a varied choice of nutritious food on the menu including special dietary needs. EVIDENCE: The home now has 3 activities coordinators who provided a range of advertised group and one to one activities and entertainments, discussion groups, social and religious events. This is provided at weekends as well. Resident’s former hobbies and current interests and ‘life maps’ are recorded in detail and individual abilities and capabilities are given consideration in planning and carrying out the activities. This was evident for one partially sighted resident where 1 to 1 activities were provided in accordance with their wishes and interests. Families are encouraged to be part of the information gathering on individual preferences where appropriate. Residents commented that they could chose to take part or not as they preferred .On the day of the visit residents from nursing and residential units had been taking part in an exercise session suited to the abilities.
Summerhill Nursing & Residential Home DS0000006157.V255558.R01.S.doc Version 5.0 Page 13 Several of those spoken with thought the quality of the food provided was “excellent”, some others thought it was “ good” and some that it was “fair” and “adequate”. There is always a choice of food each day and that there are drinks provided throughout the day. The menus, displayed in the foyer, showed a nutritious diet. Summerhill Nursing & Residential Home DS0000006157.V255558.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): 16,17 and 18 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 has a clear complaint procedure, displayed and made available throughout the home and in service user rooms. This has not changed since the last inspection. There is a complaints logging system that records all complaints and the details of the investigation and is linked to quality assurance system. Information on advocacy is provided for residents in the home and the service obtained on request. Not all staff have had recent training on abuse and adult protection and this is on the staff training plan for the coming year. The home has policies and procedures in place for adult protection; identifying and reporting abuse and whistle blowing. Systems are in place to safeguard residents financial interests and the home invoices bills and keeps receipts individually. Summerhill Nursing & Residential Home DS0000006157.V255558.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, 24, 25 and 26 The standard of the environment within the home is good providing residents with a well maintained, well equipped, clean, attractive and homely place to live. EVIDENCE: The home is well maintained with a good standard of decoration throughout that provides a clean, tidy and homely environment for residents. The lounge and dining areas are comfortable and well furnished with good lighting and seating. New carpets and chairs are being provided on both nursing and residential units to further improve the environment for residents. The gardens are well kept and have seating for the residents. Resident’s bedrooms seen by the inspector had a high standard of décor, and furnishings with en suite toilets and showers. Many residents had brought some of their own possessions in with them and this made their bedrooms more personal and homely for them. Bedrooms are light and naturally ventilated with domestic type lighting. Records of water testing for prevention of risks from Legionnaires Disease and temperature testing to prevent risks of scalds to residents are kept.
Summerhill Nursing & Residential Home DS0000006157.V255558.R01.S.doc Version 5.0 Page 16 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 DS0000006157.V255558.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): 27,28, 29 and 30 The home has addressed recent staffing difficulties with effective recruitment processes and has sufficient nursing and care staff on the rotas and on duty to be able to provide consistent care and meet resident’s needs. EVIDENCE: Staff rotas and observation during the visit suggested that despite struggling with recent sudden staff shortages and moving staff around to ensure cover the home now had a more stable staff group. This provides continuity for residents during the day and night. Staff spoken with enjoyed their work and morale was good. Residents said that staff and management were “friendly” and commented that they were happy with their care and that staff were “helpful”. The home has 48 of care staff with NVQ Level 2 in care and encourages training beyond that level. Staff training for nursing and care staff is promoted, with individual training files and induction records kept. Robust recruitment procedures and practices are observed and all necessary checks to safeguard residents are being taken prior to staff starting work there. Registered nurses personal identification numbers are checked on recruitment but the status not checked after that to make sure no changes have occurred. That would be good practice in safeguarding residents. Summerhill Nursing & Residential Home DS0000006157.V255558.R01.S.doc Version 5.0 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 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): 36, 37 and 38 Procedures are in place to safeguard resident’s interests and promote their health and safety. EVIDENCE: Staff confirm that formal and daily supervision is being done and regular staff meetings allowed staff feedback as well as internal reviews of policies and procedures, audits and information sharing. Record keeping is in good order however records of the food provided for each resident at meals are not being kept. These must be kept in sufficient detail to determine if the diet has been satisfactory in relation to nutrition and of special diets for individual residents. Records and servicing contracts indicate that the home has systems in operation and training to promote resident health and safety. There is evidence that appropriate testing and cleaning being carried out to reduce the risk Legionella and water temperature testing to reduce the risk of scalds to
Summerhill Nursing & Residential Home DS0000006157.V255558.R01.S.doc Version 5.0 Page 19 residents. Records showed that servicing and maintenance of equipment is being done. Summerhill Nursing & Residential Home DS0000006157.V255558.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 3 2 3 Summerhill Nursing & Residential Home DS0000006157.V255558.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 (1) Requirement Timescale for action 30/03/06 2. OP9 13 (2) 3. OP37 17 (2) Schedule 4 Wound management plans, assessments and evaluations must be in place for those residents with wounds. The dose of medication 30/03/06 administered must be documented on the chart where the dose varies. Records must be kept of the food 30/03/06 provided for residents at mealtimes and of any special diets. 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 Periodic checks should be made on nursing staff personal identification numbers with the NMC. Summerhill Nursing & Residential Home DS0000006157.V255558.R01.S.doc Version 5.0 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
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