Inspection on 22/06/06 for Sutton House Nursing & Residential Home

This inspection was carried out on 22nd June 2006.

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

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

Other inspections for this house

Sutton House Nursing &... 26/11/08

Sutton House Nursing &... 15/01/08

Sutton House Nursing &... 09/11/05

Sutton House Nursing &... 26/04/05

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Hawkhills

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

CARE HOMES FOR OLDER PEOPLE Sutton House Nursing & Residential Home Kingfisher Rise Ings Road Sutton, Hull East Yorkshire HU7 4FL Lead Inspector Eileen Engelmann Key Unannounced Inspection 22nd June 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sutton House Nursing & Residential Home Address Kingfisher Rise Ings Road Sutton, Hull East Yorkshire HU7 4FL 01482 784703 01482 377881 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) Mr Barry Potton Mrs Judith Sigrid Whiteley Care Home 38 Category(ies) of Dementia (38), Dementia - over 65 years of age registration, with number (38), Old age, not falling within any other of places category (38), Physical disability (38), Physical disability over 65 years of age (38), Terminally ill (38), Terminally ill over 65 years of age (38) Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th November 2005 Brief Description of the Service: Sutton House is a large elegant looking period building set in extensive grounds. It is located in the village of Sutton and is tucked away discreetly from the main road. The home is a registered nursing home providing nursing and personal care to 38 male and female service users within the categories of physical disabilities, dementia, terminal illness and old age. Accommodation is provided in eight single rooms and fifteen double rooms, all with en-suite toilets and wash hand basins. The home has three floors with a passenger lift and stairs to the upper levels. Equipment and aids/adaptations are in place to ensure service users are cared for in a safe manner whilst allowing them to be as independent as possible. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home. A copy of the latest inspection report for the home is on display in the reception area of Sutton House. Information given by the manager on 17/5/06 within the Pre-Inspection Questionnaire indicates the home charges a range of fees depending on the nursing input for the individual and type of room provided. This is £327.50 for personal care/accommodation, plus a top-up fee of £10 for residential clients and £20 for nursing clients in a shared room with en-suite facilities. Fees for single rooms with en-suite facilities are £327.50 for personal care/accommodation plus a top-up fee of £15 for residential Clients and £25 for nursing clients. Nursing clients also pay their nursing band determination on top of the basic fee. Residents will pay additional costs for optional extras such as hairdressing; newspapers/magazines, private chiropody, outings and staff escort duties for hospital visits/appointments. A full list of the above costs and fee structures is available from the home on request. Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out with the registered manager, deputy manager, staff, relatives and residents of Sutton House Care Home. The inspection took place over 1 day and included a tour of the premises, examination of staff and resident files and records relating to the service. Five of the staff on duty, two visitors and twelve of the residents were spoken to; their comments have been included in this report. Information was gathered from a number of different sources before the inspector visited the home. Questionnaires were sent out to a selection of relatives, residents and staff and their written response to these was good. The inspector received 4 back from relatives (57 ), 5 from staff (55 ) and nine from residents (81 ). The provider completed a pre-inspection questionnaire and returned this to the Commission within the given timescale. Since the last inspection (November 2005) the Commission has received one formal complaint and two expressions of concern about the care given at the home. The formal complaint was passed to the Provider to investigate and their report was given to the complainant and the Commission. This issue was dealt with quickly and the complainant was satisfied with the outcomes. The Social Service Team for Hull City Council dealt with the two concerns, the team carried out investigations and the concerns were resolved successfully. At the last inspection there were a number requirements and recommendations made in the report. Information gathered and evidence seen from this visit shows the manager, deputy manager and staff team have worked extremely hard to improve the service and care standards. They have altered working practices, attended regular training sessions and improved the staffing levels. These measures have had a positive impact that is recognised by the relatives and residents and reflected in their comments to the inspector. The management team are aware that it is important that the home continues to develop its practice and give residents a high quality service. What the service does well: The home’s statement of purpose, and service user guide are provided in a ‘handout pack’, which has been given to each resident living at the home. Information within the documents gives residents a good idea of the service provided and four individuals said ‘ we were able to talk to the manager and staff before coming into the home and find out more about what living at the home would involve and how our needs and interests would be met’. Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 6 Staff provide a good level of support and care that helps the residents in their daily life. One individual wrote ‘the nursing support is good and has significantly improved my health, whilst I have been in the home’. Another person commented that ‘the care is excellent and staff are always there when needed’. A wide range of activities and social events is on offer at the home, which residents enjoy and look forward to. On the day of the inspection a number of individuals were attending a clothes party in the dining room and there was a lively atmosphere within the building. Meals are well presented and offer people at the home a choice and variety of different foods. One resident said that ‘staff are very helpful, they will get you a drink whenever you need one and always ask what you want to eat at each meal time’. Residents are provided with a warm, safe and comfortable environment that is homely and welcoming. The home is clean and staff work hard to make sure the building is odour free. Residents said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. What has improved since the last inspection? The home cares for older people with special needs, and staff have extra training to help them do this well. Bedrooms are being decorated and supplied with new curtains and bed linen in line with a planned programme of maintenance. Corridor carpets have been replaced and there is a refurbishment plan in place for the whole building. This investment in the environment has provided residents with a safe and comfortable place to live. Staff have worked hard to create detailed and informative care records that reflect the care being given, the progress made by the individual residents, and which clearly show the residents choices, preferences and decisions about their daily lives. Residents and relatives are pleased with the way care is being given and said ‘the staff are very supportive and encourage everyone to be as independent as possible’. Staff morale is high and individuals have a better idea of their roles and responsibilities within the home. Changes to the working practices at the home have taken place and there is a definite feeling of team spirit amongst the staff. One resident said that ‘care has improved over the past few months and staff are much happier when doing their work’. Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 7 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. Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 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 Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 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): 1,2,3,4. Quality in this outcome area is good. All residents undergo a full needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met by the service. EVIDENCE: The home’s statement of purpose, and service user guide are provided in a ‘handout pack’, which has been given to each resident living at the home. Information within the documents gives residents a good idea of the service provided, but there is a need to include more about the amount of communal space available and size of the bedrooms. One complaint dealt with by the Commission in February 2006 was around the provision of sufficient space to meet the National Minimum Standards for communal living. Investigation showed that this standard was met by the home, but the provider was informed that this information needed to go into the Statement of Purpose. This has not taken place and must be implemented as soon as possible. Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 10 Information from the residents’ questionnaires/surveys showed that not all had been provided with written information about the service before they came into the home. However, four residents spoken to were able to show a clear understanding of what services and care were on offer at the home and were satisfied that they had been given enough verbal information from the staff/manager to be able to make an informed decision about coming into the home. Information leaflets on dealing with finances, residents’ rights and legal issues are also available from the home. Advocacy information is on display in the entrance hall and the statement of purpose clearly highlights the rights of the residents to assistance from outside agencies and independent support workers. Following a query from a relative about additional costs, received in May 2006, the inspector looked at the information in the home’s statement of terms and conditions and service user guide. These documents clearly set out a range of additional costs that a resident may choose to incur. A covering letter with the prices for the optional services is included in the service user pack and has been sent out to all relatives. Discussion with the manager indicated the home has introduced a fee for escorting residents to medical appointments and although this information is included in the range of additional services charged for, there is no mention of the scale of charges (£5.00 per hour). The manager should ensure all fee charges are specified in the information given to the residents/relatives. Each resident has their own individual file and four of those looked at have a full needs assessment from Social Services completed within them. The information from the assessment process is used to formulate the individuals care plan. The home has developed its own needs assessment to be used with privately funded individuals and this meets the criteria of standard 3. Discussion with the manager indicated that a senior member of staff would go out to assess any individual who wished to be considered for a place at the home. Discussion with the manager indicated that she has been working hard to develop the skills and knowledge of the staff around care and provide residents with a better service delivered by well-trained and supervised staff. The training records indicate that a wide range of subjects have been studied by the staff including safe working practices, care of the elderly and diseases relating to old age. The employment records show that the manager is using a more selective approach to recruitment; ensuring new staff have the right skills and attitude to meet the needs of the residents. Comments from the manager and deputy manager indicate that they have looked at the working Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 11 patterns within the home and talked to the staff to find out what was necessary to produce a more motivated work force. Two teams of staff have been established, which has promoted team working and given staff a sense of ownership and pride in their work. Checks of the rotas demonstrated that staff are able to work a mixed pattern of shifts, twelve hours long or seven, depending on their preferences. Night staff are rotated onto days so everyone understands the pressures of the different times of day and has insight into each others jobs. Comments from the relatives and residents indicates that they have noticed an improvement in the service over the past three months, and although some individuals still find the care can be a little up and down in standard, on the whole they are pleased with the care being given and have a good relationship with the staff. One individual said ‘the care and support could not be better’. Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is good. The health, personal and social care needs of the residents are clearly documented and are being met by the service and staff. The medication at the home is well managed promoting good health. EVIDENCE: Staff are able to access training around effective record keeping practices, and the inspector noticed a big improvement in the way staff are writing and documenting the care being given. Examination of a selection of care plans indicates that these are being completed to a higher standard than at the last inspection. Individual care plans are in place for all residents and the four examined clearly set out the health, personal and social care needs identified for each person. The plans looked at have been evaluated on a monthly basis and any changes to the care being given is documented and implemented by the staff. Risk assessments were seen to cover pressure sores, nutrition, moving/handling and activities of daily living. Information about the resident’s social interests, likes and dislikes, spiritual needs and wishes regarding death Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 13 and dying are all included within the individuals care plan. Individual choices and decisions about how care is to be given were also well documented and for two individuals is very specific and detailed so staff can provide continuous care to meet their needs. One area where the care plans could improve is to ensure that residents or their relatives (as appropriate) sign the plans to indicate they have had input and agreed the contents. This lack of signatures is due to the plans having been re-written recently and staff have, in the past, been very good about ensuring this was in place. A number of residents are using a type of chair that reduces their chances of falling/sliding out, and also prevents them moving independently. The individuals concerned must have a risk assessment in their plan to indicate the reason for using this form of restraint and that it has been discussed and agreed by them or their representative. Seven residents said that they have good access to their GP’s, chiropody, dentist and opticians, with records of their visits being written into their care plans. Information from the plans showed that individuals are able to access medical professionals as needed, including the Community Psychiatric Nurse, Tissue Viability Nurse, Dieticians and the Diabetic Nurse. They all attend outpatient appointments at the hospital and records show that they have an escort from the home if wished. Comments from the residents and relatives indicate there is a high level of satisfaction about the nursing care given at the home. One individual wrote ‘the nursing support is good and has significantly improved my health, whilst I have been in the home’. Another person commented that ‘the care is excellent and staff are always there when needed’. The Commission has received one complaint and two expressions of concern (since the last inspection) around the care and service provided at the home. Investigations by the Provider and the Social Service Team have been carried out, and where recommendations to changes in practice where made, these have been acted on by the manager. The medication policy for the home says that individuals can self-medicate if they want to and after a risk assessment has been completed and agreed. All of the residents spoken to prefer to have staff administer their medication. Checks of the medication records and the system used showed that these are much improved since the last inspection. Discussion with the manager indicated that she has introduced a half hour handover period between shifts and the nurses use some of this time to check that staff on the previous shift have completed the medication records accurately. This audit of the records is successful and has produced a system that is up to date, accurate and well managed. Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 14 Looking at the information gathered before and during the inspection, the inspector noticed that there are still some differences in the levels of satisfaction with the care provided in the home. Discussion with three residents and one visitor revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Individuals said that ‘the care is ‘excellent’ and ‘the staff are very caring and supportive’. Two individuals commented that staff helped them to remain as independent as possible and they were offered choices throughout their daily routine of what they wanted to do, how, where and when. Three individuals wrote that ‘not enough staff are available in the lounges to help residents with toileting and transfers from wheelchairs to chairs’. Discussion with the manager indicated that she has instructed that there is always one member of staff in the lounge and she would look into these concerns. Four people said that ‘staff need to listen more to the residents’, and that when they do take notice the resulting action is not always as fast as they would like. The manager said that she would bring this up at the next staff meeting and monitor the staff’s practice. Overall the majority of residents and relatives spoken to agreed that the service and care giving at the home has improved over the past three months and staff are more enthusiastic and motivated. Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 15 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): 12,13,14,15. Quality in this outcome area is good. Residents are provided with choice and diversity in the meals and activities provided by the home. Relatives and visitors are made welcome at the home and good links to the community enrich the residents social and leisure opportunities. EVIDENCE: One member of staff has taken on the role of activity co-ordinator and is employed for 10-15 hours a week to provide a range of events in a morning, afternoon and evening. Comments from the residents indicate that they enjoy the events provided and that a good range of activities is available. On the day of the inspection a number of individuals were attending a clothes party in the dining room and there was a lively atmosphere, as one person put it ‘the place is buzzing’. The manager said that recent trips out included pub lunches and Bridlington and residents spoken to were enthusiastic about their twice-weekly bingo sessions and the trolley shop that goes around the home. There were a number of visitors to the home during the afternoon and one individual said ‘the staff are very welcoming and include you in all aspects of Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 16 the residents care. The atmosphere within the building is friendly and makes you feel at home’. Open visiting hours at the home enable individuals to come at times suitable for the residents and which fit into their own busy work schedules. Information from the residents’ files indicates that there are a number of individuals who follow different spiritual faiths, including Methodist, Catholic and Church of England. The manager said that there are regular church services (fortnightly) within the home and the catholic priest visits weekly to give communion to those who want to partake. Information about advocacy services is on display in the home and includes leaflets made available to the residents and relatives from the manager. Discussion with the manager indicated that no-one at the home is currently using an advocacy service, although these have been accessed in the past. Six residents spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. Information from the pre-inspection questionnaire showed that two residents have their finances looked after by the manager of the home and three others manage their own benefit books. Residents spoken to are satisfied that they can access their personal allowances when needed. All the residents said that the home encouraged them to bring in small items of furniture and personal possessions to decorate their bedrooms. Discussion with the residents showed that they are aware of their care plans and able to contribute to them and access them through their key workers. Comments from the surveys received from staff, residents and relatives indicate that overall there is a good level of satisfaction with the meals provided by the home. One individual said ‘ I don’t always like the choice of meals, but I can have an alternative’; another said ‘I am happy with the meals and choices provided’. Observation of the midday meal showed it to be well prepared and presented, and the kitchen staff had made an effort to provide soft/pureed diets in an attractive way. However, the staff (feeding the residents) were seen to mix all the pureed meal together and did not tell the residents what they were eating. The manager said she would talk to the staff about this at the next staff meeting and monitor the practices in the dining room. Fresh fruit and jugs of squash were seen in the dining room and lounges and residents said ‘we can help ourselves or the staff will get us a glass and those who need assistance have regular drinks offered’. Diet and fluid balance charts were seen in the dining room, these were up to date and completed by the staff throughout the day. Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 17 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 and 18. Quality in this outcome area is good. The home has a satisfactory complaints system with some evidence that residents feel that their views are listened to and acted upon. Staff and residents are confident about reporting any concerns and the manager acts quickly on any issues raised. EVIDENCE: Since the last inspection (November 2005) the Commission has received one formal complaint and two expressions of concern about the care given at the home. The formal complaint was passed to the Provider to investigate and their report was given to the complainant and the Commission. This issue was dealt with quickly and the complainant was satisfied with the outcomes. The Social Service Team for Hull City Council dealt with the two concerns, the team carried out investigations and the concerns were resolved successfully. Checks of the complaints record indicate the home has dealt with six complaints since the last inspection, details of the actions taken and responses to the complainants were seen. The home has produced a simplified complaints process that is easy for residents to read and understand. This policy is on display within the home. Five residents said that they were aware of the procedure and confident that if they had any concerns these would be listened to and acted on by the manager. Two relatives wrote that they were pleased with the quick and Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 18 efficient way the Provider and manager dealt with their complaints and were satisfied with the outcomes and action taken. The staff on duty displayed a good understanding of the vulnerable adults procedure and three residents spoken to said they ‘felt safe at the home’. Staff training files show that Protection of Vulnerable Adults from Abuse training has taken place and is an ongoing process, and information from the staff surveys indicates they are confident about the whistle blowing procedure and discussing any concerns with the management team. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint, however there is a need to develop one for the management of service users money and financial affairs. Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 19 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): 19,20,21,22,24,26. Quality in this outcome area is good. Recent investment has significantly improved the appearance of this home, creating a comfortable and safe environment for those living there and visiting. EVIDENCE: The manager has a record of the ongoing maintenance and renewal programme within the home and this indicates that the provider is committed to improving the facilities and environment within the home. Since the last inspection purchases include four profiling beds and pressure relieving air mattresses for high dependency residents, a mobile sling hoist and bath slings so physically disabled residents can be showered, a new suction machine for the treatment room, a digital blood pressure machine to replace the old aneroid one, a weigh scale to use on the sling hoist so the residents who are nutritionally compromised and physically disabled are now able to be weighed more frequently, and new office equipment including a computer, printer, scanner and fax. Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 20 Replacement of the corridor carpets was requested in previous inspection reports (April and November 2005) and this work has now been completed, the corridor walls have been repainted and woodwork glossed. Bedroom 12 and 24 have had a new carpet fitted and other carpets in the residents’ rooms have been deep cleaned. Bedrooms are in the process of being refurbished and the manager said by January 2007 the whole building will have been completed. Those seen have been fitted with new curtains, bedding and comfortable armchairs in a range of colours chosen by the residents. It is recommended that the Provider look at replacing the carpets as they now look shabby and let the overall appearance of the rooms down. Repairs have been carried out to a leak in the roof and the old nurse call system has been replaced with a more up to date model. Extensive repairs have been made to the lift in the building and this facility is now in full working order. Two recommendations made in the additional visit to the home in February 2006 in response to a formal complaint have not been implemented, and will be carried forward in this report. ∗The manager should carry out a risk assessment around moving and handling in the small lounge and take appropriate action to ensure the residents health and safety is maintained. ∗The registered person should consider how the communal space provided in the main lounge could be divided to provide residents with more privacy when talking to their friends and relatives. Observation of the premises found that the wet room/shower facility on the first floor has been completely renovated due to problems with the flooring causing the ceiling below to collapse. This facility is well used by the residents and a new shower chair with movable arms has been purchased to aid the safety of the residents whilst bathing. Action has been taken to replace all the thermostatic valves in the home in order that the water flow is at the correct temperature. The development plan for Sutton House for 2006/7 shows that there is an intention to renovate the unused bathroom to the second floor and convert this into another shower facility, and purchase a shower trolley for use by the physically disabled residents. This was a recommendation made in the last inspection report (November 2005). The environment is clean, warm and comfortable and no malodours were present. Comments from the surveys indicates that the residents find the home to be spotlessly clean and are satisfied with the laundry service provided by the home. Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 21 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): 27,28,29,30. Quality in this outcome area is good. The standards of recruitment, induction and training of staff are very good with appropriate checks being carried out and staff demonstrating a clear understanding of their roles, ensuring that residents are protected from risk and looked after by motivated and knowledgeable people. EVIDENCE: Discussion with the manager and deputy manager indicates that they have worked hard since the last inspection to improve the standards of care within the home and raise the morale of the staff working there. Comments received from the residents, relatives and staff show that they have succeeded in their aims and the differences have been recognised and well received by all the respondents. Two groups of staff have been established at the home and the manager said that this has produced a higher standard of work as individuals feel supported and more confident working within their own team. There has been a reduction in the amount of sick leave and absences taken and staff appear more motivated about their jobs. Conflicts between the night and day staff have been resolved by the introduction of rotational shifts, so everyone can see what it is like to work over the twenty-four hour period. Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 22 After discussion with the staff the manager has introduced two shift patterns of twelve or seven hour durations, and staff can choose which they wish to work. Inspection of the rotas and discussion with the manager indicates that staffing levels have been increased since the last report (November 2005) and currently there is one nurse and seven care staff from 07.30 to 14.30, one nurse and five care staff from 14.30 to 20.00 and one nurse and four care staff from 20.00 to 07.30. Information from the pre-inspection questionnaire about the number of staffing hours provided and the dependency levels of the residents was used with the Residential Staffing Forum Guidance and showed that the home is 50 hours a week short of the recommended guidelines. The residential staffing guidance does not give specific hours for nursing input and it is up to the management of the home to decide how many hours of nursing care are required to meet the needs of the residents, based on the dependency levels of the individuals. The pre-inspection questionnaire shows that there are 28 residents receiving nursing care and 9 receiving personal care. The manager should consider the provision of another nurse on duty in the morning to ease the nursing workload. There is an induction and foundation course that meets National Training Organisation (NTO) specification for new members of staff, and 63 of the care staff have achieved an NVQ 2 or 3. The home provides a mandatory staff-training programme and additional, more specialised training that reflects the different care needs of the client group. There is no evidence that staff have received training around equality, diversity and disability rights and this should be included in the rolling programme of staff training and development. Discussion with the manager indicated that the local social services training group provides these sessions in their learning programme, and she would try to access this. Information in the staff training files and discussion with the staff indicates uptake of training has been good over the past 12 months and there is a staff training matrix in place to monitor this. Two of the staff are adaptation students (nurses from abroad) who are working with Lincoln University and undertaking training to show they have the necessary skills and abilities to work as trained nurses in the UK. Discussion with the manager indicates that the home employs four nurses from abroad including Russia, South Africa and India. One individual is completing a Better English course at the local college and is doing well. The manager said that she has tried to recruit more male carers in the past as she is aware that the majority of staff are female, but this has proved difficult as there have been few suitable applicants. Comments from the manager indicate that all of the residents are from a white British background, but the home is able to offer a range of services should they be approached from someone of another culture or ethnic group. The home should consider utilising the knowledge and Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 23 skills of the staff from different countries to promote cultural awareness amongst the staff and residents. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of four staff files showed that police (CRB) checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Nurses at the home undergo regular registration audits with the Nursing and Midwifery Council to ensure they are able to practice. Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 24 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): 31,33,35,37,38. Quality in this outcome area is good. The management of the home is satisfactory overall and the home regularly reviews aspects of its performance through a good programme of self-review and consultations, which includes seeking the views of residents, staff and relatives. EVIDENCE: In April 2006 the manager achieved registration with the Commission, however she has informed the inspector that she intends to retire at the end of June 2006. Discussion with the manager and the provider’s representative indicates that the deputy manager will take over the running of the home when the manager leaves. This must be confirmed in writing to the Commission and plans put into place for the support and development of the deputy manager in her new role. Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 25 The home has achieved the Hull City Council’s Quality Assurance Award (QDS 1 and 2), and there is evidence of regular audits being carried out by the manager. Staff and residents/relatives are asked to complete satisfaction questionnaires and their feedback on the service is used to produce an annual development plan for the home. Meetings for the staff and residents are taking place, although these had lapsed until recently. Minutes are kept and available for any interested parties to read. The Commission has received a copy of the regulation 26 reports and these visits to the home take place on a monthly basis. Checks of the finance systems was carried out at the last inspection (November 2005), but was not possible on this visit as the administrator was on sick leave and had the keys to the cabinet where the records are kept. Discussion with the manager indicated she is keeping a record of spending and supplying residents with pocket money from the petty cash until the administrator returns next week. Discussion with one relative indicated that they received a monthly statement of their relative’s Pocket Money Account, when they were billed for the fees; this was easy for them to follow and let them know if their relative needed any more money in their account. This standard will be assessed in full at the next inspection. Discussion with the manager and checks of the staff files showed that supervision has started within the home, and is being carried out on a regular basis. It is important that the 1-1 sessions with the staff are structured and cover all aspects of practice, philosophy of care in the home and any career or training/development needs of the individual. Improvements to the supervision process since the last inspection have produced a more consistent approach to care by the staff, and are recognised in the positive feedback from the relatives and residents throughout this report. There are a number of important policies and procedures missing from the home files, these must be developed and implemented as soon as possible. Those seen to be missing include Recruitment and Selection, equal opportunities, disciplinary/grievance procedures, redundancy, violence in the workplace and management of residents’ finances and monies. Policies and procedures are being reviewed and up dated by the manager and a full list of missing documents has been sent on to head office. Work is progressing to make sure that records required for the protection of residents and the running of the business are in place. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 26 Staff have received training in safe working practices and the manager has completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding fire, moving and handling, cot sides and daily activities of living. Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 27 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 2 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 2 3 3 X 3 X 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 3 X 3 X X 3 2 3 Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 28 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 OP1 Regulation 4 Requirement The statement of purpose must clearly set out the physical environment standards met by a home in relation to standards 20.1,20.4,21.3,21.4,22.2,22.5, 23.3 and 23.10: a summary of this information must appear in the home’s service user guide. The risk assessment process for the care plans must include information where individual residents are restrained from independent movement by use of specific equipment such as curtain chairs. The care plan must be agreed and signed by the resident whenever capable and/or representative. The provider must ensure there is a policy and procedure in place regarding resident’s money and financial affairs, which follows best practice and safeguards residents from financial abuse. Policies and procedures needed for the protection of the residents and effective running of the business must be DS0000062875.V301326.R01.S.doc Timescale for action 01/11/06 2 OP7 15 01/09/06 3 OP7 15 01/11/06 4 OP18 20 01/11/06 5 OP37 17 01/09/06 Sutton House Nursing & Residential Home Version 5.2 Page 29 developed and put into place as soon as possible. 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 3 4 Refer to Standard OP2 OP15 OP19 OP20 Good Practice Recommendations The manager should ensure all fee charges are specified in the information given to the residents/relatives. The manager should monitor staff practices regarding feeding of residents and discuss any issues through supervision and staff meetings. The Provider should look at replacing the bedroom carpets as they now look shabby and let the overall appearance of the rooms down. The manager should carry out a risk assessment around moving and handling in the small lounge and take appropriate action to ensure the residents health and safety is maintained. The registered person should consider how the communal space provided in the main lounge could be divided to provide residents with more privacy when talking to their friends and relatives. The manager should consider the provision of another nurse on duty in the morning to ease the nursing workload. Staff should receive training around equality, diversity and disability rights and this should be included in the rolling programme of staff training and development. The home should consider utilising the knowledge and skills of the staff from different countries to promote cultural awareness amongst the staff and residents. 5 OP20 6 7 8 OP27 OP30 OP30 Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Sutton House Nursing & Residential Home DS0000062875.V301326.R01.S.doc Version 5.2 Page 31 - 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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