CARE HOMES FOR OLDER PEOPLE
Sutton Manor Nursing Home Stockbridge Road Sutton Scotney Winchester Hampshire SO21 3JX Lead Inspector
Pat Griffiths Unannounced Inspection 23rd November 2006 10:00 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 Manor Nursing Home DS0000011650.V321692.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 Manor Nursing Home DS0000011650.V321692.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Sutton Manor Nursing Home Address Stockbridge Road Sutton Scotney Winchester Hampshire SO21 3JX 01962 760188 01962 761185 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) Mrs Evelyn Mary Cornelius-Reid Mrs Linda Gillum-Webb Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38), Physical disability over 65 years of age of places (38) Sutton Manor Nursing Home DS0000011650.V321692.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The home may accommodate a maximum of 20 service users who are in need of nursing care The home may accommodate a maximum of 38 service users who are in need of personal care only Staffing must be at or above the following levels 1 qualified nurse and 5 care staff 8:00am to 2:00pm 1 qualified nurse and 3 care staff 2:00pm to 5:00pm 1 qualified nurse and 4 care staff 5:00pm to 8:30pm 1 qualified nurse and 2 care staff 8:30pm to 8:00am The management hours of the registered manager must be supernumerary to the minimum staffing levels. The qualified nurse must not offer a service to service users in accommodation outside of Sutton Manor whilst on duty at the home. 25/01/06 4. 5. Date of last inspection Brief Description of the Service: Sutton Manor is one of three homes owned by Mrs Cornelius –Reid, two are in Hampshire and the other in Wiltshire. Sutton Manor is a care home that also provides nursing care. The home is registered to provide personal care for up to thirty-eight service users over the age of sixty five, in the categories of old age and physical disability, not falling within any other category, and nursing care may be provided for up to twenty of the residents. Sutton Manor is in Sutton Scotney and set within sixty acres of delightful parkland. The home has large and airy sitting rooms and dining room on the ground floor. All bedrooms have en suite facilities with the exception of one room, which has a private bathroom in an adjacent room. The current weekly fees are £662 - £787 per week. Extra services such as hairdressing and chiropody are usually billed monthly. Sutton Manor Nursing Home DS0000011650.V321692.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This fieldwork visit was unannounced and took place on 23 November 2006. All key standards were examined and the visit included looking at areas of the home such as bedrooms, communal and shared areas and the home’s kitchen and laundry as well as the gardens. Documents and records were examined and staff working practices were observed where this was possible without being intrusive. Residents, visitors and staff were spoken to in order to obtain their views of the service that the home provides. Staff were shy with the inspector during the visit and chose not to say much, but visitors that spoke to the inspector were very positive about the care their relatives received. The manager was present throughout the visit and the staff and administrator provided assistance and information when require Other information included in this report is obtained from information that the commission has received since the last visit made to the home in January 2006, such as notices received about incidents that have occurred in the home. The manager said that a preinspection questionnaire had not been received at the home, but provided the inspector with the necessary information during the visit. What the service does well: What has improved since the last inspection?
Staff training is now organised by a group training manager, with trainers in the home for induction training for new staff and a system for recording and monitoring staff training has been introduced. Several training sessions about adult protection have been held and more is planned for the new year.
Sutton Manor Nursing Home DS0000011650.V321692.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Sutton Manor Nursing Home DS0000011650.V321692.R01.S.doc Version 5.2 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 Sutton Manor Nursing Home DS0000011650.V321692.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A comprehensive pre-admission assessment is completed before a placement is offered, to ensure that all needs can be met. EVIDENCE: The files for three recently admitted residents were examined. Each contained a comprehensive assessment, which had been completed prior to admission. Prospective residents are invited to visit the home, to see the home and rooms and to have a pre-admission assessment completed. If there is a time lapse between the initial assessment and admission to the home the manager said that the assessment would be repeated, to ensure that no changes had occurred and that the home could still meet their needs. The pre admission assessments identified personal and social needs as well as health and nursing care needs. Areas that had been assessed included
Sutton Manor Nursing Home DS0000011650.V321692.R01.S.doc Version 5.2 Page 9 personal care; social, religious and cultural needs; dietary likes and dislikes; mobility, sight and hearing. The manager said that the home has a convalescence room and intermediate or respite care is available if the home can meet the needs of the potential resident. Sutton Manor Nursing Home DS0000011650.V321692.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have individual plans of care and their health care needs are met. Good practices ensure safe medication administration. Staff training ensures the residents’ rights to privacy, dignity and respect. EVIDENCE: The inspector looked at three care plans and found that assessments, such as risk assessments, manual handling, nutrition and skincare had been completed. They had identified areas of physical risk, such as risks of scalding when making tea, with guidance for staff to follow to minimise the risk. These assessments gave staff guidance on each person’s abilities and needs formed the basis of the care plan. The likes and dislike of the residents had been identified, such as what time they like to get up or go to bed. Profiles have been completed on each resident regarding their personality and daily activities. The manual handling assessment results were colour-coded so that
Sutton Manor Nursing Home DS0000011650.V321692.R01.S.doc Version 5.2 Page 11 staff could see at a glance what help or support the residents need when mobilising. The plans that were seen had been reviewed and updated regularly. The manager said that the residents are registered with a local doctors surgery who visit residents when required or the residents may attend the surgery. Residents confirmed that they were able to see their doctor when they wished. Other visiting healthcare professionals include the local dentist, optician and the chiropodist. The home has policies and procedures in place for the safe handling of medication. The manager said that the dispensary at the local surgery managed the stock control and replenishment of medication in the home and dealt with the disposal of any unused drugs. The home has a list of ‘homely remedies’, which is a list of medications that can be administered to residents which have not been prescribed by the doctor, such as paracetamol or cough linctus. The list is signed by the doctor, giving the staff permission to give these medications and under what circumstances. The staff were observed throughout the inspection knocking on doors and waiting for permission to enter. Most bedroom doors have locks fitted, so residents can have privacy if they want it, but some do not want locks on their doors Sutton Manor Nursing Home DS0000011650.V321692.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements ensure that there are a variety of activities available for the residents and the home has an open visiting policy. Residents are encouraged to exercise control over their lives. Arrangements ensure contact is maintained with family and friends and a wholesome and balanced diet is available. EVIDENCE: On the day of the visit there was a sale of floral arrangements being held in the lounge, which was well attended by the ladies in the home as well as the staff. The manager said that the residents arrange many of their own activities, which include teatime talks and National Trust visits, slide shows, nature watch and soirees. Other activities include cream teas in the rose garden, trips to Leckford estate, themed coffee mornings, T’ai Chi and keep fit. A fete is held in the gardens in the summer and a garden party was held with a ‘My Fair Lady’ theme. Sutton Manor Nursing Home DS0000011650.V321692.R01.S.doc Version 5.2 Page 13 Residents are enabled to maintain relationships within the home, as visitors are welcome at any time and there are rooms provided where they may stay overnight and meals may be ordered. Visitors that spoke to the inspector were very positive about the home ‘lovely place’, my mother loves it here – nothing is too much trouble’. At lunchtime visitors were seen enjoying lunch with their relatives in the dining room. Residents said they felt that they were able to make choices, such as what to wear each day or how to spend their time, and that staff were available to help if necessary. The home has a menu in place, which is changed regularly and choices are always available. Residents are asked daily about their menu choices and are advised of the choices available after lunch the administrator was seen to be asking the residents what they would like for their supper that evening. The food such as meat, fish and vegetables is ordered from local suppliers and delivered several times a week. The residents are able to take their meals in their own rooms or in the dining room. There is a waitress service in the dining room, where the main meal is served on the plate to the residents and then waitresses serve dishes of vegetables, so everyone has as much or as little as they wish. The inspector was invited to join some of the ladies for lunch and agreed with everyone that it was a pleasant meal. Sutton Manor Nursing Home DS0000011650.V321692.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure in place, enabling residents, relatives and staff to make complaints should they wish. Staff training in adult protection promotes the safety of the residents EVIDENCE: The home has a complaints and whistle-blowing policy in place, details of which are available for staff, residents and their visitors. The home has a complaints log, which is kept locked away to maintain confidentiality, should anyone make a complaint. The manager said that the home has policies and procedures in place regarding adult protection and they have an up to date copy of the local authority adult protection policy, which is available for staff to read. Staff training in adult protection was completed in February and March 2006 and the next training session is planned for January 2007. The manager said that she has completed a ‘train the trainers’ course in adult protection, so will be leading the training sessions. Sutton Manor Nursing Home DS0000011650.V321692.R01.S.doc Version 5.2 Page 15 Sutton Manor Nursing Home DS0000011650.V321692.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for maintaining the home ensure that residents stay in a safe environment that is pleasant, clean and hygienic. EVIDENCE: The inspector was able to tour the home and see the kitchen, laundry, communal areas and some of the bedrooms. On the day of the visit the home was seen to be clean and tidy, with no unpleasant odours. The nursing and care staff in the home are supported by ancillary staff, such as cleaners, laundry and kitchen staff. The home also has maintenance staff, who are in the home daily and any repairs that are needed are put on a list that was seen in the manager’s office. There is also a team of builders, decorators and gardeners for the group of homes.
Sutton Manor Nursing Home DS0000011650.V321692.R01.S.doc Version 5.2 Page 17 The cook showed the inspector round the kitchen and storage areas and discussed the menu and the choices that were available. The kitchen was busy whilst lunch was being prepared, but looked clean and tidy. An environmental health officer inspected the kitchen in May and everything was found to be satisfactory. The cook said that they are using the ‘Safer food, better business’ documentation in the kitchen. It is used to record daily temperatures of the fridges, freezers and cooked food as well as the ‘cleaning diary’ for the kitchen. The large laundry, with outside access to the garden, has sufficient washing machines and dryers and is accessed from the corridor so that dirty linen is not taken through the kitchen or food preparation areas. There is also a separate area where the clean clothes are kept until retuned to their owners. The lounge is large, light and airy with windows overlooking the large park that surrounds the home. There is a variety of seating arrangements to provide smaller sitting areas within the large room. The dining room has a variety of tables that can seat two to six people, and overlooks a small courtyard garden that also has a pond. The bedrooms seen by the inspector looked homely and had been personalised by the residents and their families. The bedrooms are of differing sizes and some of the larger ones have enough space for bookcases, armchairs and sofas and some had large desks and wardrobes. The manager said that where possible the rooms are decorated in colours chosen by the residents. The home has policies and procedures in place regarding infection control, which have been regularly reviewed. Suitable equipment such as disposable gloves and aprons were supplied throughout the home and staff were seen using them when required. Communal toilets had liquid soap, paper towels and disinfecting hand wash provided. Sutton Manor Nursing Home DS0000011650.V321692.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff ensure that needs of the residents are met. Arrangements ensure that the recruitment practice protects the residents and staff. Arrangements for induction and training ensure that the staff are able to meet the needs of the residents. EVIDENCE: The home employs nine registered nurses and twenty-eight care assistants as well as ancillary staff, such as the housekeeper, waiters, waitresses, cleaners, and laundry and kitchen staff. The registered manager said that currently eleven staff have National Vocational Qualifications in care and two are doing the course. When these staff have completed their course the home will have almost reached the required national standard of 50 of care staff in the home with an NVQ 2 or above. The home has a robust recruit policy and the registered manager said that part of the recruitment procedure was to obtain a Criminal Records Bureau (CRB) disclosure and the Protection of Vulnerable adults (POVA) check prior to employment, or to obtain a POVA first check and contact the commission for permission to start the member of staff’s induction.
Sutton Manor Nursing Home DS0000011650.V321692.R01.S.doc Version 5.2 Page 19 The inspector looked at the files of four new members of staff and found that all the relevant checks had been completed, such as obtaining references and CRB disclosures. Other staff files were checked and found to contain the correct information, such as proof of identity, and there was evidence that the nurses have had Nurses and Midwives Council checks on their professional qualifications before starting work in the home. The manager said that the job descriptions were being reviewed and updated to reflect current good practice. The home is part of a group of home and has a group training manager, who organises the training programme for the home. The manager said that training need are identified during staff supervision sessions and the training manager plans for the relevant training to be available. Training records seen by the inspector indicate that staff have attended training this year in manual handling, fire safety, food hygiene, first aid and adult protection. The manager said that training planned for 2007 includes fire safety, infection control and ‘challenging behaviour’. Sutton Manor Nursing Home DS0000011650.V321692.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements ensure that the home is well managed, but resident’s views are not formally sought. The residents’ financial interests are safeguarded. Arrangements are in place to ensure that the health, safety and welfare of the residents and staff is protected. EVIDENCE: The registered manager is a qualified nurse and has managed the service for many years and was able to demonstrate a sound knowledge of the needs of the residents. Since the last inspection the she has completed the registered manager’s award, which is a National Vocational Qualification in management at level 4. Residents are visited daily by the manager to ensure that they were well and have no problems, but there was no formal system in place to obtain their
Sutton Manor Nursing Home DS0000011650.V321692.R01.S.doc Version 5.2 Page 21 feedback about the service. The manager and inspector discussed the need to develop a more effective quality audit system so that the provider could demonstrate how the views of the residents impacted on the day-to-day management of the home. The manager said that a quality assurance survey would be done and the results made available on request to any interested parties and a copy would be sent to the commission. The manager said that residents do not have residents’ meetings because they don’t want them. The residents were asked if they wanted to hold meetings and only 8 responded, of the those 8 only half were for the meetings, the others didn’t mind. The residents said that they organise a lot of the events in the house for themselves and are aware that the provider and the manager are always available for them, one resident commented ‘nothing is too much trouble’. The manager said that the home does not hold any monies for the residents, they either manager their own financial affairs or have nominated representatives who act on their behalf. The manager said that some of the residents have installed safes in their bedrooms and others have lockable drawers or cabinets. The manager said that the provider or her representative visit the home frequently, but a written report has not been made for some time under Regulation 26. The manager said that it would be discussed with the provider and other managers, as one suggestion was that the managers could visit and report on different homes in the group. Comments by residents to the inspector include ‘it’s a lovely place, I’ve been here over five years’ ‘they are lovely’ ‘I’ve been here more than two years and everything is wonderful’ Comments from visitors indicated that they were happy with the care provided for their relatives ‘the staff are excellent, my mother is very happy here’ ‘Linda [the manager] keeps me informed of any problems’ Sutton Manor Nursing Home DS0000011650.V321692.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 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 3 3 X X X X X 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 3 X X 3 Sutton Manor Nursing Home DS0000011650.V321692.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Sutton Manor Nursing Home DS0000011650.V321692.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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