Inspection on 11/03/08 for Sutton Veny House Nursing Home

This inspection was carried out on 11th March 2008.

CSCI found this care home to be providing an Good service.

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 Veny House Nursing Home 20/04/06

Sutton Veny House Nursing Home 19/12/05

Sutton Veny House Nursing Home 21/06/05

Sutton Veny House Nursing Home 24/02/05

Sutton Veny House Nursing Home 27/09/04

Sutton Veny House Nursing Home 26/01/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Sutton Veny House Nursing Home Sutton Veny Nr Warminster Wiltshire BA12 7BJ Lead Inspector Susie Stratton Unannounced Inspection 11th March 2008 09:00 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 Veny House Nursing Home DS0000043651.V358777.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 Veny House Nursing Home DS0000043651.V358777.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sutton Veny House Nursing Home Address Sutton Veny Nr Warminster Wiltshire BA12 7BJ 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) 01985 840224 01985 840627 suttonveny@bmlhealthcare.co.uk Sutton Veny House Limited Mrs Patricia Gronow Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28), Terminally ill (2), Terminally ill over 65 of places years of age (2) Sutton Veny House Nursing Home DS0000043651.V358777.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users who may be accommodated at any one time is 28 of which one person only may be in the age range 60 - 64 years No more than 2 service users with a terminal illness may be accommodated at any one time The staffing levels set out in the Notice of Decision dated 12 September 2003 shall be met at all times 20th April 2006 Date of last inspection Brief Description of the Service: Sutton Veny House is a period house set in its own substantial grounds, providing pleasant surroundings for the residents to enjoy. The home provides care with nursing for up to 28 people, in a mixture of single and double rooms over a range of different floors. On the day of the site visit, there were only 20 people resident in the home. This was partly due to a planned re-furbishment programme. The manager of the home is Mrs Patricia Gronow; she leads a team of nursing, care and ancillary staff. The home is privately owned by Sutton Veny House Ltd. The Responsible Individual is Mrs Bila of Avon Care Homes Ltd. Their main office is in Wells in Somerset. There is ample parking on site. The home is situated on the outskirts of the village of Sutton Veny, close to the Wiltshire town of Warminster, which also has a range of shops, and a railway station. Sutton Veny is about 10 minutes drive from the A303, which links with the M3. The fee range is £750 to £950 per week. This does not include items such as hairdressing, chiropody and newspapers. People are given a copy of the service users’ guide prior to admission and a copy is available in the front entrance hall. Sutton Veny House Nursing Home DS0000043651.V358777.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. As part of the inspection, 20 questionnaires were sent out to residents, their relatives and social workers and five were returned. Comments made by people in questionnaires and to us during the inspection process have been included when drawing up the report. A random inspection took place on 12th February 2007. This was to investigate a complaint. No requirements or recommendations were made as a result of this inspection and several issues identified in the previous inspection were shown to be addressed. As part of this inspection, the home’s file was reviewed and information provided since the previous inspection was considered. This included the home’s annual quality assurance assessment of August 2007. The site visit took place over one day, on Tuesday 11th February 2008, between 9:00am and 5:00pm. The manager was on duty during the inspection and the proprietor was visiting the home during the afternoon of the site visit. The manager, her deputy and the proprietor were all available for the feedback at the end of the inspection. During the site visits, we met with eight residents, three visitors and observed care for five residents for whom communication was difficult. We reviewed care provision and documentation in detail for four residents, one of whom had been admitted recently. As well as meeting with residents, we met with one registered nurse, five carers, two cooks, the laundress, a domestic, the housekeeper, the administrator and a maintenance man. We toured all the building and observed a lunch-time meal. We observed systems for administration of medicines and a medicines administration round. A range of records were reviewed, including staff training records, staff employment records, maintenance records and financial records. What the service does well: Sutton Veny House presents a well-maintained atmosphere and benefits from large bedrooms and extensive, well maintained grounds. Staff training is encouraged and supported. There is a clear system for reporting of concerns and complaints, which residents and relatives felt able to use. Residents are supported by comprehensive documentation relating to their nursing and care needs, which they and/or their relatives are involved with drawing up. Staff at all levels clearly understood the importance of providing nursing and care in Sutton Veny House Nursing Home DS0000043651.V358777.R01.S.doc Version 5.2 Page 6 the way that individuals needed and following directives in care plans. Clear records are maintained of care provided to individual residents, so that senior staff can review quality of care provision. Staff are supervised in their roles and the manger regularly reviews quality of care provision. People made a range of comments about the service. One person reported “It provides kind and caring accommodation for elderly or infirm people in a very pleasant environment”, another “I don’t know of any serious problems or faults that require attention” and another “There’s an emphasis on standards here”. Comments were made about the staff, one person reported “They’re very kind here”, another “The staff are approachable and helpful” and another “The night staff are the most helpful”. What has improved since the last inspection? Sutton Veny House Limited has been purchased by a new company since the last inspection and so has a new proprietor. This person has commenced an investment programme for the environment and many of the rooms have been or are in the process of being up-graded to a high specification, with original architectural features being restored. At the previous inspection, under the previous proprietor, eight requirements and seven good practice recommendations were identified. All the requirements and six of the recommendations had been addressed in full. One recommendation had been addressed in part. The service users’ guide now includes a copy of the most recent inspection report summary. The registered manager confirms in writing to people admitted for respite care that they can meet their needs. All of a resident’s nursing and care needs are fully documented in their care plan. All turn charts, food charts and other records relating to provision of frequent care are completed in full, to show that frail residents’ care needs have been met. Precise, measurable terminology is used when documenting care provided. Care plans for residents with wounds include plans to meet the resident’s increased needs. End of life care plans have been developed for frail and dying people and where relevant, documents are signed by the resident/representative and GP. Where a resident sustains bruising, an accident record is completed. All assessments are dated and signed and liquid paper is not used when correcting residents’ records. All records of medicines’ administration are fully documented on the medicines administration record. The home has greatly reduced usage of agency staff. This has improved consistency and quality of care provision. The call bell system has been fully upgraded, including an emergency alarm facility and sufficient bleeps to enable all nurses and carers to carry one when on duty. Bed pans and commode buckets have been reviewed and any stained items disposed of and replaced. Sutton Veny House Nursing Home DS0000043651.V358777.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. The summary of this inspection report can be made available in other formats on request. Sutton Veny House Nursing Home DS0000043651.V358777.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 Veny House Nursing Home DS0000043651.V358777.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3. The home does not admit for intermediate care, so 6 is N/A Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Prospective residents and their supporters are given information about service provision and contracts; one area only needs expansion to fully inform people. Full assessments of need are made by an appropriately qualified person prior to a person being admitted so that all people can be fully assured that the home can meet the person’s nursing and care needs. EVIDENCE: Prospective residents and their supporters are provided with information prior to inspection, this includes a summary of the most recent inspection report. A copy of the full report is also available in the main entrance hall. The manager reported that she also sends out information to existing residents and their supporters as information is up-dated and following each inspection. The information is set out in an attractive style and has been expanded since the last inspection. The manager reported in her annual quality audit assessment Sutton Veny House Nursing Home DS0000043651.V358777.R01.S.doc Version 5.2 Page 10 that this had taken place following comments by residents and their supporters. It was discussed that the section on staffing of the home would benefit from some expansion, to describe how the home provides staff throughout the 24 hour period and during the week, to fully inform prospective residents and their supporters of the situation. A copy of contracts for provision of services is included in the service users’ guide; however this does not include all the information on fees required by regulation, particularly relating to information on fees where nursing is provided. This is required so that prospective residents and their supporters are fully informed about fees payable for services. All residents’ files include contracts; these have been signed by the resident or their supporters. As noted above, some up-dating is needed; however all other areas are included in the contract or in a side letter, which specifies the room(s) to be occupied. The contract also sets out clearly fees payable in the event of a person being away from the home or in the event of their death. Only one person had been admitted to the home recently. This person reported that they had been too unwell to visit the home before admission but that a family member had done this for them on their behalf. This person had a full and detailed assessment of their needs carried out by the manager. Information had also been obtained from other professionals who had previously been involved in their nursing and care. The recently admitted person had had equipment supplied to meet their nursing and care needs prior to admission. They had also been supported in bringing in range of their own items and the person reported on how they appreciated having some of their own things around them. Sutton Veny House Nursing Home DS0000043651.V358777.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Staff at Sutton Veny identify residents’ health and personal care needs and develop plans to meet these needs, together with the resident and their supporters. Care plans are largely clear and staff work in accordance with care plans to meet residents’ needs. EVIDENCE: Staff at Sutton Veny have developed their approach to provision of nursing and care. All residents have a named nurse and key worker. Staff spoken with knew their all residents and their needs, this was reflected in assessments and care plans. All residents had full assessments for risk, such as manual handling or pressure damage. Where risks are identified, care plans are put in place to direct staff on actions to take to meet individual residents’ needs. Residents spoken with reported that staff met their needs. Care plans were detailed and were completed using clear, measurable language. Where a person experienced additional needs such as those relating to short term Sutton Veny House Nursing Home DS0000043651.V358777.R01.S.doc Version 5.2 Page 12 memory loss, care plans were clear, person-centred and written in nonjudgemental language. One relative described how staff “try to give the best possible care to all their residents” another relative reported “there may be the odd “slip up”, but I do believe that “SVHNH” tries very hard to get it right” and one resident commented “The staff are approachable and helpful”. Sutton Veny cares for some residents who are very frail and have highly complex needs. All of these residents had clear and comprehensive care plans. Where equipment was used in providing care, this and the reasons for the equipment use was always documented. There were records available to show that residents were receiving the care they needed, in accordance with their care plans. For example one frail person’s care plan stated that they needed to be turned every two hours. This was fully evidenced by their turn charts. One resident reported, “I can’t get out of bed on my own, so they come to help me”. The senior registered nurse on duty reported that she reviews records on a daily basis, to ensure that staff are meeting residents’ needs and if they are not, she makes enquiry into why care did not take place or records accurately completed. Where residents needed support to take in fluids or drinks, there were full records of their dietary and fluid intake. Residents’ fluid intake was not totalled every 24 hours and this is recommended to inform assessments for risk of dehydration. Where residents needed dietary supplements, it was clear from observations, discussions with staff and records that these were provided. Where residents received their diet via tube feeding systems, there were full records in place, with evidence that healthcare professionals had been consulted and had provided relevant directions. Staff reported that they were informed of changes in residents’ conditions and actions to take to take to meet changed needs. This was fully evidenced by records, which showed that care plans were reviewed monthly or as their condition(s) changed. Records showed that the resident and/or their relatives were involved in regular reviews of care plans. People reported that the home were prompt in calling out their doctor when they were unwell. The home documents clinical observations of residents’ conditions when they are unwell, to advise relevant healthcare staff. Very comprehensive records of consultations with residents’ GPs and other professionals were maintained. One resident had an unstable medical condition and there were clear records of actions to take to meet this person’s needs when they were unstable. This was written in clear language, so that any member of staff could be in no doubt as to actions to take. Where residents had wounds, these were regularly reviewed and responses to treatment assessed. Wounds were regularly photographed. It is much to the credit of the staff in the home that they have succeeded over time in healing one resident’s major pressure ulcer, with no evidence of further breakdowns in this person’s skin integrity, for over six months. Where residents experienced continence issues, records were being developed relating to their use and monitoring of their use. Some residents had documentation relating to this in their rooms. Some of these documents had Sutton Veny House Nursing Home DS0000043651.V358777.R01.S.doc Version 5.2 Page 13 been dated and signed, other had not. This is recommended to ensure that it is clear who made the decision for user of certain aids and when review is indicated. Where residents had appliances such as urinary catheters, there were full records relating to the change and type of catheter. Not all residents with urinary catheters had the clinical indicator for their use included in their records and this is indicated so that the continued appropriateness of the use of such applications can be reviewed. Many residents needed topical applications. Carers spoken with knew about which creams were to be used. Some residents had information about topical applications in their records but others did not and some had information about some but not all of the applications. It is recommended that where a resident needs a topical application that full documentation is completed as to the type of application to be used, which part of the resident’s body it is to be applied to, how often this is to take place and date for review. This will ensure consistency in approach between all staff. A medicines administration round was observed during the inspection. It was noted that where medicines, such as antibiotic needed to be given on an empty stomach, that this took place. The registered nurse performed the medicines round in an organised manner, explaining to the resident what medicine they were to take and supporting then whilst they took the medicine. All medicines were safely stored, including Controlled Drugs and there was a full audit trail of medicines brought into the home, administered to residents and disposed of from the home. Medicines which require cold storage are kept in a medicines refrigerator. Records had been made of the refrigerator temperature until recently. These showed that the refrigerators’ temperature was stable. These records need to be recommended. Where residents are prescribed medicines which can affect their daily lives such as mood altering drugs or pain killers, a care plan has been put in place so that the effectiveness of these treatments can be assessed. Staff working in the home worked to ensure that residents’ privacy and dignity was maintained. All care was performed behind closed doors. Screens were observed to be always used in double rooms. Residents who required urinary catheters had their bags hidden away under clothing. One resident who needed equipment relating to artificial feeding had all equipment discretely stored away, so that this equipment did not detract from the homely atmosphere in their room. The laundress understood the importance of ensuring that residents’ clothing was retuned to them in a presentable manner. She reported that she was happy to perform mending when needed, to ensure that favourite clothes were returned to residents in a reasonable manner. The manager of the home and her deputy have close working links with the local hospice and have developed systems for ensuring that end of life care plans are drawn up when a resident is dying. Care plans relating to dying people were individualistic in style and reviewed when relevant. One person Sutton Veny House Nursing Home DS0000043651.V358777.R01.S.doc Version 5.2 Page 14 who had been very unwell had had an end of life care plan drawn up, they had since improved and this was fully reflected in their up-dated care plan. Where observance of a person’s religion was a key factor for them, this was documented in their records. All frail persons looked comfortable in bed and had fresh night clothes and bed linen. One relative described how very well the home had looked after their relative and supported the resident’s family when they had been unwell. Sutton Veny House Nursing Home DS0000043651.V358777.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Staff at all levels work to support residents in living the life that they prefer, this includes their daily lives, meals and social care needs. EVIDENCE: Sutton Veny employs an activities coordinator who works two full days a week. The manager also reports that she encourages her staff to interact socially with residents when providing care. This was observed to take place. Staff at Sutton Veny are developing individual profiles for all residents, with support from the resident and their relatives. Some of these profiles were highly individualised. The activities person also maintains records of the work she performs with residents. Of the four residents who responded to this section of the questionnaire, all reported that the home only sometimes provided activities which they could take part in. One person reported “We get activities two days a week, I think we need more”. This was discussed with the proprietor who reported that she was aware of the need to increase activities for residents and would be taking action, once occupancy had increased. The manager reported on good working relationships with the local churches. Sutton Veny House Nursing Home DS0000043651.V358777.R01.S.doc Version 5.2 Page 16 Residents reported that their visitors were welcome in the home at any time. One person reported “My daughter comes, she is always in and out – she can come when she wants to”. The manager has placed communications books in each resident’s room for visitors to pass on messages or make comments. Some of these books were well used, providing evidence of two-way communication between visitors and staff about a range of matters. Visitors are also requested to document when they have visited in individual records in residents’ rooms. Residents reported that they could chose how their lived their lives. One said “I go to bed early, I like it that way, I get tired”, another “I can stay up in my room and have my meals in my room” and another “I do exactly what I want here.” Residents reported that they could bring in items of their own if they wished. The proprietor is in the process of providing a dining room to the home. Currently residents eat their meals in the sitting room, sitting round large tables. Many residents prefer to eat in their rooms or are too frail to come down to the sitting room. Staff were available to support residents in eating their meals at lunchtime whether taken in the sitting room or the resident’s own room. Junior staff were supervised by more senior staff. One senior carer was observed to support more junior staff in the sitting room to ensure that residents had the aids that they needed and were properly supported when eating their meals. The chef reported that the provider had recently invested in new crockery and that this had further improved mealtimes. The annual quality audit assessment submitted by the home to us indicated that they were aware of the importance of meals provision to residents. As would be anticipated, there was a range of comments about the meals, these ranged from “I eat it - yes, yes I enjoy it”, “The food always smells gorgeous” through “The food’s alright – its food”, “The food is adequate” to “Can be boring with little change” or “The food isn’t exciting, its not my sort of thing”. The chef reported that she regularly reviews the menu with the residents, their supporters and staff. She also has information available on healthy diets for older people. The chef meets with residents to discuss their needs, one resident reported “The cook always has what’s good for us in mind”. The chef and her assistant showed a detailed knowledge of what the residents in the home liked to eat. She clearly was prepared to cook meals on an individual basis for residents if they expressed a preference. All meals are cooked from raw ingredients, including cakes and desserts. Sutton Veny House Nursing Home DS0000043651.V358777.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents are supported by systems in the home which ensure that their complaints and concerns are listened to and vulnerable persons safeguarded. EVIDENCE: Sutton Veny has a complaints procedure. This is available in the service users’ guide and in the front entrance hall. No complaints have been received by us since the last inspection. The home maintains its own log of complaints. A review of this log indicates that the home complies with its own polices and procedures when managing complaints. The home also responds to concerns raised by individuals and documents actions taken to meet concerns. Of the five people who responded to this section of the questionnaire, all reported that they knew how to make a complaint. One person reported “You can always speak to Matron or her number 2”, another “If I’ve got a bother, I go straight to ….. [using the manager’s first name]” and another “I can report it to the Matron, I’ve never had to do something like this. She would do something about it I believe.” The home has a policy and procedure on safeguarding adults, which complies with local procedures. The manager and her deputy are fully aware of actions to take in the event of a safeguarding referral. No referrals have been made via local procedures since the previous inspection. Staff spoken with were Sutton Veny House Nursing Home DS0000043651.V358777.R01.S.doc Version 5.2 Page 18 aware of actions to take to safeguard elderly people. Training records showed that staff are trained regularly in this area and a refresher course was planned for the day after the inspection. Records showed that assessments are made of residents who are prone to bruising, including medical factors which may pre-dispose them to risks of bruising. Where a person is assessed as being at risk of bruising, a care plan is developed to reduce the risk. There was evidence, including written evidence, that the manager has taken action to ensure that staff performance is monitored in this area and that any reports of bruising are effectively documented. Sutton Veny House Nursing Home DS0000043651.V358777.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents in Sutton Veny have a pleasing environment to live in, which the proprietor is investing in, to upgrade and improve. The home is clean throughout and there are safe systems for prevention of spread of infection. EVIDENCE: Sutton Veny is a large country house. As it is an older building, all rooms are different from each other and many much exceed national minimum standards. One resident commented “All the big rooms are BIG”. Most en-suite rooms are shared between two, with a locking system, to ensure privacy. The current provider has invested in the home environment since the previous inspection. Many of the rooms have been refurbished and further room refurbishments were evident during the inspection. As noted below, a dining room was being developed and it was anticipated that it would be complete about three weeks Sutton Veny House Nursing Home DS0000043651.V358777.R01.S.doc Version 5.2 Page 20 after the inspection. All rooms which have been refurbished have been completed to a high standard, with attention being paid to original architectural features in the building, for example restoring an original ceiling appearance. The home also has extensive grounds. One person commented “The gardens here are lovely” and another “I look forward to going into the gardens in the summer”. A range of equipment is provided to meet the needs of people with a disability, including hoists and slings to support people with mobility needs. Records showed that wheelchairs are maintained on a regular basis. A range of pressure relieving equipment is provided to frail people. The equipment provided was appropriate to their assessed needs. A new call bell system has been provided since the last inspection. All staff carry pagers so that they can see quickly where a call has come from. A full emergency system is available on the call bell service. All residents had been left with access to their call bells. One resident reported that they were unable to use a call bell but that staff visited them regularly. One relative commented that “staff soon go and see if there is a problem”. Sutton Veny employs a team of domestic staff. One person commented “The level of cleanliness is above average”. A domestic and the housekeeper reported that they had a good supply of cleaning chemicals. One domestic was performing a “spring clean” of one resident’s room during the inspection. This included moving all the furniture such as wardrobe and chest of drawers, cleaning behind them and the floor where the furniture has stood. She reported that they do this about once a month. Staff have a reporting system for if a carpet needs shampooing or other additional domestic attention is needed. All people reported that this system is effective in practice. All parts of the home inspected were clean. The home has policies and procedures on prevention of spread of infection. Full aseptic procedures are used for all clinical procedures. There are effective systems for removal of clinical waste. Records showed that the home effectively managed a recent infections disease outbreak, in accordance with local procedures and consulted with all relevant persons in the Health Protection Agency. It is much to the credit of staff that in a double room, whilst one person had an existing infection, that tests showed that the other person had not also sustained the infection. The home have employed new laundry staff recently. The laundry was very tidy and clean throughout. The laundress had a good understanding of her role and the principals of prevention of spread of infection. She reported that she knew who to go to if she had a query. The laundress also reported that all infected and potentially infected laundry was consistently placed in appropriate bags and that she had a good supply of gloves and aprons. However she did report that she sometimes has to re-sort items in the laundry as some items which should be separated such as towels and personal clothing, were placed Sutton Veny House Nursing Home DS0000043651.V358777.R01.S.doc Version 5.2 Page 21 in similar bags. Laundry should be separated at source to reduce potential risk of cross infection caused by handling of used laundry. Sutton Veny House Nursing Home DS0000043651.V358777.R01.S.doc Version 5.2 Page 22 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents are supported by a stable team of staff who to work together to meet their needs. Staff are recruited using safe systems, with sound induction programmes and supports for training and development. EVIDENCE: Sutton Veny has managed to recruit staff since the last inspection, so that agency staff are very rarely used. A review of off-duties and discussions with staff indicated that staff are happy to work flexibly and are prepared to cover for each other in the event of staff sickness. Many of the permanent staff have worked in the home for a long time and know the residents, each other and procedures in the home. A range of support staff, including domestic, laundry, catering and maintenance staff are also employed to support the nursing and care staff. Residents gave varied replies about staff response when they used their call bell, one reported “They sometimes take a long time to come when I press the bell”, another “If I ring my bell it depends on what is happening elsewhere as to how fast they come”, however other people reported “They come smartly when I ring my bell” and another “Staff get here quickly if I need them”. Sutton Veny House Nursing Home DS0000043651.V358777.R01.S.doc Version 5.2 Page 23 The home has effective systems for recruitment of staff. All staff submit a full employment history and any gaps in employment history are probed at interview. Police checks and health status checks are carried out on all staff prior to employment. All staff have to submit full proofs of identity, there is evidence for staff from aboard that they are eligible to work and all staff have two references, one from their most recent employer. Staff are not confirmed in post until they have completed a probationary period. The same procedures are used for any voluntary staff. All staff undergo a full induction. This induction conforms to current guidelines. Inductions are completed individually and throughout the induction period, with the inductor and inductee dating and signing sections in the induction form, as they are completed. One recently employed member of staff reported on how useful they had found their induction. There was written evidence that where an individual member of staff found difficulty with a particular area in their induction, that it would be covered again and confirmation in post not completed until the area had been successfully achieved. Staff reported that training is supported. The housekeeper reported that all her staff were to commence NVQs in cleaning shortly. A senior care assistant reported that she was to commence an NVQ assessor’s course shortly and also be trained in taking bloods (phlebotomy). Another care assistant reported that she was currently undertaking NVQ 2. There was evidence that staff whose first language was not English would be commencing appropriate English language training shortly. A review of records showed that a range of training is offered to staff relating to the needs of the client group. Registered nurses are also supported in developing their skills. The manager reported that she and her deputy receive regular support form the local hospice so as to develop their skills in palliative care. Sutton Veny House Nursing Home DS0000043651.V358777.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents are protected by the home’s effective management systems which ensure that quality of care is monitored, that staff are regularly supervised and that the principals of health and safety are up-held. EVIDENCE: Sutton Veny is managed by an experienced manager and registered nurse. The manager has gained the Manager’s Award and she is also an experienced trainer. Discussions with the manager and a review of records showed that she is able to take effective action, including disciplinary action, to improve staff performance when indicated. The manager is supported by a deputy. The deputy manger is currently undertaking the Manager’s Award. Sutton Veny House Nursing Home DS0000043651.V358777.R01.S.doc Version 5.2 Page 25 As part of the inspection, the home submitted an annual quality audit assessment to us. The manager also regularly reviews quality of care provision by sending out questionnaires to residents and their supporters. She collates these results and circulates them in newsletters to residents, their supporters and staff. The manager also holds regular residents and relatives meetings to receive their comments on care provision, these are minuted. Regular reviews of key areas also take place including wounds, hygiene and infection control practice and accident audit. The results of the audits are used to improve service provision. As a few residents commented on staff response when they used the call bell, an audit of response times when the call bell is used is advisable. The home is regularly visited by the proprietor and she completes a report into the visit. The report details a range of areas and will include action plans where relevant. The proprietor is not a clinician and so is not able to comment directly on the quality of nursing care provision. It was discussed with the proprietor that as Sutton Veny is registered to provide nursing care, that she should put systems in place to ensure that the quality of clinical care provision is also regularly audited by a person external to the home. The home does not look after any residents’ moneys. All payments for items such as hairdressing, chiropody or newspapers is dealt with via an invoicing system and the resident’s representative is invoiced on a monthly basis from the head office of the owner of the home. There are systems in place for staff supervision. Staff receive supervision on a regular basis; this includes direct observation of their practice, as well as individual meetings. Records show that training needs are considered at each supervision. Observations made during the inspection showed that senior staff work with and supervise more junior staff, ensuring that they are aware of key matters in the provision of care. The home has systems in place to ensure health and safety of residents, visitors and staff. All staff receive mandatory training in areas such as manual handling and fire safety. Full records of checks on equipment and systems are maintained and management takes effective action if issues are identified. For example, two hoists were recently taken out of use and disposed of following an inspection by the hoist maintenance company. All accidents are documented in full and if a resident has hurt their head, neurological observations are made by staff, to ensure that appropriate action can be taken if the resident’s condition deteriorates. Where residents are assessed as needing bed safety rails or lap belts, care plans are put in place, and these are regularly evaluated. The home do not currently use assessments for these items as advised by the Health and Safety Executive and they are advised that they should review the Health and Safety Executive guidelines, to ensure that all relevant assessments are used when using bed rails or lap belts. Sutton Veny House Nursing Home DS0000043651.V358777.R01.S.doc Version 5.2 Page 26 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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 3 X 3 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 3 X 3 Sutton Veny House Nursing Home DS0000043651.V358777.R01.S.doc Version 5.2 Page 27 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 Requirement Timescale for action 30/06/08 5(1)(b)(A) Service users’ terms and conditions must include the amount and method of payment of fees, including accommodation, nursing and personal care. Terms and conditions relating to these areas must be included in the service users’ guide. 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. Refer to Standard OP1 OP7 OP7 Good Practice Recommendations The service users’ guide should detail the home’s own policy on staffing and skill mix, to provide full information to service users. All information held in service users’ rooms about care provision should be dated and signed. Where a service user is having their fluid intake measured, this should be totalled every 24 hours, so that assessments for risk of dehydration can be made. DS0000043651.V358777.R01.S.doc Version 5.2 Page 28 Sutton Veny House Nursing Home 4. OP7 5. 6. 7. 8. 9. 10. OP8 OP9 OP26 OP33 OP33 OP38 Where a service user needs a topical application, a full care plan should be drawn up for every service user, to direct staff on which application is to be applied and where. This should be regularly evaluated. Where a service user has a urinary catheter in place, the clinical indicator for its use should always be documented in their records. Records of the temperature of the medicines refrigerator should be recommenced. Systems should be put in place so that used laundry does not have to be re-sorted in the laundry. Response times when call bells are used should be included in the regular audits of quality of care provision. Monthly visits by the proprietor or representative should include assessments by people who are able to comment on the quality of provision of nursing care. The home should consider guidelines from the Health and Safety Executive when drawing up assessments for the use of bed safety rails and lap belts. Sutton Veny House Nursing Home DS0000043651.V358777.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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