CARE HOMES FOR OLDER PEOPLE
Sutton Veny House Nursing Home Sutton Veny Nr Warminster Wiltshire BA12 7BJ Lead Inspector
Susie Stratton Unannounced Inspection 19th December 2005 10:55 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.V269016.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sutton Veny House Nursing Home DS0000043651.V269016.R01.S.doc Version 5.0 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 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.V269016.R01.S.doc Version 5.0 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 21st June 2005 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 inspection, there were 28 persons resident in the home. 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 Mr Barry Lambert of BML Healthcare Ltd. Their main office is in Poole in Dorset. 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. Sutton Veny House Nursing Home DS0000043651.V269016.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on Monday, 19th December 2005, between 10:55am and 4:15pm, in the presence of the registered manager. During the inspection, the Inspector met with six residents, observed care for seven residents who were too frail to converse, observed a mealtime and parts of an activities session. The Inspector also met with one registered nurse, three care assistants, the laundress, a domestic and one of the maintenance men. The Inspector toured the home, including the laundry, bathrooms and sluice rooms, reviewed documentation relating to six residents, the medicines records and storage systems, four staff files, training records, supervision records and the complaints register. What the service does well: What has improved since the last inspection?
Three requirements and eight recommendations were identified at the previous inspection. All have been addressed. Where residents are assessed as being at risk of pressure damage, clear individualised care plans are in place, these also document any equipment needed to reduce risk for the resident. All medicines administration records have been completed in full. All prescribed medicines and devices had been securely stored. Care plans had been revised as soon as the residents’ conditions changed. Care plans are written in measurable terminology. Evidence of choice of meals was available. The kitchen door was secured when the kitchen was unstaffed. Copies of staff photographs and letters of appointment are held on staff files. A policy and procedure on cross gender care has been drawn up. Staff have been made aware of their responsibilities for cleaning of their uniforms under Health Protection guidelines.
Sutton Veny House Nursing Home DS0000043651.V269016.R01.S.doc Version 5.0 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. Sutton Veny House Nursing Home DS0000043651.V269016.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sutton Veny House Nursing Home DS0000043651.V269016.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 & 5. Sutton Veny does not provide intermediate care. Residents are protected by detailed pre-admission assessments. The inspection showed that the home were able to meet the needs of residents. Pre-admission visits are encouraged. EVIDENCE: Prospective residents are assessed by the manager prior to admission. Assessments are performed in detail and further developed after admission. Assessments are obtained, where indicated, from relevant healthcare professionals. Discussions with residents, observations of nursing and care, discussions with staff and reviews of care plans showed that the home are able to meet the needs of residents. Many residents were too frail to visit prior to admission, however they said that relatives had visited on their behalf. One resident described how their relatives had visited a range of different homes in the area before deciding that Sutton Veny would be the home most able to meet their needs. Sutton Veny House Nursing Home DS0000043651.V269016.R01.S.doc Version 5.0 Page 9 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 & 11 Residents are protected by a detailed care planning system. Residents’ healthcare needs are met, this includes residents who are frail and dying. Medicines are safely administered and securely stored. Staff respect residents’ privacy and dignity. EVIDENCE: All residents have comprehensive assessments and care plans on file, which were observed to be followed in practice by staff. Where residents were assessed as having manual handling needs, dietary needs or risk of developing pressure damage, assessments were regularly reviewed and clear, individual care plans drawn up. These care plans are up-dated as residents’ conditions change. Where residents have complex nursing needs relating to actions to be taken to ensure the stability of their condition and actions to be taken in an emergency, full plans are in place, which direct staff on actions to take to ensure that the resident’s condition does not worsen and is stabilised as quickly as possible. Where a resident has additional needs relating to behaviours, a care plan is in place and records are written in non-judgemental language. Sutton Veny House Nursing Home DS0000043651.V269016.R01.S.doc Version 5.0 Page 10 Staff spoken with knew their residents’ needs well. There is an established key worker system in place, which residents and staff reported works in practice. Detailed records of consultations with residents’ GPs and other healthcare professionals are maintained. There are clear care plans in place in relation to management of residents with wounds. Full records of care provided to frail persons who need frequent care are maintained, to ensure that residents receive the care they need. Frail residents looked comfortable in bed, with clean night clothes, fingernails and hair. The home has some records relating to residents wishes in the event of illness or sudden collapse, however where a resident has expressed specific wishes, the document is not always signed by the resident/representative and their GP. As the home cares for persons who are frail, it is advisable that the end of life care plans be further developed, to ensure that residents’ needs and preferences can be met. Medicines are safely stored and full records maintained. Staff are aware of the recent legislative changes relating to disposal of medicines. Some residents are prescribed a range of drugs which may affect their daily lives, for example pain killers or mood-altering drugs. It is advisable that care plans be drawn up in relation to such needs, to ensure that the drug continues to be effective for that resident and to advise medical and other healthcare professionals of changes in conditions relating to drug prescriptions. The home are administering one drug by use of a pen system and they need to make themselves aware of a recent hazard warning notice in relation to such methods of administration, to ensure that risk to residents and staff have been reduced as much as possible. Clinical items such as catheters and syringes were tidily stored, however it was noted that one box of syringes was still in the cupboard although they had passed their use-by date. This was the only incidence noted during the inspection and these syringes were not currently in use. The home needs to set up a system to regularly check use-by dates for all items and dispose of any out-of date items. All personal care was provided behind closed doors. There are systems in place in the laundry to ensure that all items of clothing are returned to the resident, this includes socks, stockings and net underwear. It was observed that staff consistently called residents by their preferred name, first name or title and surname. Sutton Veny House Nursing Home DS0000043651.V269016.R01.S.doc Version 5.0 Page 11 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, 14 & 15 An activities programme is provided and individual resident’s needs are addressed as part of this. Residents are supported in making choices about their lives. A full menu is made available to all residents and alternatives are provided. EVIDENCE: The home has a comprehensive activities programme, which is led by an activities coordinator. She maintains clear records of activities provided and supports given to individual residents who do not wish or are too frail to be involved in activities. One resident who was too frail and did not wish to come out of their room had been left with their preferred radio station playing. A full programme of Christmas events had been arranged. On the day of the inspection, residents who wished to were enjoying sherry and mince pies in the drawing room. Residents said that it was up to them when they got up and went to bed. One resident said that they did not like mixing and that this was respected by staff. Residents can bring in items of their own and some of the rooms were highly personal, reflecting the resident’s individual likes and preferences. Residents said that they liked their meals. Three residents described the meals as “very good”, another said that their meal on the day of the inspection
Sutton Veny House Nursing Home DS0000043651.V269016.R01.S.doc Version 5.0 Page 12 was “nice and hot” and another described it as “tasty”. One resident said that they did not like some of the items on the menu and appreciated the chef cooking them something different on such days. Another resident said that they sometimes did not feel like eating and that the kitchen staff were happy to give them a sandwich on such days. Residents eat together in the drawing room at individual small tables. The home have put in for planning permission to improve the building, this will include the provision of a dining room. This will much improve the atmosphere at lunch-time and reduce any institutional atmosphere. Staff were available to support residents at mealtimes, sitting with residents who needed assistance, chatting and supporting them. When one resident dropped all their meal on the floor, this was promptly cleaned up and another meal provided. Sutton Veny House Nursing Home DS0000043651.V269016.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 17 The home has an effective complaints system. Procedures, which work in practice are in place to protect residents from abuse. EVIDENCE: A complaints procedure is on display and a full record of all concerns, as well as complaints are maintained, so that the managers can assess staff response to issues raised. Residents said that they knew who to bring up issues with. Two residents said that they would tell their key worker first if they were not happy about anything and that they would sort things out or make sure messages were passed on. Staff have all been trained in abuse awareness. One resident was observed to be showing abusive behaviours towards staff. Staff were noted to manage such behaviours in a professional and calm manner, complying with the resident’s care plan. The home’s file shows that it has an effective whistle blowing procedure. Where residents need restraints, such as safety rails, this is included in their care plan and regularly reviewed. Sutton Veny House Nursing Home DS0000043651.V269016.R01.S.doc Version 5.0 Page 14 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, 23, 24 & 26 Sutton Veny is well maintained and the owners are seeking to further develop the environment. All equipment needed to support residents is available. Rooms were clean, attractive and fully furnished. Three areas relating to equipment/furnishing have the potential to put residents at risk of cross infection. EVIDENCE: Sutton Veny presented a well-maintained environment. One maintenance issue identified by staff during the inspection was promptly dealt with. One large drawing room is provided, this gives access to a terrace, which overlooks the extensive grounds, which are attractive and well-maintained. Some residents like to sit in the entrance hall, which is provided with seating and chairs. There is a wide range of bathing and toileting facilities, to meet the needs of disabled residents. As Sutton Veny is an older building, all rooms are different from each other in shape and size, some rooms are very large. Where residents share rooms, screening was in use and residents who wished to rest after lunch were doing so in privacy. The owners have met with the Commission to discuss developments and further improvements to the home,
Sutton Veny House Nursing Home DS0000043651.V269016.R01.S.doc Version 5.0 Page 15 including increasing communal areas and modernising en-suite facilities for residents. The owners have invested in new electrically operated profiling beds and all frail residents were nursed in such beds. One resident said how well they slept in their bed. All residents had been left with access to the call bell system. One said staff came quickly when they used their bell, another said “they’re very good about coming” and another said “Staff are very helpful when they come.” Both the laundress and domestic staff were aware of their roles and all areas for which they had responsibility were clean. There is a clear procedure for handling laundry, which the laundress reported staff complied with in practice. Some of the chairs in the drawing room showed staining, this was despite clear efforts to clean them. The fabric of other chairs has deteriorated and the under-felt was showing through. It would not be possible for such chairs to be properly cleaned and as some residents have conditions, including fungal infections and urine infections, it is not possible for such deteriorated furniture to be properly cleaned to prevent risk of cross-infection. The proprietors need to replace all such deteriorated chairs. One bath hoist, which was identified to the manager, has lost its plastic coating on the underside, as such it also cannot be cleaned properly and a risk to cross-infection is therefore present. The chassis of eight commode chairs showed smearing with brown matter/debris. The domestic staff confirmed that it is the care assistants’ role to clean the chassis of commode chairs. All chassis of commode chairs must be cleaned regularly and as soon as any contamination is visible. Sutton Veny House Nursing Home DS0000043651.V269016.R01.S.doc Version 5.0 Page 16 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, 29 & 30 Sutton Veny are staffing the home as required by the Commission. They have successfully reduced reliance on agency staff. Residents are protected by the home’s recruitment system, which is managed by the head office. A comprehensive training programme is in place. EVIDENCE: Sutton Veny is required to staff the home in accordance with a Condition of Registration set out by the Commission. They were meeting the requirements of this Condition. The use of agency staff has been much reduced and the manager reported that agency staff were now only used very occasionally. Staff files are maintained in the home, however the head office performs all recruitment processes and sends copies of documents such as references to the home. The system means that staff cannot be employed until all matters have been verified. The staff files in the home are not maintained in an organised manner, of the four files reviewed, only two included all required documents. Documents which were not in place were faxed through promptly from the main office, on request. This situation needs review, so that the manager is in a position to fully review relevant records on staff in the home as and when she needs to. All staff are provided with an induction programme, BML Healthcare have provided a standard induction programme, which is used by all homes. All staff work supernumerary for a period when they commence employment, the length of time depends on their experience and their individual needs. All staff
Sutton Veny House Nursing Home DS0000043651.V269016.R01.S.doc Version 5.0 Page 17 also have to attend mandatory training in topics such as fire safety, manual handling and infection control. The manager has a system in place as part of supervision, to ensure that all staff do regularly up-date themselves. Individual training sessions in areas relating to the nursing and care needs of residents in the home, are also put on to inform staff. Sutton Veny House Nursing Home DS0000043651.V269016.R01.S.doc Version 5.0 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 36 Sutton Veny’s manager is an experienced nurse and manager. A quality audit system is in place to review service provision. Residents’ financial interests are safeguarded. Staff are supervised. EVIDENCE: The registered manager has now been in post for a year and has introduced a range of improvements in resident care, with the support of staff and managers. The manager is an experienced nurse and manager, who has managed other nursing homes in the past. The managing agents, BML healthcare regularly survey residents’ satisfaction and publish their findings to the home. The home is visited by an area manager on a monthly basis, this person meets with residents and staff in private and reviews the home environment and records. Following this, they produce a report, which includes action points where relevant. Sutton Veny does not look after residents’ moneys. All invoicing is managed by head office,
Sutton Veny House Nursing Home DS0000043651.V269016.R01.S.doc Version 5.0 Page 19 with relatives being written to from there, for payments for items such as hairdressing or chiropody. The manager has set up a staff supervision system and delegated this responsibility to senior staff. Evidence from staff and other records indicates that all staff receive regular supervision. This is not currently supported by records and it may assist the manager if they had more administrative support to ensure that filing can take place regularly and senior staff reminded of the need to fully complete documentation promptly. Sutton Veny House Nursing Home DS0000043651.V269016.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 3 3 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 x 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 3 3 x 2 STAFFING Standard No Score 27 3 28 x 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 x Sutton Veny House Nursing Home DS0000043651.V269016.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP26 Regulation 13(3) Requirement An audit of chairs must take place and a written action plan developed and submitted to the Commission, detailing when all deteriorated chairs will be replaced. The deteriorated bath hoist, which was identified during the inspection, must be repaired or replaced. The chassis of all commode chairs must be promptly cleaned after use and all visible staining and debris removed. Timescale for action 31/01/06 2. OP26 13(3) 31/01/06 3. OP26 13(3) 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations The home should develop care plans relating to residents’ medication, particularly where pain-killing or mood altering drugs are prescribed, so that the effectiveness of the drug treatment can be assessed.
DS0000043651.V269016.R01.S.doc Version 5.0 Page 22 Sutton Veny House Nursing Home 2. OP9 3. 4. OP9 OP11 5. OP29 6. OP36 The recent hazard notice relating to the use of pen injection systems should be made available to staff, so that they can review their practice when administering such medication. All clinical items should be regularly reviewed to ensure that no stocks of out of date items are stored in the home. The home should develop end of life care plans for frail and dying service users. Where relevant, such documents should be signed by the service user/representative and GP. A full review of all staff files should take place, to ensure that all are maintained in an orderly manner and copies of all required documents held by head office held on the home’s files. Administrative support systems should be developed for the manager to put in place a matrix so that she can review supervisions undertaken and to assist in ensuring that staff supervisions are filed. Sutton Veny House Nursing Home DS0000043651.V269016.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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