Inspection on 20/04/06 for Sutton Veny House Nursing Home

This inspection was carried out on 20th April 2006.

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

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

Other inspections for this house

Sutton Veny House Nursing Home 11/03/08

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 8th May 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 Veny House Nursing Home DS0000043651.V290200.R01.S.doc Version 5.1 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.V290200.R01.S.doc Version 5.1 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.V290200.R01.S.doc Version 5.1 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 19th December 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. 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.V290200.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place during April and May 2006. The home’s records were reviewed, to direct the Inspector on which areas to consider when looking at service provision. A site visit was performed on Thursday 20th April, between 9:50am and 4:25pm, in the presence of the registered nurse in charge for the morning shift and the deputy manager for the afternoon shift. During the visit, the Inspector met with nine residents, including one recently admitted resident and observed care for eight residents who were unable to communicate. Records relating to seven residents were considered in detail. The Inspector also met with four carers, the activities coordinator, the newly employed administrator, the chef, a domestic, the laundress and one of the maintenance staff. Four staff employment records, supervision and training records were reviewed. The Inspector received comments from five relatives, three GPs and had questionnaires returned from five service users. Due to issues raised during the first site visit, a second site visit was made on Friday 28 April, between 4:50pm and 5:40pm. During that visit, the Inspector observed a supper mealtime, met with and observed care for eight residents. The inspector also met with two carers, one of whom was an agency carer, the registered nurse and the manager. Feedback was given to the manager on Monday 8th May 2006 between 2:05pm and 3:50pm. During this time, records relating to admissions, complaints, maintenance, fire safety and accidents were inspected. The judgements contained in this report have been made from evidence gathered during the inspection, which included visits to the service and takes into account the views and experiences of people using the service. 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 expressed their appreciation of the service provided. One resident described the home as “fine”, another said “It’s very good compared to some homes I’ve been in” and another said “I’m happy here”. Residents also said how much they liked the staff, one said that staff were “very helpful”, another described how if they rang their bell in the night that staff made sure they were comfortable before they left, another said “I get on well with them”. One visitor said “I’m so glad …. is here”, another said “you can talk to anybody, Sutton Veny House Nursing Home DS0000043651.V290200.R01.S.doc Version 5.1 Page 6 everybody is approachable and helpful”, one relative said “Sutton Veny Nursing Home is a very nice place to be.” What has improved since the last inspection? What they could do better: Nine requirements and seven good practice recommendations were identified during this inspection. The service users’ guide must include a copy of the most recent inspection report summary, to inform prospective residents of the home’s response to inspection. All pre-admission assessments completed by the home must be dated and signed by the person completing the assessment, to provide evidence that the assessment has been performed by an appropriate professional. Where residents have nursing or care needs which are known to staff, these must always be fully documented in the service user’s care plan, to ensure that the resident receives the care that they need. All turn charts, food charts and other records relating to provision of frequent care must be completed in full, to ensure that residents’ basic care needs have been met. All records of medicines’ administration must always be fully documented on the medicines administration record. All agency staff must be advised that residents must be addressed by their own preferred name and that doors to wcs must never be left open when being used by a resident. The flooring in one en-suite room must not present a risk of tripping to residents or staff. The call bell system must have an emergency system provided, to ensure that residents with unstable medical conditions can be attended to quickly. There must be enough bleeps provided so that all nurses and cares are able to carry one when on duty, to ensure that call bells are answered promptly. If residents show bruising, an accident form must be completed on every occasion. Sutton Veny House Nursing Home DS0000043651.V290200.R01.S.doc Version 5.1 Page 7 Liquid paper should not be used when correcting service users’ records. Precise, measurable terminology should always be used when documenting care provided, the use of words such as “regularly” or “checked” should be avoided, as they do not direct actions or document care provided. Care plans for residents with wounds should include reference to how they plan to meet the residents’ increased needs for protein, vitamin C and trace minerals, as is advised by current research-based evidence. The home should continue to develop end of life care plans for frail and dying residents. Bed pans and commode buckets should be reviewed and any stained items disposed of and replaced. Reports of the regular visits to the home by a senior manager should include reports on the number and types of wounds in the home. 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.V290200.R01.S.doc Version 5.1 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.V290200.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3: The home does not admit residents for intermediate care. Prospective residents are given some, but not all the information they need to make an informed choice about where to live. Prospective residents are protected by full admission assessments, however the home cannot demonstrate that these assessments have been performed by an appropriately qualified person. Quality in this outcome area is judged to be good. This judgement has been made using available evidence, including visits to the service. EVIDENCE: There was evidence that all prospective residents are provided with a copy of the service users’ guide on admission. The guide does not include a copy of the summary of the most recent inspection report, to advise on the home’s response to inspection. One person who had been admitted to the home since the previous inspection had had a clear and detailed assessment of their needs completed. A detailed assessment had also been completed after their admission and this documented matters which had not been known about at the initial Sutton Veny House Nursing Home DS0000043651.V290200.R01.S.doc Version 5.1 Page 10 assessment. The initial assessment had not been dated or signed, so the home cannot demonstrate that this persons’ needs had been assessed by an appropriate person. Liquid paper had been used to correct one part of the admissions assessment and it is advisable that the use of liquid paper is avoided. The home does not confirm in writing to residents admitted for respite care that they can meet their needs. This should take place, as well as for long-term residents, when a respite care contract is commenced. Sutton Veny House Nursing Home DS0000043651.V290200.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Care plans are in place to support residents, however residents could be at risk by not all matters relating to their nursing and care being planned for. The home cannot show that frail residents have their positions changed as often as they need and that all residents who need support are given their meals. There are safe systems for administration of medicines, but documentation needs to be improved, to demonstrate that all residents have been given all their medication. Residents are treated with respect by the home’s staff, but this is not the case for all agency staff. Service users who are dying are supported by the home. Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence, including visits to the service. EVIDENCE: Sutton Veny cares for a range of residents, some of whom have highly complex nursing and care needs. Residents, their relatives and GPs all commented favourably on the service provided by the home. All residents had assessments of their nursing and care needs. All of the residents had care plans in place. Where a resident was assessed as being at Sutton Veny House Nursing Home DS0000043651.V290200.R01.S.doc Version 5.1 Page 12 risk, for example of pressure damage or of a poor dietary intake, care plans were in place to direct staff on how risk was to be reduced. Not all care plans included all of a resident’s needs. One resident had certain behaviours which two members of staff reported led to bruising. This person was observed to have bruising at the time of the site visit, this had not been included in their behaviour care plan. One resident’s daily record showed evidence of a sore hip, their care plan had not been up-dated the reflect this. Another resident had a dressing or protective bandage on their foot, but there was no evidence in their notes as to why this was. Generally most records relating to wounds were clear, however one resident who had a long-term chronic wound had instructions that it was to be measured “regularly” in their care plan but there were no records that it had been measured since early February. Care plans for the three people with wounds did not detail about their needs for additional protein, Vitamin C and trace minerals, as is recommended. All of the residents considered in detail had charts in place to monitor how often their position was changed and two of them had charts to record their dietary intake. None of the charts has been completed in full for the four days before the first site visit. This is of concern, as all of these residents were assessed as having risk of pressure damage and two of them as being at dietary risk. The home therefore cannot evidence that these residents are receiving the care that they need. Additionally, some staff are not documenting the actual care given, using words such as “checked”, not stating what care was provided. A similar observation was made during the second site visit on 28/5/06, where charts were observed not to be completed in full, particularly during the evenings, where one service user who was assessed as having a high risk of pressure damage had not had their position changed between 18:00 and 01:00 on one day and another with a similar assessment did not have records to show that they had been moved between 18:35 and 14:45 on the next day. One resident who needed support to eat their meals had no record of lunch on one day and no records of breakfast on another day. Another resident with similar needs had no supper recorded on another day. One relative responded to the Commission that they had observed that their relative had not had a drink with one of their meals, as the agency carer had not assisted them as needed. Medicines are stored in locked cupboards and trolleys. On the first visit, two records of medicines administration had not been completed. One unclear record was queried during the visit and followed up by the registered nurse. One resident was prescribed an invasive treatment, when required, their daily records noted that it had been administered, but a record had to been made in their medicines administration record. On the second visit, on one of the floors of the home, seven medicines administration records has not been completed. A review of staff rosters indicated that such omissions were likely to relate to agency registered nurses. It was noted as good practice that the home has drawn up care plans relating to administration of drugs to resident, which can affect activities of daily living, so that their use can be monitored and medical Sutton Veny House Nursing Home DS0000043651.V290200.R01.S.doc Version 5.1 Page 13 staff informed. There was a full audit of drugs received into and disposed of from the home. In the morning, of the first visit, staff were observed to respect residents’ dignity and need for privacy. Staff at all levels, including domestic staff, were observed to call residents by their own preferred names. The laundress had clear systems in place to ensure that residents’ own clothes were returned to them. In the afternoon, two of the staff were agency and they, in contrast to the morning staff, were observed to call residents by generic terms of endearment, such as “darling”, not their own name. One agency carer was observed to assist a resident to the wc and not shut the door until after the resident was seated on the wc. Residents who were dying were cared for in their own rooms, with a range of their own possessions around them. They looked comfortable, with clean fingernails, hair and mouths. The home has started drawing up end of life care plans and the deputy manager reported that she had attended a training session on care of the dying the day before the first site visit. Records showed that the home regularly communicated with residents’ relatives about their condition. Sutton Veny House Nursing Home DS0000043651.V290200.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Residents are supported by a range of activities. Family and friends are encouraged to visit. Residents felt able to choose how they spent their days. Residents are offered a balanced diet and are generally supported in taking their meals. Quality in this outcome area is judged to be good. This judgement has been made using available evidence, including visits to the service. EVIDENCE: As activities session was well attended. It was led by the activities coordinator, who was assisted by a volunteer. The activities coordinator supported residents, encouraging them in participating on what was going on. All residents had care plans relating to their social care needs in place. Records reflected what the residents told the Inspector about. The activities coordinator had a system for individually visiting residents who are unable to leave their rooms. Residents spoken with were confident that they could spend their days as they wished. This included when they chose to get up in the morning and go to bed at night. One said that they sometimes ate in the drawing room and sometimes in their own room, it was up to them. One resident responded in their questionnaire that they could choose whether they attended activities or Sutton Veny House Nursing Home DS0000043651.V290200.R01.S.doc Version 5.1 Page 15 not. Visitors and relatives spoken with said they could visit when they wished. All residents have a communication book in their room, these are used by key workers and relatives to pass on messages and requests to each other. All the books had been regularly used. One relative said that they found these books “very good” for passing on comments and queries. Residents who are able, are supported in going out of the home. The local mobile library was visiting the home on the morning of the first site visit. The chef was enthusiastic about their role and showed a detailed knowledge of the importance of a good diet for resident. A choice is offered at all meals, this includes a choice of drinks. All residents are given their own copy of the menu. The home does not have a dining room and residents eat at tables in the sitting room, this is not ideal and the Commission are aware that planning permission is being sought so that the home can be developed, to provide a dining room. Many of the residents are frail and need support from staff to eat their meals and to drink. One relative commented that not all agency staff were aware of their relative’s specific needs and being assisted to eat and that they had observed their needs not being met on one occasion. Residents commented favourably on the meals. Three said that the meals were “very good”, one said that if they felt like something lighter, the kitchen would make it for you. A supper mealtime was observed during the second visit and it was observed to take place in a calm, unrushed manner. Residents were supported in taking meals by staff when needed. Many of the resident had chosen lighter snacks such as fresh sandwiches or cheese on toast, which they could feed to themselves. Sutton Veny House Nursing Home DS0000043651.V290200.R01.S.doc Version 5.1 Page 16 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 & 18 Residents and their relatives are supported by the complaints process, which works in process. Systems are in place to protect residents from abuse. Quality in this outcome area is judged to be good. This judgement has been made using available evidence, including visits to the service. EVIDENCE: The home’s complaints procedure was on display. Residents spoken with knew how to bring up patters of concern. One said “I tell the carers if there’s something wrong”, another said that they felt able to complain to anyone if they needed to. All five returned questionnaires indicated that the resident knew who to speak to if they were unhappy or needed to make a complaint. One relative said that they always brought matters up with the manager or her deputy and how supportive and helpful they were when they did. The complaints log was reviewed, this showed that the home were complying with its own polices and procedures. Care staff spoken with knew how to pass on concerns made by residents. Staff showed an awareness of vulnerable adults procedures. All of the staff spoken with reported on a recent abuse awareness training session, this included ancillary as well as care staff. Staff are all given a copy of the local vulnerable adults procedure. Sutton Veny House Nursing Home DS0000043651.V290200.R01.S.doc Version 5.1 Page 17 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 presents a safe, well-maintained environment which meets residents’ needs. Effective systems are in place to ensure prevention of risk of spread of infection. Most equipment to support residents is available, however residents are at risk from a call bell system, which does not ensure that residents, particularly those with unstable medical conditions, can be promptly attended to. Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence, including visits to the service. EVIDENCE: Sutton Veny presented as being well maintained and clean throughout. One resident commented in their questionnaire specifically on the high standard of cleanliness in the home. There is one large sitting room. The home benefits from extensive well-maintained grounds. As Sutton Veny is an older building, all rooms are different form each other and many much exceed national minimum standards. Most en-suite rooms are shared between two, with a locking system, to ensure privacy. The owners are aware that some areas of Sutton Veny House Nursing Home DS0000043651.V290200.R01.S.doc Version 5.1 Page 18 the home, particularly communal space, including provision of a dining room and unshared en-suite rooms, need development and are currently seeking planning permission so that they can improve facilities. One en-suite room showed a large amount of bubbles under the flooring and could present a risk of tripping injury to residents and staff. The laundress was aware of their role and reported that they had all the equipment needed. They reported that staff complied with the home’s policy and procedures about the separation of different categories of laundry. The laundry area is well maintained. A domestic was observed to be very careful in their role, vacuuming under moveable objects as well as on top. They responded promptly when asked by staff to attend to an individual area which needed urgent cleaning. One of the maintenance staff showed a detailed knowledge of safe disposal of clinical waste. There is one washer disinfector in the home, which staff clearly used. Some of the bed pans stored in sluice rooms were old and beginning to show signs of in-grained staining. Plastic gloves and aprons were available in all relevant areas for staff. Both registered nurses reported that they used full aseptic procedure for complex wound dressings. Staff spoken with showed a good knowledge of infection control practice. Equipment such as hoists to aid manual handling and pressure-relieving mattresses and cushions are provided. All residents with complex manual handling needs are nursed in variable height beds. One resident described their bed as “very comfortable”. Staff were observed to properly use moveable ramps in one part of the home, which does not have level floor access. The home has a call bell system, which sounds on a bleep. There were not enough bleeps for all staff to carry one. This meant, for example that when one resident became unwell and needed urgent attention, the carer who attended had to go and seek a second carer who was working in the area, as they did not have a bleep and so were not aware that the resident needed attention. This made the resident’s situation more uncomfortable and delayed them receiving the attention that they needed. One relative commented in their questionnaire that sometimes their relative was left too long when they used the call bell. The registered nurse does not carry a bleep, as there are not enough, so they carry the home’s phone and care staff have to phone them for urgent assistance. If the registered nurse is already speaking on the phone, this method of communication is not possible. Additionally, the current system does not have an emergency call facility. This is of concern as several residents in the home have unstable medical conditions and may need urgent attention at any time. Sutton Veny House Nursing Home DS0000043651.V290200.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Residents are protected by the numbers of staff on duty, however the high numbers of agency staff means that other standards within this report have not been met. Staff are supported by the training offered in the home. There are safe systems for the recruitment of staff. Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence, including visits to the service. EVIDENCE: The home’s roster showed that it had had agency staff on duty for the majority of shifts each day for the two weeks before 20/4/06. It was reported that as much as possible, the same agency staff return to the home. Some staff, residents and relatives reported that when agency staff were on duty, that they could not know all of the residents’ specific needs and so they were concerned that individual needs were not being met or they had to supervise staff more closely. This meant that the workload generally was increased, as not all staff were performing at the level needed to meet residents’ needs. Issues identified in Standards 7, 8, 9, 10 & 10 were reported to relate to agency staff. One agency carer said that they liked working in the home and asked to return when they could, as it was an enjoyable home to work in. The use of agency staff was reported to relate to the current holiday period, staff sickness and that some staff had left their employment recently. This was through normal natural wastage. It was reported that new staff were being recruited. Sutton Veny House Nursing Home DS0000043651.V290200.R01.S.doc Version 5.1 Page 20 Staff at all levels reported that training was encouraged and supported. Training records are completed in detail and show the supports given to staff. One domestic reported that they had achieved an NVQ in cleaning. A carer reported that the home were supporting her in working towards NVQ 3. The new administrator is starting to manage staff records. She only commenced her role in April and is gradually organising the administrative function in the home. Staff files are now maintained in the home as well as in the provider’s central office. Of the files of four members of staff reviewed, all contained all required information, including CRB and pova checks, proof of identity and cvs. Sutton Veny House Nursing Home DS0000043651.V290200.R01.S.doc Version 5.1 Page 21 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, 32, 33, 35, 36 & 38 Sutton Veny is run by an experienced manager and registered nurse who has developed and improved the home while she has been in post. There are systems in place to review quality of care. Residents’ financial interests are protected. Staff are supervised. There are systems in place to ensure health and safety of residents and staff. Quality in this outcome area is judged to be good. This judgement has been made using available evidence, including visits to the service. EVIDENCE: The manager is experienced. There was evidence that she regularly updates both her management and nursing skills across a range of areas. She holds regular meetings for staff and residents, these are minuted. Staff were observed to perform safe manual handling during the site visits. Staff at all levels were aware of the importance of infection control. The Sutton Veny House Nursing Home DS0000043651.V290200.R01.S.doc Version 5.1 Page 22 maintenance staff spoken with showed a detailed knowledge of the importance of health and safety. They reported that the maintenance team had all the equipment that they needed and that it was regularly services. Records showed that there is an effective system for maintenance of the home, including fire safety. One resident was observed to have sustained a large bruise, a record had been made in their daily record, however an accident form had not been completed and this is indicated when bruising, particularly unexplained bruising is identified. All other accident records were clear and completed in full. There are systems in place to review the quality of the service. The home is visited by senior managers on a monthly basis. These visits do not document clinical issues, such as incidences of wounds and as three of the residents considered in detail had wounds and there was a list of other residents with wounds in the nurses’ station, this is a clinical indicator which should be regularly reviewed by the managers. The home does not look after residents’ moneys. All items, such as hairdressing are charged on a monthly basis. An account is then sent to the person responsible for paying bills on behalf of the resident. The home has a safe system for storing any residents’ valuables and records are maintained. The home has a clear system for staff supervision. Records are individualised and relate to provision of care, with action points detailed where relevant. New staff receive a full induction. One new member of staff reported that their induction had related to their individual needs. The deputy manager reported that the home has a flexible approach to new staff working supernumerary when they commence employment, according to each new employee’s previous experience. Sutton Veny House Nursing Home DS0000043651.V290200.R01.S.doc Version 5.1 Page 23 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 x 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 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 2 3 3 2 3 3 X 3 STAFFING Standard No Score 27 2 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 2 Sutton Veny House Nursing Home DS0000043651.V290200.R01.S.doc Version 5.1 Page 24 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. 2. Standard OP1 OP3 Regulation 5(1)(d) 14(1)(a) Requirement The service users’ guide must include a copy of the most recent inspection report summary. All pre-admission assessments completed by the home must be dated and signed by the person completing the assessment. All nursing and care needs must be fully documented in the service user’s care plan. All turn charts, food charts and other records relating to provision of frequent care must be completed in full, to show that frail service users’ care needs have been met. All records of medicines’ administration must always be fully documented on the medicines administration record. All agency staff must be advised that service users must be addressed in their own preferred name and that doors to wcs must never be left open when being used by a service user. The flooring in one en-suite room must not present a risk of tripping to service users or staff. DS0000043651.V290200.R01.S.doc Timescale for action 31/07/06 31/05/06 3. 4. OP7 OP8 15(1)(2) (b)(c) 17(1)(a) Sc3(3)(k) 31/07/06 31/07/06 5. OP9 17(1)(a) Sc3(3)(i) 12(4)(a) 31/05/06 6. OP10 31/05/06 7. OP19 13(4)(a) (c) 31/08/06 Sutton Veny House Nursing Home Version 5.1 Page 25 8. OP22 13(4)(b) (c) 9. OP37 17(1)(a) Sc(3)(j) The call bell system must have an emergency alarm facility and there must be enough bleeps so that all nurses and carers are able to carry one when on duty. Where a service user sustains bruising, an accident record must always be completed. 30/10/06 31/05/06 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. 2. 3. 4. 5. Refer to Standard OP3 OP37 OP7 OP8 OP11 Good Practice Recommendations The registered manager should confirm in writing to respite care service users that they can meet their needs, prior to admission. Liquid paper should not be used when correcting service users’ records. Precise, measurable terminology should always be used when documenting care provided. The use of wording such as “regularly” or “checked” should be avoided. Care plans for service users with wounds should include reference to how they plan to meet the service user’s increased needs for protein, vitamin C and trace minerals. 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. (This is in progress from the inspection of 19/12/05) Bed pans and commode buckets should be reviewed and any stained items disposed of and replaced. Reports of the regular visits to the home by a senior manager should include reports on the number and types of wounds in the home. 6. 7. OP26 OP33 Sutton Veny House Nursing Home DS0000043651.V290200.R01.S.doc Version 5.1 Page 26 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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