CARE HOMES FOR OLDER PEOPLE
The Andover Nursing Home Weyhill Road Andover Hampshire SP10 3AN Lead Inspector
Pat Griffiths Unnannounced 04.07.05 10:00 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 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. The Andover Nursing Home H54 S12147 The Andover V235258 040705.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Andover Nursing Home Address Weyhill Road Andover Hampshire SP10 3AN 01264 333324 01264 332063 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr P J Puddepha Mr B J Puddepha Mr Martin Watt Care Home 79 Category(ies) of Dementia, over 65 - DE(E) - 41 registration, with number Old Age - OP - 49 of places Physical Disability - PD - 15 Physical Disability, over 65 - PD(E) - 15 The Andover Nursing Home H54 S12147 The Andover V235258 040705.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. a maximum of 49 service users may be accommodated in the OP category. 2. A maximum of 41 service users may be accommodated in the DE(E) category. 3. A total of 15 service users may be accommodated in the PD and PD(E) categories. Date of last inspection 14.02.05 Brief Description of the Service: The Andover Nursing Home is a privately owned, purpose-built care home for service users over the age of 65. The home is registered to provide personal and nursing care care to older persons, older persons who are physically disabled and older persons who have dementia. Conditions of registration also allow for 15 service users below the age of 65 with physical disabilities to be resident at any one time. The home provides accommodation for 79 residents over four floors. There are 55 single bedrooms and 12 double rooms, all with en-suite facilities. The home is divided into two units. Unit one is on the lower ground and ground floors and provides care for elderly residents. Unit two is on the first and second floors, providing care for residents with dementia. Each unit has sitting and dining areas and there is a large lounge off the front entrance. The home is in a residential area of Andover, on a main road and close to local amenities. The home has a large garden to the rear and a small seating area at the front; there is a car park at the front of the home. The Andover Nursing Home H54 S12147 The Andover V235258 040705.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first of the two statutory unannounced inspections for the inspection year 2005/06. The key standards will be inspected over the course of the two inspection visits. The standards covering the requirements made during the last inspection were also inspected on this visit. The inspection took place over one day and the inspector was able to tour the home, seeing some of the bedrooms and the communal areas. The inspector looked at a sample of staff files and residents care plans and read some policies and procedures. What the service does well: What has improved since the last inspection?
Training in supervision skills has been undertaken by the registered nurses to ensure that supervision sessions for the care staff can begin later this year. Annual Appraisals have been undertaken. The Andover Nursing Home H54 S12147 The Andover V235258 040705.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Andover Nursing Home H54 S12147 The Andover V235258 040705.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Andover Nursing Home H54 S12147 The Andover V235258 040705.doc Version 1.40 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 standard(s) 3 Standard 6 does not apply to this service Arrangements for assessing prospective residents ensure that their individual care needs can be met in the home. EVIDENCE: The pre-admission assessment forms were found to contain the relevant information needed, such as physical and care needs, to write individual and personal care plans for the residents. The inspector looked at several personal care files on units 1 and 2 and found that pre-admission forms had been completed in all but one file. The home does not provide intermediate care.
The Andover Nursing Home H54 S12147 The Andover V235258 040705.doc Version 1.40 Page 9 The Andover Nursing Home H54 S12147 The Andover V235258 040705.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, and 9 Arrangements are in place to ensure that the healthcare needs of the residents are met. The arrangements are in place for dealing with medication and ensure that the residents are protected. EVIDENCE: The inspector read several care plans and it was seen that the residents, as the service users prefer to be addressed, have their health, personal and social care needs identified in their care plans. The residents are involved, if they wish, in their care plans and relatives often help those unable to express their wishes. The appropriate healthcare professionals, such as the chiropodist, physiotherapist and GP (General Practitioner) visit the home to ensure that healthcare needs are met. The recommendation from the last inspection has been met by the home purchasing more medicine pots, so that there are sufficient pots for each to be used only once at each medicine round. None of the residents have chosen to be responsible for their own medication. Comment cards were returned to the commission, twenty one were from
The Andover Nursing Home H54 S12147 The Andover V235258 040705.doc Version 1.40 Page 11 residents and four from relatives and visitors, providing several comments about the care received in the home, “happy with life here, but do not think the level of care is good enough considering the huge fees…. there are not enough staff to enable them to provide the best level of care”. “Staff have been helpful, but there are fewer available at weekends and bank holidays”. Several residents felt that they were well cared for ‘sometimes’; also “if there were more staff we would not be hustled and bustled as the staff seem to be in a rush”. One commented that there was a lack of privacy in the shared bedrooms. The Andover Nursing Home H54 S12147 The Andover V235258 040705.doc Version 1.40 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 14 and 15 The arrangements that are in place have not enabled all residents to make reasonable choices or control their lives. The menus indicate that a choice of meals is available. EVIDENCE: Residents have indicated that they would like more choice in their daily lives; they and their relatives have commented that the variable staffing levels and skill mix has a detrimental effect on the level of care provided. One resident commented that they would like a cup of tea more often and another would prefer to get up earlier in the morning, not just before lunch. The inspector met some residents who had communication problems associated with their health, who were not always able to indicate their preferences about any aspect of their daily life. Residents that spoke with the inspector said that there were choices available at each mealtime and that they enjoyed most of the meals. They confirmed that they could choose to take their meals in their rooms or in the dining room. Kitchen staff confirmed that they were aware of the residents likes and dislikes and that menu choices offered several options every day to reflect this. The Andover Nursing Home H54 S12147 The Andover V235258 040705.doc Version 1.40 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 standard(s) 18 Arrangements have been made by the home to protect the residents by providing a Vulnerable Adults Protection Policy. Arrangements must be made for the training of staff in adult protection. EVIDENCE: The home has a Vulnerable Adults Protection Policy. Staff that spoke with the inspector indicated a mixed awareness and knowledge of the policy and how to recognise abuse. Not all staff had received appropriate training on adult abuse and protection, but the manager advised that this will take place after the summer holidays. The Andover Nursing Home H54 S12147 The Andover V235258 040705.doc Version 1.40 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 standard(s) 19, 21, 25 and 26 The arrangements in place to ensure a safe environment are failing the residents. The home has sufficient lavatories and washing facilities but not all of them are available for use. The home is reasonably clean. EVIDENCE: The home is large with many communal areas and residents are free to wander in the home and the grounds. The front door is not locked during the day, but there are usually staff available in this area during office hours. The home recently reported to the Commission that a resident had wandered out into the road before breakfast and fallen over, requiring attention from the paramedics who were called by a passing car driver who saw the incident. The manager stated that the doors on the unit for residents with dementia are being made more secure. A requirement has been made for all entrances and exits to the home to made
The Andover Nursing Home H54 S12147 The Andover V235258 040705.doc Version 1.40 Page 15 secure, for the protection of all residents and staff, but especially the more vulnerable residents. The home is reasonably clean but with some corridor areas have grubby, foodstained carpets. The stair carpets were also dusty and grubby. The manager advised the inspector that new carpets have been ordered and will be fitted soon in some corridors and lounges and one of the bedrooms. Some areas are awaiting redecoration as the paper borders above the dado rails have been removed; the manager advised that the walls would be painted soon. It was noted during the last inspection that some lavatories were being used as storage areas for broken and unused equipment and furniture. During a tour of the home the inspector noted that the situation is unchanged. The manager advised that the situation was under review and the signs on the lavatory doors would be changed to indicate the different use of the rooms. The inspector was advised that equipment that is stored in bathrooms, such as hoists, commodes and linen trolleys, is removed before the room is used for bathing. Several bathrooms have had a small picture put on the wall, but curtains have not been fitted. During the tour of the home the inspector also noted that some wall tiles in two of the bathrooms in unit 2 are cracked and loose, coming away from the wall in the inspectors hand. The Andover Nursing Home H54 S12147 The Andover V235258 040705.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29 Arrangements for staff recruitment that are currently being used do not protect the residents. EVIDENCE: The home has had recruitment problems, but the manager assured the inspector that this was no longer a problem. The inspector looked at several staff files, one for a recent applicant did not contain written references; the verbal references that were obtained did not indicate that they were obtained verbally. New staff are starting work before their CRB (Criminal Records Bureau) clearances are received. The manager told the inspector that they are working under supervision and that he has had POVAfirst checks made. (Protection of Vulnerable Adults) The inspector and the manager discussed the use of POVAfirst checks, which are in place for occasional use to cover unexpected shortfalls in staffing numbers. The Andover Nursing Home H54 S12147 The Andover V235258 040705.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 Arrangements for staff supervision have been made and staff and residents will benefit when staff receive regular supervision seasons. EVIDENCE: The manager advised the inspector that supervision sessions had not started yet, but it was planned that they would soon. Annual appraisals have been completed. One of the registered nurses talked to the inspector about the training she had undertaken in supervisory skills and that she had shared this training with the other nursing staff. Each nurse will supervise five care staff, doing group and individual supervision and annual appraisals. The files for this are in a locked cabinet that is accessible only to the supervisory staff; the inspector did not see the records. Matron and his deputy will undertake supervision for the nursing staff. The Andover Nursing Home H54 S12147 The Andover V235258 040705.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 3
COMPLAINTS AND PROTECTION 2 x 2 3 x x 2 3 STAFFING Standard No Score 27 x 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x x x x 2 x x The Andover Nursing Home H54 S12147 The Andover V235258 040705.doc Version 1.40 Page 19 yes Are there any outstanding requirements from the last inspection? 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 18 Regulation 13(6) Requirement The registered person must ensure that all staff receive documented training in the Protection of Vulnerable Adults The registered person must ensure that all entrances and exits to Unit Two are made secure The registered person must ensure that the home has suitable storage space to ensure that equipment is not stored in an unsuitable place like the lavatories or bathrooms This requirement remains outstanding from 14/02/05 The registered person must ensure that the bathroom tiles in two of the bathrooms in Unit 2 are repaired and the bathrooms made safe The registered person must ensure that staff files contain two written references This requirement remains outstanding from 14/02/05. The registered person must ensure that care staff receive supervision sessions at least six Timescale for action 31/10/05 2. 19 23(2)(a) 31/10/05 3. 21 23(2)(l) 31/10/05 4. 25 23(2)(b) 31/10/05 5. 29 19(1)(b) & (c) 31/10/05 6. 36 18(2) 31/1/0/05 The Andover Nursing Home H54 S12147 The Andover V235258 040705.doc Version 1.40 Page 20 times a year. This requirement remains outstanding from 14/02/05. 7. 8. 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 22 Good Practice Recommendations It was a recommendation of the last inspection that the bathrooms be made more homely This recommendation remains outstanding from 14/02/05 The Andover Nursing Home H54 S12147 The Andover V235258 040705.doc Version 1.40 Page 21 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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