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Inspection on 27/01/06 for The Close Nursing & Residential Home

Also see our care home review for The Close Nursing & Residential Home for more information

This inspection was carried out on 27th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is welcoming, despite its large size and the disruption caused by the current building work on site, and staff are friendly and caring. The grounds and gardens are well maintained and attractive. The standard of cleanliness and upkeep is good, so that residents have a pleasant and comfortable environment to live in.

What has improved since the last inspection?

The home has appointed a new deputy manager so the manager now has the support of another senior staff member to help in the management and leadership. The new laundry, kitchen, staff and administrative office facilities and the residents` accommodation in single en-suite rooms, sitting/dining rooms and assisted bathrooms, provided in the completed first phase of the redevelopment of the home, are great improvements. The new car park at the rear of the home has replaced the gravelled and uneven surface and improved the access to the home. Signs have been put up that give clear directions for visitors to the home and the temporary entrance whilst the second phase of the building is underway.Fencing of the building site from the home premises has improved the safety and security for residents and visitors. A secondary electricity generator is no longer needed now that the mains electricity supplier has completed work, and the generator has been removed from the car park area.

CARE HOMES FOR OLDER PEOPLE The Close Nursing & Residential Home Burcot Abingdon Oxfordshire OX14 3DP Lead Inspector Delia Styles Unannounced Inspection 27th January 2006 11:40 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 The Close Nursing & Residential Home DS0000027175.V279327.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. The Close Nursing & Residential Home DS0000027175.V279327.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Close Nursing & Residential Home Address Burcot Abingdon Oxfordshire OX14 3DP 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) 01865 407343 01865 407734 closenhome@aol.com Cavendish Close Limited Mrs Nyembezi Chipara Care Home 65 Category(ies) of Dementia - over 65 years of age (7), Old age, registration, with number not falling within any other category (65) of places The Close Nursing & Residential Home DS0000027175.V279327.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Maximum of 52 persons with nursing needs. The total number of persons accommodated must not exceed 65. Date of last inspection 8th September 2005 Brief Description of the Service: The Close was originally a Tudor-style Victorian country house with two single storey wings, situated close to the market town of Abingdon and approximately 6 miles south of the city of Oxford. The home is set in 4 acres of grounds with access to the banks of the river Thames. In the past 12 months, an extensive new building project has started to replace outdated and unsuitable facilities. The first phase of this project was completed in August 2005 and comprises a purpose-built two-storey building, with 19 en-suite bedrooms, offices, and new kitchen and laundry facilities serving the whole site. The second phase of the project is underway, and involved the demolition of the original 2-storey house. The current registration for the home is for a reduced total occupancy of 65 beds, 52 of which may be for nursing care. The Close Nursing & Residential Home DS0000027175.V279327.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection (the home was not aware in advance that an inspection was going to be done) and lasted for four and a half hours. The inspection focussed on the ‘key’ standards not looked at during the announced inspection of the home in September 2005 and reviewed those standards where recommendations were made last year. ‘Key’ standards are those that the Commission considers should be inspected at least once every 12 months. A partial tour of the home was done and a sample of residents’ care records, medication administration records and the updated home Statement of Purpose were read. The inspector spoke with 6 residents and 5 visitors, several nurses, care and support staff. The home proprietor, Mr Halton, and registered manager, Ms Chipara-Sithole were available during the inspection. Feedback was given to Ms Chipara-Sithole at the end of the inspection. The inspector would like to thank residents, visitors and staff for their help during the inspection. What the service does well: What has improved since the last inspection? The home has appointed a new deputy manager so the manager now has the support of another senior staff member to help in the management and leadership. The new laundry, kitchen, staff and administrative office facilities and the residents’ accommodation in single en-suite rooms, sitting/dining rooms and assisted bathrooms, provided in the completed first phase of the redevelopment of the home, are great improvements. The new car park at the rear of the home has replaced the gravelled and uneven surface and improved the access to the home. Signs have been put up that give clear directions for visitors to the home and the temporary entrance whilst the second phase of the building is underway. The Close Nursing & Residential Home DS0000027175.V279327.R01.S.doc Version 5.1 Page 6 Fencing of the building site from the home premises has improved the safety and security for residents and visitors. A secondary electricity generator is no longer needed now that the mains electricity supplier has completed work, and the generator has been removed from the car park area. 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 Close Nursing & Residential Home DS0000027175.V279327.R01.S.doc Version 5.1 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 The Close Nursing & Residential Home DS0000027175.V279327.R01.S.doc Version 5.1 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): 1 The home’s Statement of Purpose and Service User Guide provide details of the home that enable prospective residents to be clear about the services the home will provide to meet their needs. EVIDENCE: An updated version of the home’s Statement of Purpose was available. Some further amendments are needed so that it includes all the information required under Regulation 4(1)(c) and Schedule I. For example, the number and size of rooms in the care home should be provided with the Statement of Purpose (readers are referred to a list at the back of the document, but this is missing). Also, a copy of the complaints procedure, that includes the stages and timescales for the process, should be included. The Close Nursing & Residential Home DS0000027175.V279327.R01.S.doc Version 5.1 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, & 10 The standard of record keeping has fallen slightly since the last inspection and further work is needed to make sure that care plans are updated and reviewed regularly. There is evidence that the health needs of residents are met and that residents are referred for specialist medical and nursing assessment and treatment if necessary. Staff have a good understanding of residents’ support needs and showed awareness of the need to protect residents’ privacy and dignity when offering personal care. EVIDENCE: A sample of seven residents’ care plans was looked at. All lacked information or updating about at least one aspect of the resident’s assessed care needs. For example, the schedules of nutrition and risk assessments for two residents with specific nutritional problems were not documented. The recommendation made at the last inspection about the use of a nutritional risk assessment tool advocated by the community dieticians has not yet been implemented. The social activity plans for several residents were blank – although this could in The Close Nursing & Residential Home DS0000027175.V279327.R01.S.doc Version 5.1 Page 10 part be because the activities organiser has been off sick for an extended period. However, all care staff should include residents’ social care needs in their assessment and care plans. There was no evaluation or follow-up about specific care needs or problems in the care plans of residents, for example, in relation to their wound care, pain relief, and effective management of someone’s occasionally aggressive behaviour. Individual staff members when asked about residents’ care needs were knowledgeable about them. The standard of written records should match that of the practical care so that all staff have consistent and up to date instructions to refer to, so that there is continuity of care for residents, and the home can demonstrate that the care has been given and is meeting the assessed needs of residents. There was evidence that specialist equipment needed by residents is available – for example pressure relieving equipment. Residents are referred by the GPs to specialist services for further investigation of problems where necessary. As noted at the last inspection, the new building, Riverview, has improved the facilities for residents: all residents’ rooms are single and have en-suite washbasin and toilet. However, St Michael’s wing communal sitting/dining room area has always been unsatisfactory, because it is a long narrow room: residents’ armchairs have to be arranged around the edge of the room, leaving little space in between. Staff have too little space to sit beside residents who need help at mealtimes and visitors (when seeing residents in this sitting/dining room) also encroach other residents’ space. Residents who need to be transferred in a hoist cannot be assisted by staff in a way that best protects residents’ dignity in this confined space. There are plans to refurbish St Michael’s and Paul’s wings of the ‘old’ building in September 2006. It is recommended that the seating arrangements in the communal areas are reorganised to improve residents’ immediate environment and personal ‘space’. The Close Nursing & Residential Home DS0000027175.V279327.R01.S.doc Version 5.1 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): 14 The system for consulting with residents and getting their views about the home is largely informal and residents feel able to make choices about their daily routine and the extent to which they are involved in the social life of the home. EVIDENCE: There are residents meetings every two months and minutes of the meetings are posted on notice boards throughout the home. Residents spoken with said they missed the activities organiser who had been off sick for several weeks, as they enjoy the opportunities for getting together with other residents and doing the different activities she organises. Most residents who were able to express an opinion felt that they were able to do what they wished but most are dependent on staff to help them and so sometimes have to wait for assistance, as staff are busy. The Close Nursing & Residential Home DS0000027175.V279327.R01.S.doc Version 5.1 Page 12 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 The home has a satisfactory complaints system with evidence that residents and their visitors feel that their views are listened to and acted upon. The home’s recruitment procedures, the policies and practices in place for safeguarding residents’ personal finances, and the induction and training programme about adult protection issues for staff, protect residents from abuse. EVIDENCE: The manager reported that she has not received any formal complaints. She, and other senior staff are readily available to residents and their visitors and it is evident that people felt able to talk to staff about any concerns or queries, so that they can be promptly followed up. Regular residents’ meetings are held – meetings took place in September and November – and any concerns or complaints are invited from residents and their families at these meetings. The home’s procedures for the recruitment and vetting of new staff, and the financial systems and administration to safeguard residents’ finances, were examined at the last inspection and were satisfactory. Minor recommendations made at that time have been implemented. All staff have training about how to identify and report suspected abuse of residents and have mandatory updates in adult protection issues. The Close Nursing & Residential Home DS0000027175.V279327.R01.S.doc Version 5.1 Page 13 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): Standards not assessed on this occasion. EVIDENCE: The Close Nursing & Residential Home DS0000027175.V279327.R01.S.doc Version 5.1 Page 14 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): 30 There is a programme of training in place for all staff. The home is approved as a suitable placement for overseas nurses undertaking ‘adaptation’ courses and undergraduate student nurses. EVIDENCE: There is evidence of the home’s commitment to providing training for its staff and the percentage of care staff who now have an approved national qualification is slowly increasing, though as reported at the last inspection, staff turnover means that a number of staff with NVQ training have left. The home is part of a group owned by the proprietor and benefits from having a training consultant who organises in-house training for staff. The manager said that the home employs a number of overseas nurses. One nurse had just successfully completed an ‘adaptation’ course and another was progressing well. Two more nurses are waiting to start their ‘adaptation’ and are currently employed as care assistants. The manager reported that it was very positive having staff undertake training courses and for the home to have student nurses on placement as it stimulated everyone to think about their practice and standards of care. The Close Nursing & Residential Home DS0000027175.V279327.R01.S.doc Version 5.1 Page 15 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, 36 & 38 The manager provides a good standard of leadership in the home and communicates effectively with residents, staff and relatives. The systems for resident consultation are satisfactory, with evidence that indicates that residents’ views are sought and do have an effect on how the home is run. The system of formal supervision of staff is not yet fully in place but there are plans for starting this now that the manager has a deputy. There is evidence that additional safeguards are in place for the safety and welfare of residents, staff and visitors during the building project work. The Close Nursing & Residential Home DS0000027175.V279327.R01.S.doc Version 5.1 Page 16 EVIDENCE: Ms Chipara-Sithole completed an application process with the CSCI to become the registered manager of The Close in November 2004. She had been the deputy and then acting manager of this home since July 2003. She has qualifications in higher education (nursing) and a BA degree in Health Service Management. Prior to her appointment to The Close, she worked for other independent care homes in senior or managerial positions since 1998. She is undertaking the Registered Manager’s Award and hopes to complete the course this year. As stated elsewhere in this report, there are regular residents meetings and the proprietor intends to use questionnaires to get feedback from residents and visitors about the services provided in the home. The manager said that, now she has the additional assistance of a deputy, the programme of formal supervision meetings with all care staff will start in January 2006 and that these will be held at the recommended frequency so that all staff have regular formal supervision meetings at least 6 times a year. ‘Supervision’ is important because it gives the opportunity for all care staff to have a ‘one to one’ meeting with their mentor/manager and to discuss any training needs they may have and their progress in their job. Improvements recommended at the last inspection had been made: namely, improving the signposting for visitors directing them from the car park to the temporary entrance to the home; warning signs for the raised manhole covers along the drive; and better separation and security fencing separating the new building site from residents’ accommodation and access pathways. There were some freestanding additional electric heaters in the large lounge; residents had felt cold in this room since the demolition of St Peter’s wing. Risk assessments should be taken to ensure that residents are protected from contact with unguarded heater surfaces that may exceed the maximum ‘safe’ temperature of close to 43ºC and from trip hazards where heaters have trailing wires. The Close Nursing & Residential Home DS0000027175.V279327.R01.S.doc Version 5.1 Page 17 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 2 X 3 The Close Nursing & Residential Home DS0000027175.V279327.R01.S.doc Version 5.1 Page 18 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The Statement of Purpose and Service Users Guide documents should be reviewed and updated to contain the schedule of rooms and room sizes and a copy of the complaints procedure (including the timescales for investigation and responses to complaints). * Maintain and further improve the standard of record keeping in residents care planning with more detail about wound care, and evaluation of care. * Consider implementing the M.U.S.T nutritional assessment tool. * Develop the assessment and care plans in relation to residents social and recreational needs. Improve the layout of seating in the communal lounge areas allowing more space for residents receiving visitors, and carers assisting residents, to improve residents’ privacy and dignity in communal areas in the older part of the home. DS0000027175.V279327.R01.S.doc Version 5.1 Page 19 2. OP7 3. OP10 The Close Nursing & Residential Home 4. 5. OP36 OP38 Implement the programme of regular formal staff supervision and maintain records. Undertake a risk assessment for the temporary use of free-standing room heaters and take action to protect residents and visitors from accidental burns from unguarded heater surfaces and trip hazards from trailing flexes. The Close Nursing & Residential Home DS0000027175.V279327.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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. Extracts may not be used or reproduced without the express permission of CSCI The Close Nursing & Residential Home DS0000027175.V279327.R01.S.doc Version 5.1 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!