Inspection on 05/10/05 for The Downs Care Centre

This inspection was carried out on 5th October 2005.

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.

Other inspections for this house

The Downs Care Centre 20/11/08

The Downs Care Centre 28/05/08

The Downs Care Centre 23/08/06

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE The Downs Christian Nursing Home Laburnum Avenue Hove East Sussex BN3 7JW Lead Inspector Liz Daniels Unannounced Inspection 5th October 2005 13.00 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 The Downs Christian Nursing Home DS0000065252.V250772.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Downs Christian Nursing Home DS0000065252.V250772.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Downs Christian Nursing Home Address Laburnum Avenue Hove East Sussex BN3 7JW 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) 01273 746611 Trinity Care (Hove) Limited Vacant Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places The Downs Christian Nursing Home DS0000065252.V250772.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is twenty-five (25) Service users must be older people aged sixty-five (65) years or over on admission Service users requiring nursing care only to be accommodated Date of last inspection 2nd June 2005 Brief Description of the Service: The Down’s Christian Nursing Home is situated in a residential area of Hove. The entrance is shared with the South Downs Health Trust, which provides an inpatient facility in a separate area of the building. The Home, which was purpose built in 1999, is set out over two floors and a passenger lift enables access to each floor. Nursing and personal care is provided in single room accommodation for up to twenty-five residents. All rooms have en-suite facilities and there is a lounge and dining room on each of the two floors. All areas are accessible for those with limited mobility. Well-maintained gardens surround the building and the relatives’ room and garden room provide additional relaxation areas for residents and their visitors. There is a large parking area to the front and side of the building. The Downs Christian Nursing Home DS0000065252.V250772.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a period of six hours beginning at 1pm. The Inspector met with the Manager and three other members of staff. Although a full tour was not undertaken on this occasion, the Inspector met with residents and a relative in their bedrooms and enjoyed entertainment organised for the residents in one of the lounge areas. A range of documentation and key records was then inspected. This report should be read in conjunction with the report from the last Inspection on 2nd June 2005. What the service does well: What has improved since the last inspection? What they could do better: The Service User guide and the complaints policy within it must be updated to include the contact details for the Commission. The system currently in place for the disposal of medication is open to the risk of medication being accessed and misused. A more robust system for filling ad-hoc gaps in the staff rota must be explored, to minimise the risk of staff shortages impacting on the personal care, health and welfare of the residents. Less than 50 of care staff are currently trained to NVQ level 2. There should be unannounced visits by a representative of the Organisation, who is not directly involved with the daily running of the The Downs Christian Nursing Home DS0000065252.V250772.R01.S.doc Version 5.0 Page 6 Home, at least monthly and the Manager must apply to be registered with the Commission. 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 Downs Christian Nursing Home DS0000065252.V250772.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Downs Christian Nursing Home DS0000065252.V250772.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 3 Good information is available for prospective residents although the Service User guide and the complaints policy within it must be amended to include the contact details for the Commission. Assessments by Health and/or Social Services are included as part of the pre-admission assessment where appropriate, meeting the Requirement from the last Inspection. Following the Home’s assessment, the Manager should confirm in writing to prospective residents that the Home could meet their needs in respect of health and welfare. EVIDENCE: A detailed Statement of Purpose and Service User guide are in place, providing information for current and prospective residents. The Service User guide and the Complaints policy within it need updating to reflect the change from the NCSC to the Commission. Once an enquiry is made to the Home, the Manager visits the prospective resident and undertakes an assessment, completing an assessment pro-forma. Where appropriate Health and/or Social Services assessments are also sought. Prospective residents are told verbally whether or not the Home can meet their needs. This is then confirmed in writing. If an admission is agreed, a copy of the Terms & Conditions is sent, identifying the The Downs Christian Nursing Home DS0000065252.V250772.R01.S.doc Version 5.0 Page 9 services provided. However, if the placement is arranged through Social Services, a Contract with them is issued and the Home sends a letter confirming the terms of the admission. The Downs Christian Nursing Home DS0000065252.V250772.R01.S.doc Version 5.0 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 the following standard(s): 7 and 9 The Care Plans reflect the nursing, social and personal needs of the residents and a good programme of review and updating is in place. The Care Plan seen for a resident with complex needs was very specific regarding the resident’s particular needs and was very good in reflecting that the resident could make choices about the care given. This meets the Requirement from the last Inspection. Good practice is in place for the administration of medication but the system currently in place for its disposal does not ensure that the medication removed by the Waste Management Company matches that disposed of by the Home. EVIDENCE: The Down’s Christian Nursing Home provides 24 hour nursing care if required. All the residents have a Care Plan that sets out in detail the action needed to ensure all aspects of the health, social and personal care needs of the resident are met. They are generated from information gathered at the initial assessment. All residents also have assessments for the risk and prevention of falls, tissue viability and the risk of developing pressure sores. A nutritional assessment is also undertaken. A copy of the Care Plan and the Risk Assessments are kept on the computer and are evaluated by the trained staff at the end of each shift. A reminder to review them is then generated by the The Downs Christian Nursing Home DS0000065252.V250772.R01.S.doc Version 5.0 Page 11 computer each month. When the monthly review is undertaken and the Care Plans are updated, a copy is put in the resident’s room enabling the care staff to access it. One Care Plan for a resident with complex needs was examined in detail. The Risk Assessments and Care Plan reflected the changing needs of the individual and the care prescribed promoted the involvement of the resident in choices as to how and when the care should be given. Although the administration of medicines was assessed there is only one resident who takes responsibility for their own medication. The resident chooses the time it is taken and the medication is kept in a locked cupboard in the room, but help from the care staff is needed to administer the medication. The clinical room was seen and was clean and well stocked. The medicine charts were seen and were correctly maintained. Policies and procedures are in place for the correct receipt, storage, administration and disposal of medicines. Photographs of all the residents are included with the medicine charts. The disposal of the medicines has recently transferred to a Waste Management Company. There is no clear tracking of the medication between being identified as for disposal and being collected by the Company, which could be several weeks later. The risks of this were discussed during the inspection and is being followed up with the Company. The Downs Christian Nursing Home DS0000065252.V250772.R01.S.doc Version 5.0 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 the following standard(s): 12 and 14 The Home recognises the importance of ensuring individual needs are met and offers choice and flexibility for the routines of daily living. A good programme of activities is in place. Good financial management of personal monies are in place although the Home should ensure residents don’t lose out on any benefits from the account. EVIDENCE: During the Inspection residents were choosing to spend time either in their own room or enjoying the entertainment that had been organised in one of the lounges. There was evidence during the inspection that the routines of daily living are flexible, dependant on the particular needs of the individuals. A new Activity Co-ordinator has been appointed since the last inspection: trips out are arranged and a varied programme of events is organised within the Home. These are publicised on the notice boards and the residents are told on a regular basis about forthcoming activities. A newsletter is also published every 3 months and can be seen on the notice board. There is a weekly Christian service held and other faiths are catered for dependant on the wishes of individuals. Many of the residents handle their own financial affairs, or solicitors are appointed to act on their behalf. Any meetings or discussions are held in private with the resident. The Downs Christian Nursing Home DS0000065252.V250772.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 A good complaints procedure is in place, but it should include details of how to refer a complaint to the Commission, should the complainant wish to do so. A comprehensive policy for the protection of Vulnerable Adults is in place. There must be a plan for training new staff and updating staff in Adult Protection. EVIDENCE: No complaints have been forwarded to the Commission since the last Inspection. There is a complaints procedure which the staff, when asked, said they were aware of and knew how to access. The procedure does not contain the contact details for the Commission. All complaints and their outcome are recorded: there have been no complaints received since the last Inspection. A resident and a relative both stated that they could raise any concerns with the Nurse-in-charge and be confident that they would be listened to and their concern acted upon. There is a policy in place for the Protection of Vulnerable Adults with clear contact details for the Organisation and the Commission: it identifies Social Services as the lead for any investigation. A video has previously been used as a training aid but this is no longer available: there is no clear plan as to how staff training will be undertaken in future. All staff seen during the Inspection were clear how to respond if they suspected Adult Abuse and all except one had had training in Adult Protection. Many of the residents handle their own financial affairs, or solicitors are appointed to act on their behalf. The Home’s management team do not act as appointees for the financial affairs of the residents. The Downs Christian Nursing Home DS0000065252.V250772.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 The environment appears non-clinical and good practice is in place to ensure the Home is clean and to minimise the risk of infection. EVIDENCE: A full tour of the Home was not undertaken during this Inspection, but selected bedrooms, the laundry room, clinical room and some of the communal areas were viewed. All areas were clean and free from offensive odours. A team of five staff are employed for cleaning and managing the Home’s laundry. A large purpose built laundry room has washing machines with a sluicing facility. There are clear procedures in place for managing infected linen and policies in place for the control of infection. Hand Washing facilities are readily accessible and there are supplies of disposable gloves available. Staff attend training in the control of infection. The Downs Christian Nursing Home DS0000065252.V250772.R01.S.doc Version 5.0 Page 15 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 and 28 The Home is currently understaffed, although every effort is being made to recruit. A more robust system for filling ad-hoc gaps in the staff rota must be explored, to minimise the risk of staff shortages impacting on the personal care, health and welfare of the residents. Less than 50 of care staff are currently trained to NVQ level 2. EVIDENCE: A registered nurse leads each shift, supported by care staff. A staff rota is in place to cover the 24-hour period. 5 carers are rostered to work with a trained nurse each day and 2 carers with a trained nurse for the night shifts. One resident has been assessed as requiring 1:1 care by a carer during the day. Domestic, laundry, catering and maintenance staff are also employed. The Manager usually works from Monday to Friday and is supported by the Deputy Manager. A team of 3 RNs cover the Night shifts and the Manager, Deputy and another RN cover the late shifts and weekends. As no Agency staff are employed, any sickness and Annual Leave has to be covered by Bank staff or the permanent staff working extra hours. The Home is currently carrying vacancies and the rotas viewed showed evidence of staff needing to work extra hours to ensure sufficient staff numbers on duty. The Manager is currently undertaking his Registered Manager’s Award (RMA). 3 carers are trained to NVQ level 3 and 1 trained to NVQ level 2. 2 more are starting their NVQ level 2 this October. However this will not ensure 50 of care staff will be trained to NVQ level 2 or above. The Downs Christian Nursing Home DS0000065252.V250772.R01.S.doc Version 5.0 Page 16 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 and 35 The Inspector found that the Home is conducted in a manner, which promotes the well being of the residents, is professional and positive. However, the Manager should apply to be registered with the Commission. There should be unannounced visits by a representative of the Organisation, who is not directly involved with the daily running of the Home, at least monthly. The person carrying out the visit should prepare a written report on the conduct of the Home, and a copy forwarded to the Commission. Good practices are in place to seek the views of residents and their relatives and to act on any issues that are raised. Overall, good systems for the financial management of personal monies are in place although the Home should ensure residents don’t lose out on any benefits from the account. EVIDENCE: The Manager is a very experienced first level nurse and has been in post for three years, although is not registered with the Commission. He is currently studying for his RMA (Registered Managers Award). There are clear lines of The Downs Christian Nursing Home DS0000065252.V250772.R01.S.doc Version 5.0 Page 17 accountability within the Home and staff, residents and a relative stated that the Manager is accessible and approachable for help and support. The Downs is part of a large Organisation (Southern Cross). Monthly, unannounced visits by a representative of the Organisation, to view the premises, review documentation, interview staff, and meet with residents or their representative does not occur. An audit is undertaken within the Home and a report sent to the Organisation every 2 months and an unannounced visit is then undertaken on the alternate months. A survey to seek the views of the residents and their relatives is undertaken every 6 months and a meeting is held twice a year for residents and their relatives. Where possible any actions needed are initiated locally and major issues are fed into the Home’s development plan. Policies and Procedures are in place to safeguard and protect the financial interests of the residents. Varied amounts of personal monies are held by the Home, in a dedicated resident’s Bank Account. Records for all expenditure and a current balance for each resident are then kept ‘on file’ and on computer. Only the Home’s Administrator can make withdrawals and payments into the account, but she and the Manager can access the records. The Downs Christian Nursing Home DS0000065252.V250772.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 2 x x x 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 3 13 x 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 x x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x x The Downs Christian Nursing Home DS0000065252.V250772.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1OP16 Regulation 22 (5)(7)(a) Requirement Timescale for action 31/12/05 2. OP28 18(1) 3. OP31 26(2)bc3 (4)abc (5)ab 8 (2)(a)(b) 4. OP31 The Service User guide must be updated to include details of the Commission. There must be written information provided to residents for referring a complaint to the Commission at any stage, should the complainant wish to do so. A minimum ratio of 50 trained 31/12/05 members of care staff (NVQ level 2 or equivalent) must be achieved by 2005. There must be unannounced 31/12/05 visits by a representative of the Organisation who is not directly involved with the daily running of the Home, at least monthly. The Manager must apply to be 31/12/05 registered with the Commission. The Downs Christian Nursing Home DS0000065252.V250772.R01.S.doc Version 5.0 Page 20 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. Refer to Standard OP9 OP27 Good Practice Recommendations There must be safe practices in place for the disposal of medications whereby there is minimum risk of it being accessed and misused before it leaves the premises. A more robust system for filling ad-hoc gaps in the staff rota must be explored, to minimise the risk of staff shortages impacting on the personal care, health and welfare of the residents. The Downs Christian Nursing Home DS0000065252.V250772.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Downs Christian Nursing Home DS0000065252.V250772.R01.S.doc Version 5.0 Page 22 - 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!