Inspection on 30/11/05 for The Normanhurst Annexe

This inspection was carried out on 30th November 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Normanhurst Annexe 16/10/07

The Normanhurst Annexe 27/04/06

The Normanhurst Annexe 10/08/05

The Normanhurst Annexe 06/01/05

The Normanhurst Annexe 07/07/04

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

CARE HOMES FOR OLDER PEOPLE The Normanhurst Annexe Brassey Road Bexhill-on-sea East Sussex TN40 1LB Lead Inspector Niki Palmer Unannounced Inspection 30th November 2005 10:30 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 Normanhurst Annexe DS0000021255.V268898.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 Normanhurst Annexe DS0000021255.V268898.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Normanhurst Annexe Address Brassey Road Bexhill-on-sea East Sussex TN40 1LB 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) 01424 217577 Mr David Lewis Mr Robert Hebbes Mrs Janet Mellor Care Home 18 Category(ies) of Dementia (18) registration, with number of places The Normanhurst Annexe DS0000021255.V268898.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of residents to be accommodated will be eighteen (18) The people accommodated will be aged sixty five (65) or over on admission Only service users who have a dementia type illness are to be accommodated 10th August 2005 Date of last inspection Brief Description of the Service: The Normanhurst Annexe is situated on Bexhill seafront and is a three-storey building interconnected with the Normanhurst Nursing Home and the Normanhurst Residential Care Home. The three homes are independently registered with reference to the category of the residents catered for. Each has a Registered Manager responsible for the day-to day running of the home. The Annexe cares for up to 18 residents with a dementia-type illness. All bedrooms are centrally heated, two of which have en-suite facilities. Residents are welcome to bring their own furniture and other personal possessions with them. The home is close to local shops with rail and bus services within easy walking distance. Carers are on duty 24 hours a day. The home’s literature states that it ‘aims to provide residents with the appropriate degree of care to assure the highest possible quality of life within the home’. The Normanhurst Annexe DS0000021255.V268898.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at The Normanhurst Annexe will be referred to as ‘residents’. This unannounced inspection took place on Wednesday 30th November 2005 between 10.30am and 3.30pm. The inspection began with discussions with one of the senior carers on duty and a telephone conversation with the Registered Manager of the home in respect of progress made since the last inspection, followed by the examination of three care records. In order to gather evidence on how the home is performing, individual discussions took place with two residents over the lunchtime period, the Inspector having been invited to join them for a meal. In addition, three care staff were spoken with during the visit and one of the Registered Providers. A detailed inspection of the premises and its facilities took place. 16 residents were accommodated at the time of the inspection. Other records and documentation inspected included: the home’s Statement of Purpose and Service Users’ Guide, pre-admission procedures, medication practices, health and safety records, activities, recruitment files and quality assurance systems. In order that a balanced and thorough view of the home is obtained, this inspection report should to be read in conjunction with the previous inspection report carried out on 10th August 2005. What the service does well: The Normanhurst Annexe provides residents with a good standard of care, which is delivered by a consistent and caring staff team. A good level of written information is provided to prospective and existing residents about what services are provided and what to expect when living at the home. A variety of planned, meaningful and stimulating activities are also in place, particularly in the lead up to Christmas. Routines regarding going to bed, rising and bathing are flexible and continue to be part of daily practices at the home, ensuring that residents’ individual preferences are respected. All residents and staff spoken with were very positive of the home and its management. The Normanhurst Annexe DS0000021255.V268898.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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 Normanhurst Annexe DS0000021255.V268898.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 Normanhurst Annexe DS0000021255.V268898.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, 3, and 4. Detailed written information is provided to all prospective residents prior to admission. The home has improved systems in place to assess prospective residents. This ensures that no one is admitted to the home, whose needs cannot be met. EVIDENCE: The home’s combined Statement of Purpose and Service Users’ Guide were reviewed and updated in November 2005. It includes details of the home’s aims and objectives, philosophy of care, admission policy and trial period offered, accommodation, activities, staffing structure and complaints procedure. Contact details of the CSCI are also included. Two new residents have been admitted to the home since the last inspection. Both pre-admission assessment documents were seen, which had been completed prior to admission by the Registered Manager, include details of those present at the time of the assessment and contain thorough information regarding individuals’ personal care needs, mental state and cognition. In addition all other healthcare professionals involved such as a Community The Normanhurst Annexe DS0000021255.V268898.R01.S.doc Version 5.0 Page 9 Psychiatric Nurse (CPN) and other specialists were clearly recorded with contact names and addresses. The Normanhurst Annexe DS0000021255.V268898.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, 8, 9 and 10. Good progress has been made by the home to ensure that all new residents’ needs are identified within their plans of care, however this needs to be prioritised to existing residents. The systems in place for the administration of medication need to be improved to ensure that practices are safe. EVIDENCE: Two individual plans of care were seen on the day of inspection. The Registered Manager has worked hard to develop a new care planning format based on the comprehensive pre-admission assessment. Although only two of the residents currently have these plans in place, it is anticipated that this will be extended to all existing residents in the near future. This must be prioritised. Residents and their relatives were informed about this process during a residents meeting held in October, minutes of which were seen. It was pleasing to note that residents’ key workers had taken the time to speak with the residents and their relatives shortly after admission to gain an insight into the individuals’ background and life history. These personal profiles were seen at the front of each care plan. Clear actions for staff to follow in order to meet residents’ assessed needs were evident throughout the plans of care seen. Assessments were in place for The Normanhurst Annexe DS0000021255.V268898.R01.S.doc Version 5.0 Page 11 nutrition, the prevention of falls and for those at risk of pressure area care breakdown. Despite a recognised assessment tool being completed for the management of pressure area care there was no outcome of the assessment, or guidance for staff to follow in relation to the use of equipment, i.e. the setting of the airflow mattress. Requirements have been made in respect of this. A sample of the home’s medication procedures and records were seen. The home uses a Nomad (pre-packed) system, which can be easily monitored. One tablet, which should have been administered that morning had been forgotten and was still in the box, although it had been signed for. When questioned the staff were unaware of the home’s medication error policy and what action should be taken in the event of reporting any error made. Neither a policy for reporting a drug error or the use of homely remedies were available for inspection. Requirements have been made in respect of this. In addition, it was concerning to note that pain relief medicines, which had been prescribed for daily use were often being refused by some residents. The home is required to liaise with the General Practitioner regarding the consequences of regular refusal and to consider whether or not the medication could be prescribed on a PRN (as and when) basis. Residents spoken with confirmed that that staff treat them at all times with dignity and respect. Indeed this was evident on the day of the inspection. Each of the residents are addressed by their preferred term, have easy access to private areas within the home and have all personal care needs carried out in the privacy of their own rooms or bathrooms. Screening is provided in all shared rooms. The Normanhurst Annexe DS0000021255.V268898.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, 13, 14 and 15. Activities are managed well by the home to ensure that residents are appropriately stimulated. The provision and variety of food is good, although additional support is needed from care staff to ensure that all residents’ dietary needs are met. EVIDENCE: A number of social activities have been made for residents leading up to the Christmas period. A school choir is due to visit the main care home, which residents from The Annexe are invited to, and a production of ‘Winter Wonderland’ has been planned, for all to attend. A Christmas quiz and bingo evening will also take place, and a party, which is to be held in The Annexe. All events and activities are advertised in the home’s monthly newsletter, which also gives details of residents’ forthcoming birthdays, a crossword and the Christmas day menu. All residents spoken with said that they are looking forward to spending Christmas at the home and expressed a wish to help decorate the home with homemade decorations. In addition, special arrangements have been made by the home for one of the residents to spend a special evening anniversary with her husband. This was detailed in minutes of the residents’ most recent meeting. The Normanhurst Annexe DS0000021255.V268898.R01.S.doc Version 5.0 Page 13 It was disappointing to note that on the day of the inspection, the television reception in the main lounge area was again unclear. Discussions took place with one of the Registered Providers of the home regarding the possibility of a new larger TV being purchased and the aerial reception improved. Staff spoken with commented on the fact that residents would benefit from new equipment being purchased such as a DVD player and wide-screen TV. In addition, it is an outstanding recommendation for the home to consider making a small part of the garden accessible and safe for residents from The Annexe to use in the summer months. This was discussed in detail with one of the administrative staff. Residents spoken with said that they could get up and go to bed when they wanted. Their preferred routines and choices were recorded within their plans of care. Staff said that although the home has a bathing rota in place, times are flexible dependent on the needs and preferences of each resident. A choice of main meal is advertised in the dining area of the home. Specialist diets are appropriately catered for including low sugar and vegetarian. All residents are encouraged to dine together in the pleasantly decorated dining room. The meal served on the day of the inspection looked appetising and plentiful with individual preferences being catered for, however the vegetarian option that was tried by the Inspector was not particularly hot, although was tasty and to the liking of other residents. Comments from residents included: “alright” “very good no complaints” and “the food is excellent”. It was noted during the lunchtime period that two of the residents were prone to wandering from the table and dining room and therefore ate very little. Although care staff spoken with appeared to have a good understanding of their dietary needs and preferences, their care plans were found to lack advice for staff to follow in order to support them each mealtime. A requirement has been made for the home to consider ways in which both residents can be supported each mealtime, for example with one member of staff to sit with them at the table and offer discreet encouragement. The Normanhurst Annexe DS0000021255.V268898.R01.S.doc Version 5.0 Page 14 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): 18. In order to safeguard the welfare of residents, the home needs to ensure that clear and up to date policies and procedures are in place. EVIDENCE: All staff spoken with confirmed that they had attended recent training in relation to Adult Protection and were able to demonstrate a good knowledge and insight as to what constitutes abuse, how to recognise it and who to report suspected abuse to. Although the home has a written policy and procedure in place for the Protection of Vulnerable Adults, it is not currently in accordance with local multi-agency guidelines i.e. that Social Services are now the lead agency. This was discussed with one of the administrative staff on the day of the inspection and a requirement made. The Normanhurst Annexe DS0000021255.V268898.R01.S.doc Version 5.0 Page 15 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, 21, 24 and 26. The Normanhurst Annexe presents as a warm, comfortable and homely place to live. EVIDENCE: All areas of the home were inspected and on the whole were found to be in good working order, clean and safe, with the exception of a broken window in the first floor bathroom and a carpet in need of cleaning/replacing on the ground floor near the kitchenette area. These were discussed at the time of the inspection and requirements made. It was pleasing to note that since the last inspection a window restrictor has been fitted to the recently refurbished shower room on the first floor and further work is planned to refit the ground floor bathroom. It is anticipated that a new longer and wider bath will be fitted and the toilet replaced. In order for ease of access the opening of the door will be reversed. In addition many of the hand basin taps throughout the home have been replaced with self-stopping taps, so there is no risk of flooding in the event of a tap being left turned on. The Normanhurst Annexe DS0000021255.V268898.R01.S.doc Version 5.0 Page 16 One of the members of staff spoken with commented that residents rarely use the bathroom on the third floor due to the fact that they have difficulty getting in to and out of the bath. A requirement has been made for the home to seek specialist advice regarding suitable and appropriate equipment in order to make the bath accessible for residents on the third floor. All residents’ bedrooms were found to be personalised and decorated to individual preferences. All residents are encouraged to bring their own possessions with them on admission to the home. The Normanhurst Annexe DS0000021255.V268898.R01.S.doc Version 5.0 Page 17 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): 28, 29 and 30. Since the last inspection significant improvements have been made in the way in which care staff are employed. This helps to ensure and protect the safety of residents. EVIDENCE: Of the 16 care staff employed by the home, four are due to finish their NVQ level 2 training imminently and a further four are due to commence. Most of the staff spoken with said that they had found the training to be helpful, relevant to their work and ‘challenging’. This was very positive. Two of the most recently employed staff recruitment files were checked for compliance with the Regulations. It was pleasing to note that both files contained proof of a POVA First and Criminal Record Bureau check (CRB), written references, proof of identification and a full history of employment. New application forms are now in place. One member of staff confirmed that she had received an induction facilitated by the Registered Manager shortly after commencing employment. A recommendation has been made for the home to consult with their professional body in respect of the new Common Induction Standards issued by Skills for Care (replacing TOPPS). The Normanhurst Annexe DS0000021255.V268898.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 38. The Normanhurst Annexe has made good progress in the overall management of the home, particularly in regard to care planning procedures and seeking the views of residents. EVIDENCE: It was very pleasing to note that since the last inspection the home has begun to think about how they can receive feedback from others about the care that is provided. The first residents’ and families meeting was held in October 2005, and minutes taken. The main items on the agenda were: complaints, Christmas, care planning and reviews. All but two of the residents attended. This good practice is acknowledged and will be followed up at subsequent inspections. A sample of the home’s health and safety records were examined. All maintenance checks and fire drills had recently been completed. The Normanhurst Annexe DS0000021255.V268898.R01.S.doc Version 5.0 Page 19 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 3 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 2 X 2 X X 3 X 3 STAFFING Standard No Score 27 X 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X 3 The Normanhurst Annexe DS0000021255.V268898.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 OP7 OP8 Regulation 15(1) 17(1a) Sch3(p)15(2) Requirement That new care planning procedures are implemented for all existing residents. That risk assessments for all residents who are at risk of pressure area care breakdown provide an outcome, instructions on how to minimise the risk and the use of equipment [THIS IS OUTSTANDING FROM THE TWO PREVIOUS INSPECTION REPORTS]. That a medication error policy and procedure is implemented within the home and adhered to. That a policy for the use of homely remedies is in place within the home. That advice from a GP is sought in respect of all residents who refuse their medication on a regular basis. This must be clearly documented [THIS IS OUTSTANDING FROM THE PREVIOUS INSPECTION REPORT] That residents who are prone to wandering at mealtimes and who require encouragement to eat a healthy diet are supported to do Version 5.0 Timescale for action 31/03/06 31/03/06 3. 4. 5. OP9 OP9 OP9 13(2) Sch2 13(2) Sch2 13(2) Sch2 31/03/06 31/03/06 31/12/05 6. OP15 12(1)(a) (b) 31/12/05 The Normanhurst Annexe DS0000021255.V268898.R01.S.doc Page 21 7. OP18 12(1)(a) 8. 9. 10. OP19 OP19 OP21 23(1) 23(2)(b) 16(2)(c) 23(1)(n) so by care staff at mealtimes. Their care plans must be amended as necessary. That the home updates its Adult Protection policy and procedure in line with local multi-agency guidelines. It needs to state that Social Services are now the lead agency and provide the relevant contact details. That the window in the first floor bathroom is repaired/replaced. That the carpet on the ground floor near the kitchen area is cleaned/replaced. That specialist advice is sought regarding suitable and appropriate equipment in order to make the bath accessible for residents on the third floor. 31/03/06 31/12/05 31/12/05 31/03/06 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. Refer to Standard OP12 OP12 OP28 OP30 Good Practice Recommendations That the home considers purchasing a wide-screen TV to ensure that all residents are able to see it. The reception should be clear at all times. That the home consider making an area of the garden secure so that residents can access the garden safely in the summer months. That at least 50 of care staff are trained to NVQ level 2 in care by December 2005. That the home consult with their umbrella body in respect of the new Common Induction Standards issued by Skills for Care (replacing TOPPS). 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