Inspection on 14/02/06 for The Normanhurst Nursing Home

This inspection was carried out on 14th February 2006.

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

The inspector 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 Nursing Home 09/01/07

The Normanhurst Nursing Home 03/10/05

The Normanhurst Nursing Home 15/03/05

The Normanhurst Nursing Home 26/07/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

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 Normanhurst Nursing Home De La Warr Parade Bexhill On Sea East Sussex TN40 1LB Lead Inspector Niki Palmer Unannounced Inspection 14th February 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Normanhurst Nursing Home DS0000014019.V281942.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 Normanhurst Nursing Home DS0000014019.V281942.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Normanhurst Nursing Home Address De La Warr Parade 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 01424-734650 Mr D C Lewis Mr R Hebbes Imelda Mary Rea Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places The Normanhurst Nursing Home DS0000014019.V281942.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That only older people requiring nursing care are to be accommodated Service users should be aged sixty five (65) years or over on admission That no more that thirty one (31) service users are to be accommodated 3rd October 2005 Date of last inspection Brief Description of the Service: The Normanhurst Nursing Home is situated close to the seafront and town centre in Bexhill on Sea. The building is interconnected with The Normanhurst Care Home and The Annexe (a registered home for older people with a dementia type illness). Each of the homes are independently registered, although under the same ownership. They run separately from each other apart from the laundry and catering, which are completed centrally within the residential care home. The home comprises of 29 single and 2 double bedrooms. There is a lounge for the residents to use on the ground floor, which opens onto the garden at the rear of the home where seating is provided. A dining room can also be found on the ground floor. The Normanhurst Nursing Home is registered to provide general nursing care to residents who are privately funded and also those who are funded by social services. The Normanhurst Nursing Home DS0000014019.V281942.R01.S.doc Version 5.1 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 Nursing Home will be referred to as ‘residents’. This unannounced inspection took place on Tuesday 14th February 2006 between 10.00am and 4.00pm. To help gather evidence on how the home is performing the Inspector sat and talked with a number of residents, met with staff and had detailed discussions with the Registered Manager. A handover of staff between a change of shifts was also observed. Records and documentation inspected included: the home’s pre-admission assessment procedures, three individual plans of care, medication procedures, the systems in place for handling complaints and safeguarding residents from harm, a sample of recruitment files, and the home’s procedures for handling residents’ personal belongings and valuables. 30 residents were accommodated at the time of the inspection. 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 3rd October 2005. What the service does well: What has improved since the last inspection? The majority of requirements and recommendations made during the last inspection have been met. The home’s pre-admission assessment procedures have improved and there is evidence of appropriate consultation taking place with residents and/or their representatives prior to admission. Recruitment procedures have been tightened up to ensure that no person is employed prior to satisfactory and robust checks being carried out. The home is working towards the required target of 50 care staff trained to NVQ level 2 in Care. The Normanhurst Nursing Home DS0000014019.V281942.R01.S.doc Version 5.1 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 Normanhurst Nursing Home DS0000014019.V281942.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 Normanhurst Nursing Home DS0000014019.V281942.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): 2 and 3. All residents are provided with a copy of their terms and conditions of residency. Improved systems are in place to ensure that no person is admitted to the home, whose needs cannot be met. EVIDENCE: Residents confirmed that they are provided with a copy of their terms and conditions of residency on or shortly after admission. Once signed, these are kept within their personal care records. A monitoring visit took place in October 2005 following concerns raised during the home’s last inspection regarding pre-admission assessment procedures. It was pleasing to note that since this time, work has been carried out to ensure that all residents’ needs including any specialist requirements are thoroughly assessed prior to admission. One newly admitted resident said that he had moved in to the home from the adjoining care home. He said that he had the opportunity to meet with one of the senior members of nursing staff before moving in, to discuss and determine his needs and wishes. Records confirmed that residents, their relatives/representatives and other health and social care professionals are involved in this process. The Normanhurst Nursing Home DS0000014019.V281942.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 and 9. The assessed needs of residents are well met by the homes care planning procedures. Medication practices are poor and these potentially place residents at risk. EVIDENCE: Three individual care planning records were inspected. Since the last inspection the Registered Manager has altered the format slightly in order to make them easier to read and follow. They are sufficiently detailed and include in depth risk assessments for the prevention of falls, use of bed rails, maintaining pressure area care and nutrition. There was evidence that the Registered Manager updates these regularly. A recommendation has been made for the Manager to consider ways in which nursing staff may become more involved in the care planning process. From observations made, particularly during the handover period of staff it was evident that all staff are regularly updated and aware of residents’ changing needs as identified within their care plans. It must be noted that the verbal daily communication between staff is of a very high standard. The Normanhurst Nursing Home DS0000014019.V281942.R01.S.doc Version 5.1 Page 10 The home’s medication systems and records were viewed and a number of concerns raised: There were several gaps apparent on the medication administration records where either a signature or reason for non-administration should appear and it was also noted that some prescribed medications had not been given as they were out of stock, yet the home was noted to have excessive supplies of other medicines in storage. Some medicines are only to be used for a maximum number of days once opened and then discarded yet no dates had been written on a number of these. This shows poor practice in relation to the home’s procedures for ordering and disposing of medicines. The home has some controlled drugs on the premises. It was concerning to find that two signatures were not always recorded within the controlled drugs register. Requirements have been made in respect of this. The home is also required to have a drug error policy in place. This should encourage staff to report any errors no matter how minor. This will help to support the home to identify any faults in their current procedures and training needs for staff. The Normanhurst Nursing Home DS0000014019.V281942.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 and 15. Residents expressed satisfaction with the choices of food and activities they are offered, however the home does not always promote and respect residents’ personal autonomy and choice. EVIDENCE: Residents confirmed that the home encourages them as much as possible to make their own decisions and choices in relation to many aspects of their lives. For example, when to go to bed and get up in the morning, whether to have their meals in the dining area or in the quietness of their own rooms and whether to participate or not in daily activities. Those who are able to can move freely around the home or go out into the local community. It was noted on the day of inspection that the radio in the main lounge area was particularly loud and inappropriate for the residents accommodated. As the majority of residents seated in the lounge area are reliant on staff to use the equipment, it appeared that the preferences of staff took precedence over residents. This was discussed with the Registered Manager and a requirement made. Residents expressed satisfaction with the variety and standard of food provided. Many commented that they are offered breakfast in bed, consulted on their choice of food and are given additional condiments as necessary. The Normanhurst Nursing Home DS0000014019.V281942.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 and 18. Whilst adequate systems are in place to ensure that all complaints will be dealt with appropriately, the home needs to ensure that up to date written policies and procedures are in place and followed in order to safeguard residents from harm. EVIDENCE: The home has a detailed complaints procedure in place to inform residents and visitors to the home that any concerns or complaints can be made directly to the home or the Commission for Social Care Inspection (CSCI). Residents spoken with said that they would feel confident in raising any concerns or complaints directly with the Registered Manager. The Inspector viewed this as encouraging. Records showed that a resident made a complaint directly to the home in January 2006. Whilst the Registered Manager addressed these concerns with the resident and staff members, it was concerning to note that it had not been raised as an Adult Protection alert with Social Services. These concerns were discussed in detail with the Registered Manager. In addition to the above, the home has not updated its Adult Protection policies and procedures as required in the previous inspection report. The Inspector provided additional information on the day of inspection. The home is required to provide all staff with up to date Adult Protection training in line with the home’s updated policies and procedures. The Normanhurst Nursing Home DS0000014019.V281942.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): 19 and 26. Some areas of the home have undergone improvements in consultation with residents. The home presents as a safe, comfortable and well-maintained place to live. EVIDENCE: Although a thorough inspection of the premises did not take place on this occasion, all areas seen were found to be clean, well-maintained and safe. A new nurse-call system has recently been installed throughout the home, which although is very loud, is effective as all calls are attended to quickly. Residents confirmed that the new system is working effectively. The ground floor has been completely re-carpeted and some bedroom floors replaced with linoleum. It was encouraging to hear that this work has been undertaken in consultation with residents in order to prevent the risk of contamination and cross infection. Good working practices and procedures for managing Methicillin Resistant Staphylococcus Aureus (MRSA) and other infectious conditions are in place throughout the home. Suitable equipment such as gloves, aprons and hand wash is adequately provided throughout. All The Normanhurst Nursing Home DS0000014019.V281942.R01.S.doc Version 5.1 Page 14 staff are now provided with alcohol gel at the beginning of each shift to ensure that the risk of cross infection between residents is minimised. All staff wear badges, which encourage residents and visitors to the home to prompt/remind staff to wash their hands between attending to residents in line with the Department of Health’s ‘Clean Your Hands’ campaign. This is noted as commendable practice. The Normanhurst Nursing Home DS0000014019.V281942.R01.S.doc Version 5.1 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, 28 and 29. Staffing arrangements are good and ensure that residents’ needs are met by sufficient numbers of skilled and motivated staff. Recruitment procedures are improved to help safeguard and protect residents. EVIDENCE: The Normanhurst Nursing Home currently employs nine Registered General Nurses (RGN’s) in addition to the Registered Manager and 14 care assistants four of whom are trained to at least NVQ level 2 in care, two others are awaiting certification and one care assistant is currently working towards qualification. Staff members spoken with said that they have found the training to be helpful, informative and the skills transferable to their work. The home is currently in the process of recruiting a full-time Deputy Manager to support the Manager in her day-to-day role. Residents spoken with said that the home is mostly well staffed however also commented that the care staff could ‘always do with an extra pair of hands’. Four staff recruitment records were seen on the day of inspection. Since the last inspection the home’s application form has been amended to allow for full details of previous employment to be recorded. No member of staff is now employed to work within the home without satisfactory Police checks i.e. PoVA First and Criminal Record Bureau (CRB). It was pleasing to note that there was evidence of proof of identification (although poorly photocopied), two written references being applied for and a statement of the applicant’s mental and physical health. A requirement has been made for the home to obtain clear (colour) photographic evidence of all applicants. The Normanhurst Nursing Home DS0000014019.V281942.R01.S.doc Version 5.1 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): 35 and 38. The Normanhurst Nursing Home is generally a well run service, however the current practices for handling residents’ personal and valuable possessions are poor. EVIDENCE: Most residents and/or their relatives manage their own finances. The home does however, have safe storage facilities for residents’ money, cash cards, or other valuables, to which only three senior members of staff have access. However on the day of inspection it was concerning to find some residents’ valuables were being stored within the home’s controlled drugs cabinet, including jewellery and a chequebook. The home is required to ensure that all personal belongings are stored securely within the home, including a record of the date that they were deposited in line with the home’s policies and procedures. The Normanhurst Nursing Home DS0000014019.V281942.R01.S.doc Version 5.1 Page 17 A number of the home’s health and safety checks and certificates were seen. All equipment is regularly maintained and serviced. Certificates seen included the homes: servicing reports lift maintenance, emergency lighting, fire alarm testing and hot water temperatures. All tests are regularly carried out by designated maintenance persons. The Normanhurst Nursing Home DS0000014019.V281942.R01.S.doc Version 5.1 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 X 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 2 X X 3 The Normanhurst Nursing Home DS0000014019.V281942.R01.S.doc Version 5.1 Page 19 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. Standard OP9 Regulation 13(2)17(1) (a)Sch3(k) 13(2)17(1) (a)Sch3(k) 13(2)17(1) (a)Sch3(k) 13(2)17(1) (a)Sch3(k) 12(2)(3) Requirement That medication administration records contain either a signature or reason for nonadministration [IMMEDIATE]. That a drug error policy and procedure is devised and implemented. That the correct procedures for ordering and discarding medicines are followed [IMMEDATE] That two signatures appear in the controlled drugs register in line with the home’s policies and procedures [IMMEDIATE]. That residents are offered appropriate choices in relation to activities within the home i.e. listening to the radio. That the home updates its policy and procedure for the Protection of Vulnerable Adults (PoVA) in accordance with local multi-agency guidelines. This should include a definition of abuse, what constitutes abuse and what actions need to be taken in the event of suspecting abuse [THIS IS OUTSTANDING DS0000014019.V281942.R01.S.doc Timescale for action 14/02/06 2. 3. OP9 OP9 30/04/06 14/02/06 4. OP9 14/02/06 5. OP14 14/02/06 6. OP18 12(1)(a) 30/04/06 The Normanhurst Nursing Home Version 5.1 Page 20 7. OP18 12(1)(a) 8. 9. OP29 OP35 19 & Sch 2 17 & Sch 4 (9)(a) FROM THE PREVIOUS INSPECTION REPORT]. That all staff receive up to date Adult Protection training in line with the home’s updated policies and procedures. That all recruitment files contain clear (colour) photographic identification. That residents’ personal belongings are stored securely within the home, including a record of the date that they were deposited for safe keeping in line with the home’s policies and procedures [IMMEDIATE]. 31/05/06 30/04/06 14/02/06 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. Refer to Standard OP7 Good Practice Recommendations That nursing staff support the Registered Manager in the formulation and update of care plans. The Normanhurst Nursing Home DS0000014019.V281942.R01.S.doc Version 5.1 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. 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