Inspection on 13/04/05 for The Nunnery

This inspection was carried out on 13th April 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 Nunnery 13/01/09

The Nunnery 19/12/07

The Nunnery 15/05/07

The Nunnery 17/01/07

The Nunnery 20/04/06

The Nunnery 23/11/05

The Nunnery 29/10/04

The Nunnery 23/05/04

Similar services:

Claremont House

Chesham House

Oak Ridge

Argyll House

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

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

CARE HOMES FOR OLDER PEOPLE The Nunnery 14 Denmark Street Diss Norfolk IP22 4LE Lead Inspector Judith Huggins Unannounced 13 April 2005 15:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Nunnery Version 1.10 Page 3 SERVICE INFORMATION Name of service The Nunnery Address 14 Denmark Street Diss Norfolk IP22 4LE 01379 643201 01379 642649 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Jane Mewse Mrs Jane Mewse Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places The Nunnery Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: There are no conditions other than the category and number of service users that can be accommodated - as specified above.. Date of last inspection 29 October 2004 Brief Description of the Service: The Nunnery is situated close to one of the roads leading from the market town of Diss. Gardens to the rear slope steeply down the banks of the Mere, and there are panoramic views across the water to the town. The street frontage and main building is old, and there is a newer extension to the rear. A shaft lift provides access to the first floor. There is a lower ground floor (as a result of the sloping site), which is accessible via stairs or a stair lift. The home is registered to provide care for 23 people, and three of the rooms would be double. These rooms are currently being used for single occupancy as their occupants do not wish to share. The Nunnery Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 4 and a half hours and was unannounced. A partial tour of the premises took place and staff and care records were inspected. Both staff on duty were interviewed, three of the 17 residents, and three visitors were spoken to. What the service does well: What has improved since the last inspection? What they could do better: Care needs must be set out very quickly after people are taken in to the home, so that staff have clear guidance about what to do for each person. These records must be updated regularly, and they should be properly dated. Residents (or their families or other representatives) must be consulted. Medicines that residents need to help keep them well or comfortable must be ordered promptly so that they do not run out, and disposed of as soon as they are no longer needed. The Nunnery Version 1.10 Page 6 Proper screening in bathrooms must be provided so that residents’ privacy is maintained at all times. The owner of the home must review her instructions to staff in the light of her own policies and stated aims, and make sure that residents can exercise choice on a day to day basis. As at the last and previous inspections, there is a need to improve the décor of the home. The appearance of some areas is “tired” and carpets stained or damaged. In two places damaged carpets put residents and staff at risk. Failures of some heaters and the lift to the first floor have also caused concern, and the heating has taken a long time to fix in some cases. Other equipment brought in to heat rooms as an emergency measure increases risk for residents. These failures, and other events at the home which affect the wellbeing of residents and the law says must be reported to the Commission, are not reported properly. Residents are also at risk from cleaning materials that are not stored safely. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Nunnery Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Nunnery Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None. EVIDENCE: The Nunnery Version 1.10 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 standard(s) 7, 8, 9 and 10 The health of residents is at risk and compromised by failure to ensure prescribed medicines are always available and delay in setting out care needs. Some progress is noted to uphold privacy, but is now slower than one would wish. EVIDENCE: Reviews are overdue, most being dated for February and in only one instance has a resident countersigned their review notes. The owner alone signed others. Three people say they do not know what is written down about their care needs, and two relatives spoken to have not seen care plans or been involved in review. One resident would not mind if care were to be discussed with family members. One person admitted on Christmas Eve, had no update of assessment and the care plan is dated only ‘2/5’ meaning the care needs of the person were not set clearly out until a month or more following admission. Not all staff can assist one person with fitting hearing aids. A resident and relatives said that only one member of staff is able to fit these properly. Discussion with staff suggests that other basic day-to-day needs (particularly The Nunnery Version 1.10 Page 10 in relation to personal care) are being met, and also health monitoring connected with diabetes. Residents said that staff are very caring, helpful and polite and “couldn’t be better.” Written messages from staff notifying the owner that medication is out of stock and with annotations from the owner, together with medication administration records, show regular occasions when residents are not receiving treatment as prescribed and considered necessary by the GP for their health and well-being. Staff questioned confirmed that this happens and this has happened recently as shown on record charts. Difficulties in identifying when medication is becoming short is made more difficult and by the amount of surplus medication stored which is no longer in use, only recently prepared for disposal according to the records. Staff confirm that they are trained in medication practices and made checks against charts and packages to ensure medication is administered safely. However, notes show that safe practice in administration is not always followed, given that one person’s tablets were found upstairs outside another resident’s room. The owner has fitted privacy bolts to WC facilities but curtaining in a first floor bathroom used by residents is net meaning electric light will shine through presenting a view to passers by, and the curtain has a curved edge providing no privacy at all in the centre. The owner said that this was being addressed in a previous action plan, but it is not yet resolved. The Nunnery Version 1.10 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 standard(s) 14 and 15 Service users right to exercise choice is infringed. Some aspects of the dining areas do not represent pleasant surroundings for service users to eat their meals although the amount and quality of food is satisfactory. EVIDENCE: The policy and procedure manual of the home refers specifically to the rights of service users to make choices, including choice of location for eating. Written guidance for staff makes reference to the Human Rights Act and says “we encourage those in our care to exercise as much choice and make as many decisions for themselves as possible”. However, there is a message written in the owner’s handwriting and signed by her, saying that “Residents are only to have meals in their room if they are ill please.” Service users and staff confirm that all meals are taken in one of the two dining areas, unless a service user is unwell. Another entry by the owner says “just a reminder that residents are not to store food in their rooms” reflecting further restriction of choice and autonomy. However, one resident has a fruit bowl and biscuits in their room. The Nunnery Version 1.10 Page 12 The menu does not provide for “easy” options to the main meal such as filled baked potato, salad etc. Similarly, no choice is shown for the lunchtime dessert such as fruit or yoghurt. Staff confirm that only one option is prepared for the main meal, although there are choices for tea (also shown on the menu). This is contrary to the owner’s own written guidance and statement regarding human rights. A range of options was presented for tea during the inspection, in celebration of a birthday and it is evident that staff make a considerable effort to celebrate such occasions. Relatives were complementary of the event. Although set with fabric tablecloths, placemats and napkins, the main dining room has stained tablecloths and food debris on mats and trivets. The carpet is torn (covered elsewhere in this report). Cigarette burns hole the carpet by the second dining area set up on the lounge. None of this presents as a pleasant place for people to take their meal. The Nunnery Version 1.10 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None. EVIDENCE: The Nunnery Version 1.10 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22, 25 Significant areas of the home are not well maintained, presenting a shabby appearance, although residents’ rooms are homely. Safety is compromised in some areas, and failures in equipment compromise the welfare of service users. EVIDENCE: The last four inspections have highlighted the need for a programme of maintenance and redecoration, and although the lounge and staff area have been repainted, paintwork elsewhere is worn and discoloured. Residents and staff are at risk from lifted carpet areas at the entrance to the dining room, and open seams and torn areas in one corner of the same room. Carpets elsewhere are stained. Work to provide a handrail to the corridor from the staff area to some bedrooms and the lounge, to aid mobility has been started as required in at least the last three inspections. A long batten of wood is in place to which the The Nunnery Version 1.10 Page 15 handrail will be fitted, according to staff. The batten has rough edges and unfinished screw holes on which residents could hurt themselves. The shaft lift has presented problems recently, requiring attention from the engineers. Maintenance records were not checked (as these are kept in the owner’s office), and she was not present at this inspection. Notes show that some heaters in resident’s rooms have failed recently. The record for one shows a failure in November. There is no corresponding entry to show when the heater had been repaired so staff were asked when the heater in the particular room had been repaired. They were not able to confirm the date of repair, eventually concluding that it was repaired some time in March. This is over four months from the original failure. In this and other cases a fan heater or convector heater has been provided. However, these are not suitable other than in an emergency and for a short period of time. There are warnings displayed regarding hot water temperatures to washbasins, and a guard has been fitted to one heater in the hall – but not securely fixed. Other surfaces were not guarded presenting a potential risk. The owner’s action plan from the last inspection said that risks to each resident from hot surfaces would be assessed but none were seen on individual files. The Nunnery Version 1.10 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 30 Staff on duty (at the inspection) are well trained and experienced, contributing to continuity of care for residents and show a good understanding of their roles. Training is given a high priority by the owner. EVIDENCE: Training records and staff files are not accessible, so evidence was taken from discussion with staff on duty. Two staff leaving at 3pm are experienced and have worked at the home for some years. Two staff interviewed during the afternoon confirm they have both attained NVQ qualifications and that both have worked at the home for at least five years. Information is in the diary regarding other courses that are forthcoming with a note from the owner encouraging staff to express an interest. Messages and the diary of staff working, show that some new staff have started on shifts, particularly at weekends, but without access to staff files at this inspection, comment could only be made about the competence of those staff present for the inspection. The Nunnery Version 1.10 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36, 37 and 38 Staff are not supervised. The health and safety of service users is compromised in some areas and some statutory records are not available. EVIDENCE: Staff cannot confirm that they are supervised as set out in standards, although they have regular access to the owner when she is at the home. Comment is made elsewhere about the condition of floor coverings. Notes show, and staff confirm that the lift has failed on some occasions. Some notes, the Commission’s files and staff interviews indicate that a full range of records is not kept, specifically that reports to the Commission about The Nunnery Version 1.10 Page 18 incidents affecting residents are not made. This includes notifications of dates and causes of death at the home, and reports of serious accidents, as well as events affecting the welfare of service users (such as the failure of heating, problems with the lift, and when someone goes missing). There are cleaning materials, including toilet cleaner and bleach, left in bathrooms and therefore accessible, presenting a risk to service users. Staff present were requested to remove these promptly. In discussion with staff it is apparent that a resident had gone missing from the home. Notification is not on record with the Commission. Records show that call points for the fire alarm system are not tested as often as they were previously, and there are no tests recorded since 4 March. One extinguisher labelled as condemned is standing on the first floor. Records show that an emergency light had a bulb needing replacement in September 2004 but records do not support that this was dealt with promptly. The safety of residents is compromised in that supplementary heaters designed for occasional use have sometimes been in use for prolonged periods, according to notes and from staff, who when asked, were unable to confirm that the heating in rooms was always repaired promptly. The Nunnery Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 2 15 2 COMPLAINTS AND PROTECTION 1 x x 2 x x 2 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 Standard No 16 17 18 Score x x x x x x x x 2 2 2 The Nunnery Version 1.10 Page 20 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 12, 14(2), 15 Requirement The registered person must ensure that care plans and assessments are regularly reviewed with the involvement of the service user and/or their representatives. OUTSTANDING FOR MORE THAN ONE PREVIOUS INSPECTION, WITH LAST TIMESCALE FOR END DECEMBER 2004. The registered person must ensure that care plans setting out how the persons wishes in respect of health and welfare are to be met, are completed promptly on admission. The registered person must ensure that medication prescribed for service users is available in the home for administration at all times. The registered person must ensure that medication no longer required is promptly and appropriately disposed of The registered person must ensure that curtaining is adequate to protect the privacy of service users TIMESCALE OF END DECEMBER 2004 NOT MET The registered person must Version 1.10 Timescale for action 31/05/05 2. 7 15 31/05/05 3. 9 12(1), 13(1)(b), 13(2) 13(2) 07/05/05 4. 9 07/05/05 5. 10 12(4)(a) 07/05/05 6. 14 12(2) and 31/05/05 Page 21 The Nunnery 12(3) 7. 19 23(2)(b) and (d) 8. 19 13(4) 9. 22 13(4), 23(2)(n) 10. 11. 25 25 23(2) and (p) 10,12, 13(4) 12. 25 10, 12 and 13(4) 13. 36 18(2) 14. 38 23(2)(c) enable residents to make choices in day to day matters including where and what to eat. The registered person must supply the Commission with a schedule of plans for improving the decor of the home. TIMESCALE OF END FEBRUARY 2005 NOT MET. The registered person must repair or - if this is not possible replace the main dining room carpet. The registered person must complete work to provide handrails to the main corridor to assist service users with mobility difficulties. Woodwork behind the rail must be worked so as not to present risk of splinters. OUSTANDING FOR AT LAST THREE INSPECTIONS AND MOST RECENT TIMESCALE OF END JANUARY 2005 NOT MET. The registered person must arrange for servicing and prompt repair of heating when this fails. The registered person must ensure the heater guard in the corridor is fixed to prevent it falling and causing an obstruction. The registered person must ensure hot surfaces are guarded, subject to risk assessment. TIMESCALE OF END JANUARY 2005 NOT MET. The registered person must ensure that supervision of staff is carried out in accordance with National Minimum Standards. TIMESCALE OF END FEBRUARY 2005 NOT MET The registered person must provide evidence that the lift is approrpiately service and maintained and that any recommended repairs are Version 1.10 30/06/05 31/05/05 31/05/05 07/05/05 07/05/05 31/07/05 31/05/05 31/05/05 The Nunnery Page 22 attended to. 15. 16. 17. 38 37 38 10 and 13(4) 37 23(4) The registered person must 31/05/05 ensure that cleaning materials are stored safely. The registered person must 31/05/05 notify the Commission of events specified in the regulation. The registered person must 31/05/05 ensure that fire detection and emergency equipment is maintained in good condition and repairs are attended to promptly. 18. 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 7 Good Practice Recommendations The registered person should date all documentation fully, not merely with the month and year. The Nunnery Version 1.10 Page 23 Commission for Social Care Inspection 3rd Floor - Cavell House St Crispins Road Norwich NR3 1YF 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 Nunnery Version 1.10 Page 24 - 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!