Inspection on 19/07/06 for The Old Rectory Nursing Home

This inspection was carried out on 19th July 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 Old Rectory Nursing Home 26/03/10

The Old Rectory Nursing Home 21/04/09

The Old Rectory Nursing Home 04/06/07

The Old Rectory Nursing Home 27/01/06

The Old Rectory Nursing Home 12/10/05

The Old Rectory Nursing Home 07/03/05

The Old Rectory Nursing Home 17/05/04

The Old Rectory Nursing Home 30/01/04

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

CARE HOMES FOR OLDER PEOPLE The Old Rectory Nursing Home, Exeter 45 Old Tiverton Road Exeter Devon EX4 6NG Lead Inspector Ms Rachel Fleet Key Unannounced Inspection 19th July 2006 09.10 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 Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 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 Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Rectory Nursing Home, Exeter Address 45 Old Tiverton Road Exeter Devon EX4 6NG 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) 01392 431839 01392 253700 enquiries@southernhealthcare.co.uk Southern Healthcare (Wessex) Limited Care Home with Nursing 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places The Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Staffing levels to be in place as agreed in the letter dated 23 June 2003 To admit two named persons outside the categories of registration as detailed in the notice dated 28th April 2006 The maximum number of persons accommodated at the home, including the named service users, will remain at 44. On the termination of the placements of either of the named service users or on either reaching the age of 65, the registered person will notify the Commission in writing and the particulars and conditions of this registration will be amended. 27th January 2006 Date of last inspection Brief Description of the Service: The Old Rectory Nursing Home is registered to provide care for people over retirement age with general nursing needs. It is owned by Southern Healthcare (Wessex) Limited. The home is on the eastern side of the city of Exeter, in a residential area approximately one mile from the centre. The former Rectory - which dates back to 1875 - has been converted and extended for its present use but retains some original features. A health centre, Anglican church, pub and local shops are relatively close, with a bus stop opposite the home. Accommodation for 44 residents is on three floors, although most bedrooms are on ground floor level. A shaft lift and platform lift provides level access within the home. However, some wheelchair users may experience difficulty using the shaft lift because of size limits, and would therefore benefit from being accommodated within the home where use of this lift is not necessary. There are two conservatory areas overlooking well-tended gardens to the rear, including a pond and enclosed courtyard garden. There is a small area for car parking at the front of the home, with time-limited roadside parking available in the area. Mature trees screen the front of the building from the road below. Weekly fees at the time of the inspection were £481 - £700. These did not include the cost of taxis, toiletries, hairdressing and chiropody - which are charged at cost price. Inspection reports produced by the Commission (CSCI) about the home are available from the reception desk in the home’s entrance lobby. The Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. There were 43 residents at the home on the day of this unannounced inspection. Lynne Brown, Home manager, had returned a CSCI pre-inspection questionnaire. Completed CSCI surveys or comment cards were returned from five residents, three care staff (including one new staff and at least one night staff), and 12 community-based health or social care professionals. The inspectors, Dee McEvoy and Rachel Fleet, met at least 17 residents around the home, some individually and some who were sitting together. The inspection incorporated ‘case-tracking’ of five residents, including a bedbound resident and new residents. This involved looking into their care in more detail by meeting with them, checking their care records and other documentation relating to them (pre-admission assessments, medication sheets, etc.), talking with staff, and observation of care these residents received - especially where they were unable to give their views in depth. The inspectors also spoke with six visiting relatives/friends, a visiting practice nurse, eight members of the nursing, care and ancillary staff, and the manager, during the nine hours spent at the home. Other records seen included those relating to staff, residents’ personal monies, the kitchen, health and safety, and quality assurance. A tour of the building included the kitchen and laundry. The inspectors ended the visit by discussing their findings with Lynne Browne. The home has since taken action to address some of the issues raised. Information gained from all these sources and from communication with the service since the last inspection is included in this report. One concern has been raised with the Commission since the last inspection, by a community-based professional, about a delay in assistance being given to a resident needing help to eat on one occasion. The caller agreed they would contact the home directly about the matter, and nothing further has been brought to the Commission’s attention. This aspect of care was followed up routinely as part of this inspection. What the service does well: Comments from residents who were asked this question included, “They care for us well”, “The food is marvellous”, “Staff are caring, polite, respectful and good humoured”, and “Staff are kind - all very nice”. Relatives’ comments included, “My gran is so very happy, and the staff are always friendly and very helpful”, and “Staff outstanding”. Both groups commented very positively about the staff from overseas. Prospective residents’ needs are assessed well, helping ensure the home can meet the care needs of people who are admitted. The staff team has a good The Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 Page 6 level of basic knowledge and skills to ensure residents are cared for safely. Residents receive good health care, partly through input from community professionals. There is generally good promotion of dignity and respect for residents, staff giving them choice and control where possible. Contact with residents’ families, friends and the community around the home is enabled, helping residents to benefit from supportive and interesting relationships. The manager has the knowledge and skills to ensure the home is run well, and runs it in the best interests of the residents. She is currently looking into provision of meals – arrangements are generally satisfactory, but some individuals’ preferences and needs could be better catered for. Residents and other stakeholders feel complaints are received well, and will be used to improve the service residents receive. Various policies and practices are used to try to protect residents from abuse, including good recruitment procedures. Residents enjoy good, clean, well-maintained accommodation with access to pleasant outdoor areas. What has improved since the last inspection? What they could do better: Comments from residents who were asked this question included about staffing - “Staffing levels in the afternoons and on Sundays”, “Staff to have more time to spend with us”, “Staff to have time to help with physio or mobility, to keep me going”; the food - “Could be better - it’s not like home cooked”; about activities – “Not much to do here”; and the laundry service. More detail in some care plans would help to prevent inconsistencies in care given, and reduce risks that some residents may not receive the care they need. Record-keeping in relation to medication management must be The Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 Page 7 improved, to avoid risks to residents’ welfare; some action has been taken since the inspection, to address this. Recreational opportunities should be more suited to residents’ needs, preferences and capacities, to promote individual residents’ quality of life. The new manager is looking into this as a priority, following consultation with the residents. Additional measures must be established to fully protect residents’ financial interests, where the home looks after residents’ personal monies for them. Some action has already been taken since the inspection to achieve this. There is adequate attention to health and safety matters, but some additional measures must be taken to further protect residents and staff; action has been taken since the inspection to address a fire safety matter. The laundry area should be improved to provide appropriate facilities and working conditions, with benefits for staff who work there and for residents. Staffing arrangements should be improved so as to ensure residents’ needs are met, or met in a timely way. Some staff and residents would benefit if all staff had training on caring for people with various communication difficulties. The manager has many relevant skills, but should be registered with the Commission to confirm they are fit to be in charge of this particular home. The registered provider must carry out regular required monitoring, to ensure residents are continuing to receive an appropriate service from the home. Staff suggestions as to what the home could do better included having more hoists, although another staff felt this reflected that some staff wanted more of the ‘popular’ models rather than using what was available; more study days, especially to achieve a certain care qualification; and for the contribution made by night staff to be recognised by other staff. 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 Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 Page 8 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 Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 Page 9 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): 3 (The home does not offer intermediate care). Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service Good systems are in place to ensure prospective residents’ needs are sufficiently assessed to promote success of any admission to the home. EVIDENCE: Surveys from residents said they had been able to get enough information about the home before moving in, so they could decide if it was right for them, in view of their needs. Some residents spoken with had known about the home prior to moving in; all were happy with the admission process, as were relatives, who added the admissions process was handled ‘sensitively’. The home uses a comprehensive assessment format, which covers the activities of daily living and highlights areas of assistance needed by residents. These were completed with sufficient detail to inform staff of residents’ needs, where seen. It was noted that sections relating to ‘hearing’ and social needs were sometimes less fully detailed than other areas, but it was not always felt to be appropriate to discuss social needs (interests, etc.) when visiting someone hospitalised because of poor health. The Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 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 - 10 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. There are adequate systems in place for informing staff about residents’ care needs, although lack of detail in some care plans may lead to inconsistencies in care and a risk that some residents may not receive all the care they need. Multidisciplinary working ensures residents receive good health care. Aspects of record-keeping regarding medication are sufficiently poor so as to put residents’ welfare at risk. There is good respect for residents, with promotion of their privacy and dignity. EVIDENCE: Residents have individualised care plans, with good detail on how to meet residents’ general physical needs. One had been much improved in all areas since the last inspection, informing staff much more fully about the resident’s needs in the light of their particular disability. However, other care plans lacked information about how residents’ social, cultural and spiritual needs, including final wishes, could be met. For example, where one care plan stated The Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 Page 11 that the resident was at risk of isolation, there was no clear guidance for staff to ensure this resident was not isolated. A lack of personal preferences in some care plans (such as food, drinks, activities and bed times) may indicate that residents are not meaningfully involved in care planning. Some residents did not recall discussing their care plan with staff, but relatives had signed some care plans. One care plan had not been reviewed regularly or recently to ensure that any changing needs were addressed; another had ‘reviews’ that did not evaluating the success, or otherwise, of care. On occasion, information from risk assessments for nutrition, pressure damage, etc. was not used to develop a relevant care plan. Daily notes reflected care given, the residents’ health, appetite and general mood. But occasionally, information recorded was not then used to inform care plans – for example, where residents had said they liked to get up early or were bored, this was not then addressed in the care plan. There was little evidence that social needs were addressed or met. Residents spoken with were happy with the care they received, commenting, “The staff are always happy to help”, “All staff are lovely”, and “We are well cared for”. This was reflected by relatives, who praised staff for the care and support provided. One said, “Staff work over and above the call of duty to ensure that people are happy and well cared for”. A recent health review for one resident showed that a steady improvement since admission to the home. A visiting practice nurse was “impressed” by the level of care at the home. The inspector was told, “ Staff are aware of residents’ needs”, that good information was available about residents’ needs, with good communication between the home and the surgery. Residents’ surveys said they always got the medical support they needed. Arrangements are in place to enable residents to get regular eye checks, dental care, chiropody, etc. The care and monitoring for one diabetic resident was good, with nursing staff demonstrating good understanding of the resident’s individual needs. It was a hot day, but staff appeared to help vulnerable residents to take enough fluids. Residents in bed appeared well cared for and looked comfortable; staff visited regularly, giving drinks and ensuring position changes. Diet intake is recorded for the most vulnerable residents to ensure they receive adequate nutrition, although weights were not always monitored regularly. Proper storage has been obtained for controlled drugs, and these stocks were well managed. However, handwritten entries had not been signed by two staff or dated, on some medication administration charts, as is good practice. Some gaps on charts suggested medicines had not been given; but there was no explanation given elsewhere as to why they were not given. Insulin doses had not always been given as prescribed in writing. Staff explained that verbal instructions had been given by the GP to allow for variation in the dose. But no written instructions had been obtained, to ensure information was accurate and up to date. Allergies had not always been noted on medication sheets, to inform staff and promote residents’ safety. Some medication requiring refrigeration was not being stored at the right temperature according to daily records kept, which could affect its effectiveness, but staff had not identified The Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 Page 12 this as an issue needing action. One resident had declined to take some medication for some days; it was not evident from records that this had been discussed with the GP to try to ensure the resident’s wellbeing in such circumstances, although the manager said this had been done. Records relating to subcutaneous fluid given to one resident were not clearly kept, to inform correctly about their fluid intake. The manager has since reported that some of these issues have been rectified. Community-based professionals said they were able to see residents in private. Residents spoken with said they were treated well by staff, and that their privacy and dignity was respected, as was observed during the inspection. Locks have been fitted to shared toilets since the last inspection, promoting privacy. One staff member was seen to diffuse a difficult situation with a resident in a calm and pleasant way. However, some residents without a callbell to hand in one lounge waited some time whilst wanting help, and became distressed, having to raise their hands to get attention. The staff, to their credit, acted in a sensitive way to meet individual needs once alerted by the inspector. The manager says she has since allocated staff to visit the lounge more regularly to check on residents’ wellbeing, to avoid situations that affect their dignity and welfare. The Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 Page 13 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 - 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. There is adequate provision for social fulfilment, with a need for more specific recreational opportunities suited to residents’ needs and capacities, to promote individual residents’ quality of life. There is good support to maintain links with residents’ families, friends and the community around the home, helping to ensure residents benefit from supportive and interesting relationships. There are good practices to promote residents’ choice and control in their lives where possible. Residents benefit from generally good catering arrangements, although a planned review will improve meals further with regard to individual preferences. EVIDENCE: On the day of the inspection, three residents were enjoying sitting in the gardens; a communion service was held at the home; an aromatherapist visited some individuals; an exercise class was planned, but did not take place. The Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 Page 14 An outing had recently been organised for some residents to visit a local church flower show, which was much enjoyed. Some residents said they were not generally interested in the activities provided; two surveys said the resident was unable to participate or could only ‘sometimes’, and another said their deafness reduced their enjoyment. Others said that there wasn’t much ‘going on’ to keep their interest, regarding activities. Seven residents were sitting in the lounge for long periods of time with little stimulation, staff contact or diversion except for the TV. There is no dedicated activities staff team. A resident said visitors were always offered a cup of tea. All visitors spoken with said they were always welcome at the home; comments included, “It is like one big family here”, and, “There is always a lovely welcome”. One said they could always get help from staff when they wanted it. Another said that when they joined their relative for lunch, the home took great care to provide them with a private and pleasant dining space. The pre-inspection questionnaire indicated there are occasional outings to the seaside, local pubs, shops, etc., as well as links with local churches. Some activities at the home are lead by organisations or individuals from the local area. Residents’ bedrooms are personalised with their own possessions. Staff only act as appointee for residents who have no other support, therefore most residents choose who assists them with their affairs. The manager has begun consulting residents about aspects of home life, to get their views on how things might be improved. Staff were seen to work respectfully in partnership with residents during the inspection. A resident confirmed they had been involved in recent discussions with senior staff about the food; the manager said this is still ongoing, having already identified meals as an area for some improvement. Most residents’ views of the food ranged from ‘very good’ to ‘adequate’. Residents’ surveys said they always or usually enjoyed the meals, apart from one who said, “Rarely.” Some residents were not aware of any choice at mealtimes but one told the inspector, “Staff are very obliging”. Menus seen looked balanced and varied. Some residents chose to take their meals in their bedroom rather than the dining room, and were enabled to do so. Lunchtimes can present difficulties, as several residents require assistance; one resident’s meal was in front of them for 15 minutes before staff could assist them (addressed in Standard 27). The mealtime observed was otherwise a pleasant occasion. The Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Positive relationships within the home ensure that residents and other stakeholders feel they get a good response to their concerns and complaints. There are good safeguarding policies and practices in use, to try to protect residents from abuse. EVIDENCE: Residents’ surveys said they always or usually knew who to speak to if they weren’t happy - one saying they were able to sort out odd complaints amicably. Residents spoken with knew who to speak with should they have any concerns, complaints or problems. One said, “I would have no hesitation in letting them know if I were not satisfied”. Staff were seen as approachable, with residents and relatives confident that their concerns would be listened to and acted upon. This included a relative who had recently spoken with the new manager about various issues. No one who returned a survey wished to speak to an inspector, and no formal complaints were made during the inspection. Residents spoken with felt well treated, describing staff as “ friendly”, “kind” and “happy”. Residents’ surveys said most had received contracts, which protects their rights. Staff confirmed that they had received adult protection training, and all were aware of their personal responsibility to report any concerns. Use of potential restraints such as bedrails and wheelchair lapbelts is The Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 Page 16 thought through, and recorded if to be used, to ensure residents’ longer-term welfare. The Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 Page 17 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents enjoy a good standard of accommodation that is well maintained. Areas used by residents are clean and pleasant, but adequacy of laundry facilities should be improved to ensure appropriate standards of hygiene in all parts of the home. EVIDENCE: All residents spoken with were happy with their bedrooms and the general environment. Décor is of a good standard. One wheelchair user, who had to move to the home in a hurry and therefore took the only vacant room, did not leave their room much because of difficulties accessing the lift in their wheelchair; however, they have been promised a more suitable bedroom when one is available. There are several pleasant communal areas around the home which residents enjoy using, and some residents described the well-kept gardens as “beautiful”. The home is generally well maintained inside and out, The Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 Page 18 with a full time maintenance person employed. A window restrictor was broken on the first floor, and a toilet door lock was also broken, which he was unaware of. The manager confirmed a maintenance log would be brought back into use, to ensure such issues are made known and addressed promptly in future. A small team of cleaners work hard to ensure the home is clean; on the day of the inspection the home was clean and generally free from odours, including sluice areas. Residents confirmed this was always or usually so. Although protective clothing such as aprons and gloves are available, some staff felt they were not always freely available in bathrooms or residents’ bedrooms to ensure infection control was well managed. The manager thought this was due to a misunderstanding about recent guidance for staff, and a training session has since been held on appropriate use of gloves. The laundry is cramped and staff cannot access hand-washing facilities readily. It was very hot on the day of the inspection, presenting a very unpleasant environment for staff. The manager has since written to say action is being taken to ensure access to handwashing facilities and to maintain appropriate temperatures. One resident told the inspector the one improvement they would like to see was with the personal laundry service - several items of their clothing had been lost. The manager is trying to address this problem. The Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 Page 19 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 - 30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Staffing is adequate to meet residents’ needs much of the time. However, there are inadequate arrangements to ensure their needs are met at all times. The staff team has a good level of basic knowledge and skills to guide practice and ensure residents’ safety. Residents are protected by the home’s good recruitment policies and practices. Training and support for staff is adequate, but some residents would benefit if all staff had up-to-date knowledge and skills needed for caring for people with disabilities that affect communication. EVIDENCE: Residents and relatives spoke highly of the staff team, including those from overseas in their praise. Comments included, “The staff are lovely”, “Staff are superb” and “Staff are very kind”. Residents’ surveys said staff listened and acted on what the resident said, and were always or usually available when residents needed them. One commented there was an “excellent rapport.” But there was evidence that staff had insufficient time to meet residents’ social care needs (see standard 12). And one resident said, “I need help with my physio exercises to keep mobile” - the only improvement they wanted was for The Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 Page 20 staff to have time to assist with maintaining their mobility. Some staff wanted more one-to-one time with residents to chat, visit the garden and so on. Lunchtime was particularly demanding of staff time (see standard 15). And difficulty getting staff attention on one occasion during the inspection affected some residents’ dignity (see Standard 10). One staff had concerns about some night staff getting residents up too early because of work pressures; but other staff spoken with did not think this occurred unless the resident wished to get up early, with one saying they were then also offered a cup of tea. Residents’ surveys said they usually or always received the care and support they needed. It was good to see that over half of the other care staff have a Care NVQ2 or higher; some have professional healthcare-related qualifications obtained in their country of origin. Staff rotas confirm there are always registered general nurses on duty, in charge of care. Residents said staff generally appeared to know what they were doing, and what help they, the resident, needed. Staff who were asked about certain residents knew their needs. Staff surveys showed appropriate recruitment procedures were followed. Of four staff files randomly selected and checked, two had all required information; one was complete except for having only one reference not two, and a fourth had no evidence of a police check. The home has since evidenced that these had been obtained although they were not yet in the staff files. This matter is now being addressed, to ensure all information is available for inspection in future. The majority of community-based professionals said staff demonstrated a clear understanding of residents’ needs; none were dissatisfied with care overall. A resident confirmed new staff worked with other staff initially, ensuring residents were still cared for by someone who knew their needs well. All staff spoken with enjoyed their job, and morale was generally very good. Staff said training undertaken at the home included mandatory training (refer to standard 38), adult protection, and weekly sessions given by the manager on care issues such as personal care and assisting residents with meals. Someone commented on poor deaf-awareness skills of staff, in relation to care of their relative who was resident at the home. A resident with very poor sight said only some staff told them where they’d put things on the resident’s table (food, medication, etc.), and they wished staff would stay a little longer before leaving. Staff training records showed only a very few had received any training on communication. Staff spoken with were very happy with support and training provided, one saying, “We work as a team”. Two of three staff surveys said they had not had formal supervision, although one of these said this was being addressed shortly. Such sessions give the opportunity for staff to discuss their individual training needs, etc. The Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 Page 21 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, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The manager has adequate knowledge and skills to ensure the home is run well, but is yet to be registered with the Commission to confirm they are fit to be in charge of this particular home. There are many strategies in place to help ensure the home is adequately run in the best interests of the residents, although the registered provider must support this by carrying out regular required monitoring. Adequate systems and practices are used by the home to safeguard residents’ financial affairs, but additional measures must be established to fully protect residents’ interests. There is adequate attention to health and safety matters, but additional measures could be taken to further protect residents and staff. The Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 Page 22 EVIDENCE: Lynne Brown has been manager at the home for three months, but is not registered with the Commission. She is a Registered Mental Nurse who has a recognised management qualification. She confirmed she had a full induction when she commenced employment, as well as updates on some health and safety topics and safeguarding. She appeared to know the home and its residents well. Two community-based professionals commented on recent improvements in the management of the home. All staff spoken with felt that the new manager had settled well and provided them with good direction and support; one said, “She is excellent, very supportive”. Residents spoken with also described the manager as ‘excellent’. One said, “She tries to visit us every day. She is wonderful”. Relatives were confident in the manager’s ability and said she was ‘approachable’ and easy to talk to. There is a quality assurance system to ensure that residents’ views and wishes are sought and listened to. The home is currently completing a food and dining satisfaction survey (seen with a number of residents), and is planning to explore residents’ social needs and preferences with an activities questionnaire. A general satisfaction survey has been completed and results will be shared with residents when collated. A suggestion box is available, and one resident said she would be confident that any suggestions would be ‘taken on board’ by the home. Residents’ meetings are held. The registered provider has not been carrying out monthly unannounced inspections of the home as required by regulation, which would ensure the home’s service continues to be developed safely and appropriately. The administrator looks after money held for residents by the home. Appropriate systems are in place to record money handed to the home and any expenditure of this money, but it was found there were occasional errors in addition, absence of a receipt or a second signature. The home acts as appointee for a very small number of residents. Their monies were paid into the home’s business bank account, which is not good practice. New accounts are now being set up solely for these residents’ monies, to ensure it is safeguarded. Health and safety is generally well maintained. Staff had received mandatory training such as manual handling, infection control and fire safety. However, two of three staff surveys said they had not been told how to contact the manager or owner in an emergency. To ensure that fire safety is promoted, weekly fire safety checks are undertaken as well as regular fire safety training and drills, to ensure that all staff are aware of the necessary procedures. An immediate requirement was issued regarding the inappropriate practice of wedging fire doors open – something identified on the last inspection; a more appropriate door holder has since been fitted, to ensure residents’ safety should a fire occur. A record is kept of maintenance for equipment such as The Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 Page 23 wheelchairs and bedrails, to ensure safety is promoted, and the manager confirmed window restrictors would also now be checked regularly in view of the broken one found during the inspection. The electrical periodic test was up to date; portable appliance testing had not been carried out for over a year, but a related risk assessment has been carried out. Staff, to avoid scalding residents, record bath water temperature; this was usually around 37 – 38°c, which could be rather cool for bathing. This was discussed with the maintenance man and manager. The kitchen is well organised and staff felt that they had the necessary equipment. Foods are generally stored correctly, with the exception of a few items in the freezer, which had not be labelled or dated; regular fridge and freezer temperatures are kept. The manager was not aware of new food safety legislation, but was going to look into this before revising the home’s food safety policy. The Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 Page 24 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 1 The Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 Page 25 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) Requirement You must make arrangements for the safekeeping & safe administration of medicines received into the care home. This is especially regarding: Safekeeping of medication by following manufacturers’ instructions, especially regarding storage temperatures, timescale for use after opening, etc.; Safe administration, including: That for all hand written entries on the Medication Administration Record (MAR) Charts, the person making the entry dates & signs it, & this is then checked and signed by a second person; signing for medication & prescribed fluids when administered, or clarifying why prescribed medication has not been given; Noting allergies on medication sheets; Ensuring ongoing omission of prescribed medication is discussed with the resident’s GP The Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 Page 26 Timescale for action 31/08/06 2. OP33 26(2)-(5) and appropriate records kept of the outcome; That verbal instruction from GPs in relation to medication are accepted & recorded in accordance with current professional guidance (e.g. Royal Pharmaceutical Society & Nursing & Midwifery Council). (2) Where the registered provider is an organisation or partnership, the care home shall be visited in accordance with this regulation by (a) the responsible individual or one of the partners, as the case may be; (b) another of the directors or other persons responsible for the management of the organisation or partnership; or (c) an employee of the organisation or the partnership who is not directly concerned with the conduct of the care home. (3) Visits under paragraph (1) or (2) shall take place at least once a month and shall be unannounced. (4) The person carrying out the visit shall (a) interview, with their consent and in private, such of the service users and their representatives and persons working at the care home as appears necessary in order to form an opinion of the standard of care provided in the care home; (b) inspect the premises of the care home, its record of events and records of any complaints; and (c) prepare a written report on the conduct of the care home. (5) The registered provider shall supply a copy of the report required to be made under paragraph (4)(c) to (a) the Commission; (b) the registered DS0000026674.V293680.R01.S.doc 30/09/06 The Old Rectory Nursing Home, Exeter Version 5.2 Page 27 manager; and (c) in the case of a visit under paragraph (2) - (i) where the registered provider is an organisation, to each of the directors or other persons responsible for the management of the organisation. 3. OP35 20 (1) The registered person shall not pay money belonging to any service user into a bank account unless (a) the account is in the name of the service user(s) to which the money belongs; and (b) the account is not used by the registered person in connection with the carrying on or management of the care home. (2) Paragraph (1) does not apply to money paid to the registered person in respect of charges payable by a service user for accommodation or other services provided by the registered person at the care home. You must, after consultation with the local fire authority, make adequate arrangements for containing fires. This is regarding inappropriate devices used for holding doors open. Previous timescale of 27/02/06 not met. Immediate requirement issued at inspection & met within 28 days. 30/09/06 4. OP38 23(4) 17/08/06 The Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 Page 28 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 It is recommended that all care plans 1) Include social & personal care needs (preferences, etc.); 2) Are reviewed regularly to ensure that changing needs are met, using information from risk assessments & daily notes to inform care planning; 3) Contain adequate detail to ensure that staff know what action to take to meet residents’ needs. It is recommended that service users’ interests are recorded & they are given opportunities for stimulation through leisure and recreational activities which suit their needs, preferences and capacities; and particular consideration is given to people with sensory impairments & physical disabilities. It is recommended that hand-washing facilities should be prominently sited in the laundry. You should, with regard to the size of the home, the number & needs of the residents, ensure that at all times suitably experienced persons are working at the care home in such numbers as are appropriate for the welfare of residents. This is especially with regard to activities & recreational needs, maintaining residents’ dignity, timely assistance with meals and other care. You should ensure staff are trained and competent to do their jobs, with regard to caring for people with sensory impairment or various communication difficulties. You should submit an application to register a manager as soon as possible, to confirm they are fit to be in charge of this particular home. It is recommended that the laundry area should be reviewed to ensure appropriate working conditions, to promote the health, safety and welfare of staff. 2. OP12 3. 4. OP26 OP27 5. 6. 7. OP30 OP31 OP38 The Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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 Old Rectory Nursing Home, Exeter DS0000026674.V293680.R01.S.doc Version 5.2 Page 30 - 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. 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