Inspection on 21/09/05 for The Old Rectory Nursing Home

This inspection was carried out on 21st September 2005.

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

The inspector 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 07/06/07

The Old Rectory Nursing Home 01/02/06

The Old Rectory Nursing Home 15/03/05

The Old Rectory Nursing Home 26/10/04

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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 Church Street Armthorpe Doncaster DN3 3AD Lead Inspector Ramchand Samachetty Unannounced Inspection 21st September 2005 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 Old Rectory Nursing Home DS0000015869.V251861.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Old Rectory Nursing Home DS0000015869.V251861.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Old Rectory Nursing Home Address Church Street Armthorpe Doncaster DN3 3AD 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) 01302 832032 01302 832032 David Mitchell Mrs Gail Sharon Bullock Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places The Old Rectory Nursing Home DS0000015869.V251861.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Approval has been granted for this home to provide care for one named person under the age of 65 years. 15th March 2005 Date of last inspection Brief Description of the Service: The old Rectory is a care Home providing both nursing and personal care for up to 35 residents in the category of older people. It is privately owned by Mr. David Mitchell and managed by Mrs. Gail Bullock. The Home is situated in the village of Armthorpe, within reach of local shops, a library, pubs and other local amenities. It is well served by public transport. The Home is a two-storey building, which has been extended to provide its current accommodation. There is a passenger lift to facilitate access between the floors. There are 35 single bedrooms and 6 of them provide en-suite facilities. There are some garden areas to the front and side of the Home. There are car parking spaces at the front of the building. The Old Rectory Nursing Home DS0000015869.V251861.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out on 21 September 2005, starting at 10.00 hours and finished at 17.30 hours. The inspection included a tour of the premises, conversations with four residents, two relatives and three members of staff. The inspector checked care documentation and other records, and observed some aspects of care provision. What the service does well: What has improved since the last inspection? The training of care staff has progressed well. 75 of its care staff are now qualified to the National vocational Qualification (NVQ), level 2 in Care. Some improvements have been made to residents’ accommodation, and more refurbishment is scheduled. The kitchen facilities are currently being modernised. The Old Rectory Nursing Home DS0000015869.V251861.R01.S.doc Version 5.0 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 Old Rectory Nursing Home DS0000015869.V251861.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Old Rectory Nursing Home DS0000015869.V251861.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 and 5. Residents and their relatives are provided with adequate information about the Home and the services it provides. Prospective residents and their relatives are encouraged to visit the Home and check whether it is suitable, before making their choice of a care home. However, the Home’s statement of purpose and its service user guide need to be improved, in line with the regulations. The care needs of residents were appropriately assessed on admission to ensure that identified needs could be met. EVIDENCE: Residents who spoke to the inspector, stated that their relatives and themselves had been encouraged to visit the Home, to look at its facilities and to meet staff and other residents before deciding to move in. They felt they had enough information about the Home. A few residents spoke about the Home’s brochure, but were not aware of its statement of purpose or service user guide. One resident said ‘ my daughter came to look round. They were made welcome. They spoke to staff and other residents and found every thing all right.’ There were copies of the statement of purpose and service user guide The Old Rectory Nursing Home DS0000015869.V251861.R01.S.doc Version 5.0 Page 9 in the entrance hall. Whilst the documents spelt out the aims and objectives of the service, they fell short of clarifying what arrangements are in place to meet the range of needs of service users. These documents must therefore be amended to ensure they fully comply with the regulations. The care records of three residents were checked. They included copies of their full assessments, which were received on admission. The registered manager had also completed the Home’ s assessments, which included nutritional, social care, needs and risks factors of the residents. These assessments were shared and agreed with individual residents and their relatives. The Old Rectory Nursing Home DS0000015869.V251861.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8,and 10. Individual plans of care for residents were based on their assessed needs, to ensure that they were receiving the appropriate care and support. Actions needed to meet the identified needs were well laid out, but their implementation was poorly recorded. Care plans were appropriately developed and signed by residents or their relatives, indicating their agreement and involvement. Care staff were proactive in ensuring that the health care needs of residents were adequately addressed. Staff attitude and approach to care was based on respect for the person and this helped to safeguard and enhance the rights and dignity of individual residents. EVIDENCE: In discussions, residents commented that staff were ‘very good and caring’. Residents spoke well of their key workers and ‘named nurse’, who they felt provided them with invaluable help. Good interactions were noted between staff and residents, and this helped to maintain a relaxed and happy The Old Rectory Nursing Home DS0000015869.V251861.R01.S.doc Version 5.0 Page 11 atmosphere at the Home. Residents were offered personal care in the privacy of their own rooms or in bathrooms. It was noted that there was on-going work to fit locks to residents’ accommodation on the first floor. Residents were in good attire and this enhanced their self-confidence and dignity. A sample of care plan was checked. They addressed identified needs and contained specific action points in order for staff to address and meet these needs. Care plans were appropriately developed and shared with residents and their relatives. Relatives, who spoke to the inspector, stated that the care plans of their loved ones had been discussed with them and that they had signed them. However, care provided is not always recorded. This hindered the evaluation and reviews of care, although the latter are carried out at regular monthly interval, if not earlier. Risks faced by residents in their activities of daily living were appropriately addressed, but they were not always reviewed along with the care plans. Care records show that residents were appropriately referred to other health care professionals as necessary. These included referral to speech and language therapist, dietician and occupational therapist. Staff at the Home had good communication with the local hospitals, primary care trusts and local GPs. The Old Rectory Nursing Home DS0000015869.V251861.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Social and leisure activities are organised by the activities coordinator and other staff. Service users spoke favourably about their involvement in such activities. The Home was providing a good catering service, which appeared to meet both the nutritional needs and food preferences of residents. The kitchen facility is being refurbished in order to improve the catering service. EVIDENCE: Residents, who spoke to the inspector, stated that they were satisfied with the social and recreational activities that take place at the Home. Some residents also spoke of the choice they had in how they spend their time. Care plans addressed social care needs of individual residents. This included cultural and faith issues. Various activities are organised for the benefit of residents. One resident stated that ‘ there are always some activities going on here. If I don’t want to take part in them, I tend to go out with my family’. Care plans checked, showed that nutritional needs and food preferences, of individual residents, were assessed and catered for. Care staff also helped residents to express their food choices at meal times, and those who had difficulty with eating were offered appropriate assistance. Residents and The Old Rectory Nursing Home DS0000015869.V251861.R01.S.doc Version 5.0 Page 13 relatives, spoken to, expressed their satisfaction with the meals provided at the Home. It was noted that the kitchen was being refurbished and that all necessary measures were taken to ensure that the meals service was kept on schedule and of good quality. The Old Rectory Nursing Home DS0000015869.V251861.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Complaints and concerns from residents and relatives are appropriately managed. The home’s complaint policy is well publicised. However, the handling of records relating to the investigation of complaints must be improved. Care practices seemed to protect residents from abuse. The policy and procedures on adult protection is in line with the local multi-agency approach. Staff have been given training on implementing these procedures to ensure the protection of residents from all forms of abuse. EVIDENCE: The Home has a complaints’ procedure and it is accessible to all residents and relatives. A copy is displayed in the entrance hall. This procedure is also referred to, in the statement of purpose and the service user guide. Residents and relatives, who spoke to the inspector, stated that they could complain, if they had reason to do so. They commented that they were confident that management at the Home would address their concerns seriously. Six complaints had been made to the Home since the last inspection. Records checked showed that they were appropriately dealt with. Two complaints were partially upheld and four were not upheld. However, records of complaint investigations were kept in individual residents’ care files. The manager was advised that such records must be kept separately, in order to maintain confidentiality. The Old Rectory Nursing Home DS0000015869.V251861.R01.S.doc Version 5.0 Page 15 The policy and procedures for adult protection were checked. They were in line with guidance contained in the ‘ No Secrets’ document issued by the Department of Health. Staff confirmed that they had been given training on issues relating to adult protection. There had been no incidence of abuse at the Home. The Old Rectory Nursing Home DS0000015869.V251861.R01.S.doc Version 5.0 Page 16 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, 22, 24 and 26. The building and its surroundings were generally well maintained, thereby enhancing its appearance and facilities. The home offers a comfortable standard of accommodation. The owners are currently modernising the kitchen and equipment for food preparation. However, some repairs and replacement of floor covering are required in some areas of residents’ accommodation. Health and safety issues and internal access for wheelchair users, were not adequately addressed. Residents were therefore, potentially at risk. Good hygiene standards were maintained and this helped with the control of infection and making the Home more pleasant. EVIDENCE: The inspector, accompanied by a senior member of staff, undertook a tour of the Home. Most of the communal areas and some of the residents’ private accommodation, which were viewed (the latter with residents’ permission) were adequately decorated and appeared in good state of repair. Residents, who spoke to the inspector, stated that they were satisfied with the The Old Rectory Nursing Home DS0000015869.V251861.R01.S.doc Version 5.0 Page 17 accommodation provided at the Home. However, the wall in the dining room was found to be scratched and required some decoration. The floor coverings in a number of areas, including residents’ rooms, appeared stained and worn out. There was a lack of storage in one resident’s room and there was no wardrobe in another one. On the day of this inspection, it was noted that refurbishment work was in progress. The kitchen facility was being modernised. Every effort was taken to ensure that residents remain comfortable during the period of refurbishment. A few potential health and safety issues were identified. Water in residents’ bedrooms was at temperatures exceeding 43 degrees Celsius. A wooden ramp was left in the corridor, outside a resident’s room. The ramp was used over some steps along the corridor. It obstructed the use of the door in and out of that room. It also hindered access along the corridor in question. Advice on its use must be sought and obtained from an occupational therapist and shared with this office of the Commission. These issues were pointed out to the senior member of staff and immediate remedial action was required. The home was found to be clean and tidy. It was free from malodours. The grounds appeared tidy and were adequately maintained. The Old Rectory Nursing Home DS0000015869.V251861.R01.S.doc Version 5.0 Page 18 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, 29 and 30. The numbers and skill mix of staff appeared inadequate to meet the needs of the needs of the resident group. The latter comprised mostly of residents requiring nursing care. Additional nurse hours must be deployed at the Home, to allow for all nursing care needs to be appropriately met and for the registered manager to carry out her duties. There was a good staff team in place, and members had the skills and knowledge to fulfil their roles within the Home. The staff recruitment and selection procedures are not robust enough to protect residents. These procedures must be improved. EVIDENCE: On the day of this inspection, the manager was working as a first level nurse. The duty rota showed that she was acting as the second nurse, on several occasions when she is working at the Home. There were 31 residents who required nursing care. This included patients, who had been discharged from the local hospital, and who needed palliative care (Fast track). The deployment of staff was not based on an assessment of dependency level of the resident group. It also fell short of the requirements of the previous registering authority (Doncaster Health Authority), especially in covering for periods of staff holidays and other absences. However, the number of care assistants on duty at the time of this inspection was adequate. The Old Rectory Nursing Home DS0000015869.V251861.R01.S.doc Version 5.0 Page 19 Residents and relatives, who spoke to the inspector, stated that they found staff to be ‘committed and hard working’. About 75 of the care assistants working at the home had obtained their National Vocational Qualifications (NVQ) in Care at level 2. In discussion, staff commented that they were provided with appropriate induction and training other than their NVQ. Such training included, health and safety, moving and handling and food hygiene. New care and ancillary staff had been recruited and had started working at the Home, since the last inspection. A sample of staff files was checked. It appeared that new staff started working before references were obtained. References were not sought from last employers, where the circumstances apply. However, all other safety checks were appropriately undertaken. The Old Rectory Nursing Home DS0000015869.V251861.R01.S.doc Version 5.0 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 38. The home is well managed to ensure the wellbeing of residents. The registered manager provides good leadership and guidance to staff and this enables staff to provide good and consistent quality of care to residents. However, a few potential health and safety issues require attention, in order to enhance the overall safety of residents. A quality assurance system is in place to allow the service to get feedback and comments from residents and their representatives. EVIDENCE: Residents, relatives and staff stated that they were satisfied with the way the Home was managed. The registered manager was described as being ‘ very able, honest and professional’ She is a first level nurse with wide experience. She is currently studying for the ‘Registered Manager Care Award’. Some residents spoke about their involvement in ‘Residents’ meetings that are frequently held. This was a way to air their views on a range of issues relating The Old Rectory Nursing Home DS0000015869.V251861.R01.S.doc Version 5.0 Page 21 to life at the Home. Residents and relatives, who spoke to the inspector, commented on the customer satisfaction questionnaire that they were requested to fill in and return to the Home. They thought that it was a good way of helping the Home to further improve its services. The manager also carries out regular audits on specific issues, from time to time. The outcomes of these surveys and audits are used to improve the quality of care for the resident group. Although the Home is generally well run, there was a short fall in the management of health and safety issues. The temperature of the hot water at outlets used by residents was higher than required and that presented a potential hazard. Another issue of concern was the obstruction caused by the use of a wooden ramp and its storage in a corridor. (See standard 19-26) The Old Rectory Nursing Home DS0000015869.V251861.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X 2 X 2 X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 2 The Old Rectory Nursing Home DS0000015869.V251861.R01.S.doc Version 5.0 Page 23 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 OP1 Regulation 4, 5 Requirement Timescale for action 09/01/06 2 OP7 12, 15 3 OP16 12, 22 4 5 OP19 OP22 12, 23 12, 23 6 OP24 12, 13, The Home’s statement of purpose and service user guide must be improved to meet the regulations. Care provided to individual residents must be appropriately recorded. The management of risk must be reviewed together with the care plan, at least once a month. Records concerning the investigation of individual complaints must be kept separate from residents’ care files. Minor repairs to communal areas, as identified, must be undertaken. Advice must be sought and obtained in writing from a qualified Occupational therapist, on the use and storage of the internal wooden ramp. Such advice must be copied to this office of the Commission. 23 The temperature of hot water at all outlets used by residents must not exceed 43 degrees Celsius. DS0000015869.V251861.R01.S.doc 09/01/06 09/01/06 23/01/06 23/01/06 02/12/05 The Old Rectory Nursing Home Version 5.0 Page 24 7 8 9 OP24 OP24 OP27 12, 23 10 OP29 The floor covering in the identified resident’s room must be replaced. 12, 23 Adequate storage space and appropriate furniture must be provided in residents’ bedrooms. 12, 18 Additional nursing staff hours must be provided to meet the needs of the resident group, and to allow the registered manager adequate time to undertake her management duties. The nursing staff level must be in accordance with needs, but not lower than the previous requirement, as issued by the Doncaster Health Authority. 12, 18, 19 Two written references must be sought and obtained before staff start working at the Home. One of the references must be from a last employer, if this is applicable. 23/01/06 23/01/06 09/01/06 02/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Old Rectory Nursing Home DS0000015869.V251861.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Doncaster Area Office 1st Floor, Barclay Court Heavens Walk Doncaster Carr Doncaster DN4 5HZ 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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