Inspection on 11/03/08 for The Polegate Nursing Home

This inspection was carried out on 11th March 2008.

CSCI found this care home to be providing an Good service.

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 Polegate Nursing Home 04/07/06

The Polegate Nursing Home 09/02/06

The Polegate Nursing Home 28/09/05

The Polegate Nursing Home 20/12/04

The Polegate Nursing Home 11/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE The Polegate Nursing Home The Polegate Nursing Home Blackpath Road Polegate Eastbourne East Sussex BN26 5AP Lead Inspector Debbie Calveley Unannounced Inspection 08:30 11 March 2008 th 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 Polegate Nursing Home DS0000014027.V360689.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 Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Polegate Nursing Home Address The Polegate Nursing Home Blackpath Road Polegate Eastbourne East Sussex BN26 5AP 01323-485888 01323 484011 meyersja@bupa.com www.bupa.co.uk BUPA Care Homes (ANS) Ltd 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) Mrs Jacqueline Taylor Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That the maximum number of service users to be accommodated is forty-four (44). To care for chronically ill service users under the age of sixty-five (65) years under the continuing care criteria. To care for chronically ill service users over the age of sixty-five (65) years under the continuing care criteria. 4th July 2006 Date of last inspection Brief Description of the Service: The Polegate Nursing Home was purpose built in May 1996 and accommodates up to forty-four service users with continuing care needs under the Health Authority’s eligibility criteria. The home is registered to provide care for service users falling in to the category of older people and those with a physical disability. The home was purpose built to provide single bedrooms with ensuite facilities to heavily dependent service users with a need for continuity of care from hospital. The resident’s accommodation is on two floors; each of these floors is provided with a large lounge. The lower floor has a dining room, which caters for all residents, and most group activities are held in this room. All areas of the home are assessable to service users, the corridors are wide enough to accommodate self-propelled / electric wheelchairs and the lifts are spacious. The rooms are spacious to allow room for hoists and other specialist equipment whilst maintaining a homely and comfortable environment. The décor of the home is pleasant, simple and well maintained and the furniture is of a good quality. There is a garden area with a patio that is accessible to service users in wheelchairs. There are suitable toilet, bathing and washing facilities provided to meet the needs of the service users, all with equipment designed for less abled persons. There are car-parking facilities to the rear of the property for approximately 25 cars. The home is in the centre of Polegate village, close to the shops, railway station and major bus routes. The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 5 Copies of inspection reports and the homes Statement of Purpose are made available on request. Fees charged as from 1 April 2006 range from £575 to £749, which does not include toiletries. Additional charges are made for hairdressing, chiropody, newspapers and outside activities such as visits to the theatre. Intermediate care is not provided. The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at The Polegate Nursing Home will be referred to as ‘residents’. This was a key inspection that included an unannounced visit to the home and follow up contact with resident’s representatives and visiting health and social care professionals. This unannounced inspection was carried out over 6.5 hours on the 11th March 2008. There were 43 residents living in the home on the day, of which five were case tracked and spoken with. During the tour of the premises ten other residents both male and female were also spoken with. The purpose of the inspection was to check that the requirement of the last inspection had been met and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. Four members of care staff and the chef were spoken with in addition to discussion with the manager, administrator and deputy manager. Telephone contact was made with visiting professionals following the visit and four relatives were spoken with during the inspection visit. The information received verbally has been incorporated into this report. An Annual Quality Assurance Assessment was received completed in full during the inspection process of this key inspection. The inspector would like to thank the residents and staff for their welcome and hospitality. What the service does well: There is a combined Statement of Purpose and Service Users Guide that gives prospective residents the information required to enable them to make an informed choice about where they live. Residents confirmed that they were visited by the Manager prior to admission to the home and two stated they had been invited to visit the home to see if they liked it enough to live there. The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 7 The menus evidence a well thought out balanced diet with a varied choice of food in line with resident’s preferences. Feedback regarding the meals provided include ‘excellent food’ ‘ the chef visits everyday’ Quality assurance systems are in place, which enables the service to monitor and improve their service. There is an open-house policy, which welcomes visitors at all reasonable times. Satisfactory arrangements are in place to safeguard residents’ finances. The atmosphere of the home is pleasant with good interaction seen between residents and staff. The Comments received from residents and families regarding the care received included: ‘ Staff efficient and polite ’ ‘ there has to be a bit of give and take on both sides’ ‘ She receives excellent nursing care and care workers are kind, considerate and supportive of her every need’ There is a robust recruitment process in place to protect the residents. The home provides a clean, safe and well-maintained environment, which is appreciated by the residents and their relatives. Comments regarding The Polegate Nursing Home were generally positive and included: ‘I have been here for a long time and like it’ ‘ I haven’t been here long, but its quiet and peaceful, I am comfortable’. What has improved since the last inspection? What they could do better: There were shortfalls found in the care plans and risk assessments, these were discussed and were to be rectified, therfore a requirement was not made at this time. The activity programme still needs to be reviewed to reflect the differing needs of the residents living in the home. The residents would benefit from a more stimulating environment in the lounge areas and for those residents that are The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 8 unable to leave their bedrooms to encourage residents to interact and prevent isolation. All residents need to have access to a call bell or a system for staff to follow in supervising the lounge areas to ensure that residents are safe and comfortable. From direct observation poor infection control measures were noted and included poor practice in the use of gloves and aprons whilst performing personal care and equipment that is unsuitable for use due to cross contamination risks. 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 summary of this inspection report can be made available in other formats on request. The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 9 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 Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides prospective residents and relatives with a good level of information about the home, its facilities, services and the costs involved. The admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission, thus ensuring the admission is appropriate. EVIDENCE: There is a range of well-documented information about the home and the services it provides. The home has a combined statement of purpose and service users guide and a copy of this is available along with the last inspection report and a copy of the homes terms and conditions of residency in the front entrance area. Relatives and relatives spoken to were clear on the service provided by the home and costs involved. The registration certificate is clearly displayed and was found to be accurate. The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 11 The last five admissions to the home were identified and the records relating to the admission procedures followed were reviewed. This confirmed that pre admission assessments are completed and provide an assessment of prospective residents care needs. These are completed by the manager at this time and discussion with the manager confirmed that these are used to ensure new admissions to the home are appropriate and that the home have the staff, equipment and environment to meet their care needs. Since the last key inspection July 2006, a new care planning system including the pre-admission has been introduced. The documentation format is comprehensive, but not all were completed in a consistent manner, but as staff become familiar with the documentation this will improve. Prospective residents’ are seen either in their home or hospital before admission and the input from relatives and other professionals is used whenever possible. This approach should be more clearly recorded on the assessment documentation to demonstrate the procedure followed. Social care professionals spoken to confirm that pre admission assessments are always completed and that these were completed promptly and efficiently. The home does not provide intermediate care. The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans provide a good framework for the delivery of care, which give adequate guidance to care staff on the care needs of all the residents. Procedures and practices in the home allow for the safe administration of medicines and on the whole the privacy and dignity of residents to be promoted. EVIDENCE: The care documentation pertaining to five residents was reviewed as part of the inspection process. A new care plan system has been introduced since the last key inspection, and these were found to include a comprehensive assessment tool of residents’ needs that identifies when a care plan is to be devised. The residents’ medical and nursing needs are recorded in these care plans in sufficient detail to enable the staff to offer appropriate care and support. The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 13 The specific needs of residents were identified and staff were able to discuss how these are met and what additional support may be required, including hoists and pressure relieving mattresses. The care plans are reviewed on a regular basis, however there was little evidence that residents and relatives are involved in this process. The residents’ spoken with expressed that they would like to be more involved in their care planning. The inconsistencies found in the care plans were discussed with the deputy manager, who concurred there are still shortfalls and stated that regular audits of the care plans are undertaken by the manager, and from talking to staff they are finding it difficult to spend the time to fully understand and complete the documentation due to time constraints and lack of staff. As care plans are being monitored and audited this will not be a requirement at this key inspection, but will be reviewed at the next key inspection. Risk assessments are carried out and these include moving and handling and nutritional assessments linked with the monthly weights. It was noted that the use of risk assessment was very limited; for example ‘bed rails’ were in use without an appropriate risk assessment or the risk assessment was not being followed and the use of call bells are not documented. Those risk assessment completed for nutritional screening, wound care, falls and moving and handling need to be based on clear criteria and followed up within the care documentation. This was also discussed with the deputy manager. Further training and workshops would benefit the staff in their documentation. Records indicated that local Doctors are called regularly and it was confirmed that specialist external advice is sought as necessary and included the dietician, physiotherapist and tissue viability nurse. The clinical rooms were clean and tidy and the equipment well maintained. There are policies and procedures in place for the storing, administrating, disposal and receipt of medication. The temperature of the fridge and room are recorded daily and of an acceptable temperature to maintain dressings and medications. The medication administration charts were viewed and were seen to be correctly completed. A self-administering policy is in place, and residents are encouraged and supported to administer their medication with a risk assessment framework. From direct observation during the site visit the residents were seen to be treated with respect and dignity, however there was concern raised from residents that due to staff shortages that their personal hygiene needs were The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 14 not being met consistently and thus impacting on some residents overall well being. This is an area that needs to be monitored by the staff to ensure that all residents are receiving the care that they wish. The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The lifestyle experience by residents at this time does not always match their expectations, choice or preferences. Meals remain good in respect of both quality and variety that meets the majority of residents’ tastes and choice. EVIDENCE: Activities take place on a daily basis, Monday to Friday, in the mornings there is an open coffee morning, which is popular with certain residents. A motivation class was also being held on the day the inspection took place where six residents took part. A monthly programme is given to all residents individually as well as being displayed on notice boards around the home. Activities offered were visiting music entertainers, bingo and a shopping trolley, where residents can buy personal items. Feedback regarding the activities from staff, residents and visitors was not positive regarding the activity provision in the home, comments included ‘ activities are only for the The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 16 chosen ones’ ‘ I don’t see anyone apart from if I need a nurse’ ‘ activities are not provided for those that are not able to communicate easily’ ‘ I do get bored’, positive comments included ‘the entertainers are good’ ‘ we get to meet up everyday’. As previously mentioned, the care plans at this time do not evidence all the residents past histories and social preferences, and therefore are not linked constructively to an activity programme. There is little documented in respect of social stimulation for the more dependant and frail residents, one resident in particular is very isolated and restricted to her bed due to her medical condition and was unable to see above her bed rails, this was discussed during the inspection with senior staff. Activities should be an important part of life to the residents of the home, as there are some independent people living there and therefore it is identified as an area that requires development to meet all the residents’ social needs. Residents are facilitated to maintain their independence for as long as they are able. There are no restrictions on visiting times as long as consideration is shown to all the residents. Residents spoken with confirmed that their choices are considered when meals and drinks are concerned, but did not fell that their input was considered in respect to bathing and getting up and going to bed. This is the opinion of residents that are unable to manage themselves and rely on the staff for moving and bathing. There are communal areas throughout the home that are available to residents and their visitors for private meetings if required. Many of the residents have individualised their bedroom with items from home and residents and relatives spoken with confirmed that they are encouraged to make it homely. It was observed during the inspection that the routines at the home are flexible, residents spoken with confirmed that they were consulted about all aspects of their lives. The home has an advocacy policy in place and the information regarding this is available to all residents. There is a good sized dining area on the lower floor, that can accommodate approximately up to 24 residents but from direct observation only six residents take their meals in there, whilst the rest eat in their bedrooms or lounge areas. The chef visits residents daily to check their wishes and this is appreciated by the residents. The menus are well thought out and demonstrate a well balanced, varied and nutritious diet. The meals provided for residents were The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 17 seen to be nutritious and attractively presented, including the pureed meal; fresh fruit and vegetables are readily available. The chef serves the meals from a hot trolley in a servery and monitors portions and eating trends. The residents comments included, ‘the food is very good’, ‘we get a good variety’, ‘its really very good’. Resident’s visitors are able to have a meal for a small charge. The home have introduced ‘ nite bite’ which allows residents to eat whenever they feel hungry. There is no daily record kept of resident’s food consumption. The home staff use a nutritional assessment tool to identify any residents with special dietary needs, including monthly weights, however as discussed during the site visit an action plan needs to be in place for those whom have been identified as at nutritional risk. The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a formal complaints system with evidence that residents feel that their views are listened to and acted upon. Staff receive training to protect residents from abuse. EVIDENCE: There are up to date complaint policies and procedures in place and it was confirmed that these are followed when investigating any concerns raised at the home. The complaint book was viewed and this demonstrated that all complaints are recorded, along with the outcome and action taken by the senior management to resolve the complaint. One complaint was seen recorded since the last inspection and there was evidence of the investigation and outcome. The staff interviewed were aware of the complaint procedure and of how to start the process if the manager is not available. Two residents spoken with were not aware of how to raise a concern and were given the homes comment cards to complete during the site visit. One resident said she would talk to the nurse in charge if she had a problem. There has been one complaint received by the CSCI, which was investigated by the organisation and closed. The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 19 The safeguarding vulnerable adults policy in the home was found to be up to date and staff interviewed were knowledgeable about the systems in place to protect vulnerable residents. There is on-going training for all staff in safeguarding vulnerable adults. The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable, clean and safe environment for those living there and visiting. Residents and their families are enabled and encouraged to personalise their room, and rooms are homely and reflect the resident’s personalities and interests. EVIDENCE: A tour of the premises was carried out and all parts of the home are well maintained and the décor is of a good standard. The home was purpose built and all bedrooms have an ensuite bathroom. The residents are encouraged and enabled to personalise their rooms with furniture and pictures, and this was evident during the tour. All personal items The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 21 are listed in the individual care plans. The staff need to ensure that residents bedrooms are not used for general storage. The accommodation for residents is on two floors with level access to the garden on both floors. Each of these floors is provided with a large lounge. The lower floor has a dining room with an adjoining small kitchen, which caters for all residents at lunchtime. Most group activities are held in this room. As found at the last inspection the lounge area on the first floor was found to be crowded with too many lounge chairs around the perimeter, so the residents are found in rows in their wheelchairs with the television as the focus point. It was not found to be a stimulating environment for the residents. it was found that the more mobile and able residents admitted not to using the lounge and preferred to stay in their room. This is an area the staff need to work on and develop so that all the residents benefit from the lounge areas and are not isolated in their rooms. The home follows a no smoking policy and suitable arrangements are made for the residents wishing to smoke. There are suitable toilet, bathing and washing facilities provided to meet the needs of the resident’s, all with equipment designed for disabled and frail people. The home is well equipped with equipment to meet the needs of residents’, and the senior staff are aware of where to procure any specialised equipment. This, in conjunction with the input from the Physiotherapist ensures that the needs of the residents are fully met. This multi-disciplinary approach is recorded in the shared care records. Senior staff confirmed that residents that do not have the capacity to ring their call bell are checked regularly, however this did not happen in the lounge areas. Residents were asking the Inspector for drinks, to switch on the fan and asking for assistance. The staff need to be very vigilant of residents needs especially during the heat wave. This occurred mainly during the morning. The home has a legionella policy in place and all hot water outlets are thermostatically controlled and are tested on a regular basis. Random outlets were tested and were of the required temperature. Polices and procedures for infection control are in place and are updated regularly. The home was clean and free from offensive odours on the day of the inspection. Poor practice by staff was observed during the day in respect of the inappropriate use of gloves and aprons whilst performing care duties. The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 22 Sluices and laundry areas were found clean and safe however some equipment in use was found to be in need of replacing as it is a source of cross infection. The home provides a good laundry service, which is appreciated by the residents. The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Robust recruitment procedures are in place to protect residents, and staff training ensures they are aware of their roles and are able to provide the support and care the resident’s need, however the staffing levels at times impact negatively on the residents well being. EVIDENCE: The staffing rota was viewed and the staffing levels were seen to be inconsistent with staffing levels at times insufficient to meet the resident’s needs. Feedback from staff and residents indicated that at times there were not enough staff to perform the care required, residents have been told that due to insufficient staff they can not have their shower or bath, the bathing records were incomplete and gave the information that some residents had not had a bath or shower since December 2007. Another area that was observed and confirmed by staff and residents was that residents were still being bathed and got out of bed just before their lunch was being served. This impacts negatively on the residents’ dignity and well being. Staff spoken to said that they felt the levels of staff on duty were insufficient at times to give the quality of care required. Two residents and one three visitors expressed concern over the staffing levels, three resident said the “staff always helpful, they look after me very well, but there are times when I don’t get a The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 24 wash until lunch time”. Another said, “ The staff are really nice, but don’t get time to linger and chat”. The staff group on the whole is stable both residents and their relatives spoke highly of all the staff saying ‘staff are kind’ ‘staff are really very nice’. The recruitment records for 5 staff members were reviewed in depth and were found to be full and contain the required information and demonstrated the appropriate induction training had been completed in respect of the job they were to undertake in the home. Staff interviewed confirmed satisfaction with the training provided and found that the training gives them insight in to their job. Staff and records seen, confirmed that they had undertaken compulsory training such as manual handling, adult protection, first aid, and food hygiene and fire safety. National Vocational Qualification training is provided for staff, approximately 45 of staff have a qualification at this time with a further 6 undertaking the training. The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38. People who use this service experience good quality outcomes in this area. The management approach at The Polegate Nursing Home is open and encourages residents, relatives and staff to be actively involved in decisions about the services provided at the home. The health and safety of residents are promoted through an ongoing training programme for staff and up to date policies and procedures. EVIDENCE: The Manager is a first level registered nurse and has been a manager for eight years within the organisation. Her qualifications include a diploma in management studies. The manager has suitable qualifications and experience to run the home competently and takes responsibility for the day-to-day running of the home. Her role is office based, supernumerary to the care and nursing staff; a head of care/deputy manager is now in post to provide support and take on some specific duties such as staffing rota and supervision. The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 26 There is an on call system for out of hour emergencies, this needs to be clarified by a clear policy and guidelines regarding nursing and staffing emergencies. Feedback from visitors and residents were in the main positive, but there were concerns raised about staffing levels. The quality assurance systems in the home include questionnaires sent out to residents and relatives following admission to the home. The introduction of this formal quality assurance and quality monitoring systems has enabled the management to objectively evaluate the service and ensure it is run in the residents best interests. There are systems in place to safeguard resident’s financial interests; with policies and procedures in place for staff to follow in respect of gifts and rewards from residents and their families. The manager confirmed and the staff training matrix evidences that all staff are kept updated on the Health and Safety procedures and updates. Staff were able to discuss the training they received and said that they were kept up to date with changes to policies in connection with fire safety and health and safety. The home has a comprehensive set of policies and procedures, which govern the running of the home, review of the manual confirmed that these are regularly updated. All relevant legislation and procedures are in place in respect of Health and safety. Evidence was seen of regular supervision sessions and all staff spoken with confirmed that they receive regular supervision. Documents relating to safe working practices and Health and Safety were available and found to be satisfactory as were accident records. It was confirmed by reviewing the training records that all staff receive the necessary mandatory training in order to perform their jobs safely. Good practice was observed throughout the inspection regarding the moving and handling of residents. An incident was observed where a resident was taken unwell and staff could not be summoned easily as they were busy else where, this was in a lounge area and the visitor concerned did not know how to summon assistance. Call bells need to easily assessable. The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 3 3 3 3 3 The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation Requirement Timescale for action 04/07/08 15(2)(b)(c That the registered person )12(1) ensures that consultation with the service user/representative is evidenced when the care plan is devised. 13(1)(b) 17(1)(a) That the registered person ensures that suitable risk assessments are completed in all areas of risk and cover the use of bedrails, risk of choking and risk of falls to promote resident safety. That appropriate risk assessments are in place with an action plan for those residents that do not have the capacity to ring the call bell. 2. OP8 04/07/08 3. OP10 12 (3)(4) That the registered person ensures that the residents’ health needs are met in a manner which respects the privacy and dignity of residents. 04/07/08 The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 29 4. OP12 12 (2) 16 (2) That the registered person ensures that all residents are given opportunities for stimulation through leisure and recreational activities in and outside of the home which suit their needs, preferences and capacities. That service users isolated in their bedrooms have a plan of care to ensure that they receive interaction and stimulation. (Timescale of 01/10/06 not met) That all service users have access to a call bell, or a method of recording that the staff are regularly checking those service users who cannot use this facility and this is underpinned by a risk assessment. (Timescale of 01/10/06 not met.) That the registered person ensures that the procedures and policies in place for infection control are followed. This pertains to appropriate and safe use of gloves and aprons. That all equipment is clean and in good order. That the registered person ensures that at all times there are suitably qualified, competent and experienced persons are working at the home in such numbers that are appropriate for the health and welfare of the residents. 04/07/08 5. OP22 OP38 16 (1) 04/07/08 6. OP26 16 (2) (j) 04/07/08 7. OP27 OP28 18 (1) 04/07/08 The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 30 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 OP38 Good Practice Recommendations That a more detailed action plan detailing prevention of incidents is document on the accident forms. That a more formal way of recording the amount of food eaten is recorded. 2. OP15 The Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Polegate Nursing Home DS0000014027.V360689.R01.S.doc Version 5.2 Page 32 - 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. 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