Inspection on 30/05/06 for The Quinta Nursing Home

This inspection was carried out on 30th May 2006.

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 Quinta Nursing Home 30/05/08

The Quinta Nursing Home 17/05/07

The Quinta Nursing Home 16/08/05

The Quinta Nursing Home 11/04/05

The Quinta Nursing Home 03/11/04

The Quinta Nursing Home 29/06/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE The Quinta Nursing Home Bentley Nr Farnham Hampshire GU10 5LW Lead Inspector Isolina Reilly Unannounced Inspection 30th May 2006 09:30 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 Quinta Nursing Home DS0000011656.V290086.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 Quinta Nursing Home DS0000011656.V290086.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Quinta Nursing Home Address Bentley Nr Farnham Hampshire GU10 5LW 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) 01420 23687 Dr Muhammad Ashraf Chohan Ms Parveen Abbas Alishah Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41), Terminally ill over 65 years of age (10) of places The Quinta Nursing Home DS0000011656.V290086.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th August 2005 Brief Description of the Service: The Quinta nursing Home is a registered to provide nursing and personal care to 41 service users in the older people category. The home is situated in the village of Bentley with some local amenities close by. Accommodation is provided on two floors with a passenger lift that allows access to both floors. All the bedrooms are single with en suite facilities. There are a variety of aids and 5 assisted baths to meet the needs of the residents. The service also benefits from gardens that are enclosed and accessible to service users where seating is available. The provider makes information available about the service, including the commissions report to prospective residents on request. Copies of this information are available at the home and may be sent out by post on request. The home states in the pre-visit information questionnaire completed by the manager that the fees range from £400 to £700 per week. Additional charges are made for hairdressing, chiropody, toiletries, activities, magazines and newspapers. These charges are listed in the home’s contract or statement of residency. The Quinta Nursing Home DS0000011656.V290086.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place over two days 30th May and 28th June 2006. The inspectors returned on the second day to finish the assessment and look at extra information received. Two inspectors looked around the home, viewed records and procedures, spoke with residents, relatives, a visiting aroma therapist, staff, and observed the interaction between them. The matron helped the inspectors during the visit. She confirmed that the staff and service users like to addressed as residents rather than service users. Information has also been taken from the pre-visit questionnaire filled in by the matron, correspondence with the home and monthly reports on how the service is doing, sent in by the provider. The commission has received written questionnaires from twenty-three residents and four visitors. The responses were generally positive but seven residents stated they would appreciate more activities and stimulation. What the service does well: Potential new residents and their family have the information needed for them to make a choice to come to the home. Their needs, likes and dislikes are fully assessed once they arrive at the home and they are given a contract telling them about the service they will receive and any charges they incur. The home show respect and helps residents to keep their dignity and privacy. The residents are able to choose their own lifestyle, social activity and keep in contact with family and friends. There is a flexible daily routine so residents are able to do their own socialising and activities. The home offers a choice of cooked breakfasts, main meal at lunchtime and evening meals with hot, cold drinks and snacks available through the day. The meals are varied, balanced and healthy. All the residents agreed that the food was good at the home. The residents are protected from abuse and feel safe at the home. The physical design and layout of the home allows residents to live in a safe well-maintained and comfortable environment, which encourages independence. An experienced matron manages the home. Systems are in place to monitor quality of the service and views of residents, relatives and friends are sought. The Quinta Nursing Home DS0000011656.V290086.R01.S.doc Version 5.2 Page 6 There are good systems in place for maintenance and repair of equipments and the building. What has improved since the last inspection? What they could do better: The pre admission assessments records done by the matron or senior nurses, when they go out to meet potentially new residents are brief and can be improved on. The health and personal care provided by the home is generally satisfactory but can be inconsistent. Written care instructions for staff are not always followed and this has created confusion for the care staff team. Some staff with poor command of the English language may have added to the confusion and inconsistency in care. However, the overseas workers are now attending English classes to help improve their language and written skills. Some of the records and instruction to staff are out of date and don’t reflect the good care given. This is an on going problem within the home but there is a noticeable improvement. The Quinta Nursing Home DS0000011656.V290086.R01.S.doc Version 5.2 Page 7 Many residents state they are “bored at the home” as there are few organised activities. The matron is aware of this and is trying to recruit an activities coordinator to provide more activities. There is a good complaints procedure but record keeping needs to improve. The home needs to look at ways of preventing cross contamination by storing clean linen away from dirty areas. Cupboards where potentially hazardous equipment and chemicals are stored need to be kept lock at all times. The staff are given regular instruction and training on fires safety but the home has yet to set up drills and evacuation practices. 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 Quinta Nursing Home DS0000011656.V290086.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 Quinta Nursing Home DS0000011656.V290086.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 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has in the past had a good admission process that was well managed with residents given clear information regarding the service. This needs to be taken up again. The home does not provide ‘Intermediate Care’. EVIDENCE: The residents and relatives spoken with stated someone had visited them from the home prior to coming to stay there. This person had asked many questions about what they liked and disliked. However, some of the residents stated that they had been unable to visit the home prior to being admitted but their families and friends had looked round on their behalf. Two out of the four pre-admission assessments seen were briefly filled in but the form used does prompt information across all aspects of care. The other two records could not be found on this visit. Past inspections have found the pre-admission records to be good and a basis for the initial care plan. However, this was not the case on this visit. The four records seen had The Quinta Nursing Home DS0000011656.V290086.R01.S.doc Version 5.2 Page 10 detailed assessments of needs, which had been completed within a few days of admission. These assessments corresponded with the care needs identified in Care Managers and health care assessments. These cover the necessary areas including, personal care, physical well-being, dietary preferences and records of regular weights. Information was seen on each file that described issues with sight, hearing, mouth and foot care. There was information on the level of mobility, dexterity and a history of falls, continence and behaviour. There was a brief description of their likes and dislikes including food, family relationships and friends and some past history. The matron stated that she would look at improving the standard of records made at the initial preadmission stage. The matron explained she and senior nurse would undertake pre-admission assessments as they have the greater experience and knowledge regarding what care needs the home is able to meet. In each resident’s room is a copy of the home’s service user guide and further copies are available by the front entrance. Some of the residents and relatives spoken with confirmed that the family had taken the information supplied at admission home with them. The relatives spoken with said that the home asked lots of relevant questions and looked after the residents very well. The residents stated that they were made welcome. The inspector observed one new resident arriving at the home at lunchtime. This new residents had to wait a little while because the staff were busy helping down for lunch. However, once staff became free the resident was introduced to other residents, staff, shown around after their lunch and taken to their bedroom to help them unpack and settle in. The inspector visited the new resident to see how they had settled in. The resident was a little anxious about having to leave their home but did like their new room. The four residents records seen contained a signed contract that were informative and contained all the necessary information. The residents and relatives spoken with confirmed that the contracts had been explained to them when they first came to the home. The manager and area manager confirmed that the home does not provide ‘intermediate care’ rehabilitative short-term type care for Social Services. The Quinta Nursing Home DS0000011656.V290086.R01.S.doc Version 5.2 Page 11 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, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care provided at the home was general satisfactory but there were inconsistencies in the quality of care given. The records of care within the home have improved but further improvements are needs. The home is good at promoting residents’ privacy and dignity. The home has a good system for storing, administering and handle medicines but disposal needs to come in line with recent changes in legislation. EVIDENCE: On the first visit, four resident files were discussed with each individual resident who confirmed that they recognised the records and the staff have discussed their needs and care with them. The care records are now kept in the individual’s rooms. One of the residents stated they were not interested in what was written about them but how the carers and nurses look after them. They stated that the staff look after him well. A further six care plans and residents were spoken with on the second visit focusing on continence and mobility needs. The Quinta Nursing Home DS0000011656.V290086.R01.S.doc Version 5.2 Page 12 On the first visit, it was observed that residents with double incontinence care needs are regularly helped to change and no offensive odours were noted when sitting next to them. Two out of the seven staff spoken with on the second visit stated they only change incontinence pads every seven hours according to manufacturer’s instructions. However, the other staff stated that pads were changed four to five hourly or as necessary. The inspectors observed that all six residents appeared clean and no offensive odours were detected that may suggest pads needed to be changed. During this second visit only one of the six bedrooms visited had an offensive odour. The matron explained that staff had recently attended a continence promotion awareness session given by the local continence promotion nurse where staff were informed that the manufacturer’s stated “pads can be used for up to seven hours”. The staff spoken with confirmed this training but there were no records at the home of this training session. The matron felt that this training session had caused the confusion with some staff and stated that the home would change pads as and when needed and it was not normal practice to leave pads on for so long. The four out of the six residents spoken with on the second visit, stated that the staff knew how to look after them and were generally good at their jobs. Two residents were unable to comment due to their medical condition. It was found that staff were aware of the individuals needs and they gave satisfactory explanations on how they would look after the individuals. However, two staff spoken with stated they would use moving and handling techniques that could put the resident and the staff members at risk. It was found that in these cases the moving and handling risk assessments and care instructions for staff were vague and did not include the issues encountered by the staff. The manger stated that she would review and up date risk assessments. Staff members training records for moving and handling were checked and all staff except a new carer had undertaken recent training. The staff spoken with confirmed this and when asked were clear about good moving and handling practices. The inspector viewed the home’s training matrix and certificates of the staff spoken with that further confirmed this. The care plans contained written risk assessments and instructions to staff on how to look after the individual. The records also included names of relatives, friends, health care professionals and social services care managers who are involved in supporting the individual. The care planning documentation includes care needs and risk assessments. Three out of the four records seen were detailed and corresponded with Care manager reviews and nursing assessments on file. Staff had recently reviewed all files seen and the resident or a relative had signed three out of the four. There were details of monthly reviews and changes to care instructions recorded. However, several records seen over the two visits when reviewed did not reflect the changing needs of The Quinta Nursing Home DS0000011656.V290086.R01.S.doc Version 5.2 Page 13 the individual and in two cases the care being given. The resident, nurses and carers spoken with confirmed that they were aware of the changes in need and provide the necessary care, although this is not reflected in the record. The same care record showed that risk assessments for pain relief, the use of bed rails, repeated falls and complex mobility issues were not present. However, the staff were aware of this individual’s needs and bed rails had been appropriately fitted and pain relief had been administered as needs. The matron explained that there was a noticeable difference in some key workers abilities and that she would address this immediately with the individuals concerned. A nurse spoken with commented she found the system logical and felt involved in the care planning and recording process. However, the carers stated that they would seek clarification from the matron and nurses if they were not sure how to look after someone. Records of doctor and nurse visits and information on outpatient, dental, optician and chiropractic appointments were seen on the files. Various residents stated that the visiting dentist and opticians had recently seen them. The recent treatment and the corresponding medical notes were present in the file. There were good clear records on wound care and photographs are available on file to visually track the improvement of the wounds. Records were seen of district nurse support with wound care and instruction to staff. All the residents spoken with were happy with the care provided by the home. Stating that staff are caring, helpful, appear to know what they are doing and look after them well. But two stated they have a problem understanding some of the overseas staff speak. The matron confirmed the home has enrolling overseas staff in English classes. The residents also said that the staff are respectful and mindful of their privacy and dignity. They confirmed they choose and wear their own clothes and see visitors and health professionals in the privacy of their own rooms. Some of the residents and relatives spoken with confirmed they had their own phone in their room. The inspectors observed this on the tour of the home. The home is able provide a portable phone for residents to use in private. The two relatives spoken with explained that they were happy with way Quinta is looking after their loved one. The inspector noted that nurse call bell were within easy reach of residents in their bedrooms so could summons help when needed. The inspector was able to speak with the visiting aroma therapist. She felt the home is general good at looking after older people and is progressive enough to ask specialist like her to come and provide alternative therapy, company and social stimulation. The Quinta Nursing Home DS0000011656.V290086.R01.S.doc Version 5.2 Page 14 It was noted on the tour of the home that communal toiletries including shampoo, bubble bath and talc were made available. This was discussed with the matron who agreed to purchase individual toiletries so that the dignity of residents who wish to use them is maintained and they are able to exercise choice in their selection. The inspector observed the staff interacting with the residents and found them attentive and professional. There were staff around most of the time in the communal areas. Refreshments and snacks for both residents and visitors were offered regularly throughout the day. The staff were observed administering medication appropriately and there is a good medication policy and procedures. Medication is stored correctly in appropriate cupboards within a locked medical room. The home has no residents self administering their own medicines but there is a satisfactory procedure including risk assessment and auditing available should an individual choose to do so. The nurses’ order and check all medicine received at the home. However, it was unclear what dosage of medicine had been administered when varying dosages are necessary. This was discussed with the nurse and matron who agreed this should be made clear. The records were seen and found to be satisfactory. The home uses the ‘Medicine Administration Record Sheets (MARS) system for recording the administration of medication. Each resident’s record also has a recent photograph and signatures samples of nurse administer medicine. The nurses and carers stated that only the registered nurses administer medicines. The home’s medical room and cupboards stored were clean and reasonably orderly with medication stored correctly in date and in sufficient quantities. The home continues to return their disposal to the local pharmacist who is happy to receive them. The matron was advised of the recent changes in pharmacy legislation that prohibits pharmacist from receiving disposed of medication from nursing homes. The matron was unaware of this change, as the local pharmacist had not informed them the system was changing. She agreed to contact the pharmacist and ask for clarification. There is a minimum and maximum temperature-reading thermometer for the fridge that is checked daily and temperature recorded. These were seen and found to be satisfactory. The home has a copy of the Royal Pharmaceutical Guidelines for residential care and a recent ‘British National Formula’ (BNF) pharmaceutical reference book. The Quinta Nursing Home DS0000011656.V290086.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents experience a lack of organised activities at the home. They are able to choose their life style and keep in contact with friends and family. Individuals are able to socialise and follow their own cultural and recreational activities but there are few organised activities within the home. The meals in this home are good, balanced and a choice is available. EVIDENCE: The inspector observed residents reading large print books, daily newspapers, magazines, crosswords and sitting watching the television. The many residents stated they were “bored” at the home as there were few organised activities available. However, one resident did state he was very busy and went out regularly to friends, socials and into the village because he was mobile and could do so under his own steam. Many of the residents had their own televisions and radios in their rooms and several have newspapers and magazines delivered. The home has a volunteer activities co-ordinator who comes in once a week on a Friday and stays a few hours. This individual goes around chatting to people The Quinta Nursing Home DS0000011656.V290086.R01.S.doc Version 5.2 Page 16 and will set up armchair exercises and movement to music. In the entrance hall were various photographs of events at the home and residents, visitors and staff enjoying the party atmosphere. There was a notice advertising the forth-coming evening of games, fun for relatives and friends. One resident suggested they would enjoy outings and days out. The matron agreed that activities could be improved and the home had advertised for an activities coordinator post but not been successful in recruiting anyone. She agreed that this needs to be improved. Several residents and relatives confirmed that clergy visit the home regularly. Three residents they received communion. Information about residents’ religious preferences and cultural aspiration were seen on file. In the entrance hall there are various information leaflets about the local area events and public transport. The relatives spoken with feel the residents are well cared for and that they are made welcome and part of the home. The inspector observed that relatives visiting that day had been offered refreshments. There were cold drinks available all day in the communal areas, hot drinks, biscuits and cake was taken around regularly throughout the day. All the residents stated that the day routine is flexible and a meal can be put aside should they wish. The inspector was able to speak to kitchen staff and found that there are good system in place for cleaning, hazards and risk assessments. The menus are kept in the kitchen and on easy view for staff and a copy is keep in each bedroom. However, it was noted that some of the rooms had the wrong week on display. The kitchen assistant confirmed that it was his responsibility to go round the rooms and change the menus each week. The manager stated that it is possible who read the menus in the room to put it back in the wrong order. She confirmed that she would look into how this could be remedied. The residents spoken with said their enjoyed the food and that it was good. Some of them particularly enjoyed the cooked breakfasts that evening staff the night before came round to asked what they would like. Records of individuals’ choices were seen in the kitchen. Information on individuals’ likes, dislikes and special diets were listed and kept updated by the cook. The inspector viewed the four-week menu and found it to be variable, balanced and with written amendments and alternatives meal. The records of food provided by the home showed that alternative meals were provided on a regular basis and the kitchen staff were aware of individuals preferences. The residents and relatives spoken with stated the quantity, quality and choice of food is good. The residents were very happy with mealtime experiences and felt they were not rushed. The meal was observed by the inspector and found to be relaxed, unhurried and the food attractively presented. This was also reflected in the responses seen on the residents’ written comment cards. The The Quinta Nursing Home DS0000011656.V290086.R01.S.doc Version 5.2 Page 17 range of choice and cooked breakfasts and access to the menus has improved since the last inspection. Daily records of foods served and temperatures of hot probed meals and freezers and fridges are kept by the cooks and were available. The Quinta Nursing Home DS0000011656.V290086.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents feel their complaints will sometimes be listened to, taken seriously and acted upon. Staff have a varied understanding of Adult Protection issues that protects residents from potential abuse. EVIDENCE: It was noted from the fifteen residents and relatives comment cards received by the commission they stated they had no reason to complain about the service received. The residents and relatives spoken with stated that they would go straight to the matron or nurses if they had a concern or complaint. They confirmed that some staff are better than others at listen to their concerns. The relative felt that the staff were patient, caring and willing to listen and the inspector observed this during the day. The staff spoken with were aware of the home’s complaint procedure. A previous complaint alleged staff were told not to whistle blow. Staff spoken with were very clear that if they had a concern or witness bad practice they feel able to report this and chat to the matron without recriminations. The home has a very good complaint procedure, which includes the address for the Commission and that all complaints will be dealt within 28 days. A copy of The Quinta Nursing Home DS0000011656.V290086.R01.S.doc Version 5.2 Page 19 the home’s complaint procedure is displayed in reception and each resident’s room. The home has received two complaints in the last twelve months, which were resolved promptly. The complaint log was seen but there were no records of the two allegations below, although they had come in as complaints originally. The records seen in the log were very brief and it was difficult to identify trends as outcomes and actions taken were not recorded. The manager confirmed that detailed records of each complaint are stored separately. The second complaint was investigated by the provider who has responded appropriately to the commission on the outcome of the complaint but has yet to feedback to the matron and this is why a record of the outcome and action taken have not been recorded. All the residents spoken with stated that they always felt safe at the home. Three out of the six staff spoken with confirmed that they have received instruction and are aware of the protection of vulnerable adults from abuse the other stated they had not. However, the matron was able to show inspectors records of Abuse training attended by six staff. The matron stated they were aware but appeared to have little understanding of this training and would ensure they receive further instruction. She also confirmed that the staff have started attending English classes to improve their language skills and prepare them toward national vocational qualifications. The staff confirmed this. The three staff who completed the training have a knowledge of how to recognise and report concerns or suspicions. The above two complaints were referred to Adult Services as allegations of abuse. The first allegation resulted in the home’s recruitment procedures needing improvement and second allegation was upheld. The home has an up to date copy of the Hampshire County Council ‘Protection of Vulnerable Adults’ policy and procedure and it’s own policy and procedures reflecting the guidelines from Hampshire County council’s own policy to help them safeguard residents from abuse. The Quinta Nursing Home DS0000011656.V290086.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home presents as a clean, homely, comfortable and suitable environment for the residents. The standard of the décor within the home is good with evidence of on-going maintenance and improvements, although storage of linen can be improved to prevent cross contamination. EVIDENCE: The residents stated that the home is always clean, warm and no offensive odours were detected. They also confirmed that there has been on going decorating. The matron explained that the cleaners are verbally instructed on the tasks and there are no written cleaning rotas despite this the home is kept clean and tidy. The manger confirmed that there has been on going redecorating and refurbishment throughout the home to keep the environment looking good. The Quinta Nursing Home DS0000011656.V290086.R01.S.doc Version 5.2 Page 21 All the residents spoken with liked their bedrooms those seen were found to be light and airy. A random selection of the bedrooms where seen on a tour around the home and were found to be clean and warm, furnished to the individuals taste and most had been personalise. The home’s radiators and pipe work are safe ensuring that potential hot surfaces are kept to low temperature. Window’s checked had been restricted to prevent accidents. However, bedroom 32 was not restricted and the maintenance person fixed this during the visit. He stated he would check all windows to ensure others had not been missed and explained that when painting window block were sometimes removed and should have been replaced. Since the last inspection, the remaining locks to be changed to single lever action locks and door handles have been done and appropriate locks have been fitted to the communal bathrooms. New comfortable chairs have been purchased for the first floor quiet lounge as the previous chairs were worn and inappropriate. In one of the communal baths toilet cleaner containing bleach had been left out and the manager disposed of it immediately. The cupboard for safely storing chemical hazardous to health was found unlocked. It was noted that storage of hoist when not being used is an on-going problem. In one corridor the hoist is stored in an alcove that leads to a communal bath toilet blocking access but leaving the corridor free of obstacles. However, the impact on residents is negligible as bedrooms all of which have en-suites surround this bathroom. Residents would only be in this part of the building if the were coming or going to their bedrooms. All residents’ spoken with felt there were enough toilets and bathrooms. The first floor bathroom is still in need of refurbishing. There is sluice on each floor but the sluice on the first floor is also a store for clean linen. The matron agreed that this was a potential for cross contamination and poor infection control. The matron and staff found a solution to the storage problem and planned to remove the clean linen from the sluice to another cupboard. During the tour of the home, the inspector noted that all the communal hand sinks had liquid soap for washing hands and disposable paper towels, which promotes good hand hygiene. There were gloves and plastic aprons available in different places around the home, including the laundry, toilets and bathrooms. The residents and relatives stated that the staff do use them. The staff confirmed that they have received regular training on infection control. The laundry room is made up of two areas and has direct access to the outside. There are two industrial size washing machines and one industrial tumble dryer all were seen working. The home has an external contract for laundry of linens and this is collected using the company’s own colour coded bags. The concern raised at previous inspections, is that dirty laundry waiting The Quinta Nursing Home DS0000011656.V290086.R01.S.doc Version 5.2 Page 22 collection is in the same area as the new laundry delivered awaiting distribution around the home. This was discussed with the matron who confirmed that she would reorganise the laundry space to improve infection control and prevent cross contamination. The residents and relatives spoken with stated that they were happy with the laundry service provided. The Quinta Nursing Home DS0000011656.V290086.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff at the home are appropriately trained, supported and employed in sufficient numbers to meet the residents’ needs. There is an improved recruitment procedure that ensures residents are not put at risk. EVIDENCE: The residents spoken with described the staff as ‘caring, friendly, helpful and around when you need them, although some are difficult to understand.’ Several residents stated that the staff were always polite and had no complaints. They also stated that they were happy at the home. All the residents and relatives spoken with said there was sufficient staff around and that the staff know what they are doing. The rotas showed that a minimum of two registered nurses and six carers during the day. There is one registered nurse and four carers each night. These figures exclude management. The rota shows a mix of experience and new staff and the matron confirmed that all staff are over eighteen years of age. This was confirmed in the written information provided by the home for this visit. The home also employs two cooks and two kitchen assistants, two cleaners, one laundry assistant and a maintenance person. The staff spoken with felt there was a good skill mix within the staff team and they worked well The Quinta Nursing Home DS0000011656.V290086.R01.S.doc Version 5.2 Page 24 together as a team. The staff asked had received a copy of the General Social Care Council’s code of practice and extra codes were available in the office. The staff rotas showed that there are seven registered nurses. These registered nurses are responsible for maintaining their own professional updating and those spoken with stated that the home supports them to keep up dated. The matron confirmed that they regularly check the nurses’ professional registration numbers to ensure that they are renewed when required. She also explained that the home is registered to train adaptation nurses from overseas. The current staffing rota reflected the staff who were working and the hours that they worked. This had been a previous requirement on two occasions. The matron agreed with the inspectors that the Rotas were now accurate. The inspectors found that all staff on duty during the visit were listed correctly on the duty roster. Staff were very clear about their need to have a reasonable break between shifts and not work extra shifts back to back and stated this did not happen any more. All but one staff member confirmed that they did not work at the sister home. This staff member stated that she was clear that she had a reasonable break between shifts including when she works at the ‘sister’ home. She confirmed that she currently works two night duties at the ‘sister home’ and four days at Quinta. The matron confirmed this and was liaising closely with the ‘sister’ home and provider to track when the staff member was working. The matron went on to say that she is activity discouraging this practice and ensure that all staff have reasonable breaks between shifts. Records checked by the inspectors showed that the staff member works six days a week and except on two occasions in June 2006 there had been reasonable breaks between and after shifts. The manager confirmed that they are working towards increasing the number of carers with qualifications in care. Currently due to staff leaving only 13 of carers hold a qualification in care. Out of the thirty carers employed by the home three have a National Vocational Qualification (NVQ) level two in care and one NVQ three in care. The matron explained that eight carers are waiting to start their NVQ 2 in care but this has been delayed while they attended English classes to improve their verbal and written language skills. The carers spoken with confirmed this. The staff spoken with felt that the recruitment process within the home is thorough. The inspector was able to see four different staff records and two were detailed with the necessary checks taken to ensure staff are fit to work at the home. However, one file had a criminal records (CRB) and protection of vulnerable (POVA) check completed by the sister home where they started working and then moved onto Quinta. The inspectors explained to the matron that whist it was the same company because the individual had changed job, a The Quinta Nursing Home DS0000011656.V290086.R01.S.doc Version 5.2 Page 25 new CRB and POVA check is required. The second staff file seen had a satisfactory CRB check but did not included a POVA as this had not be requested. The matron was surprised and would be further investigating this with CRB. The matron was proactive in resolving an issue regarding immigration letters for the recruitment of an overseas employee. The provider audits and monitors the recruitment process and reports to the commission through regular regulation 26 reports. Other records seen on file include signed contract of employments, job descriptions, correspondence and annual leave requests. The matron stated that she was responsible for organising staff training and is supported by the senior nurse. Staff recently joined Quinta are in the process of completing their induction programme. However, the manager was unable to confirm if the ‘in-house’ induction programme meets the amended Skills for Care Council standards. The matron produced blank induction booklets from a company that stated they meet the industry standards for induction but she had not used these with the new staff member who started recently. The matron stated that from now on she would use the recognised induction workbooks to ensure staff receive the minimum standard of induction training. The new staff spoken with confirmed that they are going through their induction and have found it useful. Other ‘in-house’ induction documents including dates and signatures when task had been completed were seen on staff records. The home’s training records and plan shows that external and internal training is undertaken. The staff confirmed that they undertake regular training. The inspector viewed copies of individual staff training certificates and other records of instructions. The staff have received training in the necessary health and safety subjects such as fire safety, first aid, moving and handling, infection control, control of substances hazardous to health, health and safety and food hygiene. Other training courses attended by staff include elderly abuse, risk assessment, dementia and confusion, foot and nail care, catheter care, palliative care, pressure sores, catheter care, staff supervision and national vocational qualifications. The staff spoken with confirmed this and information on staff training in pre-inspection questionnaire reflects the above training. The Quinta Nursing Home DS0000011656.V290086.R01.S.doc Version 5.2 Page 26 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, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An experienced manager is running the home and there is a good system for involving residents in the day-to-day running of the home and an appropriate quality assurance system. The residents’ health, safety and welfare are generally promoted by the home with systems that ensure everyone is protected within the home, although fire safety could be improved and keeping necessary cupboards locked. EVIDENCE: The manager is a registered general nurse and is anticipating completing her national vocational qualification registered managers award by July 2006. The residents and staff spoken with confirmed that there is a clear line of authority within the home and the matron is supportive. The matron The Quinta Nursing Home DS0000011656.V290086.R01.S.doc Version 5.2 Page 27 communicates with the provider via a designated third person and completes a weekly report on how the home is performing. She has undertaken recent up date training in pressure care, moving and handling, risk assessments fire safety, infection control seminar, elderly abuse, food hygiene, first aid and medication. The inspectors viewed the matron’s training certificates for the above courses. The matron has not received supervision. She was asked to complete the self-assessment part of her annual appraisal sometime ago and is still waiting for the appraisal to be undertaken. The residents stated that their family or financial appointees rather than the home look after their money and the matron confirmed this. All the staff, residents and relatives spoken with found the matron to supportive and approachable. In the staff files seen, there were written notes of supervisions undertaken and most staff spoken with stated they had been receiving one to one supervision sessions. However, two overseas staff member were not sure if they had but records showed that they had. Regular risk assessments are undertaken and recorded to ensure that the safety within the home room by room. These were sampled and found to be satisfactory. It was noted that a door marked “to be kept” locked was not. This was in one of the busy corridors on the ground floor so many people have access to it. The cupboard houses the lift mechanisms and a potential hazard should anyone enter. The matron stated she would ensure that doors to be kept locked are locked at all times. The managers explained the formal quality assurance process and looking to produce a development plan for the next year. All systems within the home are audited annually. However, some tasks are monitored weekly. The records were seen by the inspector and found to be satisfactory. Some of the staff spoken with were aware of the audit process. The residents spoken with stated that they felt their opinions were valued within the home and some participate in the residents’ and relatives meetings. The minutes for the last meeting were available in the front entrance hall. The staff felt they were included in the day-to-day decision making within the home, stating that changes and or issues are discussed and actions agreed at regular staff meetings that are minuted. The minutes were available from the offices for reference. Since the last inspection, the commission has received regular Care Homes Regulations 2001, regulation 26 monthly reports on the performance of the home. The Quinta Nursing Home DS0000011656.V290086.R01.S.doc Version 5.2 Page 28 The manager shared with the inspector the quality survey questionnaires completed by residents, relatives, friends and health and social care professionals. These were found to be positive in the main; issues identified were followed through and resolved. The residents commented on the comings and goings of the home’s maintenance man. Records were sampled of maintenance undertaken on all equipment within the home and found to be satisfactory. The residents and relatives spoken with stated that they felt safe at the home and some confirmed that the fire alarms are regularly tested. The matron explained the recording system for fires safety maintenance, training, evacuation and visual checks. The visual checks of all fire safety equipment has been recorded and undertaken at appropriate intervals to ensure the safety of the residents. However, it was noted that whilst staff had received regular training in fire safety the home had not undertaken any drills or evacuation practices. The home has a satisfactory reference file for the Control of Substances Hazardous to Health (COSHH) information leaflets for each chemical being utilised within the home. There are various copies around the home one for the cleaners, the kitchen and the main file held in the office. However, on the tour of the home it was noted that the COSHH cupboard was felt unlocked. The matron agreed this was not safe and the cupboard was locked immediately. Records of accidents and incidents were seen by the inspectors and tracked back to January 2006 when the commission stopped receiving Care Homes Regulations 2001, regulation 37 notice on adverse events at the home. It was found that there had been several incidents and accidents but none that had necessitated a resident being taken to hospital. This was discussed with the matron who will be reviewing the criteria set by the home for generating regulation 37 notices. The incident and accident reports were found to be satisfactory and the four residents tracked were recorded appropriately in their daily records. The Quinta Nursing Home DS0000011656.V290086.R01.S.doc Version 5.2 Page 29 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 2 17 x 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 2 The Quinta Nursing Home DS0000011656.V290086.R01.S.doc Version 5.2 Page 30 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 14(1a) Requirement Pre admission and risk assessments must be current and accurate reflecting the changing needs of residents. This requirement has been partially met but remains outstanding since December 2004. The provider must ensure that care plans reflect care given, give clear instruction and guidance to staff. The provider must ensure that service users have the opportunities for stimulation through leisure and recreational activities in and outside the home. There is up to date information about activities circulated to all service users. This requirement remains outstanding since 5th December 2005 The registered individual must keep appropriate records of all DS0000011656.V290086.R01.S.doc Timescale for action 31/08/06 2. OP7 15(1) 31/08/06 3. OP12 16(2)(n) 31/08/06 4. OP16 22 31/08/06 The Quinta Nursing Home Version 5.2 Page 31 complaints and allegations at the home including outcomes and actions taken. These records must be summarised in a log, enable the home to identify trends. The provider must ensure that staff have practices fire drills in accordance with Hampshire Fire and Rescue guidelines. The home must ensure that cupboards identified as hazardous are kept locked at all times. The lift machinery cupboard is clearly labelled to be kept lock and must be kept locked at all times. 5. OP38 23(4) (c)(iii) (e) 13(4) (a)(c) 31/08/06 6. OP38 31/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Quinta Nursing Home DS0000011656.V290086.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Quinta Nursing Home DS0000011656.V290086.R01.S.doc Version 5.2 Page 33 - 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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