Inspection on 23/01/06 for White Rock Nursing Home

This inspection was carried out on 23rd January 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

White Rock Nursing Home 28/10/08

White Rock Nursing Home 05/03/07

White Rock Nursing Home 20/04/05

White Rock Nursing Home 01/02/05

White Rock Nursing Home 01/07/04

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

CARE HOMES FOR OLDER PEOPLE White Rock Nursing Home 15 Chestnut Avenue Barton On Sea New Milton Hampshire BH25 7BQ Lead Inspector Isolina Reilly Unannounced Inspection 23rd January 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address White Rock Nursing Home DS0000011454.V279889.R01.S.doc Version 5.1 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. White Rock Nursing Home DS0000011454.V279889.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service White Rock Nursing Home Address 15 Chestnut Avenue Barton On Sea New Milton Hampshire BH25 7BQ 01425 613627 01425 613627 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 Siobhan Dodd Mrs Rosemary Ann McLelland Care Home 30 Category(ies) of Dementia (6), Dementia - over 65 years of age registration, with number (30) of places White Rock Nursing Home DS0000011454.V279889.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The number of persons for whom accommodation and nursing care is provided at any one time shall not exceed 30 No more than 6 service users can be accommodated at any one time in the category of DE between the ages of 60-64 years No detained patients Date of last inspection 20th April 2005 Brief Description of the Service: White Rock Nursing Home is registered to provide nursing care for up to thirty people over the age of 65 who suffer from dementia type care needs. The home can also admit up to 6 people between from the age of sixty years of age. Mrs Dodd owns the home and employs Mrs Ann Mc Lelland as the registered manager. The home is situated in a quiet avenue in a residential area of Barton-on Sea and aims to provide a homely environment. The building is on two floors with a shaft lift giving level access to all areas of the home. The home has three lounges, a dining room and a large, well-maintained enclosed garden. There are five shared bedrooms and twenty single rooms. White Rock Nursing Home DS0000011454.V279889.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This second unannounced inspection took place over one day. The inspector view records, procedures, spoke with staff including agency staff and two relatives. The patients were briefly spoken with, as long meaningful conversations were difficult due to their high level of need and confusion but the inspector was able to observe their reaction to staff and their environment. The matron and one of the two deputies helped the inspector during the visit. This and the previous inspection report of 20th April 2005 can be read together for a full summary of how the home has done against the key National Minimum Standards. What the service does well: What has improved since the last inspection? What they could do better: The home is looking to start the next stage of involving the registered nurses and care staffing within the new structure. This will help staff feel they can take part in making decision on the day to day running of the home. White Rock Nursing Home DS0000011454.V279889.R01.S.doc Version 5.1 Page 6 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. White Rock Nursing Home DS0000011454.V279889.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection White Rock Nursing Home DS0000011454.V279889.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 The home does not provide ‘Intermediate care’. Standards one, two, three and four were assessed and met at the previous inspection on the 20th April 2005. EVIDENCE: The matron confirmed that the home does not have a contract with Adult Services to provide ‘intermediate care’. White Rock Nursing Home DS0000011454.V279889.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 10 The home’s system for the administration of medication is good with clear and comprehensive arrangements in place to ensure patients’ medication needs are met. Key standards seven, eight and ten were assessed and met at the previous inspection on the 20th April 2005. EVIDENCE: The deputy manager was briefly observed administering medication appropriately and the good medication administration practices are reflected in the home’s policy and procedures sampled. The home administers medicine direct from pharmaceutical packs and bottles and is stored appropriately within a locked cupboard inside a locked medical room. The home uses the ‘Medicine Administration Record Sheets (MARS) system for recording the administration of medication. The receipt of each medicine is checked; quantity noted and signed. The registered nurses administer the medication. The receipt, administration and disposal of medication records were sampled by the inspector and found to be in the main satisfactory with only one gap in the signatures across the thirty records seen. The deputy stated that she would address this directly with the staff member who had missed the signature. White Rock Nursing Home DS0000011454.V279889.R01.S.doc Version 5.1 Page 10 Since the last inspection the home has improved and met the pharmaceutical requirement to ensure that administration of medicine records are completed and accurate. The matron confirmed that the owner had given all registered nurses written reminders of the requirement to ensure that records are completed and accurate. The deputy showed the inspector the home’s medical room and cupboards that was found to be a clean clinical area with medication stored correctly in date and in sufficient quantities including dressings. The registered nurses double check prescriptions for quantity and ensure that unnecessary items are not being prescribed. The deputy manager confirmed that she regularly undertakes checks of medication rooms and stock levels. The deputy manager and matron spoken with confirmed that since the last pharmaceutical inspection in July 2005 one registered nurse has undertaken refresher training in the safe handling of medication. However, the other nine registered nurses have yet to undertake refresher training. This was discussed with the matron who explained that as part of the new supervision programme they would undertake on the job assessments including administration of medication to see if refresher training is required. A copy of the Royal Pharmaceutical Guidelines for residential care was available a long with the “A recent Pharmaceutical Reference Book”. It was noted that the home has samples of staff signatures and initials. White Rock Nursing Home DS0000011454.V279889.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 and 15 The home with the assistance of relatives and friends are able to assist patients to retain the maximum control over their lives within the limits of their mental capacity. The meals in this home are good offering both choice and variety, catering for special dietary needs in pleasant surroundings. EVIDENCE: The relatives and staff spoken with stated that the day routine is made as flexible as possible taking into account the individuals likes and previous life styles. The inspector observed staff interacting respectfully and appropriately with knowledge of individuals needs, likes and dislikes. The staff confirmed that some patients are unable to express their likes and dislikes so they rely on observation of reaction to different activities and on detailed history from family and friends. The inspector sampled the four-week menu and found it to be variable, balanced with changes recorded for the main meal. This was discussed with the cook who agreed that a written record of all meals offered throughout the day should be recorded. She explained that this would be addressed when implementing the new “safer food better business” hazard analysis and new White Rock Nursing Home DS0000011454.V279889.R01.S.doc Version 5.1 Page 12 style recording system. The matron confirmed that she is due to attend a local workshop on this. The cook confirmed that one patient was a vegetarian and other food preferences had been passed on by family, friends and staff observations. The layout of the kitchen is small but utilised to maximum effect ensuring the efficient running of the kitchen. The inspector observed the mealtime and noted that most patients were eating their meals with gusto, although many required assistance and food was pureed. The puree meals were attractively presented with individual food groups and colours separately placed on the plate. The home keeps daily records of the temperatures of hot probed meals; freezers and fridges are kept by the cooks and found to be satisfactory. White Rock Nursing Home DS0000011454.V279889.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The home has a satisfactory complaints procedure available and staff have a good understanding of Adult Protection issues that protects patients from abuse. EVIDENCE: The relative spoken with felt that the staff were patient, caring and willing to listen. The staff spoken with were aware of the home’s complaint procedure. The home’s complaint procedure includes the address for the Commission and states complaints will be dealt within 28 days. However, it was noted that the title of the commission has yet to be changed from the National Care Standards Commission to the Commission for Social Care Commission. The matron assured the inspector that the home is due to undertake a full audit of procedures within the home and necessary amendments will be undertaken shortly. A copy of the home’s complaint procedure is displayed by the front door. The home has received one complaint in the last twelve months, which was unsubstantiated and had being independently investigated by the Nursing and Midwifery Council (NMC). The matron is forwarding a copy of a regulation 37 under the Care Homes Regulation 2001 report to CSCI and evidence of the complaint and investigation outcome. The home’s complaint log was seen and found to be satisfactory. The matron confirmed that detailed records of each complaint are stored separately. White Rock Nursing Home DS0000011454.V279889.R01.S.doc Version 5.1 Page 14 The staff spoken with confirmed that they have received instruction and are aware of the protection of abuse of vulnerable adults. They have attended training on recognising and reporting of concerns or suspicions. A further training session has been arranged for the day following this visit. There has been no allegation of abuse at this home. 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. White Rock Nursing Home DS0000011454.V279889.R01.S.doc Version 5.1 Page 15 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): The above key standards were assessed and met at the previous inspection on the 20th April 2005. EVIDENCE: White Rock Nursing Home DS0000011454.V279889.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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): 30 The staff at the home are well trained with good systems in the home to enable them to do their job. EVIDENCE: The relatives spoken with described the staff as ‘caring, friendly, helpful and seemed to know what they are doing.’ One relative stated that the staff were always polite, looked after them well and had no complaints. The home’s training records showed that the home undertakes external and internal training. The staff confirmed that they undertake training regularly and the inspector sampled copies of individual staff training certificates and other records of instruction undertaken by the staff. From discussion and reading of documentation it was evident the home is maintaining a proactive and supportive ethos towards staff development, knowledge and skills. Other training courses attended by staff include health and safety, moving and handling, first aid, fire safety, food hygiene, two day on dementia, bereavement skills, nutritional assessments, syringe driver update, promotion of countenance, catheter care and Age Concern activities. Most of the staff spoken with stated that the home has a positive supportive ethos and staff training, although training over and above three days is undertaking in the staff own time. The staff and the matron have discussed the concerns regarding this with the owner. The matron showed the inspector the new style supervisions that are due to be introduced and explained that over the last year the home has developed and implemented a completed new White Rock Nursing Home DS0000011454.V279889.R01.S.doc Version 5.1 Page 17 management structure. The staff spoken with confirmed this. The structure has now been implemented down to senior care staff level, which includes meeting communication and responsibility. However, during a discussion with some care staff there was a feeling that they do not have an open forum other than supervision to voice their opinions and discuss issues with the management. This was discussed with the matron who explained that the home has prioritised the implementation of the management structure and the next stage is to include the care staff and registered nurses in this structure with regular meetings and formal communication systems. White Rock Nursing Home DS0000011454.V279889.R01.S.doc Version 5.1 Page 18 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): 35 The home does not look after patients’ money and there is a system of invoicing to cover any expenses incurred by the home. EVIDENCE: The matron confirmed that the home does not look after patients’ money. On admission it is explained that the family, advocates or person with ‘power of attorney’. This is detailed in the home’s service user guide, and the patient’s contract and terms of residency. If the patients wish to receive hairdressing, chiropodists and other services these costs will be invoiced to the relevant person looking after the patient’s financial affairs. This system can also include newspapers, magazines and toiletries. White Rock Nursing Home DS0000011454.V279889.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X X White Rock Nursing Home DS0000011454.V279889.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 White Rock Nursing Home DS0000011454.V279889.R01.S.doc Version 5.1 Page 21 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. 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