CARE HOMES FOR OLDER PEOPLE
Yew Tree Nursing Home North End Road Yapton Arundel, West Sussex BN18 0DU Lead Inspector
Helen Tomlinson Unannounced Wednesday, 21 September 2005, 08.00am, V248129
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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 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. Yew Tree Nursing Home H60-H11 S47860 Yew Tree V248129 210905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Yew Tree Nursing Home Address North End Road, Yapton, Arundel, West Sussex, BN18 0DU Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01243 552575 Mrs Janette Mary McCorquodale CRH 40 Category(ies) of PD-12, OP-40, PD)E)-12 registration, with number of places Yew Tree Nursing Home H60-H11 S47860 Yew Tree V248129 210905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Only service users over the age of 40 years in the PD category can be admitted. Those service users currently residing at Yew Tree falling outside condition 1 may remain in the service, providing the registered managers assessment. Date of last inspection 22nd February 2005 Brief Description of the Service: Yew Tree Nursing Home is a care home registered to offer personal and nursing care for up to 40 residents in the categories of old age, or with a physical disability over the age of 65 years. Within the 40 residents 12 could be aged over 40 years and under 65. The home is situated in the village of Yapton, near Bognor Regis. Shops, a public house and links for public transport are within walking distance. Accommodation is provided in two buildings which are linked with a corridor on the ground floor. Both buildings have bedrooms on two floors. The upper floor is accessed by a passenger lift. Communal space consists of a large lounge/dining room and a smaller lounge on the each floor. There are gardens accessible and suitable for the residents. There are twenty four single bedrooms and eight double bedrooms. Some have ensuite facilities. Yew Tree Nursing Home H60-H11 S47860 Yew Tree V248129 210905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The inspector arrived at 8am and left the home at 5.45pm. The registered manager, Mrs McCorquodale and the deputy manager were present throughout the inspection. Over the course of the inspection 11 residents, five visitors and eight members of staff were spoken with. Staff were observed giving support and assistance. Three residents files were examined in detail and other records were seen as was necessary. A tour of the premises took place. Staff files were examined What the service does well:
At the time of this inspection the residents accommodation had a variety of complex needs. Some residents had both physical and mental health needs whilst others required assistance with physical nursing needs and had no mental health problems. There was a large age range in the home with the youngest resident in their twenties and the oldest over 100 years old. Despite this wide variety in the needs and abilities of residents in the home there was a strong sense of community. Each resident was assisted and supported as an individual who lived within that community. Staff showed a very good understanding of the need to respect the differences of each resident. Residents also supported and encouraged each other and the atmosphere was one of mutual co-operation. Residents were not admitted to the home unless a full assessment of their needs had been carried out. The registered manager considered the suitability of the home and the current residents when accepting new residents for accommodation. Staff respected the privacy and dignity of the residents in their care. They were polite, calm and supportive in their approach. Visitors to the home said staff were friendly, helpful and approachable. They discussed how the staff and manager would “do the little extra things” which made a big difference to the care of their relative. Both residents and visitors said they would discuss any concerns or issues with the staff or manager. There were a variety of activities and pastimes available for the residents. Staff supported the residents with activities both in groups and one to one. Residents commented favourably on the activites saying there was always something to do. The home was clean, tidy and well maintained. Staff were aware of maintaining the safety of the residents and identifying and reducing risks. Yew Tree Nursing Home H60-H11 S47860 Yew Tree V248129 210905 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Yew Tree Nursing Home H60-H11 S47860 Yew Tree V248129 210905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Yew Tree Nursing Home H60-H11 S47860 Yew Tree V248129 210905 Stage 4.doc Version 1.40 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 standard(s) 3 and 4 Residents did not move into the home without their needs being assessed. EVIDENCE: The resident’s files examined had assessments of need documented. These had been carried out by the registered manager before the resident moved into the home. She discussed how she would also assess the suitability of any prospective resident to mix and live comfortably with those already living at the home. A large amount of information was gathered prior to a resident being accommodated and assessments from other professionals were on file where appropriate. Since the last inspection additional training had been supplied to ensure the staff had sufficient knowledge to meet the needs of the residents accommodated. Yew Tree Nursing Home H60-H11 S47860 Yew Tree V248129 210905 Stage 4.doc Version 1.40 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 standard(s) 7,8,10 All residents had a plan of care. In practice health care needs were met although this was not always fully documented. Residents were treated with dignity and their privacy was protected. EVIDENCE: All resident’s files examined had a plan of care present. These varied in the detail they contained. Some had a lot of detailed information about the resident which helped to give a clear picture of their needs, abilities and preferences. Others did not contain so much information and had out of date records mixed with current records which led to some confusion about the current situation. The plans of care should clearly document the current needs of the resident and how these are to be met. It was not clear on some care plans how frequently the resident’s needs and abilities had been reviewed. These should be done monthly. One of the plans of care had been drawn up in consultation with the resident and signed. This should always be done, or with a relative/representative if the resident is unable to be consulted. Assessments of the resident’s health care needs were documented. These were not always up to date or consistent with other information kept in the file. A corresponding plan of how to meet the health care need was not always present. For one resident a nutritional assessment, which was not dated,
Yew Tree Nursing Home H60-H11 S47860 Yew Tree V248129 210905 Stage 4.doc Version 1.40 Page 10 documented a weight loss in the past year. The plan of care for that resident was to assist them to lose weight. The manager explained this resident was not underweight and the assessment should have been reviewed. For one resident the pressure sore development risk assessment in place showed them to be at “very high risk.” No plan of prevention was documented although appropriate measures were seen to be in place. The registered manager explained that she was aware of the shortfalls in documentation and was in the process of changing the current system. The documentation did not reflect the care given and staff questioned were aware of the health and social care needs of the residents accommodated and how these were to be met. Staff had received specialist training when a resident with any specific medical condition, which was new to them, was accommodated. This included parental feeding, supra-pubic catheters and ventilators. Staff were seen to treat the residents with respect and maintain their dignity. Residents and visitors said the staff were “kind and patient”. Staff knocked on the bedroom doors before entering. Bedroom and bathroom doors were closed when assistance was being given. Residents could choose to be alone in private should they wish. Yew Tree Nursing Home H60-H11 S47860 Yew Tree V248129 210905 Stage 4.doc Version 1.40 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 standard(s) 12,13,14 and 15 Residents could join in activities and recreational pastimes in the home. Residents individual lifestyle choices were understood and respected by staff. Social and community contacts were maintained. Residents received a wholesome, varied and appealing diet. EVIDENCE: There were two members of staff who were employed to provide social and recreational activities for the residents, Monday to Friday. These staff were cheerful and enthusiastic about their work, talking and laughing with residents and visitors. They provided one to one and group activities for the residents. They interacted well with both the more able and the physically and mentally dependant residents. Both these two staff and other staff members knew the social background of the residents which assisted them to have meaningful chats. A variety of more structured activities were available including board games, movement to music, videos, arts and crafts and one to one activities including manicures, card games and reading to residents. During the weekends the care staff provided activities as they were able. A minibus used to be available for residents to have outings. This is no longer usable and the charges of taxis makes outings less frequent. Contact with the local community was maintained with community groups visiting the home as appropriate. Residents were assisted to visit the local amenities, including the nearby public house were one resident was shortly to hold a birthday party for other residents and staff. Another resident was using
Yew Tree Nursing Home H60-H11 S47860 Yew Tree V248129 210905 Stage 4.doc Version 1.40 Page 12 the village hall for this purpose. Residents were assisted to see their visitors either in private or in the lounge, as they wished. Visitors spoken with said they felt welcomed in the home at any time and those seen chatted with staff and other residents. Relatives said they could be part of the care, within acceptable limits, should they wish. Residents spoken with said they were asked their individual preferences and choices for the day to day routines of life. They could choose when to get up and go to bed. They said the routines were flexible and they were not expected to do the same thing at the same time each day, if they did not wish. Choices around food likes and dislikes were explored and the kitchen staff knew these and catered for them. Small details were recorded in the residents plans of care, regarding their daily routines. Staff were aware of these. The nightime routines, preferences and choices were also recorded separately. Residents said they liked the meals served at the home and had a choice of food at all mealtimes. Breakfasts could be eaten in the dining room or the resident’s own bedroom. At lunch time residents were assisted discreetly to have their meal. Hot and cold drinks were served throughout the day. Special diets were catered for and staff knew the residents own choices and made sure these were met. Yew Tree Nursing Home H60-H11 S47860 Yew Tree V248129 210905 Stage 4.doc Version 1.40 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 standard(s) None of these standards were assessed. EVIDENCE: Yew Tree Nursing Home H60-H11 S47860 Yew Tree V248129 210905 Stage 4.doc Version 1.40 Page 14 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 standard(s) 19 and 26 Residents live in a safe, well maintained and comfortable environment. Specialist equipment was available to meet the resident’s needs. The home was clean, pleasant and tidy. EVIDENCE: Residents benefit from a well maintained home, which was clean and tidy in all areas. The residents and visitors said they were satisfied with the cleanliness of the home and the communal areas were free from offensive odours. An unpleasant odour was present in one bedroom and the manager discussed the action taken to eliminate this and the future plans. The large communal lounge/diner provided a variety of seating, with a smaller sitting area being separated by large fish tanks. The smaller lounges provided a more homely environment for residents and visitors. The fire safety precautions within the home met with the guidance of the local fire service. Devices which meet with their approval were fitted to bedroom doors. Staff had received fire training and fire drills took place. The home had become a “No smoking” home, with staff and residents smoking outside should they wish. Yew Tree Nursing Home H60-H11 S47860 Yew Tree V248129 210905 Stage 4.doc Version 1.40 Page 15 Staff were aware of the procedures to follow to prevent the spread of infection within the home. Protective clothing was available. Some staff had received training regarding the control of infection. The laundry facilities were suitable to meet the needs of the residents. The manager was advised to seek specialist advice regarding the procedures for one resident in the home. Yew Tree Nursing Home H60-H11 S47860 Yew Tree V248129 210905 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 The needs of the residents were met by the numbers and skill mix of the staff. The recruitment procedure in the home did not fully protect the residents. EVIDENCE: The duty rota for week commencing 19/9/05 was examined. The numbers and skill mix of the staff was appropriate to meet the needs of the residents currently accommodated. The manager discussed that the staff numbers would be changed should the needs of the residents make this necessary. Staff said they were happy with the numbers of staff on duty and felt it was adequate to meet the resident’s needs. They discussed how they worked together as a team and would work extra hours to help out or provide cover should it be necessary. Residents said the numbers of staff appeared adequate and they received help quickly enough should they use their call bells. The manager was advised to use the “Residential Staffing Forum” calculations to ensure the staff numbers continue to meet the dependency needs of the residents. Two files for staff from overseas, recruited through an agency, were examined. These did not contain all the information required to ensure they were fit to work with vulnerable adults. The references were not specific to the home or the job. There was no verification of these references. There was not a full employment history and the gaps had not been explained. One member of staff had started work prior to the manager receiving a satisfactory check against the Protection of Vulnerable adults register. The manager said this member of staff had worked under the supervision of an experience staff member for this time. It was discussed that the registered manager was
Yew Tree Nursing Home H60-H11 S47860 Yew Tree V248129 210905 Stage 4.doc Version 1.40 Page 17 responsible for ensuring all necessary checks and verification of information supplied, prior to the person starting work at the care home. Yew Tree Nursing Home H60-H11 S47860 Yew Tree V248129 210905 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Resident’s health and safety was protected. EVIDENCE: Staff were aware of the need to keep the home tidy and safe for the residents. Some had received training in health and safety within the home. Staff had received moving and handling training. One example of poor handling was seen, which could have put the staff member at risk. This was brought to the attention of the registered manager. Appropriate equipment for safe moving and handling was present and maintained. Accidents were reported and recorded. A recommendation from the last inspection regarding the availability of hazard data for the maintenance man had been met. The registered manager said all equipment in the home was maintained as necessary. Yew Tree Nursing Home H60-H11 S47860 Yew Tree V248129 210905 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x 3 Yew Tree Nursing Home H60-H11 S47860 Yew Tree V248129 210905 Stage 4.doc Version 1.40 Page 20 NO Are there any outstanding requirements from the last inspection? 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 29 Regulation 19 Schedule 2 Requirement The registered provider must not employ anyone to work at the care home unless they are fit to do so. All necessary information must be obtained and verified. Timescale for action 31/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 7 Good Practice Recommendations All identified needs and potential risks must have a plan of care documented and implemented. All residents assessed as at risk of developing pressure sores must have a plan of prevention documented. All health assessments must be regularly reviewed. Plans of care should be drawn up in consultation with the residents. Advice regarding barrier nursing should be sought. 2. 3. 4. 8 7 26 Yew Tree Nursing Home H60-H11 S47860 Yew Tree V248129 210905 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Ridgeworth House Liverpool Gardens Worthing, West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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