Inspection on 28/01/06 for Yew Tree Nursing Home

This inspection was carried out on 28th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Yew Tree Nursing Home 14/06/06

Yew Tree Nursing Home 21/09/05

Yew Tree Nursing Home 22/02/05

Yew Tree Nursing Home 08/09/04

Similar services:

The Shelley

Thorndene

Springfield House

Sutton Lodge Nursing Home

Insight - Eastchurch

Southfields

Magenta

Seabourne House

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

CARE HOMES FOR OLDER PEOPLE Yew Tree Nursing Home Yew Tree Nursing Home North End Road Yapton Arundel West Sussex BN18 0DU Lead Inspector Miss Helen Tomlinson Unannounced Inspection 28th January 2006 07.10a 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 Yew Tree Nursing Home DS0000047860.V281075.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. Yew Tree Nursing Home DS0000047860.V281075.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Yew Tree Nursing Home Address Yew Tree Nursing Home North End Road Yapton Arundel West Sussex BN18 0DU 01243 552575 01243 554901 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) Yew Tree Care Ltd Mrs. Janette Mary McCorquodale Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (12), Physical disability of places over 65 years of age (12) Yew Tree Nursing Home DS0000047860.V281075.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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 manager’s assessment t that their care needs can continue to be met 21st September 2005 Date of last inspection 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 DS0000047860.V281075.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The inspector arrived at 7.10am and left the home at 3.15pm. A CSCI pharmacist reviewed medication handling. The night staff on duty were spoken with on arrival. The handover from night to day staff was observed. A tour of the premises took place, staff records, individual care plans and other documents were seen. Staff were observed giving care and support to the residents. Ten members of staff, seven residents and two visitors were spoken with. The registered manager was in the home during most of the inspection. 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. Staff showed an understanding of the need to respect the differences of each resident and support them as an individual. What the service does well: What has improved since the last inspection? Yew Tree Nursing Home DS0000047860.V281075.R01.S.doc Version 5.1 Page 6 The format for the care plans to be documented had changed since the last inspection. This was now simplified with each resident having an individual file for their information to be stored. The registered manager had verified references, as far as possible, for staff members coming from overseas. 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 DS0000047860.V281075.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 Yew Tree Nursing Home DS0000047860.V281075.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): None of these standards were assessed. Standard 3 was assessed and met at the last inspection. Standard 6 is not applicable to this home. EVIDENCE: Yew Tree Nursing Home DS0000047860.V281075.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): 7,8 and 9 Residents had a plan of care. This did not contain sufficient detail as to how their needs should be met. They were not kept up to date. Resident’s health needs were met though this was not always thoroughly documented. Medicines stored in a fridge, below the correct temperature and incomplete records relating to medicines potentially put residents at risk. Standard 10 was assessed and met at the last inspection. EVIDENCE: Several resident’s files were seen. Since the last inspection the method of recording the plans of care had been reviewed. This now consisted of a separate file for each resident, with their health assessments and plans of care kept together. For one resident, who had been living at the home for three weeks, there was no detailed plan on file of how their needs were to be met. Many of the documents in the file were blank, for example the client handling form, the nutritional assessment and the weight chart. This despite the persons nutritional needs being assessed as a risk. In the other files seen these charts were completed, though they were not up to date and some contained conflicting information. For one there were changes to the moving and handling assessment which had not been transferred to the plan of care. Yew Tree Nursing Home DS0000047860.V281075.R01.S.doc Version 5.1 Page 10 Where risks were identified, following an assessment, this was not transferred to a plan of care or management. This included a high risk of falls, development of a pressure sore and malnutrition. The reviews of the care plans were unclear, with some having been reviewed recently and frequently, but most not having been reviewed for several months. The registered manager acknowledged that work needed to be done to get this information up to date. An example of a reviewed file was sent to the Commission, following the inspection, which showed a commitment to improve the care planning and assessment process in the home. On arrival two residents had bed rails in place with no protectors. Two further residents had chairs against the bed side. Staff said this was to prevent them falling out. It was discussed with the manager that all residents must have protectors in place whenever bed rails are in use. The need for bed rails should be assessed for any resident identified as at risk of falling out of bed. An issue of one resident, who was shouting loudly in the lounge and dining room, was raised with staff. It was observed that this resident was upsetting and irritating other residents, who were shouting back. One resident described the dining room as “rowdy.” One member of staff dealt with the shouting in a sensitive manner, resolving the issue. Other staff members had ignored the resident. A strategy for the management of this behaviour should be in place and all staff aware of it. The registered manager was aware of the situation and said the resident was having further assessments carried out to try to resolve the issue for all residents. The home has medication policy and procedures available to staff. The home’s procedure for disposal of medicines did not comply with recent guidelines. Staff keep records of the temperature of the medicines fridge, which included temperatures below the correct range. Lockable medicine storage was tidy. Records of receipt of medicines for three recently admitted residents were not available. A list is maintained of the signatures and initials of the nurse authorised to administer medicines. On Medication administration record charts were handwritten clearly. On rewriting each month these were checked by a second nurse. Records of verbal orders did not indicate the prescriber or who received the order. A risk assessment for a medicine being supplied for self- administration had not been completed Yew Tree Nursing Home DS0000047860.V281075.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): 15. Standards 12,13 and 14 were assessed and met at the last inspection. Residents had a varied diet provided. The dining area was not made pleasant for all meal times and some residents did not have adequate supervision with food and drinks. EVIDENCE: The residents spoken with said they enjoyed the food given to them. They said they got a varied diet and a choice of meal. On arrival at the home eleven residents were up and staff and the residents who were able said this was their choice. Those sat in the dining room were at tables which were showing signs of wear and tear. No cloths were present. They were all given a hot drink at the same time, which meant some residents had been up from bed for nearly an hour without a drink. A varied breakfast was served, with some residents having full cooked breakfast and some toast and cereals. It was observed that some residents who required assistance in the form of supervision were left to manage their food themselves. This resulted in one resident with sight problems eating another resident’s breakfast, since it had not been explained to either of them when the breakfast was served. The serving of drinks was the same, with a lack of supervision for the residents. The breakfast routine should be reviewed. Yew Tree Nursing Home DS0000047860.V281075.R01.S.doc Version 5.1 Page 12 At lunchtime the dining room was a more pleasant environment and adequate supervision was given to all residents present. This was on a one to one basis and discreet. Yew Tree Nursing Home DS0000047860.V281075.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 Residents and relatives felt their concerns would be dealt with appropriately. Residents were protected from abuse. EVIDENCE: One complaint had been made to the home in the past twelve months. A record of the complaint, investigation and the outcome was kept. The complainant had been kept informed and the issue resolved to the satisfaction of all concerned. A copy of the complaints procedure was in the service user guide. It was recommended that a copy be put on display in the home. Those residents and visitors spoken with said they would approach the manager, or any senior member of staff, if they had any concerns or complaints. Staff had received training in the protection of vulnerable adults. Those spoken with were aware of their responsibility within their role, to protect the adults in their care. This included the reporting of suspected abuse. Written procedures were present in the home. Yew Tree Nursing Home DS0000047860.V281075.R01.S.doc Version 5.1 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 the following standard(s): 20,21,22 and 24. There was adequate communal space for the resident’s use. Sufficient toilets and bathrooms were provided. The necessary equipment to meet the needs of the residents accommodated, was present in the home. Bedrooms were personalised, where residents wanted this. Standards 19 and 26 were assessed and met at the last inspection. EVIDENCE: The communal space in the home consists of a large lounge/dining room, on the ground floor, with dining tables at one end and armchairs at the other. A smaller area is divided off the large lounge, by a screen of fish tanks. This area has patio doors onto the garden. A smaller, more homely lounge is present also. This lounge is used as a quiet room and for many of the activities which take place in the home. Efforts have been made to have a domestic and homely feel to the large communal space. Redecoration is of a domestic nature, but the size and layout make this more difficult. The smaller area and the quiet lounge are homely. The communal areas were tidy and uncluttered. They were clean, with domestic assistance present in the home every day. Yew Tree Nursing Home DS0000047860.V281075.R01.S.doc Version 5.1 Page 15 There is outdoor space in the large gardens, with suitable seating areas. There is also a sensory garden to the side of the building, which was being developed in the summer. Residents said they liked sitting out in the good weather. There were toilets close to the communal areas of the home. These were clean and suitable for the residents, with raised toilet seats, frames and grab rails where needed. Residents had commodes provided in their bedrooms, should they not have en-suite facilities. One bathroom was not accessible to the residents, due to steps leading to it. There was an assisted bath on the ground floor which staff said was in use for most residents. The manager said a level access shower was being installed on the ground floor to provide further, accessible facilities. The equipment needed for the residents currently accommodated was present in the home. This included hoists, hand rails, assisted baths and eating and drinking utensils. Not all bedrooms were seen on this inspection. Those that were were clean and tidy, with the necessary items for the resident to be able to use their bedrooms, should they wish, for sitting in during the day. They were personalised with pictures, photographs, pieces of furniture and other items. Residents had their own entertainment equipment in them, should they wish. Some bedrooms were malodorous. The manager was aware of this and was working to eliminate the problem. Yew Tree Nursing Home DS0000047860.V281075.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): 27,28,29 and 30 The numbers and skill mix of staff was sufficient to meet the needs of the residents. Staff receive training for the work they are to perform. Not all information required to be available for staff employed in the home was present. EVIDENCE: At the time of this inspection the numbers and skill mix of staff was sufficient to meet the needs of the residents accommodated. There was one qualified nurse with five care assistants on duty at night, two qualified nurses and nine care assistants in the morning and two nurses with seven care assistants in the afternoon and evening. Many of the staff working in the home were from overseas, with English as their second language. This was not seen to cause any issues at the time of this inspection and additional English language lessons were given to all these employees, by a qualified teacher employed by the home. Staff spoken with said there was plenty of opportunity for learning within the home. Training courses were provided, both in house and externally. A comprehensive training programme was in place and at least eight training events had taken place already in 2006. These included both statutory training such as health and safety and also specific training such as care planning and admitting new residents. The manager stated that staff were encouraged and supported to complete NVQ training, should they wish to do this. Some staff members had completed level two and three with additional members currently taking the course. Yew Tree Nursing Home DS0000047860.V281075.R01.S.doc Version 5.1 Page 17 At the last inspection a requirement was made that all information required by the Regulations, in order to protect the residents, was obtained prior to any new member of staff starting work at the home. Some staff had started work without evidence that the correct checks had been made. References and other information obtained through an employment agency had not been verified. At this inspection the manager had verified, as far as possible, the information provided by the agency. The information on file regarding the CRB and POVA checks was incomplete and did not provide evidence that satisfactory checks had been obtained, prior to the person starting work. The manager said this information had been obtained, by the registered providers. They were requested to confirm this in writing following the inspection. Not all gaps in employment were explained. The requirement made at the last inspection remains in place due to the evidence not being available. Yew Tree Nursing Home DS0000047860.V281075.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): 31,33,35,36 and 38 The residents benefit from a home which is managed by an experienced and appropriately qualified person. Reviews of the quality of care provided should be carried out. It was not possible to assess standard 35 since the manager did not have access to the information. The registered providers were requested to confirm they met this standard, following the inspection. Staff did not receive formal or recorded supervision by a senior member of staff. The practices and procedures in the home protected the residents. An issue of safe moving and handling was raised. Yew Tree Nursing Home DS0000047860.V281075.R01.S.doc Version 5.1 Page 19 EVIDENCE: The registered manager is a registered general nurse and has completed the Registered Managers Award. She has worked at the home for fourteen years and as the manager for nine years. She attends training courses to keep herself up to date. Staff and residents spoke highly of her describing her as approachable, fair and helpful. There was no formal method of reviewing the quality of care and facilities provided at the home. The manager talks with residents, staff and relatives on a daily basis and discusses the quality of care provided. This was not recorded and a cycle of continuous improvement was not in place. It was discussed with the manager that a system for reviewing the quality of care, which involved all with an interest in the home, must be put into place. Staff said they could talk to the manager at any time, during their working day. The manager and other senior staff worked alongside more junior staff providing ongoing support and observing their practice. Formal one to one or group supervision sessions did not take place. The informal supervision was not recorded. All staff working at the home must be appropriately supervised. Most staff had received training on health and safety within the care home. On the day of the inspection the home was tidy and free from hazards. Fire safety measures were in place, fire doors were closed or held open by a device which met with the guidance of the fire service. Staff had received fire safety training. Accidents were recorded and appropriate action taken. An issue of unsafe moving and handling of a resident was noted and a recommendation made that this be reviewed. Yew Tree Nursing Home DS0000047860.V281075.R01.S.doc Version 5.1 Page 20 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 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X 3 3 3 X 3 X X STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 2 X 2 Yew Tree Nursing Home DS0000047860.V281075.R01.S.doc Version 5.1 Page 21 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 15 Requirement All residents must have an up to date plan of care, which is comprehensive and kept under review. Residents, when possible, should be involved in the drawing up of the plan. Staff must understand the action to be taken when the temperature of the medicines fridge is outside the correct range. 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. This requirement remains unmet since the inspection of 21/09/05. The timescale given of 31/10/05 has expired A system for reviewing and improving the quality of care must be in place. All staff working at the care home must be appropriately supervised. Timescale for action 30/04/06 2 OP9 13(2) 28/02/06 3 OP29 19 Schedule 2 31/10/05 4 5 OP33 OP36 24 18(2) 31/05/06 30/04/06 Yew Tree Nursing Home DS0000047860.V281075.R01.S.doc Version 5.1 Page 22 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 2. 3 Refer to Standard OP8 OP8 OP9 Good Practice Recommendations The need for bed rails should be assessed for any resident who staff identify as at risk of falling out of bed. All health assessments must be regularly reviewed. Receipt of all medicines should be recorded. A risk assessment should be recorded for residents wishing to retain responsibility for some or all of their medicines. Recording verbal orders should be reviewed. Disposal of unwanted medicines should be reviewed according to CSCI guidance. Residents should be supervised and assisted when given drinks or meals. The dining area should be a pleasant place for residents to eat and drink, at all times of day. The way residents are assisted when moving and handling should be reviewed, especially for those residents with variable abilities. 4 OP15 5 OP38 Yew Tree Nursing Home DS0000047860.V281075.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Worthing LO 2nd Floor, 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 © 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 Yew Tree Nursing Home DS0000047860.V281075.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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