Inspection on 28/06/07 for Yew Tree Nursing Home

This inspection was carried out on 28th June 2007.

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

Yew Tree Nursing Home 30/01/06

Yew Tree Nursing Home 12/10/05

Yew Tree Nursing Home 29/03/05

Yew Tree Nursing Home 31/08/04

Yew Tree Nursing Home 30/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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 Place Romsley West Midlands B62 0NX Lead Inspector Nic Andrews Unannounced Inspection 28 June and 2 July 2007 09:15 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 DS0000004156.V340827.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. Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Yew Tree Nursing Home Address Yew Tree Place Romsley West Midlands B62 0NX 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) 01562 710809 01562 710592 Yew Tree Nursing Home Limited Mrs Sharen Ellen Guise Care Home 35 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (35), of places Physical disability (4), Physical disability over 65 years of age (35) Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. An age limit of 55 - 65 years applies to people with needs in category PD. 30th January 2006 Date of last inspection Brief Description of the Service: Yew Tree Nursing Home is a large, detached purpose built property that was originally built in 1993 for 29 older people. In June 2006 the premises were extended to provide accommodation and nursing care for a further six service users. Therefore, the home is currently registered for a maximum of 35 older people. Some of the service users may also have a dementia illness or a physical disability. The home is situated on a level site within a ‘green belt’ area in a quiet part of the village of Romsley. The village shops, a Post Office and a public house are in close proximity to the home. The home and the large garden is accessible to people who use wheelchairs. The home also provides adequate space for car parking. The service users are accommodated on the ground and first floor of the premises in thirty-three single bedrooms and one double bedroom. The double bedroom and twenty-six of the single bedrooms have an en suite facility. There is a combined lounge/dining room on the first floor and two combined lounges/dining rooms on the ground floor. There is also a small lounge on the ground floor. The home also provides a treatment room, a hairdressing room and a staff training room on the first floor and a nurse’s station on the ground floor. In addition to the two staircases, the home also provides a passenger lift to enable the service users to access the accommodation on the first floor more easily. The home provides its own catering and laundry service. The stated aim of the home is to enable older people to continue living as independently as possible by receiving care and support consistent with their incapacities and disabilities. The fees ranged from £387.00 to £516.00 per week. Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place over the course of two days. The home was inspected against the key National Minimum Standards with the help of the registered manager and administrator. Time was also spent assessing the home’s response to the requirements that were made as a result of the previous inspection. Various records and a number of different policies and procedures that the home is required to maintain were also inspected. A tour of part of the premises was also made. Individual discussions were held with three service users, three relatives of service users, five members of staff and one visiting professional. The care of two of the service users was case tracked. As part of the inspection Comment Cards were issued to the relatives of ten of the service users. The comments that were made in the eight Comment Cards that were completed and returned are reflected in this report. What the service does well: What has improved since the last inspection? Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 Page 6 Since the last inspection an extension had been built to provide a further six bedrooms. Consequently, the number of service users for which the home is registered had been increased from 29 to 35 older people. The extension also included a new, fully disabled bathroom and wet room and a staff training room. A storage room had been converted into a hairdressing room. The home was developing a person centred approach to personal care delivery with a greater emphasis on the service users’ choice and empowerment. 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. The summary of this inspection report can be made available in other formats on request. Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 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 DS0000004156.V340827.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5. The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users are provided with information and with the opportunity to visit the home to enable them to make a choice about admission. Their needs are assessed and they are given a contract that tells them about the service they will receive. EVIDENCE: The home’s statement of purpose contained clear and relevant information. It was pleasing to note the emphasis that it placed on the rights of the service users. However, it did not include all of the details referred to in Regulation 4, Schedule 1 and Standard 1.1. The statement of purpose should be amended so that it includes the address of the registered provider, the relevant qualifications and experience of the registered provider and registered manager, the relevant qualifications and experience of all the staff e.g. nursing staff; details of the staffing within the organisational structure, specific details of the range of needs that the home is intended to meet, the arrangements made for the care and accommodation of the service users in the event of a temporary closure of the home as a result of fire and the size of all the rooms. Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 Page 9 The service users’ guide also contained clear and relevant information. However, the service users’ guide should also include details of any special needs or interests catered for, the service users’ views of the home, the address and telephone number of the Commission for Social Care Inspection (CSCI), the physical environment standards and information about how to contact the local social services and health care authorities. The administrator confirmed that all of the service users had been issued with a statement of their terms and conditions of residence (contract). The service users’ files that were inspected contained a copy of their individual contract. The contracts were signed and dated. The contents of the contracts were satisfactory. It was confirmed that all prospective service users were assessed prior to admission. The assessments were usually carried out by the registered manager and/or the care manager in the service users’ own home, place of residence or in the hospital in which the prospective service user was a patient. The form that was used for assessing the care needs of prospective service users contained a reference to all of the aspects of care listed in Standard 3.3. It was confirmed that all prospective service users were given the opportunity to visit the home prior to admission. However, because of the individual circumstances of the prospective service users it was not always possible for them to make use of the opportunity to visit. The home provided a trial period of four-weeks following admission. The administrator confirmed that the home did not normally have the capacity to admit prospective service users in an emergency. The service users and the relatives with whom discussions were held confirmed that they were given the opportunity to visit prior to admission and that they received written information about the home. Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The service users’ health and personal care is based on an assessment of their individual needs. The staff adhere to the home’s procedures for the safe handling and administration of medication. The principles of respect, dignity and privacy were understood and put into practice. EVIDENCE: It was confirmed that all of the service users had a care plan that was based on an assessment of their individual needs. A twenty-four hour nursing assessment was carried out on admission. In addition, a nursing care dependency chart was also completed on admission and then at least every month. The manual handling assessment helped to determine the use of hoists, slide sheets etc. The care plans included twelve core activities for daily living and other details regarding the service users’ care. The care plans were comprehensive and contained relevant information. However, some of the instructions regarding the intervention/action aimed at meeting the desired outcome were not as specific as they should be. For example, the care plans contained statements such as, ‘check regularly when in bed’, ‘monitor it (the pressure relieving mattress) for maintenance of pressure’ and ‘to use syringe Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 Page 11 for medication’. The care plans should specify the frequency of and/or any circumstances when, any required interventions by staff should be carried out. Two requirements were made as a result of the previous inspection. The first requirement was that all aspects of the care plans must be reviewed monthly. The second requirement was that robust systems must be in place for service users identified at being nutritionally at risk. Both requirements had been implemented. It was confirmed that all of the service users were registered with the local GP surgery. The GP visited the home every week. The majority of service users depended on the staff for assistance with their personal care tasks. The staff managed the two service users that had pressure sores and one service user that had an ulcerated leg without the support of the community nursing service. The help of the district nurse and continence adviser were not normally sought. The nursing staff attended wound care study days and members of the Wound Care Society provided monthly updates. The home had its own supply of pressure relieving equipment, mattresses and cushions to meet varying degrees of dependency and hospital beds that adjusted to the position required by the individual service user. All the staff attended courses and updated themselves on issues such as incontinence. A community psychiatric nurse visited one service user. Seven service users had a diagnosed dementia illness or Alzheimer’s disease. Two of the seven service users had been diagnosed with long-term schizophrenia. The service users were assessed for incontinence on admission and were monitored each month. Nutritional screening is carried out on admission using a recognised assessment tool. Service users were weighed monthly. Weight gains and losses were monitored and, if necessary, the GP was asked to prescribe supplementary feeds. A visiting ophthalmic service went to the home to carry out eyesight checks. A dental service was also provided as required. The service users that are diabetic were tested routinely and the staff liaised closely with the diabetic nurse at the surgery to arrange any further therapy check ups. Audio appointments at the local hospital were arranged through the GP. The chiropodist visited every three months. The monthly Waterlow Pressure Assessment charts, dependency level charts and the nutritional assessment scores were used to determine the level of staffing required in accordance with the Department of Health guidance. The service users’ blood pressure was checked every month and blood sugar levels every six to twelve months. Risk assessments were carried out in respect of falls, nutrition, swallowing, epilepsy and the use of bed rails. It was confirmed that all the bed rails had bumpers. It was stated that the provision of more hoisting equipment would be helpful. The visiting professional with whom a discussion was held felt that the standard of general nursing care was ‘very high’. She said that the care plans were ‘comprehensive, easy to use and up to date’ and that the nursing practices were ‘good’. She said that she had a positive relationship with the staff and that the staff were ‘receptive to advice which is carried out’. Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 Page 12 The home used the Nomad monitored dosage system for the administration of medication. The drugs trolley and medication were kept in a dedicated, lockable treatment room. Only the Registered General Nurses administered medication and, apart from the registered manager, only they had access to the treatment room. The senior member of staff on duty was responsible for holding the key to the treatment room. The Medication Administration Record (MAR) charts contained a photograph of the individual service users to assist correct identification. The MAR charts had been completed correctly. Two members of staff signed the MAR charts when the details of the medication were written on to the MAR charts by hand. The date of opening was recorded on the outside of the medicine packets. Creams that are in use were audited each month to ensure that they had not passed their expiry dates. The home had a controlled drug cabinet that complied with the Misuse of Drugs (Safe Custody) Regulations 1973. The controlled drug register was up to date and correctly maintained in respect of six service users that were in receipt of controlled drugs. There was an appropriate system for recording the receipt and return of medication. Copies of the prescriptions were retained by the home. The home had a dedicated fridge in which medicines that required cold storage could be kept, for example insulin, eye drops and creams such as Daktacort. A daily record was maintained of the temperature of the fridge. Blood-sugar monitoring was undertaken once a month in respect of five service users not in receipt of insulin but whose diabetes was diet and tablet controlled. A list of the names and signatures of the staff involved in the administration of medication was maintained. Sharps were disposed of safely. Clinical waste is collected monthly. The registered manager confirmed that all the care staff had undertaken ‘Safe Handling of Medication’ training provided by Abacus. It was also confirmed that two members of staff had undertaken accredited training in the administration of medication. The registered manager was advised that all the staff involved in the administration of medication should undertake accredited training. One service user was in receipt of oxygen when required. The oxygen supply that was available for use in an emergency was checked each day. The door to the treatment room was appropriately labelled. The home’s medication policies and procedures included the administration of drugs and a specific procedure for the disposal of unwanted drugs and medication. It was confirmed that all the policies were being reviewed to ensure that they were measurable on the monthly audits. None of the current service users administered their own medication. However, a lockable facility had been provided in the service users’ bedrooms to ensure the safekeeping of their medication if this became necessary. The staff with whom discussions were held understood the importance of upholding the service users’ privacy and dignity. The responses that were given to the questions they were asked about personal care giving reflected good practice. It was confirmed that examinations and treatment provided by visiting professionals were carried out in private. Some service users had their own mobile ‘phone or land line telephone. A mobile handset was also available to enable all the service users to make and receive telephone calls in private. Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 Page 13 All of the bedrooms had been installed with a telephone point. Mail was given to the service users unopened. The service users wore their own clothes and their clothes were appropriately labelled. The only items of clothing that were received by the home were those that were donated for fetes and jumble sales. However, the home held three sets of male and female clothing for use in an emergency for service users that were admitted direct from hospital. The home did not have a communal store of clothing. The staff received instruction during their induction on how to treat the service users with respect. There was one double room and it provided curtain screening. The service users with whom discussions were held confirmed that they were treated with respect, that their right to privacy was maintained and that the staff knocked their bedroom door before entering. One relative, speaking of her mother, said ‘The staff never talk down to her. They never speak to her like a child’. Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The home promoted the service users’ quality of life by offering choice, seeking their views, encouraging them to retain contact with their family and friends and by the provision of a good standard of food. EVIDENCE: The home employed a full-time member of staff who was responsible for coordinating the service users’ social and leisure activities. The activities coordinator provided a programme of activities that included Bingo and other board games, quizzes, I Spy, and reminiscence sessions. Entertainers visited the home twice a month. Music and movement sessions were held once a fortnight. The home received visits from the local minister of religion and the main Christian festivals were celebrated. A Christian service was held in the home approximately every five to six weeks. Service users received visits from representatives of the Roman Catholic and Methodist churches and from the Salvation Army. A mobile library and a ‘talking book’ service were provided. A garden party was planned for 6 August 2007. The activities coordinator confirmed that he was able to spend time talking to the service users individually. The focus on activities was within the home. However, occasional outings were arranged to various places including the local pub, garden centres and the botanical gardens. Posters advertising social events Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 Page 15 and other activities were displayed on the notice boards. Similar information was also circulated to the service users’ relatives with the monthly invoices. A wine tasting event was planned for the near future. The activities coordinator was hoping to encourage the service users’ individual interests and to develop a greater interest by the service users’ in their social history. It was felt that a more diverse programme of activities could be provided and better documented. The relative of one service user stated in the Comment Card that the home could improve by providing ‘more outings’. There were no unnecessary or unreasonable restrictions regarding the visiting arrangements. The service users’ right to refuse to see their visitors was respected. The service users confirmed that they were able to see their visitors in private and that their visitors were always made welcome and offered a cup of tea. The relatives of two service users said that they were able to make themselves a drink and to stay for lunch if they so wished. The first floor lounge could be used for private meetings or celebrations, if required. The relatives, friends and representatives of service users should be given information, preferably in the service users’ guide, about the home’s policy on maintaining relatives and friends’ involvement with service users at the time of admission. The home received regular visits from one volunteer who had undergone appropriate checks. The home also received visits at Christmas from the Brownies and from the children at the local nursery. Each month a meeting was held with the service users and their relatives preceded by a ‘Sunday tea’. Six meetings had been held so far. The meetings took the form of an open forum based on a discussion around a particular theme in which the service users and their relatives were encouraged to participate. The registered manager stated that the service users were encouraged to exercise their right to make choices in regard to their daily routines, the clothes they wore, their personal appearance, the time they got up and went to bed, where they sat and with whom they wished to sit. The home tried to resist ‘family pressure’ that was sometimes exerted to direct how the service users should be treated. Information about the local advocacy service was displayed on the notice boards. Awareness of the advocacy service was to be promoted by an insert in the next set of monthly invoices issued to the service users’ relatives. The home had become a member of the CareAware advocacy service in order to access the information available. A reference to the advocacy service was included in the service users’ guide. The registered manager stated that prospective service users were always encouraged to consider bringing personal possessions with them on admission and facilitated this by offering transport. Nevertheless, the service users’ guide should include a clear statement about the service users’ entitlement to bring personal possessions with them when they are admitted to the home and also their right of access to the personal records held about them by the home in accordance with the Data Protection Act 1998. The service users and their relatives confirmed that the daily routines were flexible and that there were no unnecessary rules or restrictions governing their movements or activity. Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 Page 16 The relief cook confirmed that the service users’ food preferences and dietary needs were recorded at the time of admission. It was also stated that the chef prepared the four-week menu in consultation with the service users. The care staff asked the service users each morning what they would like to eat for their lunch and teatime meals. A choice of food was provided. Breakfast was served between 7.30 and 10.00 am and included a full English breakfast, if requested. Lunch was usually served at 12.45 pm and included two meat choices and an alternative meal, if required. The teatime meal was served at 5.00 pm and usually consisted of a choice of various items on toast, jacket potatoes, soup or sandwiches. Supper was served at 7.30 pm. Drinks and snacks were served mid-morning and mid-afternoon and were also available throughout the day. The special dietary needs and preferences of service users, including those that were diabetic, were catered for appropriately. The catering staff were aware of the service users’ food allergies. Sixteen service users required staff assistance when eating. Plate guards were used when necessary. Ten service users were in receipt of liquefied meals and two service users had their meat pureed but were served vegetables in the usual way. The food portions were prepared separately. The home had embarked on the Council’s ‘Safer Food Better Business’ initiative. A record was maintained of the food, fridge and freezer temperatures. The relief cook said that she followed a cleaning schedule but it was not written down. She confirmed that all the food was labelled and dated and that all of the kitchen equipment was in proper working order. The dining areas were pleasantly decorated and provided congenial settings in which to eat. The record of the food provided showed that the service users received a wholesome and balanced diet. The food that was observed being served during the inspection was appealing and nutritious. The comments by the service users about the food were favourable. One service user described the food as ‘very good’ and another as ‘satisfactory’. One service user said, ‘Some days it could be better. On average it’s not too bad, I can’t grumble’. The relative of one service user stated in the Comment Card that the home provided ‘good and plentiful food’. Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The service users feel confident about making a complaint and the home has policies and procedures in place that help to ensure that the service users are protected from abuse. EVIDENCE: The home had a clear, simple complaints policy and procedure. A copy of the complaints procedure was displayed on the notice boards. However, the wording needed to be changed so that the policy and procedure stated clearly the action that would be taken in response to a complaint rather than the action that should be taken. The complaints procedure as set out in the service users’ contract included the name, address and telephone number of the CSCI to which any complaint may be referred at any stage. The complaints procedure referred to in the statement of purpose and service users’ guide should include the same information. An incorrect reference in the complaints procedure to the ‘Nursing Homes Inspectorate’ was deleted during the inspection. The complaints procedure should also include an assurance that all complaints will be responded to within a maximum of 28 days. Since the previous inspection three complaints had been made against the home. One of the complaints had been made direct to the CSCI. Two of the complaints had been unsubstantiated and one complaint had been partly substantiated. The complaints had been taken seriously and investigated thoroughly. The record of the complaints and the action taken was well documented. The service users with whom discussions were held said that they felt confident about making a complaint and that any concerns expressed Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 Page 18 would be dealt with quickly and appropriately. All the service users and relatives that were spoken to said that all the staff were approachable. The home had a policy and procedure for the protection of vulnerable adults dated November 2006. The policy needed to be amended to include information about how to contact the Adult Protection Coordinator and the CSCI to which all incidents of suspected or alleged abuse should be referred. The policy also needed to state clearly that any member of staff against whom an allegation of abuse is made will automatically be suspended from duty pending the outcome of the investigation into the alleged abuse. The wording of the policy also needed to reflect the home’s primary duty to protect service users from abuse without the service users’ consent, if necessary. The policy and procedure was discussed with the registered manager and administrator and subsequently amended. The home also had a ‘whistle blowing’ policy and a policy on physical restraint. The registered manager confirmed that all new staff were given leaflets of abuse and a copy of the code of conduct and practice set by the General Social Care Council. The staff were provided with training on the protection of vulnerable adults from abuse. The next training session was due to be held on 4 July 2007. The home had a copy of the Department of Health guidance ‘No Secrets’. The registered manager confirmed that since the previous inspection no incidents of suspected or alleged abuse had been reported or otherwise come to her attention. None of the staff had had their names referred for consideration for inclusion on the POVA list. The registered manager had no concerns about the way any of the service users were treated or cared for by the staff. The home’s policy on dealing with the service users’ money and financial affairs was satisfactory. Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The service users lived in a clean, safe and well-maintained environment. EVIDENCE: An external maintenance consultancy firm was responsible for the maintenance of the premises. The firm coordinated a planned and emergency programme of maintenance that included major repairs and any items of equipment that required certification. The home also employed a full-time maintenance man who maintained the premises on a day-to-day basis. The registered manager confirmed that she carried out a monthly internal risk assessment/audit on every room including all of the communal areas. The gardens were tidy, safe and accessible to service users. The registered manager stated that the last visit to the home by the Fire Safety Officer was on 16 March 2006. It was confirmed that there were no outstanding fire safety issues. A fire risk assessment had been carried out in April 2007 and this included the additional provision of special chairs to be used in the event of an evacuation of the premises. The Environmental Health Officer carried out an inspection on 20 Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 Page 20 February 2007. The registered manager confirmed that there were no outstanding issues arising from the visit. Keypads were being fitted to two internal doors on the first floor corridor. A loose wire in bedroom 3 needed to be boxed. The administrator confirmed that this matter was being dealt with during the inspection. A requirement was made as a result of the previous inspection that worn flannels and towels must be replaced. The requirement had been implemented. The registered manager stated that the locks on the bedroom doors were being replaced as part of the home’s programme of routine maintenance and renewal i.e. refurbishment plan. Standard 24 was not fully assessed on this occasion. However, the home’s response to the requirement that was made as a result of the previous inspection was assessed. The requirement was that the service users must be provided with lockable space for medication, money and valuables and a key which he or she can retain unless the reason for not doing so is explained in the care plan. The requirement had been implemented. The service users’ bedrooms that were viewed during the inspection had been personalised and were comfortably furnished. The premises were clean, tidy and free from unpleasant odours. The laundry was appropriately sited and contained two washing machines and two dryers. The washing machines had a sluicing facility. There was also an automatic sluicing facility on the first floor. The laundry floor finishes were impermeable and these and the wall finishes were readily cleanable. The laundry contained a wash hand basin and paper towel and liquid soap dispensers. The home used the ‘red bag’ system for dealing with soiled linen. Protective aprons and disposable gloves were available and in evident use by the staff. The home’s infection control policy was satisfactory and had been reviewed in November 2006. An infection control audit was carried out every three months. The last audit was undertaken on 31 May 2007. The service users and the relatives with whom discussions were held expressed their satisfaction with the standard of cleanliness of the home, their individual bedrooms and the laundering of the service users’ clothes. The relative of one service user stated in the Comment Card ‘The home is always clean. Dad is always immaculate’. Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The staffing levels and the arrangements for staff deployment and training are sufficient to meet the needs of the service users. The staff are supported and enabled to understand their roles and responsibilities. EVIDENCE: The staff duty rota showed that the home was adequately staffed and that additional staff were on duty at peak times of activity during the day. During the week from 8.00 am to 2.00 pm, one RGN and seven care staff were on duty. In addition, the registered manager, care manager and activities coordinator were also on duty with support from administrative, catering and domestic staff. From 2.00 to 8.00 pm, one RGN and six care staff were on duty. One care assistant and one domestic worked from 5.00 to 11.00 pm and from 8.00 to 11.00 pm respectively. From 8.00 pm to 8.00 am, one RGN and two care staff were on duty. The level of staff cover reduced slightly at weekends and the registered manager did not normally work a weekend shift. Agency staff, normally care staff not registered general nurses, were used to cover maternity leave, annual leave and paternity leave. Wherever possible, the same person was used in order to ensure a level of consistency. The home had two, weekend night care vacancies. The registered manager ensured that the staffing levels were adequate by calculating the service users’ levels of dependency. This was done every month using the Department of Health guidance. All the service users and relatives with whom discussions were held spoke positively about the staff. One service user said, ‘They look after me to Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 Page 22 the best of their ability’. Another service user said, ‘They’re all very helpful. Nothing is too much trouble. They give attention to detail. Patient care is good’. One relative said that she was happy with the care her mother received and stated, ‘The staff are caring and totally committed’. The Comment Card received from the relative of one service user stated, ‘All staff show a caring attitude and are helpful when asked for assistance. First class provision’. Another respondent stated, ‘Yew Tree treats all residents with dignity and respect. Is always attentive to residents’ dress and cleanliness. It supports family members. Friendly and caring staff. Décor and cleanliness of the home is excellent’. Another respondent stated, ‘My mother likes all the staff. I always find the staff cheerful, helpful – doing their jobs very well indeed. I am pleased with the level of individual attention my mother receives’. Another respondent included the comment ‘pleasant staff’. Another respondent stated, ‘All staff have residents well being first and foremost. The level of care has been excellent. I have never known such dedicated people. I am kept well informed’. Another respondent stated, ‘Welcoming, friendly, open atmosphere, relationships between staff, staff/residents, staff/relatives excellent enabling residents to retain dignity. Residents seen as/treated as individuals with individualised needs and personalities, communication excellent’. The registered manager confirmed that more than 50 of the working week was covered by staff who had completed the NVQ level 2 training. However, less than 50 of the care staff had undertaken the NVQ level 2 training. The National Minimum Standards require homes to have achieved a minimum ratio of 50 trained members of care staff with NVQ level 2 or equivalent, excluding those members of the care staff who are registered nurses. The home employed 22 members of care staff including one member of staff who was on maternity leave. Of these, 9 members of staff had obtained the NVQ level 2 or equivalent or above. Therefore, the home fell below the required ratio. However, it was pleasing to note that one member of staff was undertaking the NVQ level 3 training and that 9 members of staff were in the process of completing NVQ level 2 training. The files of four members of staff were inspected. There was evidence to show that the staff had undergone a CRB check and the files contained proof of the person’s identity. Two of the files did not include a photograph. However, it was confirmed that a photograph of each member of staff was displayed in the home near to the main entrance. Three files contained two written references and a completed application form. The application form had an ethnic monitoring form attached as part of the home’s equal opportunities policy and practices. However, the file of one member of staff recruited from abroad contained only one written reference and did not contain an application form. The member of staff had been recruited through an employment agency. The registered manager subsequently stated that the home’s agreement with the recruitment agency stated that all relevant checks had been obtained on the home’s behalf. The home must ensure that the same elements of the recruitment procedures apply to all staff. The staff with whom discussions Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 Page 23 were held confirmed that they had been given a contract, job description and a copy of the code of conduct and practice. The home had a satisfactory staff induction programme that was part of a training resource provided by an external organisation. The induction programme complied with the Skills for Care standards and included a training set that supported the induction information. The induction included instruction, policies and procedures of the home and observed practice. The application form enabled past learning to be recognised and any immediate learning needs are identified during the first day of induction. A skills audit was used to identify future training needs. Core training was arranged for all staff prior to enrolment on NVQ courses. The home had an annual training needs form and continuing professional development plans for each member of staff. Training needs were identified six months or one year in advance, training dates were arranged and an attendance list maintained. The registered manager confirmed that all the staff received a minimum of three paid days training per year. Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home was based on openness and respect for the service users’ best interests, rights and safety. EVIDENCE: The registered manager was an RGN having qualified in 1987. She had considerable relevant experience and was competent to run the home. She had worked in nursing homes since 1989 and had been the registered manager of the home for the past eight years. She had completed the NVQ level 4 in management training in 1993 and had one session to complete in the Registered Managers’ Award training. The registered manager had also undertaken more recent training including appraisal and supervision in March 2007 and dementia care and fire risk assessment training in April 2007. The registered manager ensured that she kept abreast of current practice issues by attending the monthly meetings of the RNCC and by attending other relevant Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 Page 25 training events and conferences. The registered manager displayed a strong ethos of being open and transparent in her management of the home. She led and supported a strong staff team who had been appropriately trained. The senior staff member responsible for the day-to-day care of the service users was also an RGN level 1 nurse who also had considerable experience. She had undertaken recent relevant training including heart failure and dementia care pathways in April 2007, oxygen therapy and diabetes training in May 2007 and end of life care in June 2007. The home had obtained three quality assurance systems. One was the registered nursing home system and the other two were commercially produced systems. It was stated that one of the commercially produced systems did not cover the requirements and standards in sufficient detail to enable the home to measure its own progress. The registered manager said that she was drawn towards the second system because it was more specific and provided an audit checklist on each standard with a measurable outcome. Three of the data sets had been completed and were met. Aspects of care where the home needed to improve such as social and leisure activities had been identified. The registered manager intended to develop an improvement plan based on the outcome of the one system. It was also stated that questionnaires were issued to the service users and/or their representatives every six months. The home also issued ‘themed’ questionnaires to six or eight new service users. Questionnaires had not been issued to visiting professionals. The registered manager confirmed that no one connected with the running of the home acted as an agent or as an appointee on behalf of any of the service users. It was also stated that no money was kept routinely in safekeeping by the home on behalf of any of the service users. No money or personal possessions were kept by the home on behalf of any of the service users at the present time. The registered manager confirmed that, if these circumstances changed, a record would be kept and receipts would be issued in respect of any money or personal effects that were handed over for safekeeping. The home had a safe with restricted access that could be used for the secure storage of money and any personal items. A list was maintained of the service users’ property, clothing etc. These items remained with the service users in their own rooms. The service users’ guide and the statement of terms and conditions of residence (contract) contained information about the level of insurance provided by the home to cover the loss of the service users’ personal effects. The home had a health and safety policy. Hazardous substances were kept in a lockable store. The home had a policy and relevant information on COSHH. Fire awareness training had been provided and the fire safety records were accurate and up to date. All of the keypads were linked to the fire alarm system. The home maintained a record of accidents and these were audited every three months. Evidence was provided to show that the passenger lift Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 Page 26 and hoists had been serviced appropriately. The home maintained copies of the registered provider’s reports following the monthly visits made to the home in accordance with Regulation 26. The home also retained copies of the Regulation 37 notifications sent to the CSCI. Evidence was provided to show that all gas and electrical installations had been serviced. The maintenance man conducted outrun tests every month, checked the boiler and water temperatures and made sure that the tanks were clean and covered. Water samples were tested on 22 June 2007 and were clear. All of the windows were top-openers. The radiators had low surface temperatures. The home had provided training for staff that covered all of the core areas and included the protection of vulnerable adults from abuse, diabetes and nutrition and pressure care. The home was a member of the wound care society. However, staff had not received training in person centred care. A requirement was made in regard to Standard 38 as a result of the previous inspection that environmental risk assessments must be reviewed on a regular basis. The requirement had been implemented. However, risk assessments had not been carried out on all of the safe working practice topics referred to in Standards 38.2 and 38.3. Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 2 X 3 X X 2 Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 Page 28 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. 1 Standard OP29 Regulation 19 Requirement Timescale for action 31/08/07 2 OP38 13 Action must be taken to ensure that two written references are obtained in respect of all current members of staff and prior to the appointment of any new member of staff and that a job application form is completed and any gaps in employment records explored. This is to ensure that the service users can be confident that they will receive their care from suitable people. Risk assessments must be 31/08/07 carried out and recorded for all the safe working practice topics covered in Standards 38.2 and 38.3. This is to promote and protect the health, safety and welfare of the service users. Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 Page 29 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 OP1 Good Practice Recommendations The statement of purpose and service users’ guide should be amended to include all of the information as detailed in this report in accordance with Regulations 4 and 5, Schedule 1 and Standard 1. This will enable prospective service users to have all the information they need to make an informed choice about where to live. The care plans should set out in detail the specific action that has to be taken by care staff to ensure that all aspects of the service users’ needs are met. Consideration should be given to the provision of more hoisting equipment in order to promote the service users’ healthcare. The service users’ individual social and leisure activities and interests should continue to be developed in order to satisfy their personal preferences and needs. The relatives, friends and representatives of service users should be given information, preferably in the service users’ guide, about the home’s policy on maintaining relatives and friends’ involvement with service users at the time of admission. This will help to ensure that service users maintain contact with their family and friends as they wish. The service users’ guide should include a clear statement about the service users’ entitlement to bring personal possessions with them when they are admitted to the home and also their right of access to the personal records held about them by the home in accordance with the Data Protection Act 1998. This will help the service users to exercise control over their lives. The complaints procedure should include all of the relevant information as outlined in this report in accordance with Standard 16. The contents of all the copies of the complaints procedure referred to in the statement of purpose, service users’ guide and contract or displayed on the notice boards within the home should include the same information. This will ensure that service users and their relatives and friends are aware of the correct procedure DS0000004156.V340827.R01.S.doc Version 5.2 Page 30 2 3 4 5 OP7 OP8 OP12 OP13 6 OP14 7 OP16 Yew Tree Nursing Home 8 9 OP28 OP33 10 OP33 11 OP38 for making and responding to a complaint. The arrangements that are made for staff to receive NVQ level 2 training should continue in order to ensure that a minimum of 50 of the care staff attain a qualification. The home should continue to develop one, comprehensive quality assurance system that includes obtaining the views of stakeholders in the community e.g. visiting professionals, on how the home is achieving goals for service users. This will help to ensure that the home is run in the best interests of the service users. There should be an annual development plan for the home based on a systematic cycle of planning-action-review, reflecting aims and outcomes for service users. This will help to ensure that the home is run in the best interests of the service users. All the care staff should receive training in person centred care. This will help to promote an holistic approach to the care of the service users. Yew Tree Nursing Home DS0000004156.V340827.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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