Care Home: Cleeve Hill Nursing Home

Similar services:

• The Vicarage
• Fairfields Country Rest Home
• 7 Hyde Road
• 5 Seafield Road
• Poldhu
• Queensmount
• Trevaylor Manor
• Didsbury Court Rest Home

What the care home does well What has improved since the last inspection? The ongoing building and refurbishment programme continues to improve the overall environment of the home, particularly the work now being completed to upgrade the old building, making a very pleasant and comfortable environment in which to live. Although there are still concerns about communication problems with some overseas staff, the staff are making efforts to improve their language skills and this was noted at inspection. Parts of the recruitment procedures have improved greatly but there is still a need to ensure that a full carer history and two references are in place on all files. What the care home could do better: There must be suitably qualified, competent and experienced staff working at the care home to ensure that there is no risk of misunderstanding of needs and delivery of care because of poor staff communications. Checks to be made to ensure that any gaps in past employment are explained.Improve on one or two lapses in record keeping identified in the report. CARE HOMES FOR OLDER PEOPLE Cleeve Hill Nursing Home Cleeve Hill Cheltenham Glos GL52 3PW Lead Inspector Mrs Janet Griffiths Unannounced Inspection 7th & 9th April 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cleeve Hill Nursing Home DS0000016410.V360387.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. Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cleeve Hill Nursing Home Address Cleeve Hill Cheltenham Glos GL52 3PW 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) 01242 672022 Cleeve Hill Healthcare Ltd Ms Mary Ann Gangoso Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50), Physical disability (2) of places Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) - maximum of 50 places Physical disability (Code PD) - maximum of 2 places The maximum number of service users who may be accommodated is 50, 9 of whom will be accommodated in the specialist/palliative care unit. 18th June 2007 2. Date of last inspection Brief Description of the Service: Cleeve Hill Nursing Home is situated on the slopes of Cleeve Hill about three miles from Cheltenham. The home has its own grounds of two and a half acres. The premises consist of the original building and purpose built extensions. The accommodation is on two floors accessed by a shaft lift and a stair lift. A ramp from the main corridor to the entrance provides access for wheelchairs. The home provides two communal lounges and dining rooms all overlooking the well maintained gardens with beautiful views of the surrounding countryside. At the front of the home there is an accessible patio area. Major building work has been ongoing over the last year and has improved on catering facilities and has built an extension to accommodate a further eight residents. Now this is completed the home has increased its registration number to fifty, nine specifically for palliative care needs. Further work is nearing completion to refurbish the original building and providing en suite facilities in the majority of rooms and a new reception area has been developed, together with a refurbished lounge/dining area. The gardens at the front and back of the building are also being landscaped and further parking facilities are developed Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 5 Information about the service to include CSCI reports is made available by the provider to prospective service users through the homes’ Statement of Purpose and Service Users Guide. At the time of inspection the fees are £650 per week for personal care and £925 per week for nursing care. Additional charges are made for hairdressing and toiletries (list of charges provided), chiropody and beautician, newspapers at cost and telephone according to BT rates. Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This unannounced key inspection site visit took place over nine hours and forty- five minutes on two days in April 2008. During this time the inspector spoke to a number of residents, staff working in the home, the manager and the proprietor of the home. A tour of the premises was carried out, but not all rooms were visited on this occasion, only those where residents were visited in their rooms. Five residents’ files were examined in detail to include their medication records. Other records examined included staff recruitment and training records, accident, complaints and compliments records and maintenance/servicing records. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was completed and its contents used as part of the inspection process and report writing, as was the collation of survey results from service users, relatives and staff. What the service does well: The people who live at the home are happy with the care provided on the whole, despite there still being some communication difficulties at times. Well-trained, enthusiastic and motivated staff maintain a good standard of care. Staff have access to regular mandatory training updates and a variety of other specialist training The home has good activities facilities with a wide and varied weekly programme. Residents and the surveys completed also praised the quality and the choice of food provided. Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 7 Provides a warm and friendly welcome to visitors to the home and provides the residents with a very pleasant and comfortable environment in which to live. When asked what the home does well, relatives comments in the surveys received included the following: • ‘Creates an atmosphere similar to a friendly hotel; treats all residents individually according to their needs and wishes; responds quickly to emergencies or changes in patient needs; treats relatives and friends as part of a large family; food is excellent,varied, beautifully prepared and delicious; management systems work well and can adapt quickly to change in needs/wishes; management and staff always ready to listen and are always cheerful and friendly; comprehensive entertainment programme’. ‘The rooms are large and pleasant with lovely views over the hills. In fact, as a family we are very happy with the way Mum is being cared for and the awful worry of her being on her own is gone’. ‘Overall provides a good standard of nursing care and also other aspects e.g.entertainment activities. The staff are friendly and do care about the well being of all the residents. they respect the needs of all the residents’. • • What has improved since the last inspection? What they could do better: There must be suitably qualified, competent and experienced staff working at the care home to ensure that there is no risk of misunderstanding of needs and delivery of care because of poor staff communications. Checks to be made to ensure that any gaps in past employment are explained. Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 8 Improve on one or two lapses in record keeping identified in the report. 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. Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 9 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 Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 10 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 and 3. Standard 6 not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their families have all the information they need to make an informed choice regarding placement at the home, and pre-admission visits take place to carry out an assessment and ensure that needs can be met. Residents normally move in on a long-term basis therefore Std. 6 was not assessed. EVIDENCE: Prospective residents/ their families are provided with a copy of the service Users Guide that provides all of the relevant information about the home. This is constantly being reviewed and updated to ensure that all the changes to the home have been reflected in the information. Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 11 A copy of the CSCI last inspection report as well as other information about the home is also on display in the main reception area. Residents spoken with and surveys received confirmed that they had been provided with adequate information before admission, and many had either been receiving home care services from the Companies’ home care agency or had stayed at the home for respite care. Others had chosen the home through recommendations of family and friends and all said they were very happy with the choice. The Annual Quality Assurance Assessment (AQAA) states that ‘Each service user is given an opportunity to visit the home and spend some time within the home before a decision is made. A trial period is always suggested to the proposed service user. If the user is unable to visit the home then the manager or the deputy manager will go out to see them and answer any questions they have at the same time explain the way in which the home is run. A comprehensive documentation in a form of service user’s guide is provided to the proposed service user’. Copies of preadmission assessments were seen in some of the files examined, as were copies of contracts. Again, most surveys received stated that they had received a contract and in response to whether they had received enough information about the home prior to admission the following statements were made: • • ‘No because I was very ill and had to be moved in quickly, but my daughters have since told me they were given all the information’. ‘I knew of the home as I had home care and meals from the home but I came in as an emergency’. Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 12 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): 7,8,9,10 & 11 Quality in this outcome area is good. These judgements have been made using available evidence including a visit to this service by the key inspector. People who live in this home have their health care needs met through individually planned care. This clearly sets out needs and how they are met, to include healthcare referrals and interventions where required. They are also protected by the medication administration procedures that the home has in place and are treated with respect; their privacy and dignity are protected. EVIDENCE: A total of five care files to include some of those most recently admitted service users were examined and a number of residents were spoken with. All had assessments completed and the information provided was very informative. Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 13 Care plans were in place in all of the files seen and these were detailed, reflected the current needs and most were reviewed monthly. Residents’ sign consent for care on admission but they and all of the relatives confirmed in surveys received that they are always or usually kept informed of any changes in their care, making the following statements: • ‘When Dad was alive and in here, we were always informed immediately if he was unwell and the Dr. from the local practice would have a telephone chat. Local practice is very good and home contact them if they have any concern or if we have voiced any concern’. ‘This hasnt happened (accident or hospital) but my mother had had a couple of infections and the nursing staff have always told me about it, visits, progress and treatment’. ‘There have been odd lapses but normally I have been kept informed’. ‘We have full confidence in the activities of the Nursing Home and when my mother had to go into hospital recently we had full confidence that this would be well managed’. • • • Risk assessments are also completed to include a pressure sore, moving and handling, falls, continence and nutritional risk assessment, where appropriate. In the case of the moving and handling assessment it was not always clear on the form the date when this was first completed, and on the pressure sore risk assessment not all the pressure relieving equipment in use was documented. This is to be addressed. One sample of records seen clearly demonstrated how staff were providing appropriate palliative care, liaising with doctors to ensure adequate pain relief etc. ‘The annual quality assurance assessment (AQAA) states that ‘Care of the dying policies and procedures properly taken into account both the wishes of the patient and any religious observations of his/ her religion’. Also ‘End of Life Care Pathway has been developed to improve our services and continue to comply with specific care and requests of end of life service users’. There was also a very clear audit trail where someone had been assessed as at high risk nutritionally, and then developed a nutritional care plan, carried out regular weight recording and sought advice from the dietician. Records seen also confirmed visits from doctors, the continence advisor, Parkinson’s disease specialist, the Macmillan service, stoma nurse and the speech and language therapist (SALT). A physiotherapist visits the home weekly to provide physiotherapy advice where required, but more intensive physiotherapy has to be requested and acquired through the resident’s doctor. Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 14 There had been some concerns raised in the past over the timeliness of calling a doctor and treatment being given, but records examined during the inspection confirmed that appropriate action was taken in this instance. Residents and relatives confirmed in the surveys that they received the medical support they needed. Several residents were spoken with who are currently remaining in bed because of their conditions and these are nursed on pressure relieving aids, have hoists available to aid moving and handling procedures and have records in place to record turning programmes and fluid and diet charts. All of the medication records were examined during the inspection and were well maintained. Each medication administration record (MAR) also contains a photograph of each resident to aide identification. There were several hand written entries where it was noted that two signatures to check and countersign these entries were absent. Otherwise, there were no gaps in recording. The dispensing pharmacist also carries out regular audits and the Primary Care Trust (PCT) carries out regular reviews of medication. There were a few instances where residents’ self-medicate and a consent form was in place and the home completes a risk assessment and reviews this regularly to check safety in compliance. A check was made of all the controlled medications held at the home and was found to be accurate. The home carries out its own checks at shift changes during the day. When asked whether they felt their needs were met all of those residents who completed surveys said that they always/usually had their needs met, with one stating ‘ the staff are very attentive’. Relatives surveys received included the following comments: • ‘There were some settling in difficlties, probably due to difficulty in communication with some of the care workers but at each stage his care has been gentle, understanding, sympathetic, kind and above all, cheerful’. ‘The general approach and attitude of the staff and the way they handle residents is very good’. ‘There have been occasions when I have had to bring to the attention of the home manager my concerns about the standard of care and action has been taken, if not immediately then after a second prompt. The care seems generally good, but I have nothing to compare with, as my wife has been resident only at this home’. DS0000016410.V360387.R01.S.doc Version 5.2 Page 15 • • Cleeve Hill Nursing Home • Staff genuinely care and consider every need as they make sure her clothes match, that she has a scarf in her colour and suggested perfume would be a nice present and it was’. Residents also confirmed that their privacy and dignity is respected and staff were observed knocking or doors and addressing residents by their preferred name. Everyone has a single room with the majority having en suite facilities. The service users guide states that privacy and dignity will be respected by offering locks on doors, screens in double rooms and staff who will knock before entering rooms. Lockable cupboards for personal possessions are also provided and the house safe can be used for storing valuables. Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 16 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 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who live in the home are supported to realise their own preferences and expectations, both in the home and in the community and are able to maintain contact with friends and family. They also receive a wholesome, appealing and balanced diet in pleasant and comfortable surroundings. EVIDENCE: The home currently employs two activities co-ordinators and two other coordinators are about to be appointed to ensure that the home provides some form of activity/social interaction for every resident should they wish to participate. A record is kept in each resident’s file of their social care activities and a Map of Life completed where possible to identify people and pets etc who have been significant in their lives. Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 17 A weekly activities programme is displayed on the notice board and given to each resident individually. A copy of April activities was provided for the inspection and includes such activities as flower arranging, visits from Sparky the dog, ‘how many words can be made from four pence’, Spring collage, name that tune and balloon hockey. Notices of coming events and photographs of previous social events such as the Easter bonnet parade are also on display on the notice board. There had been a few negative comments at the last inspection and in a few surveys about the reduction in activities and outings since one co-ordinator left, but this is improving now and there were activities going on throughout the day on both days of inspection. The home also will provide a variety of therapeutic techniques on request including physiotherapy, gentle exercise to music, aromatherapy massage, Indian head massage, manicure, pedicure and numerous beauty therapies. Most service user surveys received stated that they always/usually take part in the activities arranged by the home. One did feel that they would like more activities that use ‘brain power’ and one was concerned that they did not always know where they were taking place and was worried about finding their way back to their room. Relatives’ surveys included the following comments: • • • • • • ‘They certainly make an effort over events such as Mothering Sunday and Easter’ ‘ All interests and abilities are included’ ‘ Activities with those who can participate and occasional trips out are good’ ‘Attempts to involve residents in activities, quiz, cards, crosswords etc’ ‘A comprehensive activities programme’ ‘Seek to stimulate the brain with all important quizzes, music, crossword puzzles etc most days of the week with a schedule to inform them of the weeks events’ But one felt that their relative has become bored as their condition has deteriorated and they can no longer entertain themselves. They no longer read, watch television or knit and they felt the activities were not currently as good. Spiritual needs are also met, either through the communion service held once every 5 weeks at the home, visits from residents own chaplains or by enabling residents to attend their own churches if they wish. One staff survey did feel that the home should provide a higher level of pastoral care by having a regular visit from a chaplain every week. Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 18 However, it was reported that the home is on a rota with the local church and other homes in the area and is visited as often as the church is able. Visitors are made welcome at any time of the day or evening and residents have access to privacy when having visitors. There are beverages available for visitors on both floors of the home, and an en suite room where relatives may stay/rest when the resident is ill, is almost completed at the rear of the home. Food at the home is considered a very important part of the residents care. A breakfast buffet bar has recently been introduced for those residents who wish to go along to the dining rooms and help themselves to breakfast. Otherwise this is served in their rooms. For the remainder of the day there is a wide choice of three-course lunch, as well as a very tempting dessert trolley and a number of choices for supper. Special dietary needs are also catered for. Everyone spoken with was full of praise for the meals provided with several saying that the home is like a four-star hotel. Several said that they often had meals at the home with their families, which they enjoyed. Surveys received stated that they usually liked the meals provided and included the following comments: • • • ‘Good choices. Make an effort for special occasions of Christmas’. ‘The meals seem to improve all the time and are delicious’. ‘The food is good and the fact that Mum’s appetite is not large and needs tempting is taken into consideration. We have as a family had meals with Mum.’ Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 19 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People in the home are protected by the systems in place EVIDENCE: The home has a clear complaints procedure, which is on display in the home and also included in the service users guide provided to each service user. Residents spoken with and surveys received confirmed from both residents and their relatives that they are fully aware of how to complain, adding the following comments: • • • • • • ‘Verbally (not so far tho’) and would follow up with a letter if required’. ‘ Help would be given as and when required by family or friends’. ‘I have had no occasion to find out’. ‘Ive never needed to make a complaint’. ‘I would talk to the deputy manager in the first instance who is regularly accessible and available’. ‘If there is a problem I usually speak to the care home manager but I am not aware of a formal complaints procedure’. Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 20 A record is kept of any complaints received and these were checked at inspection and acted upon according to the homes complaints procedure. A file of thank you letters and cards is also on display within the front hall. The home has policies on adult protection and on suspicions of abuse/neglect Staff also receive training on Protection of Vulnerable Adults, confirmed by the training matrix provided and further training is planned. The AQAA states that ‘Service users and relatives can be provided with advocacy service information. ‘All staff are trained in the protection of vulnerable adults (POVA) and work to these regulations’. ‘Procedures are in place to respond to evidence or suspicion of neglect and other forms of abuse’. ‘We assist service users to be politically active as they choose; many service users use the postal voting system’. Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 21 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): 19,24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained, clean and hygienic throughout. Equipment is provided to aid mobility and promote independence. Individual bedrooms are decorated and equipped to meet the needs of their occupants. EVIDENCE: The major building works are now almost completed and the residents are living in pleasant surroundings, decorated and furnished to very high standards. They also enjoy the benefits of the refurbished lounge/dining area with library facilities, and a new telephone, television and internet service in every room, although they have been experiencing some problems with the telephone system as indicated in one survey comment: Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 22 • ‘He has his own phone which he is able to use, but the nursing home network is more appropriate to a suite of offices. He cannot get an instrument with big buttons or a programmable memory, so that he could call friends and relations with a press of one button’. The proprietor stated that he is attempting to improve this situation and obtain telephones that people who are less able, would be able to use. Many of the rooms in the older main part of the building have also recently been refurbished and almost all have en suite shower facilities. There were a few comments from surveys about older rooms needing redecoration, better furniture and more shelving for books and ornaments, but this is now being addressed with the refurbishment programme. A hydrotherapy assisted bath is available for all the residents, which reportedly increases the peripheral blood circulation and creates a deep heat effect to reduce pain and inflammation in joints of arthritis sufferers and induces a deeper relaxation diminishing need for sedatives and other medication. A further assisted bath is probably to be fitted on the first floor. One relative stated that it would be nice if residents could have a bath more readily instead of showers, and someone felt there were not enough commodes. During a walk around the building the inspector visited at least ten of the residents in their own bedrooms. All of the rooms seen were clean, odour free and in good decorative order, with evidence that each person had had the opportunity to personalise their rooms with photographs, items of their own furniture and other treasured possessions. There were a few comments about the crowded communal lounge, but unfortunately, it becomes crowded when residents gather there for the Activities’ programmes each day. The co-ordinators are attempting to hold activities in some of the other communal areas, such as the new dining room and therapies room, in order to encourage residents to use other areas of the home. Pre-lunch drinks for example are always taken in the dining rooms. Another problem voiced is that a number of residents appear to spend a large part of their day sat in wheelchairs, which also take up quite a lot of room. This has been more prevalent with less activities staff available but has been noted and hopefully will improve with more staff allocated to this provision. On relative survey also commented on the general state of wheelchairs by saying that: Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 23 ‘Those in use at the home are for the most part well past their sell by date and there is not always one available when required. I have raised the issue on a number of occasions in the past but nothing changes. I am reluctant to bring my own chair to the home because it will become one of the pack’. Those seen in use during the inspection appeared clean and in good working order. There had also been a comment about malodours in the home in the past from a visitor to the home. There were no malodours during the inspection but the manager is aware that along one corridor on the ground floor there is no fresh air circulating, which may cause problems and this is to be addressed. One relative had also mentioned poor standards of cleanliness, and one resident survey did state that ‘Daily cleaning not always very thorough, dust under beds etc’, but there was no evidence of this at inspection and residents spoken with and surveys stated: ‘It’s spotless and smells delightful with fresh flowers everywhere’ ‘The home is spotless and smells fresh’. The AQAA states that the plans for the next 12 months are ‘to complete the inside refurbishments of bedroom as they become vacant; to put up a water feature in the garden area to complement the stunning view that the home already has and will continue to provide our users with an environment that is acceptable for them to live’. Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 24 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, & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home have their needs met by sufficient skilled staff who are able to meet the needs of the current number of people living at the home. They are also protected by the homes recruitment system. Staff are supported to undertake regular and relevant training. EVIDENCE: Staffing levels during the inspection appeared to be adequate to meet the current needs of the residents but this is under constant review when planning rotas in accordance with dependency levels and information regarding dependency and staffing levels has been forwarded to the Commission regularly. The AQAA states that ‘The home has organised the shift pattern such that more staff are available at times when service user’s needs are high and not too many staff when users’ needs are low’. Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 25 Rotas were provided at inspection and indicate that there are generally eight care staff and two nurses on duty each morning, this reduces to 5/6 carers on the late shift and two nurses and three carers at night. The manager is also on-duty from Monday to Friday each week. In addition to the care staff, domestic, catering, laundry, maintenance, reception and administration, drivers and the activities co-ordinators are onduty. All of the residents spoken with were very happy with the care provided and no one gave any indication that they felt the home was short-staffed, or that they had been kept waiting for attention at any time. No call bells were heard constantly ringing. All those who completed surveys stated that the staff are usually available when needed and said that they always/usually get the care and support they need; most said staff always listen and act on what they say The following comments were received from the surveys: • • • • ‘Always acknowledge requests but may be delayed dependent on priorities’. ‘Always acknowledge requests but sometimes delayed for priorities’. ‘ Sometimes the home seems very short staffed’. ‘With so many others in the home it is understandable if they are already engaged if I call but I know they will come as quickly as they can’. The home continues to employ a high proportion of staff from overseas, with many coming from Eastern Europe. English lessons are provided for staff and those observed during the inspection appear to have much improved communication levels than the previous inspection. Generally residents and relatives spoken with feel that all the staff are very caring, and surveys included the following comments: • • • • • • ‘Whenever my mother has required attention, this has always been done very efficiently and carefully’. ‘They appear to be very caring and patient’. ‘Good levels of personal care’ ‘Great care and kindness’ ‘They help my mother feel that nothing is too much trouble. It is a well run nursing home but at the same time seeming like a home’. ‘The nurses and carers appear to be very considerate and caring to each individual in the home’ but the following concerns are still voiced: • ‘Lack of the English tongue’. DS0000016410.V360387.R01.S.doc Version 5.2 Page 26 Cleeve Hill Nursing Home • • • • • • • ‘Drawback lack of the English spoken word’ ‘Language remains a problem. It is difficult if one is old and hard of hearing to understand strongly accented English. The girls try very hard but cannot always make mother understand’. ‘Problems arise when my mother cannot make some carers understand what she needs. The home has a high proportion of Eastern Europeans, who on the whole are very caring and friendly. I know they have a programme of English training and so their best, but on the odd occasion new employees can cause awkward problems’. ‘The English of some staff members is difficult to understand or make them understand’. ‘Communication in English is sometimes a problem, but staff skills and training are at a very high level’. ‘Most of the care and domestic staff are foreign. There can be communication issues between residents and care staff and also between English speaking staff and their overseas colleagues. In their defence the home does provide language lessons but I would like to see a higher proportion of English speaking staff’. ‘There is a concern about th e ratio of english speaking to overseas (nonfluent) carers, though the current situation appears satisfactory. All nurses are pleasant, willing and helpful. When staff were asked if there is enough staff to meet residents needs, most said usually, with one stating: • ‘Sometimes if there are several heavily dependent clients- extra care staff are not allocated. On the whole the level of staff is sufficient’. Most felt they had the right knowledge, skills and support to meet residents’ needs. Six staff files were examined on this occasion, of staff newly appointed since the last inspection. All the required paperwork and checks were in place with the exception of a full carer history in some cases and then absence of two written references and one from the last employer in some cases. However, these references were found on the second day of inspection, waiting to be filed. No interview records were seen initially but some were later found also waiting to be filed. All had completed application forms although some of these were brief and all now have CRB and POVA first checks, the latter being in place before the person starts work as required. From previous information eight care staff have NVQ 2 or above and the training matrix indicates that another four are currently working towards this qualification. Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 27 Most also felt that their recruitment and induction was carried out thoroughly. Evidence was seen within staff files of an induction programme being completed but there have been ongoing discussions with both the manager and proprietor about how improvements can be made to the induction programme particularly with reference to overseas staff and confirmation of their understanding. Discussions have also taken place with one of the trainers for the home and there are plans to provide translations of mandatory health and safety information, to ensure that all new staff fully understand their responsibilities with regards to issues such as fire safety etc. The training matrix provided indicated that mandatory training such as moving and handling, fire safety, health and safety, COSHH, first aid and food hygiene are on-going, together with Protection of Vulnerable Adult training. Other specialist training includes nutrition, infection control, continence, dementia, syringe driver, male catheterisation, vene-puncture, PEG/dysphasia, end of life, drug updates, wound maintenance and ear syringing and hearing aid care. Training on the Mental Capacity Act is now being organised and further distance learning training on dementia is being organised with Swindon College. Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 28 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): 31,32, 33,35, 36, & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home have their best interests met by the manager and staff who are committed to their responsibilities. They and the staff are generally protected by the health and safety systems in place in the home. Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 29 EVIDENCE: The manager of the home is a Registered General nurse with more than a decade of experience in care of the elderly. She has also completed the Registered Manager’s Award. A deputy manager was appointed 3/4 months ago and together with the proprietor supports the manager in her role. Regular staff meetings are held at all levels and minutes of these meetings are kept. To ensure that residents are involved in the running of the home, regular residents forums are held, the last being February 2008; as a result of discussions held more trips out are being organised and a breakfast bar commenced to try to overcome cold toast issue. Both qualified nurses and care staff meetings are held monthly. The deputy manager is now responsible for completing annual appraisals for all staff currently and the principle carer completes supervision of carers. The appraisal process is now being implemented yearly to coincide with anniversary of commencement of employment. Clinical supervision is carried out 3-6 monthly A random sample of appraisal and supervision records was seen and the process discussed with the deputy manager. In response to the question ‘what does the home do well?’ staff surveys included the following responses: • • • • ‘Has a daily report on each resident in the home from the night staff before change over’. ‘Supports relatives and residents when residents come to Nursing Home initially, and ongoing. Provides consistently high level of nursing care’. ‘Holistic approach with all clients. Lots of activities provided e.g. trips out, entertainment in house. Very good menu choice and a friendly working environment’. ‘Activities for clients and general care of them’. The home has a quality assurance programme in place, which includes a yearly satisfaction survey being handed out to residents/their families, the results of the last seen at the last inspection. Twenty were sent out and fifteen were returned (75 ), with most responses being very positive particularly regarding quality of nursing care provided- 80 scored excellent; meal service and choice of meals- 81 excellent and room comfort and cleanliness- 80 scored excellent. Only 6 scored poor on furniture and fittings, laundry service and electrical appliances to include telephones (see comments above). Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 30 The AQAA states that ‘ It was identified in the Quality Assurance questionnaire that most of the users’ relatives have difficulty with parking spaces when they visit. The Director has drawn a car parking arrangement to free parking spaces for users’ visitors and other allied professionals who are visiting’. ‘It was also identified that some foreign staff have difficulties in understanding the English language, therefore an English Lesson is on going every weekdays and this is held at the Training Room in the nursing home’. Any accidents or adverse incidents are monitored closely and accident records were seen in the resident’s files of those examined. An accident audit is completed monthly and again this information has been forwarded to the Commission and where frequent accidents have been noted appropriate action has been taken. The home does not act as appointee for any resident but does hold small amounts of money for some on request and a record of any financial transaction undertaken on their behalf is kept and was seen. Most of the records seen in the home are well maintained with one or two exceptions such as dates and signatures on some risk assessments and pressure relieving equipment noted (as identified in Standard 8 above). Daily records are kept on each resident and these are informative, signed and dated, recording any significant event with any relevant action taken. Policies and procedures are in place and copies supplied to new staff on appointment. These are reviewed regularly and updated where required. Records were provided to show that statutory maintenance/servicing of equipment is arranged in a timely fashion. A recent Environmental Health inspection of the new catering arrangements was completed and a four-star rating was awarded and a certificate given to display. Fire prevention processes are in place confirmed by training records and records of fire alarm and emergency lighting checks. A very comprehensive fire risk assessment has been completed which identifies everyone’s responsibilities and includes the evacuation process. Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 31 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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 32 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 OP27 Regulation 18(a) Requirement Timescale for action 31/05/08 2. OP29 19 There must at all times be suitably qualified, competent and experienced staff working at the care home. This is to ensure that there is no risk of misunderstanding of needs and delivery of care because of poor staff communications. All new staff must give a full 31/05/08 employment history, together with a satisfactory written explanation of any gaps in employment. 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. Refer to Standard OP8 OP9 Good Practice Recommendations Record any equipment used on pressure sore risk assessment form. Two staff to check and countersign any handwritten entries on medication administration records. Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 33 3. OP29 An interview record should be kept to explore any discrepancies/gaps in career history and reasons for leaving previous positions. Sign and date all risk assessments completed- relevant to moving and handling assessments in this instance. 4. OP38 Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Cleeve Hill Nursing Home DS0000016410.V360387.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!