Care Home: Devonia House Nursing Home

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What the care home does well People who use the service speak very highly of the Matron and staff. Comments include: "Absolutely fabulous staff here" and "I`m very happy here, staff are marvellous people".Local healthcare professionals hold the home in high regard and consider Matron to be a competent nurse and manager. People are encouraged to maintain contact with their family and friends and the home is considered to be friendly and welcoming. Visitors were seen to be made very welcome by the Matron who appeared to be on good terms with them. People and their family know how to make a complaint. Matron is considered to be very approachable and she visits each person daily. Where a complaint is made it is recorded and dealt with however apparently minor. This has led to improved outcomes for all people at the home. What has improved since the last inspection? The last inspection was the Random Inspection 4th August 2008. Requirements were made regarding record keeping: assessment of need, care planning, monitoring. Also, the method used to administer medicines, dignity regarding the use of the tannoy/call bell system, food left when people could not get to it and an unclean kitchen. These were dealt with immediately, although there is still a question mark as to the use of the tannoy/call bell system where people may believe their conversation is private when it is not. What the care home could do better: CARE HOMES FOR OLDER PEOPLE Devonia House Nursing Home Leg O`Mutton Corner Yelverton Devon PL20 6DJ Lead Inspector Anita Sutcliffe Unannounced Inspection 17th September 2008 08:45 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 Devonia House Nursing Home DS0000067360.V370510.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. Devonia House Nursing Home DS0000067360.V370510.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Devonia House Nursing Home Address Leg O`Mutton Corner Yelverton Devon PL20 6DJ 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) 01822 852081 01822 852081 Mr Anthony John Bloom Miss Jean Sherriff Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (10), Physical disability over 65 years of age of places (32) Devonia House Nursing Home DS0000067360.V370510.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Registered for a maximum of 32 service users in the category Physical Disability over 65 years PD(E) Registered for a maximum of 10 service users in the category Old age OP 8th October 2007 Date of last inspection Brief Description of the Service: Devonia House is a converted Victorian house situated in the rural village of Yelverton. The home is on the edge of Dartmoor National Park. Yelverton village is within walking distance of Devonia House and has a church, newsagents, post office and bank. There is a bus stop nearby which has routes to Tavistock (4 miles) and Plymouth (10 miles). The home has been owned by Mr and Mrs Bloom since 1992 and managed by the same registered nurse, Miss Jean Sherriff, since 1987. The home is registered for 32 people of either gender over the age of 65 who require nursing and/or personal care. Accommodation is presented on 2 floors with level access to most of the rooms. It provides 23 single rooms, 17 with en-suite facilities, 4 double rooms all with en- suite. There is a dining / lounge area and one smaller lounge. The home has well-maintained gardens and some of the rooms are afforded scenic views over Dartmoor and Walkham Valley. The current fees for the home are £585 - £700 per week. Additional charge is made for personal items such as toiletries and newspapers. The current inspection report is available in the entrance to the home and written information about the home (the Statement of Purpose and Service User’s Guide) is available on request. Devonia House Nursing Home DS0000067360.V370510.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that people who use this service experience good quality outcomes. Information about the home has been collected towards this inspection since 8th October 2007. The annual quality assurance assessment (AQAA) was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service such as now many people are resident and how many staff employed. We sent surveys to people who use the service and staff so they could give their opinion of the service. We spoke to one person’s family. We were also accompanied by an ‘Expert by Experience’. They are people who, because of their shared experience of using services, and/or ways of communicating, visit a service with an inspector to help them get a picture of what it is like to live in the home. Since the last key inspection was completed some information led us to do a Random Inspection of the home. Following this we issued two Immediate Requirements. The Random Inspection report is not published but is available on request from the Commission. Reference to the findings of the Random Inspection is made within this report. As part of this visit to the home we looked at all communal areas, several bedrooms, the kitchen and laundry. We spoke with many people who use the service and observed staff going about their work. We looked in detail at the care and support that two people received, meeting them and looking at their records. We spoke with the registered manager and some staff. We also looked at some records at the home. People who use the service may be described within this report as residents, clients or service users. The registered manager is known at the home as Matron. What the service does well: People who use the service speak very highly of the Matron and staff. Comments include: “Absolutely fabulous staff here” and “I’m very happy here, staff are marvellous people”. Devonia House Nursing Home DS0000067360.V370510.R01.S.doc Version 5.2 Page 6 Local healthcare professionals hold the home in high regard and consider Matron to be a competent nurse and manager. People are encouraged to maintain contact with their family and friends and the home is considered to be friendly and welcoming. Visitors were seen to be made very welcome by the Matron who appeared to be on good terms with them. People and their family know how to make a complaint. Matron is considered to be very approachable and she visits each person daily. Where a complaint is made it is recorded and dealt with however apparently minor. This has led to improved outcomes for all people at the home. What has improved since the last inspection? What they could do better: People must receive confirmation, in writing, that their assessed needs can be met by the home. This protects them as part of the contract between them and the home. Fixtures and fitting must not become worn and a hazard – the worn hallway carpets must be replaced. The Matron and owner agree that one nurse and two staff are needed to ensure needs are fully met during the night period. There must therefore be arrangements in place to ensure that this is always achieved regardless of staff holidays and with emergency arrangements in place to cover staff sickness. Staffing numbers was the biggest concern raised by people who use the service and staff. All staff, including non nursing and care staff, should receive training relevant to the work they do so they have up to date knowledge available to them. The use of the tannoy/call system should be reviewed so that people never have conversations with staff which they believe to be private when actually the conversation is being broadcast to others. Measures should be taken, through care planning, to ensure that no person becomes socially isolated and there are opportunities for stimulation and engagement. Devonia House Nursing Home DS0000067360.V370510.R01.S.doc Version 5.2 Page 7 The laundry floor should be ‘readily cleanable’ to reduce the possibility of cross contamination. Staff should receive regular formalised supervision of their work and also have their opinion about the home surveyed as part of quality monitoring. This may help to prevent discontent within the home. There should be a procedure in place to inform staff what to do in the event of emergency or crisis, examples being fire damage and multiple staff illness. 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. Devonia House Nursing Home DS0000067360.V370510.R01.S.doc Version 5.2 Page 8 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 Devonia House Nursing Home DS0000067360.V370510.R01.S.doc Version 5.2 Page 9 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&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be assured that their needs will be fully assessed and understood before they are admitted to the home. EVIDENCE: Seven of the eight people surveyed said that they received enough information before moving in. From their comments it was clear that many chose the home because of its reputation or position in the village. One said: “My father was always happy there.” Another said: “It is about a mile from my home and I have had an elderly relation there and had known of two or three neighbours who have been here and been satisfactorily looked after”. We looked at the assessment records of the last person to be admitted to the home. Previously we had found assessment information to be very limited and we issued a requirement to improve. On this occasion the information Devonia House Nursing Home DS0000067360.V370510.R01.S.doc Version 5.2 Page 10 was much more detailed and described the person’s needs, including, emotional, social and health. However, although not negatively addressing the diverse needs of race, ethnicity, gender and sexuality the opportunity for people to provide this information was not in evidence. We saw assessments of risk, such as prevention of pressure sores and adequate diet, was properly addressed. We saw that assessment information is often provided from health and social care professionals involved in that person’s care. We met the last person admitted and they said the home was “magnificent”. We saw the Matron (the manager) taking steps to ensure their medication needs were fully met and they were comfortable. Where a piece of equipment had been provided but not liked this had been changed. We discussed with the Matron (the manager) how much the person is involved in their own assessment; we were told they are fully involved. We had previously required that the home write to every new admission to confirm that their assessed needs can be met. This will protect the person admitted to the home. This has not yet been achieved. Matron said it would be so for any new admission. Devonia House Nursing Home DS0000067360.V370510.R01.S.doc Version 5.2 Page 11 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. This judgement has been made using available evidence including a visit to this service. People can be assured that their health care needs will be met. EVIDENCE: We looked at the care records of two people who currently use the service. We had previously made an immediate requirement for care plans at the home to be improved. Care plans should provide information about people’s needs and wishes and fully inform staff how they are to deliver all necessary support and care. The plans we saw provided a good standard of information including health, emotional and social care needs. One member of staff said the new standard of plans was an improvement and a new member of staff confirmed she is able to use them for information. We discussed with Matron (the manager) how well people are able to access their plans of care, and she is considering how this might be improved. Devonia House Nursing Home DS0000067360.V370510.R01.S.doc Version 5.2 Page 12 Asked if people receive the medical support they need seven said always and one said usually. Asked if people receive the care and support they need seven said yes and one said usually, one person adding: “The girls look after me very well”. Comments to the Expert by Experience include: “Good bunch of girls, look after us very well” and “*** gives me a super bath each week and always washes my hair, I feel so good afterwards”. The home admits many people for end of life care. We saw that Matron (the manager) and staff have received specialist training in this and take a keen interest in how to further improve. We saw records and heard discussion indicating that there is considerable knowledge in how to manage pain, physical and emotional wellbeing and support of the person’s family. A local general practitioner and district nurse hold the home in high regard and the home works closely with external staff who specialise in end of life care. We saw that monitoring records are now in place. These include fluid intake and specialist care provided. The standard of information recorded is much more detailed than previously; this lessons the possibility that concerns relating to health will be missed. The Expert by Experience said that at all times staff were heard to speak to people in a friendly manner with due respect. Most were addressed by their title and surname, others by a forename. The previous concern relating to personal and intimate information heard over a ‘tannoy’ call system is not fully resolved. We heard the system in use and people might say anything to the staff unaware that the conversation is not private. Previously one person was unaware the conversation was being ‘broadcast’. The home must ensure that people know this is the case so as to ensure that privacy and confidentiality is always maintained. We looked at how the home manages medicines. On this occasion we found no other than a well managed and professionally conducted system. We also observed how well people’s individual needs, such as pain relief, were being managed. The home is now following the guidelines of the Royal Pharmaceutical Society more fully. However, although no people are currently prescribed ‘dangerous drugs’, needing specialist storage, the storage available for this does not comply the Misuse of Drugs (Safe Custody) Regulations 1973. This was discussed. Devonia House Nursing Home DS0000067360.V370510.R01.S.doc Version 5.2 Page 13 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 adequate. This judgement has been made using available evidence including a visit to this service. Many people at Devonia are leading their life in the way they prefer but opportunities for stimulation are very limited leading to some isolation. EVIDENCE: Three people said through survey there are never activities arranged at the home that they can take part in and one said sometimes. Comments include: “I have no wish to take part in any activities”. “Unable to take part in activities due to illness” and “I do not wish to take part”. However, one person did add: “It can be lonely at times and therefore I would like to see some form of social activities taking place” and the family of another said there was no activities or stimulation and their mother was unhappy about this. The Expert by Experience asked people how much time they spend in their room and of the eight interviewed all said that they chose to stay in their own bedroom. No one was aware of any activities in the lounge in the recent past, “Although there had been some a long time ago”. It did appear that the people currently living at Devonia House are content to sit in their rooms and Devonia House Nursing Home DS0000067360.V370510.R01.S.doc Version 5.2 Page 14 read, write letters, hold phone conversations, receive visitors or watch television. Four ladies took lunch together (usually five but one person was in hospital) and some conversation ensued. On separate occasions a couple of people were seen to be visiting other bedrooms and holding conversations. One person said: “When I had the use of my legs I used to walk to the dining room and seek out others to either talk to or avoid”. This person now eats in her room. We saw records of people’s interests and hobbies but currently this is not part of planned care. Staff should have instruction on how they are to support people to continue activities of interest to them, especially important where people have dementia and/or limited short term memory. Sometimes this may just be spending time with them. We saw visitors welcomed into the home during the visit and some, who helped to complete surveys for people who use the service, talked of friendly staff. We also saw letters of praise about the service from family. There are no visiting restrictions and family are encouraged and accommodated to stay if severe illness has raised concerns. We looked at how much choice people have in their daily routine especially the choice of when and how they are woken in the morning. This was raised as one of the concerns, which led to the recent Random Inspection. Everyone spoken with was convinced that they woke of their own accord and one person said: “If the carer is later than usual I get up myself, use the bathroom and sit out ready to dress”. People also said they decided when to retire. Of the eight people surveyed and asked if they like the meals at the home two said always and six said usually with comments: “Meals are quite adequate although not outstanding” and “On the whole the food is quite good”. Food was described to the Expert by Experience as “Fabulous”, “Not gourmet but adequate”, “Lovely”, “Generally excellent as mainly fresh food used – but I do not eat meat” and “Alright”. Although there was no choice of menu, people were content that an alternative meal would be provided if they disliked the set meal. On the day of the visit lunch consisted of home baked gammon, carrots, cauliflower and mashed potato with parsley sauce and mustard available on the table. The dessert was bread and butter pudding with custard plus pouring cream if desired. This home made food was hot, palatable, and well presented. Only four people ate in the large and well-decorated dining room although there was space for many more. We saw records of food preferences and the home has now formalised records of whether the diet taken by people is adequate. Devonia House Nursing Home DS0000067360.V370510.R01.S.doc Version 5.2 Page 15 Devonia House Nursing Home DS0000067360.V370510.R01.S.doc Version 5.2 Page 16 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 are protected from abuse and any concerns or complaints will be responded to. EVIDENCE: All eight people asked through survey if they know who to speak to if they are not happy said yes. All eight said they knew how to make a complaint with one adding: “I would if I needed to”. People told the Expert by Experience that they greatly appreciated the daily visit to their room by the Matron (manager) or in her absence the deputy, one added: “Gives me a chance to raise any issues”. We looked at the complaints received at the home. Most were made earlier in the year and related to the standard of food. It is commendable that, what might be considered by some as minor complaints, have been dealt with as important issues. We have received anonymous complaints about the home. Following these we undertook an unannounced inspection. Some of the complaints raised were substantiated, for example, breakfasts left in front of people who could not Devonia House Nursing Home DS0000067360.V370510.R01.S.doc Version 5.2 Page 17 reach or had fallen asleep. Some were not substantiated. However, in each case that a regulation had been breached the home acted quickly to improve. The matron (manager) has recently received some training in how to handle concerns, which might be abuse. She and staff have further training arranged for October. We asked what she should do in the event of such an allegation and she correctly knew what she should and should not do. Asked if they know what to do if a person their relative, advocate or friend has concerns about the home five staff said yes and one said no. We looked at the home’s Whistle Blowing policy. This informs staff what they should do if they have concerns. The information within it is incorrect and could lead to mishandling of any allegation. This was discussed and the manager said she would correct it. This includes the contact details for the Local Authority Safeguarding team and The Commission. Also, ensuring it is clearly written that the home does not undertake any investigation itself, something the manager does now know. Staff are aware how to take any concerns outside the home if they feel it is necessary. There was one safeguarding concern raised in February which, based on the good reputation of the home, was passed back to them to investigate. Devonia House Nursing Home DS0000067360.V370510.R01.S.doc Version 5.2 Page 18 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, 22 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a warm, clean and homely environment but safety must be a higher priority. EVIDENCE: People surveyed said: “I have a nice big room with a big picture window which can be opened out on to a balcony, although I have not used it.” and “The home is comfortable and warm”. Five said the home was always fresh and clean and three said it usually was. The Expert by Experience found the bedrooms were very clean and homely with personal items and memorabilia on display. He said that although a veritable “rabbit warren” the house was well lit and clean throughout and there were no unpleasant odours. Devonia House Nursing Home DS0000067360.V370510.R01.S.doc Version 5.2 Page 19 There were previous complaints (raised by staff and a person using the service) around the amount and standard of equipment available to enable safe moving and handling of immobile people. We found their complaint to be upheld. Staff confirmed that this is now fully resolved and the matron (manager) listed new equipment she has received and some she is about to order. Staff also confirmed that they have the protective clothing necessary to reduce the likelihood of the spread of infection, such as gloves and aprons. At our previous inspection visit we made an immediate requirement that the kitchen be cleaner. On this visit we found it was clean and much of it had also been redecorated. We visited the laundry. It is a small space but the equipment is sufficient to meet the needs of the home. Staff said that soiled and unsoiled laundry is kept separate, thus reducing the likelihood of cross contamination in a confined space. However, the laundry is carpeted, this being quite unsatisfactory where the floor needs to be ‘readily cleanable’. The provider said that there are already plans in place to tile both the floor and the walls. We anticipate this to be achieved within a short period of time. There have also been concerns regarding the corridor carpets, as they appear to be at the point of becoming a trip hazard, and therefore a danger, in many places. This was identified at the last key inspection, October 2007 and again at the random inspection August 2008. This must be made safe by 31st October. The provider says this is already being arranged. With ramps and mechanical lifts around the home people with restricted mobility are able to access all parts of the home and the gardens. The gardens are very well tended and attractive and we were told people have enjoyed using the veranda to sit during the very infrequent good weather. Devonia House Nursing Home DS0000067360.V370510.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. People are extremely fond of the staff and hold them in high regard, but arrangements for staff numbers and staff training could be improved. EVIDENCE: Without exception people were very complimentary about the staff saying: “Good bunch of girls, look after us very well”. “Most Staff are good and kind, very caring - a couple of grumpy ones”. “Absolutely fabulous staff here”. “I’m very happy here, staff are marvellous people”. “I like being looked after by people I know” and “*** (one of the night staff) couldn’t be more kind or caring”. Throughout the inspection the issue of staff numbers was regularly raised. People who use the service said: “Sometimes due to holidays and staff sickness staff are a little slow and things take slightly to long.” “Sometimes at night when there should be a Sister and two carers on duty there is only a Sister and one carer” and “There seems to be fewer daytime staff here of late”. Of staff, asked if there are there enough staff to meet the individual’s needs of the people who use the service, four said there were, three said usually and Devonia House Nursing Home DS0000067360.V370510.R01.S.doc Version 5.2 Page 21 two said never. Comments include: “Generally the home is very short staffed”. “I don’t believe there are enough staff to look after the amount of residents in the home”. “Yes unless a member of staff rings in sick at the last moment, of course you can never have enough staff it is not easy to recruit good staff that will settle” and “Most of the time we are fully staffed but we cannot predict illness, emergencies etc.” We saw the record of staff meetings held early in the year where the issue of insufficient staff numbers was raised. We discussed this with Matron (the manager) and the provider. They agreed that the minimum number of staff needed during the night is one nurse and two care staff. They say that, with the exception of holidays and illness, those staffing numbers are usually met. There must be arrangements in place so that they are always met and people are not put at risk. Staff told us through survey and interview about the arrangements and training for new staff. They felt it was adequate and they were well supported whilst learning the work. However, in one case fire safety training did not take place until several weeks after the staff start date; this introduces an unnecessary risk. Most staff, but not all, felt their training was adequate. We also found that domestic staff only receives training in fire safety. They must receive all training relevant to their work, such as the handling of cleaning chemicals, infection control and how to move objects safely. The safeguarding of people at the home, with whom they spend much time, is also important as they may see or be told information and need to understand its significance. Care staff confirmed that they are encouraged to undertake National Vocational Training in care and the manager told us that nine of the fifteen had achieved NVQ 2 and one had achieved NVQ 3. This is an indicator of staff competence. We looked at the recruitment records of the last three staff employed, and discussed the recruitment arrangements at the home. We saw that recruitment is robust, with all necessary checks completed to ensure staff are safe and suitable to work with vulnerable adults. Devonia House Nursing Home DS0000067360.V370510.R01.S.doc Version 5.2 Page 22 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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although well run the home could be further improved. EVIDENCE: The registered manager (Matron) has considerable nursing and managerial experience. People were very complimentary about her. There is confidence in her commitment, knowledge and abilities. She keeps herself up to date. Recent training has included safeguarding vulnerable adults and the Mental Capacity Act (how to protect people where they do not have the capacity to make decisions for themselves). However, we found several breaches of regulations at the August Random Inspection of the home. Although quickly dealt with they should not have occurred in the first place. Devonia House Nursing Home DS0000067360.V370510.R01.S.doc Version 5.2 Page 23 The home sent us their annual quality assurance assessment (AQAA) when we asked for it. It was clear and gave us all the information we asked for. The home runs a mostly informal quality assurance system. This includes keeping in close contact with people through doing a ‘round’ every morning and seeing each person individually. Visitors feel confident in approaching Matron. Also, survey forms are available to people who use the service and their visitors. We saw that people’s complaints are well handled; following a run of complaints on the standard of food this was dealt with. A small number of staff say they have not always felt listened to, and that things they have raised were not acted upon. However, we saw that the same points they had raised were recorded in staff meetings. Staff opinion should also be sought through survey, anonymous if they wish. Staff opinion is an important part of quality assurance. There should also be regular formalised staff supervision of their work, a time when issues can be raised and dealt with. A new member of staff had received a form of supervision but the manager says this is not a regular arrangement. Matron (the manager) said that people who use the service manage their own personal money. Their family or representatives do this where they are unable. Currently the home holds no valuables or money on behalf of people. We looked at how well the home manages health and safety. Care staff receive the necessary training, such as moving and handling and fire safety, but domestic staff have unmet health and safety training needs, for example, the control of infection. Also, new staff should receive fire safety information soon after starting employment, not several weeks later. The home has many assessments of risks including that of fire safety. People have risks individual to them assessed, such as falls and prevention of pressure sores. From this any identified risk can be addressed. There is current risk from the uneven and worn carpet (see Standard 19) and the laundry floor covering (see Standard 26), both, we were told, would soon be rectified. We saw records that equipment is serviced and maintained and therefore should be in good working order and safe to use. We saw from the AQQA, providing information about the home, that there is no policy or procedure for managing in the event of an emergency or crisis, examples being fire damage or multiple staff illness. We discussed this with Matron who agreed that this should be done. Devonia House Nursing Home DS0000067360.V370510.R01.S.doc Version 5.2 Page 24 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 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 3 X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Devonia House Nursing Home DS0000067360.V370510.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 (1) Requirement Timescale for action 30/09/08 2. 3. OP19 OP27 13 (4) 18(1) 4. OP30 18(1)(c) The manager must confirm in writing to the person that their needs, as assessed, can be met by the home. This will protect the person admitted to the home by ensuring their needs are understood and can be met. It is part of the contract between them. Not met by 31/08/08 Floor coverings must be even 31/10/08 and in a good state of repair so that trips and falls are avoidable. There must be arrangements in 31/10/08 place so that the number of necessary night staff agreed (now considered to be one trained and two care) are always met so that people are not put at risk. Domestic staff must receive 28/02/09 training appropriate to the work they are to perform, such as the safe handling of cleaning chemicals, infection control and how to move objects safely. Devonia House Nursing Home DS0000067360.V370510.R01.S.doc Version 5.2 Page 26 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 OP10 Good Practice Recommendations People must be fully aware that their conversation with staff may be being broadcast to others within the building and staff should ensure this does not happen. This is to protect people’s dignity. There should be arrangements in place, as part of care planning, to ensure that people are not socially isolated and they have the opportunity for stimulation. The laundry floor and walls should be ‘readily cleanable’ so the carpet in the laundry should be replaced with a more suitable flooring. Staff opinion should be sought as part of the quality assurance system at the home so that their opinion is included in the information. Staff should receive formal supervision of their work so any issues pertaining to work can be discussed and worked through. There should be a procedure in place to inform staff what to do in the event of emergency or crisis, examples being fire damage and multiple staff illness. 2. 3. 4. 5. 6. OP12 OP26 OP33 OP36 OP38 Devonia House Nursing Home DS0000067360.V370510.R01.S.doc Version 5.2 Page 27 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. 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