Care Home: Durban House Nursing Home

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What the care home does well Effective assessment processes that include the provision of good information means that people are confident their needs will be met when they move into the home and they have an understanding about the running of the home. Excellent care planning procedures means that people using the service receive the care and support in the manner they prefer. People living at the home have their health care needs met by the use of effective health care assessments and monitoring and prompt referrals to health care professionals. People living at the home have opportunity to take part in meaningful activities. People living at Durban House enjoy a varied nutritious menu that provides them with choice at mealtimes. People living at the home are confident that complaints will be taken seriously and be responded to promptly.Robust recruitment procedures mean that people living at Durban House are supported and cared for by staff suitable to work in the caring profession. People living at the home are protected from the effects of abuse by a staff team that has a good understanding of safe guarding procedures. Excellent staff development and training provision ensure that people living at the home are cared and supported by a highly skilled and knowledgeable work force. Effective management, that incorporates the views and wishes of people living at the home into the development of the service, means the home is run in the best interests for people living there. What has improved since the last inspection? Risk assessments are completed with twelve hours of a person moving into the home along with action to be taken to reduce identified risks recorded in the persons documents. Improvements in the storage of medications and regular auditing of medication procedures means that people have their welfare protected. The communal areas of the home have been rearranged after seeking people`s views to provide areas that cater for different interests of people living at Durban House. Curtains around beds have replaced the use of screens; this means that for people who share a bedroom their privacy and dignity is better protected. What the care home could do better: The service plans to provide the handbook (service users guide) in different formats such as large print, pictorial form and audiotape. This will mean that information about the home will be accessible to more people. The service tells us it plans to continue to improve activities. They will encourage family members of people living at the home to take part in activities and outings; this will create family events. The service plans to improve the environment by building an extension that will allow for safe access into the garden areas. At present they are waiting for planning permission to be granted before commencing building work.The manager tells us she plans to have more than 50% of the care staff with NVQ level 3 in care. CARE HOMES FOR OLDER PEOPLE Durban House Nursing Home Woodley Lane Romsey Hampshire SO51 7JL Lead Inspector Gina Pickering Unannounced Inspection 10:00 6 March 2008 th 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 Durban House Nursing Home DS0000060803.V359304.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. Durban House Nursing Home DS0000060803.V359304.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Durban House Nursing Home Address Woodley Lane Romsey Hampshire SO51 7JL 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) 01794 512332 01794 514258 durban@jsai.co.uk J Sai Group Ltd Perpetual Makanyara Chikuyo-Mafunga Care Home 33 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0), Physical disability (0) of places Durban House Nursing Home DS0000060803.V359304.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Physical Disability (PD) 2. Dementia (DE) The maximum number of service users to be accommodated is 33. Date of last inspection 30th January 2007 Brief Description of the Service: Durban House is a registered care home providing nursing and personal care to 33 service users in the older person category. The home is situated in a residential area in the village of Romsey on the outskirt of Southampton. Accommodation is provided on two floors with passenger lift and stair lift that allows access to all parts of the home. There are five shared rooms and the rest are single and are all fitted with wash hand basin or en suite facilities. There are a variety of aids and adaptations that are available to maintain and promote service users independence. J.Sai Group Ltd owns the service with another home in the Hampshire area. The current fee charged is £513.50- £681.52 Durban House Nursing Home DS0000060803.V359304.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 three stars. This means that the people who use this service experience excellent quality outcomes. The inspection considered information received by the Commission about the service since the last key inspection in January 2007. This includes information provided to the Commission in the form of the home’s Annual Quality Audit Assessment form in which the registered provider or manager tells the Commission how the service has developed over the past twelve months and how they propose to continue to improve the service. We surveyed people who use the service, relatives, staff and health care professionals who have input into the service. Information received from these surveys has been used to inform the inspection process. A visit was made to the service on 6th March 2008. We looked at documentation relating to four people using the service. We had conversations with the registered manager, seven staff members, five people who live at the home and one visitor as well as looking at various documentation as part of the inspection process. What the service does well: Effective assessment processes that include the provision of good information means that people are confident their needs will be met when they move into the home and they have an understanding about the running of the home. Excellent care planning procedures means that people using the service receive the care and support in the manner they prefer. People living at the home have their health care needs met by the use of effective health care assessments and monitoring and prompt referrals to health care professionals. People living at the home have opportunity to take part in meaningful activities. People living at Durban House enjoy a varied nutritious menu that provides them with choice at mealtimes. People living at the home are confident that complaints will be taken seriously and be responded to promptly. Durban House Nursing Home DS0000060803.V359304.R01.S.doc Version 5.2 Page 6 Robust recruitment procedures mean that people living at Durban House are supported and cared for by staff suitable to work in the caring profession. People living at the home are protected from the effects of abuse by a staff team that has a good understanding of safe guarding procedures. Excellent staff development and training provision ensure that people living at the home are cared and supported by a highly skilled and knowledgeable work force. Effective management, that incorporates the views and wishes of people living at the home into the development of the service, means the home is run in the best interests for people living there. What has improved since the last inspection? What they could do better: The service plans to provide the handbook (service users guide) in different formats such as large print, pictorial form and audiotape. This will mean that information about the home will be accessible to more people. The service tells us it plans to continue to improve activities. They will encourage family members of people living at the home to take part in activities and outings; this will create family events. The service plans to improve the environment by building an extension that will allow for safe access into the garden areas. At present they are waiting for planning permission to be granted before commencing building work. Durban House Nursing Home DS0000060803.V359304.R01.S.doc Version 5.2 Page 7 The manager tells us she plans to have more than 50 of the care staff with NVQ level 3 in care. 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. Durban House Nursing Home DS0000060803.V359304.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 Durban House Nursing Home DS0000060803.V359304.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, 2, 3 & 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Effective assesment procedures that include the provision of good information about the home mean people move into the home confident they will receive the support and care they need and with an understanding about the running of the home. People living at the home are made aware of their rights and obligations by the provision of statement of terms and conditions of residency at the home. The home does not provide intermediate care. EVIDENCE: The AQAA told us all people expressing an interest in the home receive a handbook about the service the home offers. During our visit to the home we looked at the handbook. It contains details about the running of the home and the services offered at the home such as contact details of the registered provider and manager, a description of the staffing numbers and skill mix at Durban House Nursing Home DS0000060803.V359304.R01.S.doc Version 5.2 Page 10 the home, a sample of the contract a person will enter into if they move into the home, details about the environment, visiting times, provision of meals, routines and activities at the home and the complaints procedure. The handbook incorporates the information required in the statement of purpose and service users guide. A copy of the handbook is kept in every person’s bedroom. The handbook is set out in a manner that allows a persons to ‘dip in and out of it’ accessing the specific information they want. The manager told us the service is planning to make these documents available in other formats such as large print, audiotape and pictures to enable more people to access the information. People who use the service told us that they received enough information about the home prior to moving into the home. People who use the service told us in surveys they received a contract for living at the home. We saw contracts and statements of terms and conditions for people living at the home during our visit. Those people that are not selffunding receive a statement of terms and conditions of residency at the home that details the fees that are being paid by their funding authority. This means that everybody living at the home has an understanding of their rights and obligations as well as the registered providers rights and obligations. The AQAA told us that a detailed assessment process is completed before a person moves into the home. We looked at four assesment documents as part of the inspection process. The assessments detail the personal, physical, health and mental health needs of the person as well as information about their social interests and hobbies, next of kin and any legal instructions. Staff told us that there is good information about a person when they move into the home to allow care and support to be given to as needed immediately. A care manager told us that the assessment process was effective meaning that her client received the care she needed when she moved into the home. Durban House Nursing Home DS0000060803.V359304.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 excellent. This judgement has been made using available evidence including a visit to this service. Excellent care planning processes that involve the person living in the home, their representatives and all staff at the home mean that people living at the home receive the support and care they need in the way they like, including in the final days of their life and after death. People living at the home have their health care needs met by a work force that has a good understanding of health care issues, by effective monitoring and assessments and by prompt referral to health care professionals when needed. Good medication practices and effective monitoring of these mean that people using the service have their wellbeing protected. Good practices and provision of equipment means that a person’s privacy and dignity is protected. EVIDENCE: Durban House Nursing Home DS0000060803.V359304.R01.S.doc Version 5.2 Page 12 The AQAA told us improvements have been made in care planning for people when they move into the home. All people are assessed for risks within twelve hours of moving into the home. We looked at four peoples documents and care plans. The admission information confirmed that all assessments including moving and handling, falls and skin integrity are complete within twelve hours of the person moving into the home. This means that the home has complied with requirement made at the previous inspection about this issue. Care plans incorporate personal preferences with regard to sleeping and rising routines, daily routines, whether they prefer to be cared for by a female, male staff or do not mind and other personal preferences such as one person does not like to be alone in a room or hobbies they like to take part in. Details about how a person likes to be supported in their personal and health care is found in the plans. Discussion with people living at the home, staff members and a visitor indicated that people’s wishes as documented in care plans are adhered to. Nutritional assessments are made using a professionally recognised tool and a care plan is developed if nutritional risks are identified. Professionally recognised tools for pain assessment, moving and handling and dependency are used and a plan of care developed accordingly if a risk or a need is identified. The AQAA told us that care staff have received training about skin integrity and will receive further training about this topic in the next twelve months. Care plans and daily notes evidence an excellent understanding about the support a person needs to maintain skin integrity. Care plans are reviewed monthly. People who use the service and their representatives are encouraged to be involved in the care planning. Relatives are made aware of the care plans and all plans looked at included the signature of the person’s representative, this generally being a relative. Care staff told us about their involvement in care planning; as their skills are developed by NVQ training and good supervision they are taking on responsibilities for care planning. The manager told us that she believes that care staff should be developing care plans, as they are the ones that are supporting and delivering the personal care to people living at the home. Nurse’s complete care plans for nurse interventions that cannot be completed by the care staff. The team of trained nurses working at the home facilitate the health care of people living at the home. Documentation evidences the contact people have with doctors and other health care professionals including alternative therapies such as aromatherapy. Instructions from doctors about a person’s health care are recorded in the doctor’s notes of the care planning documentation as well as being incorporated into the care plan and medication administration record sheet if needed. Relatives, in surveys, told us that people living at the home always receive the care expected or agreed upon. People living at the home told us in surveys they always or usually receive the care they need. Durban House Nursing Home DS0000060803.V359304.R01.S.doc Version 5.2 Page 13 Comments included on surveys about the provision of health and personal care at the home included from relatives “all interventions are explained and care plans/records are discussed and signed off”, “my fathers personal care is very good. I have never visited this home and found it not to be so” and “when he has been unwell he has received prompt medical attention”. And from a person living at the home “Durban House is providing all the nursing care one could wish for”. Throughout the inspection process information was obtained evidencing the privacy and dignity of people living at the home is promoted and protected. Care plans detail people’s wishes about personal care and their wish to have either a male or female carer supporting them with their personal care. In the last twelve months all shared rooms have been provided with cubicle style curtains to provide more privacy than the use of screens does. When a person needed hoisting in the lounge screening was provided to ensure the persons privacy and dignity was not compromised. Staff members were observed talking with and assisting people at the home in a friendly and pleasant manner. No breaches of privacy were observed throughout our visit to the home; staff were always seen to knock on a persons bedroom door and wait for a response before entering the room. The AQAA told us that improvements to medication systems in the form of regular audits of the medications, the review of the ordering system and homely remedies and a new medication fridge being obtained had occurred in the past twelve months. We looked at the medication administration records for four people living at the home. The record clearly states the dosage and time each medication is due to be administered. Medications altered by medical staff are clearly documented and are detailed in the persons care plan documents. The nurse administering the medications signs for all medications taken by a person, and the reasons for any missed doses are documented on the record sheet. The medication storage area was looked at. At the previous inspection there had been excess stock of certain wound dressings and the room had been dusty and in poor state of repair with missing ceiling tiles. These issues have now been rectified; the storage area was clean and tidy with no missing ceiling tiles. The manager confirmed that the new ordering system had resolved excess stock problems. The storage and monitoring of controlled medications comply with the Misuse of Drugs (Safe Custody) Regulations 1973. The AQAA told us that all staff administering medications (trained nurses) have additional training about the management of medications. We looked at training records that evidenced that the nurses had received additional training about the management of medications. This means that their understanding about medications gained when completing their nurse training has since been updated; this protects and promotes the wellbeing of those living at the home. The AQAA told us that the manager regularly audits the medications practices to ensure procedures are being complied with. We saw evidence to confirm that this is occurring. Durban House Nursing Home DS0000060803.V359304.R01.S.doc Version 5.2 Page 14 In the past twelve months we have received one complaint about the home that had been passed onto the home to investigate. This complaint included some concerns about the interaction between the home and relatives when a person was in the final stages of their life. The home had kept us informed of the outcomes of this complaint. Due to this complaint we looked at issues surrounding the information provided in care plans about a person dying. For all care plans looked at there were details about the person wishes about dying, whether they wanted to be admitted to hospital for further treatment or remain at the home and die at the home. Letters evidenced the involvement of relatives in this decision. Care plans also detail a person’s wish after death regarding burial or cremation and which funeral directors they wish to use. Training records evidence that in the past twelve months staff members have undertaken training about the care of a person dying. Durban House Nursing Home DS0000060803.V359304.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to this service. People living at the home have the opportunity to take part in meaningful activities and to maintain contact with their family and friends. People living at the home are able to exercise choice and control over their life. People living at the home benefit from a varied and healthy diet. EVIDENCE: The AQAA told us that an in-house activity coordinator has responsibility for coordinating activities at the home. Part of this process includes the development of individual care plans for activities and social interaction. This helps to ensure there are suitable activities planned that people who live at the home have an interest in. The manager told us that the home is working with a psycho geriatrician and occupational therapist to develop an activity programme that people with dementia can enjoy. Photographs displayed in the home evidence the enjoyment people living at the home have had from shopping trips, boat trips and trips to garden centres. People living at the home told us in surveys that there are usually activities arranged by the home they can join in with if they wish. During our visit to the home people told us Durban House Nursing Home DS0000060803.V359304.R01.S.doc Version 5.2 Page 16 there are activities they can join in or they can occupy themselves either in the communal areas or in their own bedrooms. We observed staff spending time with people living at the home on an individual basis looking at book of Southampton in the past or in general conversations. This observation and comments made in staff surveys evidence that staff recognise the importance of one to one interaction with people as well as group activities. The AQAA told us links have been made with local churches and services are held at the home every month. The AQAA told us that there are no limitations on visiting times; people at the home can choose when to receive their visitors. One visitor we spoke to during our visit to the home confirmed that he can visit at anytime of the day, though he has to respect the wishes of the other person that shares a room with his wife by not visiting late into the evening when that person is wishing to go to sleep. Relatives told us in surveys the home always supports people living at the home to remain in touch with their relatives and friends, whether by the use of telephone, visiting or email. Throughout the inspection process evidence was gathered confirming that people living at the home are able to make choices in their daily lives. Examples of these include being able to make choices about involvement in activities, where and when to take their meals and their wishes regarding care support being included within the care planning process. People were observed being able to move freely or with assistance around the home, choosing whether to use the communal areas or sit in their bedrooms. Relatives told us in surveys the home supports people to live the life they choose. People living at the home told us they choose what they want to do. Discussion with staff at the home evidenced that they believe that Durban House is the home of the people who live there; their choice about what to do in their own home must be respected. The service users guide (handbook) tells us at what times meals are served and people living at the home can choose where to take their meals, be it in the dining room, lounge areas or in their bedrooms. During our visit to the home we observed people taking their meals in the dinning area, lounge areas and in their bedrooms. People confirmed to us that it is their choice where to take their meals. Surveys from people living at the home told us they usually enjoy the food provided by the home. Staff members discuss the daily menu with people as well as it being displayed in the dining room. On the day of our visit to the home the menu was for lunch lamb cobbler, sausage and onion, salads or omelettes, cream potatoes, peas, cauliflower ice cream or blackcurrant cheesecake. And for supper home made spicy parsnip soup, sandwiches, egg dish, cheese on toast, salmon fishcake with grilled tomatoes, arctic roll or ice cream. The AQAA told us that ‘lunch clubs’ had been formed. The manager told us this is where friendship groups gather at lunchtime to sit Durban House Nursing Home DS0000060803.V359304.R01.S.doc Version 5.2 Page 17 and chat over the meal. Lunchtime was observed to be a social and chatty occasion for those people choosing to take their lunch in the dining room. Durban House Nursing Home DS0000060803.V359304.R01.S.doc Version 5.2 Page 18 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 who live at the home are confident that complaints will be taken seriously and responded to promptly. People who use the service are protected from the effects of abuse by a staff team that has a good understanding about safeguarding procedures. EVIDENCE: The AQAA told us people who live at the home and their relatives are made aware of the complaints procedure by discussion during the initial assessment process, in documentation such as the service users guide (handbook) and because the procedure is displayed in the home. Both people who live in the home and their relatives told us in surveys that they know who to address any concerns and complaints to and they are confident that complaints will be responded to in an appropriate manner. Comments received include “I have always found the response to problems good”. Staff told us in surveys they know how to respond to any complaints or concerns received. They said “whether serious or minor, straightforward complaints are usually resolved on the spot” and that complaints are logged and the manager is informed of them immediately. The AQAA told us that the home has received two complaints in the last twelve months, one of which was not resolved within the twenty-eight day time scale. We looked at the complaints logbook. This evidenced that Durban House Nursing Home DS0000060803.V359304.R01.S.doc Version 5.2 Page 19 suitable action was taken to resolve both of these complaints despite one not being resolved within twenty-eight days. As detailed in the health and personal care section we have received one complaint about the service that was forwarded to the provider to investigate. Of the two complaints detailed in the complaints log book one of those was the complaint forwarded from the Commission. The AQAA told us that all staff members have received training about safeguarding adult procedures. Training records evidence that staff have undertaken this training. Discussion with staff evidenced they have a good understanding about different types of abuse and the action to take should they suspect abusive incidents have occurred. The manager also demonstrated a good understanding about safeguarding procedures in conversation. There have been no safeguarding referrals made in the past twelve months. Durban House Nursing Home DS0000060803.V359304.R01.S.doc Version 5.2 Page 20 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 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service benefit from living in a safe and comfortable environment, which is suitably furnished and maintained. EVIDENCE: As part of the inspection a tour was made of the environment looking at a sample of bedrooms, bathing facilities, communal areas, the kitchen and the laundry. The AQAA told us that colour schemes for blinds in communal areas and bedrooms is chosen by the people living at the home. On the day of our visit some of the upstairs bedrooms were being decorated and having new Durban House Nursing Home DS0000060803.V359304.R01.S.doc Version 5.2 Page 21 carpet fitted. General conversations with people living at the home informed us that they were able to make choices about the colour schemes of the rooms. Bedrooms were to varying degrees personalised with the person’s own belongings such as ornaments, pictures and small items of furniture. Bedrooms that are shared have cubical curtains to promote the privacy of each person. The AQAA and the manager told us that these had been provided to improve upon the privacy that had previously been provided by screening. Communal areas consist of a large area that is separated into two lounge areas and a dining area along with a smell conservatory that used more in the summer months. These areas are decorated in a homely manner and offer a variety of seating for people to use. The AQAA told us that the lounge and dining areas had been rearranged after seeking the views of people living at the home. There are now two seating areas in the larger lounge/ dining area; one has a television for people to watch, the other has a CD player for people to listen to their choice of music. The conservatory is a quiet area for people to enjoy. We observed people who use the service moving freely between the communal areas and their bedrooms making the choice about where to sit and how to occupy themselves. The home has a pleasant garden for people to use. At present access to the garden is through the car park. The manager told us that this has been identified as a risk and plans are in place to extend the home that will provide a safe access to the garden area for people living at the home. At present a member of staff escorts people to the garden to ensure their safety. A shaft lift enables people to access both floors of the home. There are sufficient bathing and toileting facilities for people who live at the home. The AQAA told us that bathing facilities have been improved in the past twelve months with refurbishment of a shower room and the installation of a new assisted bath. Policies and procedures are in place about hygiene practices and the control of infection. The AQAA tells us that these were last reviewed in September 2007. A team of housekeepers are responsible for the cleaning of the home. One of them told us they always have the necessary equipment to ensure the home is clean, tidy and free from malodours and that there are sufficient numbers of them to maintain high cleaning standards. During our visit the home was observed to be clean and tidy with no offensive odours. People who live at the home told is in surveys that the home is always clean and fresh. The homes laundering facilities are on the ground floor. The position of laundry and good laundry practices reduce the risks of cross infection from dirty laundry. The laundry floors and walls are easily cleanable and were clean and tidy on the day our visit. Durban House Nursing Home DS0000060803.V359304.R01.S.doc Version 5.2 Page 22 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 excellent. This judgement has been made using available evidence including a visit to this service. Excellent staff development and training provision ensure that people living at then home are cared and supported by a highly skilled and knowledgeable work force in suitable numbers. Robust recruitment procedures mean that people living at Durban House are supported and cared for by staff suitable to work in the caring profession. EVIDENCE: A staff rota displayed in the home details who and in what capacity, such housekeeping, kitchen or care staff, is on duty at any one time. Surveys from staff and relatives told us that there is usually enough staff on duty at any one time to meet the needs of people living the home. Observation during our visit to the home showed that staff members have time to sit and talk with people living at the home and call bells were answered promptly indicating that there were sufficient numbers of staff on duty at that time. We looked at a sample of staff records. These evidence that good recruitment practices are followed ensuring that no one commences employment at the home prior to two written references being received and CRB and POVA Durban House Nursing Home DS0000060803.V359304.R01.S.doc Version 5.2 Page 23 information being obtained. These processes protect the welfare of those living at the home. Staff surveys confirmed that checks such as references and CRB were obtained prior to them commencing employment at the home. Staff records also contained copies of certificates for courses attended and qualifications obtained by staff members. The manager maintains a training matrix that clearly identifies the training staff have had and what training they need to update. Since the last inspection structured training about care of people with dementia has been put in place with most care staff achieving NVQ level 2 in dementia care. Non-care staff such as housekeepers and kitchen staff have had the opportunity to achieve NVQ qualifications in their field of work. Staff told us in surveys that the manager is very proactive in providing training. Comments included “training is very important in the home” and “the manager is keen to develop her staff and is expert at identifying training needs and strengths/capabilities in her staff. We regularly have in house training to help us understand the needs of individuals and improve our service to them. The manager is continuing the NVQ programme and developing her senior carers to take on supervisory roles”. The AQAA told us that 96 of care staff have NVQ level 2 or above in care. The manager told us she is committed to providing a workforce that has 100 of its carers with NVQ level 2 in care and 50 level 3 in care. The manager also spoke about how training is provided for any identified need. An example of this is that following a complaint received by the home further training about the care of people dying was put in place. Training records evidence that staff have received this training. Staff told us in surveys that their induction programme covered what they needed to know to begin supporting and caring for people at the home. The manager confirmed that induction programmes follow Skills for Care common induction standards. We saw a copy of the induction programme used by the home to confirm this. Durban House Nursing Home DS0000060803.V359304.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a home that is effectively managed and seeks the views of those using the service to influence the development of the home. Robust procedures ensure that the finances of people using the service are protected. Good health and safety practices protect all people at the home. EVIDENCE: We registered the manager in July 2007 since when she has completed the registered managers award. Staff, visitors and people who live at the home spoke highly of the manager. The manager spoke of her working relationship with the registered providers evidencing that they work together to improve the service at the home and consequently outcomes for those living at the Durban House Nursing Home DS0000060803.V359304.R01.S.doc Version 5.2 Page 25 home. For example the manager explained that the providers are wiling to fund staff training believing knowledgeable and skilful staff provide the best outcomes for people using the service. The manager was able to demonstrate her commitment to improving the service at the home to improve outcomes for people living at Durban House. Examples of this include risk assessments being completed promptly when a person moves into the home, the provision of curtains around beds to improve privacy and dignity for people in shared rooms and the regular auditing of medication procedures to protect the wellbeing of those living at the home. The AQAA told us people who use the service, their relatives and visiting professionals are surveyed about the service provided at the home. Information from these is used to influence the running and development of the home. Examples of this include improved disabled access to the home as well as main entrance access so that the visitors do not wait for a long period whilst waiting to be let in by a member of staff, rearrangement of communal areas taking into consideration different interests of people who live at the home and a greater variety of outings for people at the home. The manager told us she is looking into ways of involving people living at the home and their relatives in the development and running of the home. The provider’s monthly reports about the quality of the service provided by the home contribute to quality assurance processes at the home. These reports are available at the home and include views of the people who live at the home as well as audits of documentation and the environment and views of staff at the home. Procedures are in place about the handling of money for people who live at the home. People can make use of a safekeeping facility if they wish. Records are kept of monies held for people including details of income and expenditure. The AQAA told us the home has a health and safety policy that was last reviewed in September 2007. Records indicted that staff receive training about health and safety issues. We saw risk assessments for the environment that detail working practices to be followed to reduce identified risks. Suitable moving and handling equipment is available. The AQAA told us that in the past twelve months the home has been purchasing profiling beds that promote the wellbeing of people at the home and assist staff with moving and handling of people. The fire logbook indicates that fire safety checks are carried out in accordance with the Fire and Rescue Services guidelines. The home has a policy for the control of substances hazardous to health known to staff. Chemicals and other items are securely stored in locked cupboards. The manager and the cook told us they are due a food hygiene inspection shortly. The cook discussed food hygiene practices in the kitchen and showed us around the kitchen areas. The AQAA told us that all catering staff and care staff had undergone training about food hygiene practices. No concerns have been raised to us about food hygiene practices at the home. Durban House Nursing Home DS0000060803.V359304.R01.S.doc Version 5.2 Page 26 We looked at a sample of service certificates evidencing that services and equipment are maintained at manufacturers recommended intervals. This protects the wellbeing of all at the home. Durban House Nursing Home DS0000060803.V359304.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Durban House Nursing Home DS0000060803.V359304.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Durban House Nursing Home DS0000060803.V359304.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Durban House Nursing Home DS0000060803.V359304.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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