Care Home: Eversley Nursing Home

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What the care home does well What has improved since the last inspection? What the care home could do better: This home provides an excellent service and only needs to continue in what it does and hold on to its ability to be self critical and innovative. CARE HOMES FOR OLDER PEOPLE Eversley Nursing Home 95-96 North Denes Road Gt Yarmouth Norfolk NR30 4LW Lead Inspector Ms Dorothy Binns Unannounced Inspection 5th August 2008 09:45 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 Eversley Nursing Home DS0000015636.V369682.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. Eversley Nursing Home DS0000015636.V369682.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Eversley Nursing Home Address 95-96 North Denes Road Gt Yarmouth Norfolk NR30 4LW 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) 01493 854086 01493 857007 Jody@kingsleycarehomes.com Country Retirement and Nursing Homes Limited Jody Donaldson Care home with Nursing – Code N 18 Category(ies) of Care home with nursing (N) registration, with number of places Old age, not falling within any other category (OP) 18 Both Physical disability (PD) 1 Both Dementia (DE) 18 Both Eversley Nursing Home DS0000015636.V369682.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 the following gender: Either whose primary needs on admission to the home are within the following categories: Older People, not falling into any other category - Code OP Dementia - Code DE Physical Disability - Code PD 2. The maximum number of service users that can be accommodated is:18 Date of last inspection 21st August 2007 Brief Description of the Service: Eversley Nursing Home is situated in the town of Great Yarmouth within reach of local shops. It is a three-storey building with access to the 16 single and 1 shared room by a shaft lift. The communal areas consist of two lounges and two dining rooms with a separate small quiet room. The home has a patio area with shrubs and flowerbeds and a small space for parking. Eversley is a registered care home that provides nursing care for 18 older people and is owned by Country Retirement and Nursing Homes Limited. In March 2007 the registered person applied to change the registration to accommodate people with dementia who needed nursing care and this was granted. Currently the home accommodates thirteen people with dementia and three older people who are physically frail. One resident is under 65years. The charges for the home are £536 per week for nursing care of people with dementia. Residential care clients pay less. Residents are expected to pay extra for chiropody and hairdressing. The inspection report for the home was displayed on the home’s notice board available for service users or visitors to read. Eversley Nursing Home DS0000015636.V369682.R01.S.doc Version 5.2 Page 5 Eversley Nursing Home DS0000015636.V369682.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 3 stars. This means that people who use the service experience excellent quality outcomes. Care services are judged against outcome groups, which assess how well a provider delivers the service. This report gives a brief overview and current judgements for each outcome group. For the inspection the manager completed a lengthy questionnaire about the service which told us what was happening in the home, what improvements had been made and where the manager thought further improvements could be made. Records held by the Commission and previous inspection reports were also checked. This information was valuable in helping the Commission reach a judgement about how well the home was faring. This key inspection also comprised an unannounced visit to the home that lasted seven hours. Records and policies were examined and discussions took place with the manager and staff in the home. In addition, four people living in the home were interviewed in private to see what they thought of the home. One relative was also interviewed. Overall this home is functioning very well and providing an excellent service to the people who use it. What the service does well: The home is good at making sure that people considering coming into the home are properly assessed beforehand so the home knows they can cater for the person’s needs. This also gives reassurance to the person that they will be properly looked after. The assessments are then turned into care plans which tell staff in detail what assistance the person needs and how they like things done. This makes residents feel comfortable as they know things will be done as they want it. “Staff do whatever you ask” said one. Another said “the girls are very good”. The home is good at monitoring the health of the residents and liaises with outside community resources to make sure residents get attention when they need it. The home also has good systems itself for monitoring health needs. In terms of choice and how residents are treated, the home’s emphasis is very much on doing what the resident wants- they come first. Routines are flexible, residents’ dignity is protected and overall people feel comfortable in the home. Some of the comments were: “It’s more like home” Eversley Nursing Home DS0000015636.V369682.R01.S.doc Version 5.2 Page 7 “I get up when I want – I suit myself” “The atmosphere is very relaxed – like being in a hotel” “I feel quite comfortable” The home is good at keeping records correctly so that residents are protected and things get done. There are excellent training opportunities for staff who have benefited from a great deal of training this last year including in dementia and in studying for a national care qualification. This can give confidence to residents and their relatives that they are being served by a skilled workforce who are well supported by the manager. The home and the organisation generally is good at checking its own procedures and finding out how people experience the care. They have good quality assurance systems and have a number of ways that they involve the residents and relatives in decisions about the home. People feel listened to. What has improved since the last inspection? What they could do better: This home provides an excellent service and only needs to continue in what it does and hold on to its ability to be self critical and innovative. Eversley Nursing Home DS0000015636.V369682.R01.S.doc Version 5.2 Page 8 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. Eversley Nursing Home DS0000015636.V369682.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 Eversley Nursing Home DS0000015636.V369682.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): 3 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents have a full assessment of their needs before coming into the home ensuring that the home can take care of them in an individual and appropriate way. EVIDENCE: Four care records were examined and found to have a very full assessment by the home of all the areas of need and abilities. An assessment had been carried out first by the social worker who refers the person to the home and the manager or a nurse then carries out the full assessment before the person comes into the home. All physical aspects of care are assessed so that the home is able to judge what assistance the person needs, but also their general demeanour and communication are assessed to see what help they may need in interacting with the staff and voicing their views. A social history was also taken and significant dates noted. Hobbies and talents were also listed. Each person also had a falls assessment and any risks in moving and handling to Eversley Nursing Home DS0000015636.V369682.R01.S.doc Version 5.2 Page 11 enable staff to see that the person is able to move around safely, and also a nutritional assessment to see what problems if any have to be monitored. Health is also assessed as is any risk of pressure sores. Such a full assessment ensures that residents are individually assisted and the care is directed in the right way. This assessment prepared the way for a care plan outlining what assistance is needed and how the resident will be cared for on a day by day basis. The manager said that the person is also offered a trial visit so they can see the home and see what they think. They are also given a prospectus and the terms and conditions of the home in big print (seen) so they understand how the home works and what they will pay. Eversley Nursing Home DS0000015636.V369682.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 and 10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents can be confident that their health and personal care needs are understood, recorded and catered for in the home and they are assisted in a dignified manner. Medication is administered much more safely and the home’s procedures and records help the staff to give a very good service. EVIDENCE: Four care records were checked at random. All had a care plan covering different areas of each person’s care ensuring that staff knew what to do for each person. Care plans covered personal care, safety, health problems, sleep patterns and social care. They were signed by the resident where possible and/or the next of kin showing that they were involved in the making of the care plan. Daily notes were written up by the nurses on how the person had spent the day and how they had fared in relation to the care plans and they were reviewed every month to see if there needed to be any changes. In addition the carers complete an accountability chart showing that the details of care such as shaving or the cleaning of dentures has been carried out. Where Eversley Nursing Home DS0000015636.V369682.R01.S.doc Version 5.2 Page 13 people are not able to speak up for themselves this is a useful tool to ensure that people are looked after properly. Care plans also mentioned things like “likes a glass of wine” and “likes newspapers” which one of the nurses confirmed the person was given every day. Residents also have a key worker and a named nurse who are responsible for their care and for carrying out those individual tasks like seeing that they have enough toiletries or liaising with relatives. This also ensures that people don’t slip through the net and have someone taking a special interest in them. In addition the manager has organised life story books for each resident which gives information about what is important to each resident and helps staff to more fully understand the residents. These have included personal issues regarding gender issues or religion which have helped the staff to have more understanding. The assessment and care plans gave plenty of evidence that health care needs were monitored. The records showed any particular conditions that the home needed to consider but also showed where the home had assessed for any risks of for instance falling and how this might be prevented. Diet, weight, skincare and sleep were also monitored where necessary with specific charts on food and drink consumption. Nurses attend to wound care and injections as required and are responsible for the nursing care. The manager works closely with the lead clinical nurse to ensure that standards are maintained. (Minutes of meetings with nurses seen). Some liaison had been formed with the district nurse for advice. The care plans showed when the resident had had contact with the doctor and there was recent evidence that the optician, dentist and chiropodist had been in the home. The manager said they liaise with the continence nurse and one of the staff has a special responsibility for continence matters. There has also been recent contact with a community psychiatric nurse to help with a particular person. The nurse was able to provide a training session for staff on a specific mental illness to help them in their work. One person had had some advice from the Blind Society. In the homes own quality audit this year, a survey form had been received from a general practitioner who comes into the home giving a glowing report of how well the home assisted him in his contact with the residents and in their knowledge about their care. This is a helpful guide for both the manager and residents knowing the GP is happy with the care that is offered. In terms of privacy and dignity, residents were able to confirm that they were attended to in the privacy of their rooms and were cared for kindly. “Staff do whatever you ask” said one. Another said “I feel quite comfortable”. One person who had been in the home a long time said “it is much better. It’s like being in a hotel”. Staff interviewed said they fully understood about the need to maintain dignity and privacy and this was part of the philosophy of the home. Residents are able to see their visitors in private and to spend time in their room whenever they wish. Some residents were seen to be in their rooms. An incident was brought up at the staff meeting (minutes seen) about clothes getting mixed up and residents found wearing someone else’s, which is not upholding their dignity. This was seen to be dealt with by the manager Eversley Nursing Home DS0000015636.V369682.R01.S.doc Version 5.2 Page 14 who looked at how staff sorted the laundry. A watchful eye is still being kept on this. This was a good example of things not being right and the manager doing something about it in order to protect the residents. A requirement was made at the last inspection for locks to be put on toilet and bathroom doors so people could have their privacy. The action plan sent in by the home said they would attend to this. Locks are now placed on all these doors. At the last inspection there were serious concerns about how medication was administered and about stock control. The home responded immediately to the findings and informed the Commission within a week, of the actions they were taking to remedy the situation. At this inspection, it was clear that several changes had been made. The home has moved to a monitored dosage system where the pharmacist packages the tablets into individual sealed units for each resident. There is a photo of the resident on each pack ensuring that staff know who to give the medicine to. Three records were checked at random against the medication containers and were found to be administered correctly. Because of the new system, stock control is much easier with dates and amounts recorded on each medication sheet. A returns record was seen for medication that is not required. A separate record is kept for controlled drugs which were seen to be securely locked away in a separate cabinet in the locked drugs room. Two staff sign when controlled drugs are given out. One care plan showed that the resident is able to administer most of her own medication and a risk assessment about that was on file to show that it had been carefully considered and discussed with the resident. Only the nurses give out the medication but have had extra training in the administration of medication following the last inspection. In addition the manager has introduced a system for monitoring medication administration and a record was seen of her random checks and audits. This ensures staff are careful and gives good protection to the residents. Eversley Nursing Home DS0000015636.V369682.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 and 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents were very positive about the quality of their life in the home and felt very comfortable with the routines. They have more opportunities now to be involved in social activities and with their families, and receive a wholesome diet. Those not able to exercise choice are carefully monitored by the home to see that they are well looked after. EVIDENCE: On arrival at 9:45am only two residents were in the lounge and staff said that people were taking their time getting up and about and were still in their rooms. Residents spoken to all said they did things when they wanted to. Regarding bedtimes, one person said she heard her neighbour come up to bed at 11.45pm the other night and she herself goes to bed when she likes. Another said, “if I want to go to bed, I go to bed – I just suit myself”. One person said “it is more like home, the girls are very good and you go to bed when you want”. One staff said that some residents have lost their sense of time and they may ask them if they wish to go to bed, but if they don’t want to, there is no pressure at all. Another staff said that if a resident is not sleepy at night they can sit with her downstairs until they want to go to bed. All staff Eversley Nursing Home DS0000015636.V369682.R01.S.doc Version 5.2 Page 16 questioned said they maintained very flexible routines to allow residents as much choice as possible. Care plans stated the approximate time for people to have breakfast, one showing about 10am as this resident often got up late. People could also have their breakfast in their room or in the dining room. Other mealtimes were usually at the same time every day but the way staff discussed the routines, the impression was that the home would try and cater for whatever the person wanted. Similarly with bath times, one person said she only had one a week as she had bandaged legs but others could have more frequently. This showed that routines were not hard and fast and were adapted to each person. Three residents are bedfast and one person chooses to stay in their room a lot. Staff were seen in attention and checking on them and a chart is completed showing the contact they have with staff. At the last inspection there was a requirement for the home to increase the amount of activities for residents so that they had more stimulation. The manager has worked hard on this in a number of ways. Staff now provide some activity every day in the form of cards, games, exercise, doing their nails or reading newspapers. A list was seen of what is provided and who participated. Staff interviewed during the inspection thought the residents had a lot of stimulation now. One said she played dominoes with residents and liked doing their nails. In addition the manager has introduced special events. The home had a barbecue very recently with relatives and staff involved, and residents have been on a boat trip and a sponsored walk along the promenade. A visit to the zoo is arranged for September and an organisation that brings pets into the home has been approached, as has a vicar for one of the residents. One resident is taken to the pub sometimes. They have also had several themed lunches, in some using the expertise of their foreign staff preparing a meal from their country (confirmed by staff). Residents meetings are also held every three months with relatives invited (minutes seen). Residents and relatives can put forward their ideas for activities. Two outside organisations also visit the home, one every week to do aromatherapy, the other twice a month to do games and crafts. A hairdresser also comes every fortnight. The manager has also completed life story books for everyone with the resident and relatives sitting down with the keyworker and helping to compose the book and providing pictures. Examples of these were seen and they were excellent. The manager said that where they discovered a previous interest for a resident in the process of doing these books, they have transferred that information to the residents care plan so that staff can find ways of retaining that interest for the resident. She gave an example of finding out that one resident always had a budgie so they are going to make arrangements for her to have one in the home. Another person used to play the piano so they are encouraging him to play in the home. The manager also felt this had encouraged relatives to be more involved in the relative’s care and this was beneficial for the resident. Eversley Nursing Home DS0000015636.V369682.R01.S.doc Version 5.2 Page 17 This is a home for people with dementia so most residents were not able to talk at length about their experiences. However one said that staff did take her out to the seaside, another said she played cards and that staff asked you if you wanted to do the activities. She also said you could say no. One person who was able to elaborate, said the residents meetings had made a difference and she was able to be a spokesperson for other residents not able to say very much. She said they had a lovely barbecue recently but that she herself does not do all the activities as she likes her own company and was free to do as she liked. She said it was “a very relaxed atmosphere in the home – like a hotel”. One relative seen said she thought the residents did a lot of activities. Residents said they could have visitors when they liked and see them privately in their rooms. One relative was in the home at the time of the inspection and was seen helping her relative to eat their lunch. She said she came every day and liked to help and she was made very welcome by the staff. One resident said that relatives sometimes stayed for lunch and could phone up before they came and ask to stay if they wanted to be with their relative. The manager reported that she had seen an increase in the number of relatives coming to the home. She had approached them to be involved in the life story books and in coming to social events and felt the residents had benefited from that. They helped to run the recent barbecue and were invited to residents meetings to have an input in the home. Residents are encouraged to make their own decisions when they can and residents all felt they had a choice about their routines and how much they participated in the activities. They are encouraged to bring possessions into the home to make their rooms individual. Relatives have become more involved in the home and can speak on their resident’s behalf. All residents, or with the help of their relatives, conduct their own financial affairs. The home is not involved in handling anyone’s money. The manager had found an advocate for one person who has no family and is in the process of linking the person with a befriender. The four residents seen at the inspection were all very positive about the food they received and said it was very good. They felt the portions were good and they were also able to have snacks and drinks when they liked. The menus were examined and found to be varied and nutritious. An alternative was offered to the main course and the menu also advertised a vegetarian choice. The menu was displayed in the dining room. The teatime meal was a hot meal and residents confirmed that they also had cake. At breakfast there was plenty of choice with different cereals as well as prunes and juice. Residents were observed having their lunch of smoked haddock with vegetables followed by steam pudding. Cheese pie was the alternative. Some residents had staff helping them, some were in their bedrooms and one person had a relative helping. Some soft diets are prepared and one person was seen with food that had been liquidised. Each part of the meal had been liquidised separately Eversley Nursing Home DS0000015636.V369682.R01.S.doc Version 5.2 Page 18 giving a better appearance. The home keeps a record of food prepared and copies of the diets it offers. Each resident also has a nutritional assessment on their care plan so staff know if there is a risk of a resident not eating or drinking enough. A chart is kept of what the person consumes and their weight. The manager has also attended a course on nutrition and was aware of the need to provide a wholesome diet. She said she had introduced healthy snacks like smoothies. The cook is also involved with the residents and is planning to have baking sessions with them. The information provided by the home showed that she has been trained in safe food handling. Eversley Nursing Home DS0000015636.V369682.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 and 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents and their relatives can be confident that their complaints will be listened to and acted upon and that they will be protected from abuse. EVIDENCE: The complaints procedure was seen in the service users guide which is given out to residents before they come to the home and it was also seen posted up on the notice board. The procedure refers to the Commission and lets people know how they may contact the Commission if they are not satisfied with how their complaint is dealt with. The manager also keeps a record of any complaint and this showed what steps had been taken to investigate the complaint and what actions were being taken to deal with it, including any disciplinary actions with staff. Three complaints have been made in the last twelve months. One complaint showed that it had been raised at a residents meeting and was listened to and dealt with. None of these complaints have reached the Commission showing that the manager is listening to her residents and responding to their concerns. The home has a policy dealing with allegations of abuse and this links in to local multi agency procedures. It also states that the Commission will be informed where allegations are reported. No allegations have been made in the last year and none have reached the Commission. All staff spoken to confirmed that had received training on the prevention of abuse and the Eversley Nursing Home DS0000015636.V369682.R01.S.doc Version 5.2 Page 20 training record showed that most staff have received it. The manager stated that all staff will have a refresher course in September. Eversley Nursing Home DS0000015636.V369682.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 and 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents live in a safe and attractive environment that is well maintained and adapted to maximise their independence. The home is comfortable and homely, clean and hygienic. EVIDENCE: At this site visit nearly all parts of the building were seen. There have been a lot of renovations since the last inspection making the home much more attractive for the residents. The home has undergone a lot of redecoration and carpeting which was noticeable in the communal areas and in some of the bedrooms. It is much brighter and more attractive for the residents. The televisions in the lounges have been replaced by much larger screen versions. The adapted shower room has been upgraded making it a more useful facility for the residents and providing an alternative to the bathroom which has a hoist. Locks have been put on all bathrooms and toilets increasing the privacy Eversley Nursing Home DS0000015636.V369682.R01.S.doc Version 5.2 Page 22 of residents. Maintenance work has been carried out on the roof and there has been more planting in the garden. The home has a shaft lift for residents to use and there is a call bell facility in each room. Both of these facilities were tested and found to be working satisfactorily. A maintenance man is employed to carry out routine tasks and keep facilities working. Residents mainly have single rooms with only two double rooms in the home and some rooms have had new furniture. Nine bedrooms have ensuite facilities. Residents are able to personalise their rooms with their own possessions. There is good signage in the home with all residents having their picture and a number on the door to their room. Toilets are also signposted. This is a good aid to those who can’t remember. Overall the home is comfortable and homely and is being maintained satisfactorily. It is also on the level and easy for those who use wheelchairs to get about. The home is clean and free from offensive odours. Laundry facilities have been upgraded with a new infection control trolley which separates out the laundry. The washing machine has a sluice wash and clean linen is stored separately. The home uses a red and yellow bag system for the collection of clinical waste. The home has appropriate procedures and facilities for dealing with soiled linen and the training records showed that staff have been trained in infection control. One of the nurses is the infection control link nurse who deals with any specific problems and helps other staff. The manager said that she was involved in the planning of the laundry to ensure good hygienic conditions. Eversley Nursing Home DS0000015636.V369682.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents can be confident that staff are properly vetted before they start work and that their needs will be met by a skilled workforce. The emphasis on training is excellent and residents are in safe and competent hands. EVIDENCE: The rota for the day showed that one nurse was on duty at all times including at night and that during the day there were also three care assistants on duty through till 9pm. The number of staff on duty during the inspection corresponded with the rota. The rota showed that one carer was on duty with the nurse during the night. This was considered to be very good staffing for the number of residents and enabled staff to have time to sit with the residents and to have some time to provide social stimulation as well as assist with their varied personal needs. A cook and housekeeper were also on duty every day between 8am and 3pm. Staff were observed attending to the residents in an unhurried and pleasant manner and the residents had only good comments to make about the staff. “”Staff do whatever you ask”, “the girls are very good”, “it’s a very relaxed atmosphere” “I feel quite comfortable” were some of the comments. One person had previously had a concern about a member of staff and this had been picked up by the manager showing that residents were listened to. Eversley Nursing Home DS0000015636.V369682.R01.S.doc Version 5.2 Page 24 The home employs five qualified nurses in the home and ten care staff. Of the care staff four have completed a national care qualification (NVQ2) and four are in the process of doing it. The standard of 50 of care staff with such a qualification is almost achieved and will be exceeded when the four currently studying for it have completed their studies. Three staff files were examined and found to contain the relevant references and checks required to maintain a rigorous recruitment procedure. Work permits and police checks in country of origin were also included. Interview notes on recent files were seen and evidence of qualification (pin numbers) were also in evidence. Not all files had a photograph which needs to be part of the documentation kept on each staff. The manager had a camera and said she would rectify this straightaway. All staff confirmed they had contracts of employment and understood their terms and conditions. The home has an equal opportunities policy. One nurse from a minority background said she felt no discrimination. The manager confirmed in the information provided to the Commission that all staff undergo an induction training and this now complies with the Skills for Care induction training. Staff files showed the induction programme had been followed and the newest staff was still in the middle of completing hers. (It takes 12 weeks) Staff complete workbooks on their training and the manager confirmed she verifies their work and links their progress into further training. The training includes the basic training on health and safety, first aid and infection control as well as moving and handling and the philosophy of care. All staff also receive training on the prevention of abuse and the manager says all are booked on a refresher course in September. The staff files and training plan showed that there had been substantial training during the last year and staff including the nurses felt they had excellent opportunities for training. Nearly all staff have had training in dementia and the manager who already has completed training on dementia care mapping, has plans for further training on this topic including studying the Diploma in Dementia at the university of East Anglia. The nurses have also received further training on medication following criticisms in last years inspection report and on wound care and tissue viability. Some staff had received training on continence and nutrition. There had also been extra training on palliative care, challenging behaviour and on care planning. Certificates for much of this training were seen on the staff files examined and confirmed by the staff interviewed. The manager confirmed that she has a budget for training and is able to identify courses she would like to make available. She has excellent support from the regional office. The residents experience the staff as very competent and good. “Staff are very experienced”, said one. Others said “staff treat you properly” and “the girls are very good”. Eversley Nursing Home DS0000015636.V369682.R01.S.doc Version 5.2 Page 25 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): 31,32,33,35,36,37 and 38 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Residents live in a home which is run by a very capable manager who understands her responsibilities very clearly and whose approach is open and inclusive. The systems for seeing that the home runs smoothly are in place and the emphasis is very much on seeing that residents have a good quality of life and are kept safe and well. EVIDENCE: The manager had been in post only a week at the last inspection but is now registered and has been at the home for a year. She is experienced in the care industry and has a management qualification. She also has training in dementia care. She is not a qualified nurse but is supported in the home by a Eversley Nursing Home DS0000015636.V369682.R01.S.doc Version 5.2 Page 26 lead clinical nurse who carries out the nursing assessments. She is very familiar with diseases and conditions associated with old age, and is keeping up her training. There are clear lines of responsibility in the home and with the management of the larger organisation. The area manager was on site during this visit. The manager has worked very hard in this her first year in ensuring that channels of communication are working. She has meetings with staff at all levels on a regular basis and has introduced residents meetings where relatives are invited as well. Minutes of these meetings were available. This has allowed people to have more say about how the home is run and for staff and relatives to feel involved. She has also started a newsletter sent out to relatives. She has an open door policy and both staff and residents said the manager was very approachable. Residents’ comments included “I would speak to matron” (if she wasn’t happy), “if I have a worry, I’d go to the manager or chief nurse”, “you can contact the manager if you want to say anything private”. One relative said “things have improved with this manager”. The nursing staff also said they worked well with the care staff and “everyone gets along”. One nurse said “the manager is doing a very good job and is concerned for the residents welfare”. Another said “she has improved their (the residents) quality of life”. All of this was a ringing endorsement of the manager. The manager has also introduced mentoring in the staff group and provided extra responsibilities for specific staff to encourage their development. She has systems in place for the organisation of the home including supervision, safety checks, care reviews. From the evidence of both staff and residents, she instils excellent standards of care. The home has good quality systems in place to check how well things are going in the home and see where improvements are necessary. A quality monitoring report was seen for March 2008 and this is carried out every six months. All aspects of the home are checked including the building, recruitment, medication and care to see whether procedures have been followed. Monthly visits are carried out by the provider in this case the area manager to see what is happening in the home and action points are made as a result of that visit where changes or improvements have to be made. Surveys have also been sent out recently to residents, relatives and other professionals involved with the home and the results of those will be analysed. Examples of surveys were seen. The meetings the manager has with residents and staff also enable people to have a voice and to speak up on a regular basis. The improved contact with relatives who were involved in the life story books and who now receive newsletters has also helped communication. The home also makes the inspection report from the Commission accessible and implements any requirements identified in inspection reports. The Annual Quality Assurance Assessment document supplied to the Commission by the home had a good analysis of what is happening in the home and what improvements the manager still wants to make. It demonstrates a high level Eversley Nursing Home DS0000015636.V369682.R01.S.doc Version 5.2 Page 27 of self-awareness and clearly details the ways in which they are planning to improve the home. The residents control their own money or with the help of relatives, and the home is not involved in looking after or administering any residents’ money. All the staff spoken to confirmed they had one to one supervision on a regular basis where they could talk about their work with the manager and look at any difficulties in their work or opportunities for training. The staff files sampled showed records of these meetings and the manager produced a supervision plan with dates for the year for all staff. The nurses are supervised as well by the lead clinical nurse. Staff also receive support in their regular meetings, and handover meetings are also held at the end of each shift ensuring that staff are up to date with what has been happening with each resident and to enable them to ask for advice if they are unsure. Records required for regulation were all in place and satisfactorily completed. Residents and their relatives are involved in the writing of the care plan and have access to it. Records are held securely in locked cupboards and maintained in accordance with the Data Protection Act. In terms of health and safety, policies were seen to be in place including the employer’s responsibilities to ensure safe working practices. Staff training was provided in all matters relating to risk and safety including, moving and handling, infection control, food hygiene and first aid. Risk assessments were seen on each care record and the accident record was also in place. The manager confirmed that accidents were analysed to see whether remedial steps were needed. The environmental health officer’s report was seen which gave an excellent rating on food safety. Servicing certificates were seen relating to equipment in the home (the lift and hoists) and the fire record confirmed that appropriate drills and checks were carried out. Gas, electricity and water temperatures were all checked on a regular basis. No concerns were found relating to health and safety with all records up to date and appropriately completed. Eversley Nursing Home DS0000015636.V369682.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 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 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 4 x N/a 3 x 4 Eversley Nursing Home DS0000015636.V369682.R01.S.doc Version 5.2 Page 29 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. 1 Refer to Standard OP29 Good Practice Recommendations The manager should include a recent photo of each member of staff in their recruitment files. Eversley Nursing Home DS0000015636.V369682.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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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