Care Home: Ingleborough Nursing Home

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What the care home does well The home is clean and comfortable; it is on the high street in Ingleton village, this makes the village centre easily accessible and visible. Relatives spoken with explained how they were able to visit people daily because of its location. Many people who live in the home have previously lived in the nearby villages, and are able to maintain their local friends and contacts. People are provided with enough information before they move in permanently. Someone from the home visits them before moving in and they are offered the opportunity to visit the home for a look around and to ask questions about how the service is delivered. This helps people make an informed decision about whether Ingleborough is the right place for them to live.There is an established staff team who work a regular shift pattern, this provides people with a consistent and reliable service. Staff are kind and helpful and make an effort to provide the service in the manner that people want. Comments made by people living at Ingleborough were: ` Terribly nice you feel they care about us.` `Good, kind and patient.` `They do almost everything well.` A good choice of food and drinks are available. This ensures people receive a varied and nutritious diet. One person spoken to said `The food is excellent.`. Over half of the staff team have their National Vocational Qualification level two in care; this means the staff are suitably trained to care for people properly. The home is managed in a manner that puts the people who live their first. It concentrates on the needs, wishes and views of the people who use the service. What has improved since the last inspection? Due to the hot water taps being very hot at the previous inspection a requirement was made for the provider to develop a strategy to prevent people from being scalded from the wash hand basins in their bedrooms or communal bathrooms and toilets. The management team have put into place a maintenance programme and ways of making sure that people are not at risk of scalding. What the care home could do better: No requirements have been made at this inspection. There are some recommendations, such as risk assessments need to be recorded and reviewed more regularly; this is to help protect people from risks. Also the registered persons need to be sure staff are updating their training regularly and recruitment procedures are always robust. This helps staff to make sure they are always following the best practices and people are kept safe. CARE HOMES FOR OLDER PEOPLE Ingleborough Nursing Home 1 High Street Ingleton Carnforth North Yorkshire LA6 3AB Lead Inspector Caroline Long Key Unannounced Inspection 09:30 7th November 2007 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 Ingleborough Nursing Home DS0000068935.V348933.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. Ingleborough Nursing Home DS0000068935.V348933.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ingleborough Nursing Home Address 1 High Street Ingleton Carnforth North Yorkshire LA6 3AB 01524 241593 01524 241165 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) Ingleborough Nursing Home LLP Mrs Linda Deaville Care Home 55 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (53), of places Physical disability (2) Ingleborough Nursing Home DS0000068935.V348933.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th December 2006 Brief Description of the Service: Ingleborough is a care home providing both nursing and personal care for up to fifty-three people over the age of sixty-five years, this can include up to two people with dementia and two people with physical disabilities over the age of forty years. Ingleborough was previously a hotel and is located in the centre of the Dales village of Ingleton, becoming a residential home in May 1977 and registering to provide nursing care in November 1983. The home has pleasant garden areas to the rear western side of the home with attractive features, including a pond. Parking is available in the private car park on the easterly side of the site and being in the centre of the village, local amenities are easily accessed. On the 7th November 2007 the weekly charge is £340 - £524. This is subject to a financial assessment. Items not included in the charge are hairdressing, private chiropody, newspapers/magazines and toiletries. The Commission for Social Care Inspection report is displayed in the home for anyone to read. Ingleborough Nursing Home DS0000068935.V348933.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection focused on the key standards and also matters, which were raised at the last inspection. This is what was used to write this report. • • • Information about the home kept by the Commission for Social Care Inspection. Information asked for before the inspection, this is called an annual quality assessment questionnaire. Information from surveys that were sent to people who live at the home, their relatives, health professionals and the staff. Five surveys were returned from people who live at Ingleborough and two were received from relatives. Also surveys from both a care manager and a General Practitioner and three from staff. An unannounced visit to the home. This was carried out by one inspector and lasted over seven hours and included talking to staff and the registered individual about their work and the training they have completed. And checking some of the records, policies and procedures the home has to keep. Some time was spent observing staff supporting people and talking with the people who live at Ingleborough. Three peoples care records were looked at in detail. • • • What the service does well: The home is clean and comfortable; it is on the high street in Ingleton village, this makes the village centre easily accessible and visible. Relatives spoken with explained how they were able to visit people daily because of its location. Many people who live in the home have previously lived in the nearby villages, and are able to maintain their local friends and contacts. People are provided with enough information before they move in permanently. Someone from the home visits them before moving in and they are offered the opportunity to visit the home for a look around and to ask questions about how the service is delivered. This helps people make an informed decision about whether Ingleborough is the right place for them to live. Ingleborough Nursing Home DS0000068935.V348933.R01.S.doc Version 5.2 Page 6 There is an established staff team who work a regular shift pattern, this provides people with a consistent and reliable service. Staff are kind and helpful and make an effort to provide the service in the manner that people want. Comments made by people living at Ingleborough were: ‘ Terribly nice you feel they care about us.’ ‘Good, kind and patient.’ ‘They do almost everything well.’ A good choice of food and drinks are available. This ensures people receive a varied and nutritious diet. One person spoken to said ’The food is excellent.’. Over half of the staff team have their National Vocational Qualification level two in care; this means the staff are suitably trained to care for people properly. The home is managed in a manner that puts the people who live their first. It concentrates on the needs, wishes and views of the people who use the service. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ingleborough Nursing Home DS0000068935.V348933.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ingleborough Nursing Home DS0000068935.V348933.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 does not apply to this service. People who use the service experience excellent quality outcomes in this area. People are provided with good information about the home and their diverse nursing and personal needs are identified and planned for before moving in, this makes sure Ingleborough is the right place for them to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered individual explained most of the people in the home had local connections, and had previously visited the home before they decided to stay there. She explained she sees the home as part of the local community and ‘does not like to let anyone down who lives near.’ She and the nursing staff explained how they would carefully consider whether the home would be able to meet the persons needs and whether anyone new would be compatible with the other people living there. The nursing staff explained how they would normally visit a person to carry out an assessment of their needs at home or in hospital and collect together any necessary Ingleborough Nursing Home DS0000068935.V348933.R01.S.doc Version 5.2 Page 9 information. So they could assess whether the home could meet the persons needs and whether the home had the necessary special equipment or skills to enable them to look after the new person properly. Also where possible the person would be encouraged to visit, so they could meet the staff and become accustomed to the surroundings. On admission a key worker is allocated to each new person. The key worker role is to take a special interest in the person. On the day of admission a member of staff is allocated to help them settle in and find their way around. A person who had recently moved into Ingleborough explained, how they had previously lived in a nearby village, so knew about the home. Also how their relative had come to the home to look around and had received enough information on their behalf. They were also able to explain how one of the nurses had visited them in hospital and asked a lot of questions and how staff had welcomed them into the home. Another person spoken with said they already knew such a lot of the staff they immediately felt welcome and as they had arrived at about teatime, the staff had made an effort to introduce them to the other people in the home over tea. They also confirmed their relative had visited and looked around the room. A relative explained how they had visited and were very impressed, following the first visit they had brought another relative, both had felt well informed and impressed with the reception they had received. They also described how the nursing staff had travelled to another region to meet their relative and carry out the assessment. Also, on the day their relative moved in how the staff had welcomed everyone including the carer who had escorted the person from the other home. Three peoples care records were looked at in detail all had assessments, which were carried out before the person moved into the home. These showed the nurse had taken into consideration peoples dependency needs and contained some of the people’s personal, and religious needs and preferences. Information from other agencies was also seen on the files. The registered provider explained people receive a statement of purpose before they move in and notes which describe the service Ingleborough offers are kept in each person’s bedrooms. These were seen during a tour of the premises. Five surveys returned all said they had received enough information before they moved into the home. The home does not offer intermediate care. Ingleborough Nursing Home DS0000068935.V348933.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience good quality outcomes in this area. People are receiving their health and personal care based on their individual needs and choices. Staff follow the principles of respect, dignity and privacy when supporting people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living in the home, health professionals and relatives made many positive comments about the care provided for instance: • • • ‘So grateful there is such a place.’ ‘Would rate most things tremendously high, very good personal care.’ ‘A good level of nursing care for local residents with a warm and friendly atmosphere.’ The General Practitioner wrote: Ingleborough Nursing Home DS0000068935.V348933.R01.S.doc Version 5.2 Page 11 ‘I think they provide a very good all round package of care. The staff seems to genuinely care about the residents, who are all clean and well presented. Excellent standard of nursing care and the diet caters well to the individual needs. Work closely with the doctors.’ During the inspectors visit staff and people spoken with said staff respect their privacy and dignity, and staff were observed responding to requests by people courteously and respectfully. People were well dressed, colour co-ordinated and clean. This was confirmed to be normal by relatives who visited regularly and explained how their relative liked to be colour co-ordinated and wear jewellery, and how the staff always made sure this was done. They also said that other people always looked appropriately dressed and cared for. Three peoples’ case records were looked at in order to check that a plan had been formulated which helped staff provide support to people according to their needs and wishes. The home operates a kardex system, which involves a physical and mental assessment of people’s needs, which is completed within the first few days of their stay. All of these were very detailed and contained enough personal and nursing information to make sure people were provided care in the way they preferred and their health care was maintained. Examples of this were how they needed to be referred to the chiropodist, and whether they preferred personal care from male or female workers. Their preferred daily routines, such as where they wanted to eat breakfast, and the time they liked to go to bed. Besides information about their social and religious interests, it also included details about their previous employment. These were used to help produce the care plans, which were all detailed. This encouraged people to be independent and contained information about communication, mobility, nutrition, and personal care needs. All these had been reviewed regularly and following one person’s case showed where the assessment had identified a nutritional need, this was reflected in the care plan. The records showed the home was promoting the prevention and treatment of pressure sores. Nursing staff explained they update and review the care plans for people with nursing needs and the senior carer workers carry this out for people with residential needs, all staff said they read the care plans and use them. To keep all the staff up to date there is a handover of information in the morning, after lunch and late evening. However during the inspectors visit when asked three people were unaware of their plans of care but two said they would ask for the things they needed. Ingleborough Nursing Home DS0000068935.V348933.R01.S.doc Version 5.2 Page 12 The records also contained relevant risk assessments. These covered dependency, handling, nutritional, pressure areas and pain. Although, these had not been reviewed regularly there were none in place for bedrails. However the nursing staff were able to show how a risk assessment had taken place and permission had been sought from the person or their representative and this had been written in the daily records. The staff were also aware of the information available on the Medical and Healthcare Regulatory Products agency website and the registered individual also explained regular checks were made and recorded by the maintenance man. The management of risks takes into account the needs of people balanced with their aspirations for independence and choice. Where restrictions are in place there needs to be evidence that people living in the home or their representative are involved with any decisions made and agrees to them. Staff promotes the rights of people to access the health care professionals that they need both within the home and in the community. The surveys, people spoken with during the inspectors visit and the three records looked at all showed people do have access to the GP, physiotherapist, and district nursing staff. The GP carries out a weekly surgery at the home. A key worker scheme operates in the home. The delivery of personal care is individual and flexible. Discussions with people confirmed they were aware of their key workers, one explained how their key worker had been to buy them a birthday card to send to a relative. Daily records were looked at and they would provide essential information to track any changes people may experience to their health. The home uses the Nomad system for drug administration, this is where the pharmacy dispenses the medication into a box, which contains specific compartments for the day and time the medication has to be given. This system is used to help staff administer medication safely. The local pharmacy also gives the home advice and looks at the medication systems regularly. At Ingleborough the nursing staff only administer the medication. A sample of medication records were checked by the inspector and found to be correct and the staff were able to explain the procedures for monitoring medication and for administering controlled drugs. Ingleborough Nursing Home DS0000068935.V348933.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15. People who use the service experience good quality outcomes in this area. People have the lifestyle they choose. Staff provide opportunities for peoples social, cultural and recreational expectations to be met and a varied diet is provided according to their choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live at Ingleborough have generally come from the local community. There is a large window that overlooks the high street, enabling some people to watch village life. The registered individual explained how the home tries to play an active part in the community. During the inspectors visit there were many visitors to the home, as they came in they often greeted the other residents by name and asked how they were. People spoken with during the site visit said relatives could visit, as they wanted one said theirs came every day. From the five surveys when asked if there were enough activities held in the home three stated there usually was and two said there sometimes was. Ingleborough Nursing Home DS0000068935.V348933.R01.S.doc Version 5.2 Page 14 However, during the site visit two people who live in the home and a relative gave a list of activities which happen each day such as the hairdresser, music by movement, a organist, board games’ fashion sales and quizzes. There was also evidence of the staff taking people out voluntarily, one person was taken to church every week, and another said they had been to a concert at the church. Also a member of staff had taken another person into town in the mini bus. The registered individual explained they generally use the mini bus, which has a lift installed for outings in the summer. Another person confirmed there were activities but they preferred to read, a further person was observed listening to a talking book. The cook showed photographs of how the home has themed days each month, where the dining room is decorated and food and activities follow a theme. Examples of the themes were Halloween, Valentines Day, and a day by the sea. A relative also described how good these days were and how much effort the staff put into them. The registered manager in the annual quality assessment questionnaire states the staff try to make routines of daily living as flexible as possible as part of the practices of person-centred care. They also have a radio controlled call system so that people can use it from the garden and outside areas of the home. This was confirmed by people spoken with, one who when asked about their daily routine said they would tell the staff what they preferred. People who were spoken with in the home said the food was ‘very good’, and ‘excellent’ and if there was something they did not like they would be offered something else. The home has two sittings the first is for people who want to sit and talk to each other, the second is for people who need help. The staff explained this gives them more time to spend with people who need help and prevents everyone from feeling rushed. Staff were observed helping people in a discreet and sensitive way, and giving people time to finish their meal comfortably. The tables were set with tablecloths, and napkins, also when there are theme days the chef decorates the dinning room and prepares food reflecting the theme. The chef plays an active role in the dining room, greeting and talking to people. She explained how she purees vegetables and adds agents to fortify them and then shapes them back into original vegetable shape. This is to provide people with more appealing food. Also to make sure people are receiving a nutritious diet the chef prepares fruit ‘smoothies’ each day. Ingleborough Nursing Home DS0000068935.V348933.R01.S.doc Version 5.2 Page 15 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): Standards 16 and 18. People who use the service experience good quality outcomes in this area. People have access to an effective complaints procedure and are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All the people who returned their surveys and those spoken with during the inspectors visit stated they knew who to complain to and would feel comfortable letting either the management or a member of staff know if they had any concerns. Relatives stated any concerns had been responded to. The complaints policy is part of the patient guide and everyone has a copy in their bedrooms. The complaints policy has not been changed since the last inspection when it was found to be in line with the regulations. The complaints records showed there have been no complaints or concerns made to the home. The registered individual explained any very minor issues are dealt with straight away. The home belongs to the Premium Advocacy Service of Care Aware so that everyone can have a voice on their behalf. Advocay leaflets were displayed on the hall way notice board and by reception. The home provide a pay-phone for people to use for private phone calls and also have a cordless phone for incoming calls, people can also have phones connected in their rooms. Use of Ingleborough Nursing Home DS0000068935.V348933.R01.S.doc Version 5.2 Page 16 a telephone enables people to make their views made to an independent party. A health professional also confirmed they have ‘never had any issues raised by relatives on revisiting people and never had any reason for concern or they have not expressed any issues.’ Talking to the staff and the providers showed they were aware of the procedures that constitute abuse, and the procedures to follow to alert people correctly. Some staff have received training on abuse as part of their National Vocational Qualification in Care, however others have still not received training. To protect both people who live in the home and the staff, they need to be aware of what constitutes abuse. The registered individual explained the home has recently commissioned a training analysis of the staff training needs by a local college, within this safeguarding adults had been identified and prioritised as a need, which they hoped to respond to. Ingleborough Nursing Home DS0000068935.V348933.R01.S.doc Version 5.2 Page 17 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. People who use the service experience adequate quality outcomes in this area. People live in a comfortable and clean environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Ingleborough Nursing Home is an old hotel in the centre of Ingleton Village, which has been changed into a nursing home. There are several small lounges on the ground floor, so people have a choice of a quiet lounge, a TV lounge or one that overlooks the high street. A tour of the premises included all of the public areas, some bedrooms, bathrooms, toilets, and the laundry and kitchen. Although the home has a number of double bedrooms most are now used as single rooms, unless people prefer to share. Where people were sharing screens were available to protect their privacy. Ingleborough Nursing Home DS0000068935.V348933.R01.S.doc Version 5.2 Page 18 Due to the hot water taps being very hot at the previous inspection a requirement was made for the provider to develop a strategy to prevent people from being scalded from the wash hand basins in their bedrooms or communal bathrooms and toilets. The registered individual explained all the bathrooms now have a valve to prevent the water from going above 43 centigrade, and the main boiler that services the main building has been replaced. They have also assessed people in the home as to whether they would want to or are able to use the sinks in their bedrooms. For the ones who would be able to use their sink they had made arrangements for valves to be put on. The registered individual when contacted following the inspectors visit also explained these have now been replaced. There is both ramped and level access to all parts of the home and two three persons vertical lifts are available to provide level access to all three floor. Only three of the single rooms and two of the shared rooms have benefit of ensuite toilet facilities and in consequence commodes are used extensively. The bedrooms contained people’s personal possessions and furniture, all rooms have a television point and telephones can be installed if desired. The registered individual had recently bought new quilt covers for their rooms. Most of the home is accessible via lifts and there is a modern radio controlled call alarm system in every room. There is a range of specialist equipment available and over the last year a specialist high-low bed and oxford sling hoist has been purchased. In the annual quality assessment questionaire the registered individual listed many improvement, which have been made over the last twelve months, for instance, various rooms have been decorated and re-carpeted. Hard flooring replaced in conservatory with a special carpet called flotex carpet and new chairs for the main lounge. Repairs have been carried out to railings outside of the front of building. High-level remedial works to guttering has been carried out. During the site visit the hall carpets were being replaced. However there are still areas which need further attention such as the upstairs bathrooms, the registered individual explained each week she carries out a inspection of the premises to assess what maintenance work needs to be carried out, she also explained the bathroom is budgeted for replacement in 2008. The registered manager in the annual quality assessment questionnaire states that the staff have all attended infection control training and there is a infection control policy in place. During the site visit there were hand wash gel and gloves available for staff. The registered manager in the annual quality assessment questionnaire states they follow the department of health’s essential steps to assess their current infection control management. Ingleborough Nursing Home DS0000068935.V348933.R01.S.doc Version 5.2 Page 19 The home is kept spotlessly clean so that the risk of people becoming ill from poor hygiene is unlikely. The home was free from offensive smells for the duration of the inspectors visit. People say that this is always the case and described how this made the home a good place for them to live. Ingleborough Nursing Home DS0000068935.V348933.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. People who use this service experience good outcomes in this area. People receive the care they need from an experienced and skilled workforce. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All the comments made by people in the home, their relatives and health professionals were very positive examples were: ‘Terribly nice you feel they care about us.’ ‘Good, kind and patient.’ ‘They do almost everything well.’ ‘Lovely time for everyone.’ ‘All the staff are most caring and helpful to me in what is a very difficult situation for us. Nothing is too much trouble and my relative gets the very best attention the meals are excellent.’ A health professional commented: ‘There always appears to be staff around and qualified staff on duty and available to speak to I am aware that they have supported people in accessing their beliefs and supporting individuals.’ Ingleborough Nursing Home DS0000068935.V348933.R01.S.doc Version 5.2 Page 21 The home has an established staff team, many who have worked in the home for many years; this has enabled the provider to produce a permanent rota. This means staff work the same shifts in a two-week period over the year. People in the home can therefore have the benefit and knowledge of exactly who will be working each day and of consistent care. Discussion with the registered individual and the staff rota showed that for one week there are generally seven care workers and two nursing staff on duty in a morning and in a evening five care staff, and two nurses. With one nurse and two care workers at night plus a person who is on call. At present the annual quality assessment questionnaire shows there are forty-one people living in the home. Staff were observed carrying out their duties in a calm and relaxed manner. They responded quickly and appropriately to requests from people and spent time talking to them. During the inspectors visit people living in the home, staff and relatives said they felt that there is generally enough to care for peoples needs. The registered individual and the staff explained the registered manager carries out induction for three days, where all the policies and procedures are explained. Following this they will work with the senior carer or the trained nurse. To ensure consistency and to maintain the quality of the care provided the home should try to ensure the same senior workers work with anyone new. The records of staff training were not really updated and did not evidence up to date training, however all of the people in the home surveyed stated the staff have the skills necessary to provide the care. Also, during the inspectors visit the people living in the home and their relatives also said they felt safe and staff seemed knowledgeable about their work. The registered individual explained they have recently asked for a training analysis by a local training provider and have commenced staff on distance learning training such as dementia, infection control and food and nutrition. The registered individual explained over half of the care staff are qualified to at least national vocational qualification level two in care. The home has a well-developed recruitment procedure that seeks to ensure that only suitable people are employed. Staff files examined showed that all appropriate and relevant pre employment checks are carried out before anyone is offered employment. However one record for a nurse had references and criminal record bureau check received five days following starting employment. The registered individual explained they had only started their induction during that period and all had been received before they had commenced working on shift. People living at Ingleborough are not involved in the choosing of staff that works in their home Ingleborough Nursing Home DS0000068935.V348933.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38. People who use this service experience good outcomes in this area. The home is run in the best interest of those who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is managed in a manner that concentrates on the needs and wishes of the people who live there. People spoken to say that they receive a reliable service from staff that is courteous, respectful, and deliver services in a responsible and professional manner. They also say that the management team are approachable and easy to talk to. The registered manager of the home is a registered nurse with eighteen years experience of management . She is supported in her role by a deputy manager who is a registered general nurse and is working towards national vocational qualification level four in management. There is also a business Ingleborough Nursing Home DS0000068935.V348933.R01.S.doc Version 5.2 Page 23 manager who has been in post for twenty three years and is the responsible individual. There are experienced heads of departments and a team of senior care staff to provide supervision and help with induction training of new staff. A Comment made by a health professional about the business manager was: ‘the manager is always helpful on the phone and is very keen to keep supporting local service users and families.’ The senior care staff explained they carry out supervision and appraisal for the junior care staff, all of the staff stated that they had regular supervision. However the records could not be seen as they were only accessible by the staff that carry out supervision and none were on duty when the inspector visited. During the site visit the responsible individual explained how staff provides support for people who require help in managing their finances. She showed how money is kept in individual named purses in a locked cabinet, and records are made of all purchase and receipts are kept. The registered individual explained that the home uses the Registered Nursing Home Association quality assurance system. Holding regular quality assurance meetings, where they review the quality of the service provided in different areas such as care plans and medication. Also sending out surveys annually to relatives and people who use the service, she was able to produce records, which confirmed this happens. The information in the pre assessment questionnaire confirmed that equipment is maintained; gas and electricity supplies in the home are safe and serviced appropriately. Fire detection and fire fighting equipment is tested and maintained and staff are regularly trained. Records showed accidents were responded to and recorded appropriately but were all kept together. To meet with confidentiality and data protection separate records for each accident should be kept with a log to track where the details are held. Where the home had checked the water temperatures of taps, these had not included people’s sinks where the water temperatures could have been too hot. The management team need to be confident that they are carrying out enough checks to keep people safe. Ingleborough Nursing Home DS0000068935.V348933.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 4 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 4 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Ingleborough Nursing Home DS0000068935.V348933.R01.S.doc Version 5.2 Page 25 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 2 3 Refer to Standard OP7 Good Practice Recommendations Risk assessments need to be reviewed when any changes occur to people’s health, this is to help prevent people being at risk. The proper checks should be carried out prior to staff starting any type of work in the home; this is because the staff will have access to people’s records. The training analysis the home has requested should be followed. Staff needs to be provided training, which is regularly up dated to help them carry out their job effectively and safely. The home needs have clear documentation when bed rails are used, to show peoples have agreed to their use and that any risks have been identified and acted upon. OP29 OP30 4 OP38 Ingleborough Nursing Home DS0000068935.V348933.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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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