Care Home: Nuffield Care Centre

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What the care home does well Residents live in a clean and homely environment, which is decorated and furnished to a very high standard. All persons consulted with regarding the home spoke mainly positively about their experiences with the home. A sample of their comments include: "all seems very nice"; "offers good value for money"; "very well looked after"; "Atmosphere very nice and friendly" and "happy with absolutely everything the home does". Personal support is offered in ways, which promotes and protect resident`s privacy and dignity. Flexibility in the daily routines helps to promote resident`s choices with evidence that residents are treated as individuals.Residents who receive intermediate care are supported by appropriately trained staff who have the equipment and skills to help them to regain their independence. Dietary needs of residents are catered for with a varied selection of food available that in the main meets resident`s tastes and choices. Links with families are valued and supported by the home. A resident said: "my wife can visit any time, its a free arrangement she is always made to feel welcome". Residents benefit from a core staff team that have worked at the home for a number of years and who have the collective skills and experience to deliver the services, which the home offers to provide. A sample of comments made by staff included: "Helpful doing their best"; "Staff are friendly and amenable although they seem to use a lot of agency there is not a lower standard of care it just takes them that bit longer" and" very patient not patronising". Resident`s benefit from a well-motivated and knowledgably manager who promotes good care practices. The home regularly reviews aspects of its performance through a good program of self-review and feedback. What has improved since the last inspection? This is the first inspection of the home under its new registration and therefore there are no areas of shortfalls outstanding from previous inspections. The manager reported the in the last months the home has undergone further redecoration which has created a pleasant living environment throughout. A large recruitment drive is helping to increase the number of permanent staff employed. What the care home could do better: The homes literature needs to include the full range of residents needs the home caterers for and the different types of placements offered. This is to ensure that prospective residents and their representatives have the information they need to make informed decisions about moving to the home. Care plans need to provide clear guidance for staff on all aspects of the health, personal and social care needs of residents in order that residents needs are identified and met in a consistent way. In order to further enrich resident`s lives it has been required that opportunities for social engagement and meaningful activities be provided based on residents identified needs and preferences. There must be a reduction in the use of agency staff to ensure that good care standards are able to be consistently maintained.Advice must be sought from the fire authority on some elements of the homes fire safety practices in order to ensure adequate standards of protection in the event of a fire. CARE HOMES FOR OLDER PEOPLE Nuffield Care Centre Haigh Crescent Oaklands Park Redhill Surrey RH1 6RA Lead Inspector Jane Jewell Unannounced Inspection 10:30 19 March 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Nuffield Care Centre DS0000069893.V358005.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. Nuffield Care Centre DS0000069893.V358005.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nuffield Care Centre Address Haigh Crescent Oaklands Park Redhill Surrey RH1 6RA 01737 772525 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) linda.andrew@saffronland.co.uk Mr Amin Lakhani t/a Saffronland Homes Group Ms Linda Christine Andrew Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places Nuffield Care Centre DS0000069893.V358005.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing only - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 2. Physical disability (PD) maximum number of places (8). The maximum number of service users to be accommodated is 35. Date of last inspection First inspection under new company name Brief Description of the Service: Nuffield care centre is registered to provided nursing care for up to thirty-five older people. The home was purpose built in 1989 and purchased by its current owners in 2005. In 2007 the registered provider changed the name of the company which owns the home thus created a new registration for the home, therefore this is the first inspection of the home under the companies new name, in all other aspects the home remained the same. The home provides long term placements along with eight intermediate care bed, which are used to provide a programme of rehabilitation following discharged from hospital for up to six weeks prior to residents returning to independent living. The Home is part of a retirement village complex and provides some remote services to the villagers. The home is presented across two floors with a passenger lift providing level access to all floors. Resident’s accommodation consists of all single accommodation with the majority of bedrooms providing toilet en-suite facilities. Communal space consists of several lounges, dinning rooms and a large garden. The fees for residential care are currently £449 to £800 per week, depending on the services and facilities provided. Extra such as: newspapers, hairdressing, chiropody, toiletries are additional costs. Nuffield Care Centre DS0000069893.V358005.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is Two star. This means the people who use the service experience GOOD quality outcomes. The information contained in this report has been comprised from an unannounced inspection undertaken over six hours and information gathered about the home. This includes discussions with relatives and stakeholders involved in resident’s care. The manager had comprehensively completed an Annual Quality Assurance Assessment (AQAA) form prior to the inspection and the information contained in this document has been used to inform the inspection of the home. The inspection was facilitated by Linda Andrew (Registered Manager). There were thirty-one residents living at the home at the home at the time of the inspection. The focus of the inspection was to look at the experiences of life at the home for people living there, this involved observing residents and their interactions with staff and examination of the homes facilities and documentation. Signs of residents well-being/ill-being (terminology used for observing behaviour for people who do not verbally communicate) were observed and are also included in this report. The Inspector would like to thank the residents, staff and management for their assistance and hospitality during the visit. What the service does well: Residents live in a clean and homely environment, which is decorated and furnished to a very high standard. All persons consulted with regarding the home spoke mainly positively about their experiences with the home. A sample of their comments include: “all seems very nice”; “offers good value for money”; “very well looked after”; “Atmosphere very nice and friendly” and “happy with absolutely everything the home does”. Personal support is offered in ways, which promotes and protect resident’s privacy and dignity. Flexibility in the daily routines helps to promote resident’s choices with evidence that residents are treated as individuals. Nuffield Care Centre DS0000069893.V358005.R01.S.doc Version 5.2 Page 6 Residents who receive intermediate care are supported by appropriately trained staff who have the equipment and skills to help them to regain their independence. Dietary needs of residents are catered for with a varied selection of food available that in the main meets resident’s tastes and choices. Links with families are valued and supported by the home. A resident said: “my wife can visit any time, its a free arrangement she is always made to feel welcome”. Residents benefit from a core staff team that have worked at the home for a number of years and who have the collective skills and experience to deliver the services, which the home offers to provide. A sample of comments made by staff included: “Helpful doing their best”; “Staff are friendly and amenable although they seem to use a lot of agency there is not a lower standard of care it just takes them that bit longer” and“ very patient not patronising”. Resident’s benefit from a well-motivated and knowledgably manager who promotes good care practices. The home regularly reviews aspects of its performance through a good program of self-review and feedback. What has improved since the last inspection? What they could do better: The homes literature needs to include the full range of residents needs the home caterers for and the different types of placements offered. This is to ensure that prospective residents and their representatives have the information they need to make informed decisions about moving to the home. Care plans need to provide clear guidance for staff on all aspects of the health, personal and social care needs of residents in order that residents needs are identified and met in a consistent way. In order to further enrich resident’s lives it has been required that opportunities for social engagement and meaningful activities be provided based on residents identified needs and preferences. There must be a reduction in the use of agency staff to ensure that good care standards are able to be consistently maintained. Nuffield Care Centre DS0000069893.V358005.R01.S.doc Version 5.2 Page 7 Advice must be sought from the fire authority on some elements of the homes fire safety practices in order to ensure adequate standards of protection in the event of a fire. 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. Nuffield Care Centre DS0000069893.V358005.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nuffield Care Centre DS0000069893.V358005.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 2 3 4 5 and 6 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides both prospective and existing residents, with information about what services are provided and what to expect when living at the home. The way in which prospective residents are assessed ensures that the home admits only those residents who’s needs can be met by living at the home. Residents who receive intermediate care are supported by appropriately trained staff who have the equipment and skills to help them to regain their independence. EVIDENCE: There is a range of information about the home and the services it provides, this includes a statement of purpose and service user guide which are displayed at the home and given to prospective residents, representatives and other interested parties. These documents need to include further information Nuffield Care Centre DS0000069893.V358005.R01.S.doc Version 5.2 Page 10 on the range of residents needs catered for and of the differently types of placements offered by the home. This is necessary in order to ensure that prospective and existing residents are aware of the range of services offered. The manager agreed to update these documents promptly. Newly admitted residents and their family said that they were: “given information about the home in a book when my mother was admitted” and “felt that all the information a family needed to know was in the booklets kept in bedrooms”. Residents are provided with a written contract of the terms and conditions of residency with the home. This can be used with residents and their families to make explicit the placement arrangements and clarify mutual expectations around rights and responsibilities. A signed copy of the contract is retained in resident’s files. The home ensures that prospective residents are accommodated only following an assessment of their needs by the manager or nursing staff. Advice is sought during the assessment process from health care professionals and others who know and understand the needs of the prospective residents. This information is then used to base the decision as to whether their needs could be safely met at the home. The vast majority of residents and their representatives consulted with spoke of being provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home. Most residents consulted said that it was their families that looked around the home on their behalf, however for some residents due to the emergency nature of their admission to the home it was not practical for them or their representative to visit the home in advance. One such resident and their representative said that this did not matter as the home is well known in the area and therefore they had some prior knowledge of the home, which helped to reassure their relative about going to the home. There is a range of resident’s needs and placements offered at the home. This includes residents who have complex physical needs, residents who have mental health needs and short stay residents receiving rehabilitative support. Through observation, looking at records and speaking to relatives, evidence was gathered that the home is meeting the needs of residents. All persons consulted with regarding the home spoke positively about their experiences with the home. A sample of their comments include: “all seems very nice”; “offers good value for money”; “very well looked after”; “Atmosphere very nice and friendly” and “happy with absolutely everything the home does”. The home works closely with Intermediate care teams to ensure that residents referred for rehabilitation receive the support they need, in order to complete the maximum four weeks programme offered with a view to them returning to independent living. Staff showed an understanding of the aims and objectives Nuffield Care Centre DS0000069893.V358005.R01.S.doc Version 5.2 Page 11 of intermediate care and spoke of the training they receive and the equipment provided to be able to provided the appropriate individual support to residents. Nuffield Care Centre DS0000069893.V358005.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 and 11 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans need to provide staff with the information they need to be able to meet the range of resident’s needs. Residents receive the health care intervention they need from a range of health care professional. Procedures and practice in the home allow for the safe administration of medicines. Personal support is offered in ways, which promotes and protect resident’s privacy and dignity. EVIDENCE: The home has just introduced a new computerised care planning system. Five care plans were looked at in detail, these provided staff with the basic information they needed about residents. Much work is still needed before the care planning system provides the information on the range of residents Nuffield Care Centre DS0000069893.V358005.R01.S.doc Version 5.2 Page 13 needs. Examples were noted whereby resident’s social and behavioural management guidelines were not being identified. Good practices were noted when residents needs had changed and this had promptly been recorded and the necessary guidance provided for staff. It is acknowledge the significant amount of work having recently been undertaken to transfer information to the new care planning documentation. The manager was confident that once the documentation had been “bedded down” they could further review the process in order to address the shortfalls in the care plans noted at this inspection. A staff member said: “once it is fully established they should be good but the disadvantage is that only one staff can access the computer on each floor at a time”. All residents consulted with expressed little or no interest in the development and review of their care plans, but felt that they could ask to see what is recorded about them. Individual risk assessments were in place, which covered core and individualised areas of risks for residents. These recorded the actions to manage or reduce any identified risks. The home maintains a daily record for each resident on events and occurrences. An example was noted whereby an event a resident shared with the inspector had not been recorded in their notes. The manager felt that it would have been appropriate to do so in order to inform the staff team and agreed to ensure that staff were aware of the types of events that must be recorded. Records of medical intervention showed that the home works closely with health care professionals including Occupational therapists, physiotherapists, GP’s and chiropodists to ensure residents receive a range of health care intervention. Residents and relatives consulted said that when they have requested medical advice or intervention then this has been sought promptly. During the inspection staff were seen to be respectful and considerate to all residents and visitors. Staff were observed using residents preferred forms of address and knocking on bedroom doors prior to entering. Staff consulted with showed a good understanding of good practices in preserving resident’s rights to privacy and dignity. Staff were able to give examples of how they promote these rights in their every day care practices. The system for the administration of medication was good with clear and comprehensive arrangements in place to ensure resident’s medication needs are able to be safely met. The medication practices enabled a clear audit trail of medication entering the home, being administered or being disposed of. Staff spoke knowledgeable and sensitively about good practices in end of life care, which ensured residents individual wishes were respected. A relative said “the home ensured that my mother had all the medical support she needed to make her last days as comfortable as possible”. Nuffield Care Centre DS0000069893.V358005.R01.S.doc Version 5.2 Page 14 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 People who use the service experience Good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Flexibility in the daily routines helps to promote resident’s choices. There is evidence that residents are treated as individuals. Links with families are valued and supported by the home. Resident’s lives would be enriched by further opportunities for occupation and stimulation being provided. Dietary needs of residents are catered for with a varied selection of food available that in the main meets resident’s tastes and choices. EVIDENCE: There is evidence that residents are treated as individuals. Observation of the daily routines and discussion with residents and staff show that staff accommodate resident’s personal wishes with regard to meal times, going to bed, rising and bathing. During the inspection residents were observed to move around the home choosing which room to be in and what level of company they wanted to enjoy. A resident said “Very happy here I can do Nuffield Care Centre DS0000069893.V358005.R01.S.doc Version 5.2 Page 15 what I want”. A relative said: “although he needs a lot of assistance he can choose when to go to bed and get up etc”. Variable feedback was received on the opportunities provided for occupation. Several residents stated that they were not aware of any organised activities. One resident said that they preferred to occupy their own time. Another resident spoke of attending a weekly exercise class. A relative spoke about the various activities that were organised over the Christmas period. A member of staff has recently been employed part time as an activities co-ordinator, but they were not always able to undertake this role, as they were often needed to cover care duties. Care plans did not currently provide information on resident’s social needs and preferences. In order to further enrich resident’s lives it has been required that opportunities for social engagement and meaningful activities be provided based on residents identified needs and preferences. Visitors commented upon how welcomed they are made to feel during their stay, this included being offered beverages, staff being friendly and approachable. Several relatives spoke of having meals with their relative. A resident said: “my wife can visit any time, its a free arrangement she is always made to feel welcome”. Two resident spoke of the importance of having their own telephone with one commenting: “so nice to just be able to call whoever I want when I want”. Consistent feedback was received from both residents and staff that the standard of food was improving with the use of more permanent cooks. A sample of comments received regarding the food included: “not too bad at the moment, a few months ago it had gone down hill”; “excellent”; “adequate”; “it’s a shame they don’t do a cook breakfast”; “seems very good now hasn’t always been”; “you are given a menu and you tick what choice of meal you would like, there is quite a bit of choice pretty good range of choice” and “good range of choice”. Records of meal provided showed that a varied menu is available including specialist diets. The meal served at the time of the inspection was presented well with residents individual preferences observed. Many residents selected to eat their meals in their bedroom while others eat in communal dining rooms. Residents were observed receiving appropriate support to eat their meals Nuffield Care Centre DS0000069893.V358005.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. An effective complaints procedure and appropriate adult protection policies and training for staff protect the rights and interests of residents. EVIDENCE: There is a complaints procedure in place for residents, their representative and staff to follow should they be unhappy with any aspects of the service. Both residents and relatives consulted with said that they were aware of how to raise any concerns and felt comfortable to do so and that where they have raised minor concerns in the past these have been addressed promptly. A resident commented: “If had any concerns you could just tell the nurses that you were not happy” and a relative said: “complaints I would go to the manager, I see her quite a bit she is always around always available and accessible”. The manager reported that there has been one reported complaint in the last twelve months. Evidence was seen that the homes complaints procedure was followed and the matter dealt with in a timely manner. There are written policies covering adult protection, which identifies different types of abuse, possible indicators of abuse and how to report suspected abuse. Staff have received formal training in safeguarding adults and prevention of abuse and the staff consulted with showed a good understanding of their roles and responsibilities under safeguarding adults guidelines. Nuffield Care Centre DS0000069893.V358005.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 20 21 22 24 25 and 26 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a clean and homely environment, which is decorated and furnished to a very high standard. The home ensures that residents private accommodation is equipped to provide comfort and privacy and to meet the assessed needs of those people residing in the room. EVIDENCE: Nuffield care centre is a purpose build two story building in the centre of a retirement village on the outskirts of Redhill town. A relative said: “it is purpose built so it has all the amenities that it should, it has a nice feel to it, always clean”. Since the previous inspection some redecoration has been undertaken which has been completed to a high standard. Overall the home is decorated and furnished to a high standard with much effort made to create a homely feel throughout. Standards of maintenance were noted to be good at Nuffield Care Centre DS0000069893.V358005.R01.S.doc Version 5.2 Page 18 the time of the inspection. However feedback was received from a relative and a staff member that maintenance issues can take some time before they are addressed. The manager felt that this would improve with the recent recruitment of onsite maintenance staff. The good provision of communal space allows for residents to engage in different activities and to be with people that they want to be with, and to move freely around the home. There is an attractive garden area surrounding the home, which includes a raised decking balcony. There are seats located around the garden making this an attractive and accessible area for residents to enjoy. Resident’s staying at the home for long term placements spoke of personalising their bedrooms, all of the residents consulted with said that they liked their bedrooms. A resident said: “It has everything I need at my fingertips”. There is sufficient number of toilets and bathrooms located around the home including seventeen bedrooms, which provide en-suite facilities. There was a range of individual aids and adaptations to assist resident’s mobility and independence, including raised toilet seats, walking aids, hoist ramps and grab rails. A shaft lift provides level access around the home. Fitted throughout the home are call points, which enable assistance to be summoned when pressed. Consistent feedback was received from residents and relatives that calls for assistance are not always answered promptly. Comments included: “I suppose they respond as quickly as they can but sometimes you would like it to be a bit quicker”; “Staff very kind a little bit short staffed when you rang the bell they did take a time to answer” and “occasionally I have noticed that the buzzer seem to ring for a long time”. The manager was asked to look into this situation to ensure that all calls for assistance were answered in a timely manner. Laundry facilities are clean and hygienic. Systems are in place for the control of infection and all staff have been trained in this area and were observed to be working in ways that minimised the risk of infection, by wearing gloves and aprons when required. Nuffield Care Centre DS0000069893.V358005.R01.S.doc Version 5.2 Page 19 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 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from a core staff team that have worked at the home for a number of years and who have the collective skills and experience to deliver the services, which the home offers to provide. However, there must be a reduction in the use of agency staff to ensure that good care standards can be consistently maintained. EVIDENCE: Variable feedback was received from residents, staff and relatives on whether there was sufficient staff on duty for staff to undertake their roles in a timely manner and for residents to receive the support they needed, when they wanted it. This related to the high use of agency staff, which was described as affecting the efficiency of the staff team as agency staff did not always know the practices at the home. The manager explained that they are currently in the process of employing more permanent staff in order to reduce the use of agency staff. Although the home has not been required to address this area of concern due to the manager being proactive in addressing this issue, the reduction in the number of agency hours used is clearly needed to ensure that standards of care are able to be consistently maintained. Nuffield Care Centre DS0000069893.V358005.R01.S.doc Version 5.2 Page 20 There is a core group of staff, who have worked at the home for a number of years and showed much commitment and enthusiasm towards the home meeting its aims and objectives. All interactions between staff and residents, , were courteous and respectful with humour often being used to communicate with residents. A sample of comments made by residents regarding staff included: “Helpful doing their best”; “large variation in the quality of staff sometimes as they have to use agencies and some are useless however the regular staff are perfect”. A sample of comments made by relatives included: “Staff are friendly and amenable although they seem to use a lot of agency there is not a lower standard of care it just takes them that bit longer” and“ very patient not patronising”. The home is being proactive in ensuring that most staff have the opportunity to complete a National Vocational Qualification (NVQ ) in Care or are in the process of working towards it. The personal files of newly appointed staff were inspected and these showed that a good recruitment process is followed which includes the use of an application form, interviews, Criminal Records Bureau (CRB) checks and written references prior to employment commencing. There is a commitment to improving staff skills through an ongoing training programme both in practical matters and the broader aspects of working with older people. A staff member said: “lots of opportunities to do training”. A training and development plan is available which identifies the training undertaken and planned for in order for the home to meets its aims and objectives and residents needs. The manager confirmed that all new staff complete an induction into the home, however it could not be established at inspection whether this complied with the national induction guidelines “skills for care”, which are industry recommended minimum standards. This is designed to help ensure that all new staff entering into the care industry have a minimum level of initial training. The manager agreed to confirm with the training and development officer the standard of induction being used. Nuffield Care Centre DS0000069893.V358005.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 36 and 38 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a well-motivated and knowledgably manager who promotes good care practices. The home regularly reviews aspects of its performance through a good program of self-review and feedback. A range of regular health and safety checks helps to promote the health and safety of residents and staff, however advice must be sought on some elements of the homes fire safety practices in order to ensure adequate standards of protection in the event of a fire. EVIDENCE: Nuffield Care Centre DS0000069893.V358005.R01.S.doc Version 5.2 Page 22 The manager has many years experience in managing nursing services for older people. They are a Registered nurse and have completed the recommended management qualification. All persons consulted about the home spoke positively about the manager with particular reference to their approachability and close working relationship with staff. A sample of comments included. “Fine”; “cares about residents and families”; “can talk to her about anything very approachable”; “she is very hands on and very good, her door is always open” and “very good team work the manager and deputy complement each other very well” The relationship between residents, staff and the manager was observed to be friendly and informal and the general atmosphere of the home was relaxed and open. The manager demonstrated a good understanding of the running of a care home and modelled good care practices. There were clear lines of accountability between the home and the provider. A representative of the provider visits at least once a month to undertake the required monthlyrecorded visit to the home. There are several mechanisms in place for the manager to obtain feedback on the services of the home and whether it is achieving its aims and objectives. These include: internal audits, placement reviews and written feedback from residents and relatives. Examples were noted whereby improvements to working practices and menus have been made based on feedback received. Staff are in the main supervised by the nursing staff working along side them each shift. Nursing staff spoke of receiving clinical supervision from the manager. Care staff spoke of receiving irregular formal supervision, but felt supported to be able to do their job. The manager was aware of the need to ensure a more robust programme of formal supervision for care staff in order to monitor individual staff performance. Residents are encouraged to retain control of their own finances for as long as they are able to do so and if unable then this responsibility is taken on by a relative or another responsible persons external to the home. The manager reported that they do hold small amounts of money for some residents with a robust system in place to ensure that any expenditure made is clearly accounted for. Written guidance is available on issues related to health and safety. Records submitted by the manager prior to the inspection stated that all of the necessary servicing and testing of equipment has been undertaken. Some systems were in place to help support fire safety, this included: regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to be undertaken. However a significant number of bedroom doors were fitted with a “Hook and Eye” mechanism in order to keep the door propped open. These would have to be Nuffield Care Centre DS0000069893.V358005.R01.S.doc Version 5.2 Page 23 manually unhooked in the event of a fire in order for bedroom doors to close and therefore provide the necessary level of protection. In the event of a fire or alarm sounding staff are instructed in the homes fire procedure to close any propped open doors on the way to the nearest fire exit. The manager reported that they undertake a monthly fire risk assessment, which records some findings and the actions taken to ensure fire safety precautions in the home. However it was not clear that the system for closing propped open doors in the event of a fire had been robustly risk assessed to ensure that this would offer adequate protection. It has been required that advice and consultation be sought from the fire authority in order to establish the suitability of this type of door opening mechanism from a fire safety point of view. Nuffield Care Centre DS0000069893.V358005.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 x 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 2 Nuffield Care Centre DS0000069893.V358005.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? First inspection STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Requirement Timescale for action 30/05/08 2 OP12 3 OP38 That care plans provide clear guidance for staff on all aspects of the health, personal and social care needs of service users and which make explicit the actions needed to meet these needs. 16(2)(m) That service users social needs 30/05/08 and preferences are identified and recorded on individual care plans and opportunities for social engagement and meaningful activities are provided based on these identified needs in order to enrich resident’s lives. 30/05/08 23(4)(a-c) That the provider contacts the fire authority for advice and consultation regarding the fitting of “hooks and eye” bolts to bedroom doors, to ensure that they provided the appropriate level of protection in the event of a fire. Nuffield Care Centre DS0000069893.V358005.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Nuffield Care Centre DS0000069893.V358005.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Nuffield Care Centre DS0000069893.V358005.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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