Care Home: Plymouth House Nursing Home

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What the care home does well The home continues to have a relaxed and informal atmosphere. Residents and relatives spoken with confirmed that they were pleased with the care provision and could relate easily with the staff. Residents were observed to be at ease with the staff. The home benefits from retaining a committed and stable staff team, and all staff have a good knowledge and understanding of residents` care needs. The home has a very small staff turnover, with many staff having worked at the home since it opened. Two care staff have progressed to attain registered nurse status, and continue to work at the home. Some of the bedrooms have been personalised by individual residents, and this helps to generate a homely ambience. The home follows a thorough recruitment procedure. This assists in further safeguarding the residents. The home provides a very flexible menu, and residents` individual dietary needs are catered for. The manager ensures that the residents` likes and dislikes with food are met, and shops to ensure this is achieved. Residents and relatives were complimentary about the quality of food and choices available. The grounds are well maintained providing pleasant views from the home. What has improved since the last inspection? Further decoration has been completed since the last visit and this assists in improving the home`s appearance. The lounges and dining areas have been upgraded and new tables and chairs have been provided. What the care home could do better: Some facilities are not suited for all the residents. It was recommended that the home review bathing / shower facilities. The home could further develop activities and therapies for the more dependent residents. CARE HOMES FOR OLDER PEOPLE Plymouth House Nursing Home Alcester Road Tardebigge Bromsgrove Worcestershire B60 1NE Lead Inspector Chris Potter Unannounced Inspection 31st January 2008 2:30 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 Plymouth House Nursing Home DS0000004134.V340860.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. Plymouth House Nursing Home DS0000004134.V340860.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Plymouth House Nursing Home Address Alcester Road Tardebigge Bromsgrove Worcestershire B60 1NE 01527 873131 F/P 01527 873131 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) Mr Francis Edward Ursell and Mrs Margaret Irene Ursell Mrs Margaret Irene Ursell Mrs Margaret Irene Ursell Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (25), of places Physical disability over 65 years of age (25), Terminally ill (25) Plymouth House Nursing Home DS0000004134.V340860.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th October 2006 Brief Description of the Service: Plymouth House is a care home providing 24-hour nursing care and accommodation for 25 elderly residents. The home is privately owned by Mr and Mrs Ursell, and has been operating since 1983. Mrs Ursell is the registered manager and a first level registered nurse. She is responsible for the day-to-day management of the home. The home is a traditional detached residence that has been converted to accommodate 25 residents. The home has maintained its traditional features both internal and external. Accommodation is provided on the ground, first and second floor with a passenger lift to enable residents to access all areas of the home. Residents are accommodated in either single or shared bedrooms, some rooms benefiting from en-suite facilities. Other areas used by residents include two lounge/dining areas. The home has extensive gardens that are well maintained and easily accessible. The home is located in Tardebigge with wonderful views over the open countryside. A local bus service stops directly outside the home. The home’s fees range between £550.00 and £600.00 per week. Hairdressing, newspapers, and chiropody are not included in the fees. These fees were correct at the time of the inspection for more up-to-date information please contact the home direct. Plymouth House Nursing Home DS0000004134.V340860.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was Plymouth House’s key unannounced inspection; this is an inspection where we look at a wide range of areas. To help us plan the inspection we looked at pre-inspection information in the form of an Annual Quality Assurance Assessment requested from the home some month’s earlier, and survey forms received from relatives. During the visit to the home, care records, staff records and other records and documents were inspected. There was a tour of parts of the accommodation and discussions with the owner, manager and staff on duty. The inspection took place on the 31st of January 2008. The inspection lasted a total of 4 hours. What the service does well: The home continues to have a relaxed and informal atmosphere. Residents and relatives spoken with confirmed that they were pleased with the care provision and could relate easily with the staff. Residents were observed to be at ease with the staff. The home benefits from retaining a committed and stable staff team, and all staff have a good knowledge and understanding of residents’ care needs. The home has a very small staff turnover, with many staff having worked at the home since it opened. Two care staff have progressed to attain registered nurse status, and continue to work at the home. Some of the bedrooms have been personalised by individual residents, and this helps to generate a homely ambience. The home follows a thorough recruitment procedure. This assists in further safeguarding the residents. The home provides a very flexible menu, and residents’ individual dietary needs are catered for. The manager ensures that the residents’ likes and dislikes with food are met, and shops to ensure this is achieved. Residents and relatives were complimentary about the quality of food and choices available. The grounds are well maintained providing pleasant views from the home. Plymouth House Nursing Home DS0000004134.V340860.R01.S.doc Version 5.2 Page 6 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. Plymouth House Nursing Home DS0000004134.V340860.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 Plymouth House Nursing Home DS0000004134.V340860.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): Standards 1,2,3 and 6 (the home does not provide intermediate care therefore this standard is not applicable). Quality in this outcome area is good. The home provides prospective residents and relatives with appropriate information and advice to assist them in making their choice about the home. The manager and deputy manager assesses all potential residents prior to their admission to ensure the home can meet the assessed needs of the resident. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home keep their Statement of Purpose and Service User’s Guide under review and updates them with relevant changes or changes with legislation. Plymouth House Nursing Home DS0000004134.V340860.R01.S.doc Version 5.2 Page 9 Since the last inspection the home has updated their Statement of Purpose and Service User Guides. Copies of both documents were available in the reception area of the home for all residents and relatives to view. Residents spoken to at the time of the visit confirmed they had been provided with the relevant information to assist them in choosing the home. They had also been invited to view the home and meet the staff prior to being admitted. The home provides all residents with a contract of terms and conditions on admission to the home. When signed, a copy is maintained in the home. The manager and deputy manager complete the pre-admission assessment for every potential resident. Three residents’ care files were reviewed and a copy of the pre–admission assessment was included. The pre-admission assessment then forms the basis of the resident’s care plan. Plymouth House Nursing Home DS0000004134.V340860.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): 7,8,9,10 and 11 Quality in this outcome area is good. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three residents’ care records were reviewed at the time of the inspection. The care documentation provided appropriate information to assist staff in understanding the residents’ care needs. The record identified each resident’s health care needs and why the person had required 24-hour nursing care. All appropriate risk assessments had been completed on admission to the home. The potential risk identified through the risk assessment had then been developed into a plan of care to minimise that risk. Both risk assessments and Plymouth House Nursing Home DS0000004134.V340860.R01.S.doc Version 5.2 Page 11 care plans had been regularly updated. The care plan included a detailed record of each resident’s life history, which assists staff in understanding the resident’s needs. All staff are clearly aware of the resident’s care needs, and were observed being respectful and friendly with the residents. A physiotherapist is employed by the home, and assists staff in meeting the residents’ moving and handling assessments. A relative was visiting the home at the time of the inspection to thank the staff for the care that they had provided for their family member who had been a resident in the home for many years, and sadly died recently. They rated the home as “excellent” and could not thank them enough for the wonderful care that had been provided. Residents spoken with during the inspection were most complimentary about the home’s facilities, the staff and the high level of care provided. All commented that they had no complaints. The management of medication was well organised. The manager confirmed that the home receives a good service from the local General Practitioners who cover them. Plymouth House Nursing Home DS0000004134.V340860.R01.S.doc Version 5.2 Page 12 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. The opportunities for some residents to partake in activities are satisfactory. Flexible routines of daily living give residents a choice in how they spend their day. Visitors are actively welcomed into the home. The home offers a varied menu based on the residents’ likes and dislikes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was evident during the day that residents are encouraged to exercise their own personal choice. Some residents chose to sit in the small quiet lounge; Plymouth House Nursing Home DS0000004134.V340860.R01.S.doc Version 5.2 Page 13 some residents were in the main lounge whilst others preferred to stay in their own bedrooms. The care records include a detailed summary of the residents’ life history - this assists staff in understanding their care needs further. The home provides activities based on an individualised needs assessment. Televisions and music systems are in the lounges. Some residents are able to go out on a one-to-one trip, and the staff make every effort to ensure that the residents’ maintain family links. A music therapist visits the home regularly for those residents who wish to participate. The home has some very dependent residents who are too poorly to participate in activities. The home has pet cats, and residents are obviously fond of them. Relatives are able to visit at anytime. A resident spoken to confirmed this at the time of the inspection. The home’s menu is based on the residents’ likes and dislikes and the manager goes shopping to ensure that this is achieved. Residents and staff, who were asked, stated that the food and choices available were good. All residents who are able to sit at the tables for meals are assisted. Some residents chose to stay in the quiet lounge. Staff assist residents with their food where it is required. Plymouth House Nursing Home DS0000004134.V340860.R01.S.doc Version 5.2 Page 14 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. There is a complaints procedure in place that is up to date, and available to both residents and relatives. The policies and procedures regarding protection of people who use the service are satisfactory. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Plymouth House receives minimal complaints - the last one recorded was in 2004. Records examined demonstrated that the home follows their complaints policy, and outcomes are recorded. A copy of the complaints procedure had been given to all residents, and was available for relatives and visitors. The manager feels the reason for the low number of complaints is because the home is small and she visits daily, and spends time talking to the residents and their families. A procedure for responding to allegations of abuse is available. The home’s manager is confident that all her staff would report any concerns if they had Plymouth House Nursing Home DS0000004134.V340860.R01.S.doc Version 5.2 Page 15 any. Induction training covers the protection of vulnerable adults, and ongoing training is provided for the staff. Plymouth House Nursing Home DS0000004134.V340860.R01.S.doc Version 5.2 Page 16 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 adequate. The home provides a homely environment, which is warm, comfortable and well maintained for the residents. The standard of housekeeping is commendable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides accommodation for residents in both single and shared bedrooms. The home is a large traditional building, which has been converted to accommodate up to 25 residents. Given the age of the building, some of the corridors are narrow and communal areas and bathrooms are quite small. Plymouth House Nursing Home DS0000004134.V340860.R01.S.doc Version 5.2 Page 17 Residents are carefully assessed for the rooms with restricted access. The home’s décor is in keeping with the home’s external appearance. Since the last inspection the home has redecorated the main lounge and the quiet lounge, and provided some new furniture. This has enhanced the appearance of these areas. Some bedrooms had carpets replaced. It was recommended that the home review the bathing/shower facilities, given the dependency of some of the residents it must be difficult to offer the residents a choice of bath or shower with the present facilities. The main lounge/dining room is quite cramped when the home is full. The residents’ bedrooms are personalised to reflect each resident’s personality and give a more homely atmosphere. All radiators are protected and windows fitted with restrictors. The grounds around the home are well maintained providing a pleasant outlook from the home. Residents are able to sit outside when the weather permits. A small courtyard is used by the small number of residents who smoke. All areas of the home observed were commendably clean and tidy. Plymouth House Nursing Home DS0000004134.V340860.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. Staffing levels are appropriate to meet the health and personal care needs of the residents. The service recognises the importance of training, and tries to deliver a program that meets the requirements of the National Minimum Standards. The service has a recruitment procedure that meets the Regulations and the National Minimum Standards. The procedure is followed in practise and there is accurate recording at all stages of the process. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection the home was accommodating 17 residents. The duty rotas for the home were reviewed and these showed that the home was providing appropriate staffing levels to meet the health and personal care needs of the residents. The home never uses agency staff; any shortfalls are Plymouth House Nursing Home DS0000004134.V340860.R01.S.doc Version 5.2 Page 19 covered by permanent staff working additional hours. This assists in providing continuity for the residents. Since the last inspection the home has developed a training matrix. This records all training that the staff have completed and identifies when updates are due. The home is aiming to achieve that 50 of carers complete NVQ Level 2 in Care over the next 12 months. Since the last inspection the home has only recruited two staff members and their files showed that the home had followed their recruitment procedure. Appropriate checks have been completed prior to each member of staff commencing employment within the home. The home has an equal opportunities policy in place and staff are advised about this. Plymouth House Nursing Home DS0000004134.V340860.R01.S.doc Version 5.2 Page 20 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 and 38 Quality in this outcome area is good. The manager has the required experience and is competent to ensure the needs of the residents are met. The home has a quality audit system in place to monitor the service and the outcomes. The home has a good system in place for ensuring the health and safety of the residents and staff are met. This judgement has been made using available evidence including a visit to this service. Plymouth House Nursing Home DS0000004134.V340860.R01.S.doc Version 5.2 Page 21 EVIDENCE: The manager has many years experience, and provides a good role model for her staff. Staff and residents are most complimentary about the manager and how approachable and supportive she is. Both the manager and deputy manager demonstrate a clear knowledge and understanding of the residents’ care needs. The registered manager has not completed the Registered Manager’s Award, but is proposing that the deputy manager undertake the qualification to assist her with developing management skills. The AQAA contains excellent information that is fully supported by appropriate evidence. It includes recognition of the importance of equality and diversity and a wide range of evidence showing how the residents are listened to. It demonstrates a level of self-awareness and recognises the areas that it still needs to improve, and how they plan to do this. A recognised quality assurance system is in place, the model recommended by the Registered Nursing Homes Association, and the results of this are available. The home does not manage the resident’s finances, the resident or their relatives look after them, the home invoice them for any charges i.e. hairdressing. Regular review and update of policies and procedures is in place, and staff are updated about any changes. Health and safety systems are regularly reviewed and updated and are developed on the basis of experience in the home, outcomes for people using the service and learning from external developments. All staff receive health and safety training and a record of this is maintained in the home. All records requested were available and up-to-date at the time of the inspection. Records are securely stored in the home. Plymouth House Nursing Home DS0000004134.V340860.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 4 17 X 18 3 2 X X X X X X 4 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 4 Plymouth House Nursing Home DS0000004134.V340860.R01.S.doc Version 5.2 Page 23 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. 1 Standard OP28 Regulation 18 (1) a Requirement A system should be put in place to ensure 50 of carers attain a qualification at NVQ Level 2 in Care or equivalent, and that this level of qualification is maintained. This is to further assist the carers in meeting the needs of the residents. Timescale for action 31/12/08 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 OP31 Good Practice Recommendations To assist the deputy manager further develop management skills, it is recommended that the Registered Managers Award is undertaken. It is recommended that the home review activities/therapies for the more dependent residents, and include this in their care file. 2. OP12 Plymouth House Nursing Home DS0000004134.V340860.R01.S.doc Version 5.2 Page 24 Plymouth House Nursing Home DS0000004134.V340860.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Plymouth House Nursing Home DS0000004134.V340860.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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