Care Home: South Bebside Nursing Home

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What the care home does well We thought the actual care of residents was excellent. All of the residents looked clean and well cared for. Residents told us that they were well looked after and were happy with the standard of care. Residents told us that staff provided them with privacy and encouraged them to remain in control of their own lives. Residents told us that their routine varied depending on their wishes. Residents general health appeared to be good. Staff were clear about the care needed by individuals and appeared confident in their role. The premises were very clean, tidy and odour free. Residents told us that the home was always clean and that they received a good laundry service. Residents rooms were very well personalised. One resident told us she was encouraged to bring furniture and books with her. Another resident had been helped by staff to buy some things for her room as she did not have any relatives. The food was very good. We tasted the food and found that it was hot, well presented and well cooked. The cook told us that the menu was spread over four weeks and rotated on a seasonal basis. The cook home bakes the cakes and biscuits. Money held for residents was well managed. Clear accounts are held detailing all transactions. Residents and relatives are consulted through quality surveys. We looked at the results of previous surveys which were positive in areas of care. Complaints within the home were well managed. Residents told us that they knew how to complain and felt able to do so if necessary. The home does not receive many complaints. The manager said he thought this was because they were small enough to deal with niggles as they arose. External health and safety checks were up to date. Fire safety checks were also up to date. What has improved since the last inspection? A new shower room has been provided on the first floor. This is easy for residents to access and was well decorated. What the care home could do better: The standard of decoration in the bathrooms and some bedrooms does not reflect the very good care that is provided. The bathrooms are shabby and dated. The scuffed walls and lifting flooring makes them difficult to keep clean and therefore not fully hygienic. Similarly some vanity units are chipped showing exposed woodwork which is also an infection hazard. Some hot water taps were not fitted with thermostatic valves to regulate the water temperature. This means staff cannot practice good hand washing technique by washing hands under running water. The nurse on duty was very busy, she was constantly interrupted which could lead to errors in practice. She completed her tasks very well but this was due to her competence and organisational skills. We have recommended that two nurses are on duty. We witnessed one carer wheeling a resident backwards in the wheelchair instead of forwards. The resident was visually impaired and the carer did not communicate properly with her. Key inspection report Care homes for older people Name: Address: South Bebside Nursing Home Patterdale Road Blyth Northumberland NE24 4JU     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Janet Thompson     Date: 0 4 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: South Bebside Nursing Home Patterdale Road Blyth Northumberland NE24 4JU 01670-364881 01670351986 south.bebside@fshc.co.uk www.fshc.co.uk Ringdane Limited (wholly owned subsidiary of Four Seasons Health Care Limited) care home 38 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home South Bebside was purpose built in July 1998 to provide care for thirty-eight service users. It is a traditional brick building. The residents have access to the patio area to the front of the building where there is seating. The building has a foyer with seating and the nurses station, and the open area from which the lounge and the bedroom corridors are accessed. The home is situated in an area of predominantly domestic housing although it is close to public services and shopping facilities. The charges for the home vary depending upon the needs and requirements of the individual residents. The home provides information about the service through the service user guide and a copy of the last inspection report from The Commission for Social Care Inspection is available in the entrance to the home. Care Homes for Older People Page 4 of 26 Over 65 36 0 0 2 Brief description of the care home Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This is an overview of what the inspector found during the inspection. The quality rating for this service is three stars. This means the people who use this service experience excellent quality outcomes. We have reviewed our practice when making requirements. Some requirements from previous inspection reports may have been deleted or carried forward to this report as recommendations. This will only happen when it is considered that people who use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Before the visit we looked at information we received since the last visit to the home. This includes how the service dealt with any complaints, changes to how the home is run, the views of people who use the service and the managers views of how well they Care Homes for Older People Page 6 of 26 care for people. We sent questionnaires to people who use the service and some of the staff at the service. Seven completed questionnaires were returned to us. An unannounced visit was made on 4th August. During the visit we talked with people who use the service, some staff and the manager. We looked at information about people who use the service and other records which must be kept. We checked that staff had the knowledge, skills and training to meet the needs of the people they care for and we looked around the building to make sure it was clean, safe and comfortable. Following the inspection feedback was given to the manager. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: The standard of decoration in the bathrooms and some bedrooms does not reflect the very good care that is provided. The bathrooms are shabby and dated. The scuffed walls and lifting flooring makes them difficult to keep clean and therefore not fully hygienic. Similarly some vanity units are chipped showing exposed woodwork which is also an infection hazard. Some hot water taps were not fitted with thermostatic valves to regulate the water temperature. This means staff cannot practice good hand Care Homes for Older People Page 8 of 26 washing technique by washing hands under running water. The nurse on duty was very busy, she was constantly interrupted which could lead to errors in practice. She completed her tasks very well but this was due to her competence and organisational skills. We have recommended that two nurses are on duty. We witnessed one carer wheeling a resident backwards in the wheelchair instead of forwards. The resident was visually impaired and the carer did not communicate properly with her. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are fully assessed before they enter the home. Evidence: Residents spoken to told us that they or their relatives had visited the home before they were admitted. One resident was admitted straight from hospital, she could remember the manager from the home visiting her there. Records confirmed that pre-admission assessments are carried out. These assessments covered all areas of need and were sufficient to enable staff to plan care for residents. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive personal care that is well planned and properly recorded. Evidence: Three care plans were examined and two were case tracked. This means that we spoke to the individual residents or observed their care then matched our observations to what was written in the care plan. Both case tracked care plans did reflect the actual care needed by the residents. Care plans took account of peoples diverse and differing needs. People were supported to achieve independence and meet individual goals. Other health professionals contributed to the planning of care. These contributions were clearly recorded. The actual care people received appeared to be very good. We spoke to residents who told us that they were well cared for. They said staff responded quickly if they rang the call bell and were attentive to their needs. We noted that everyone was well dressed and looked clean and cared for. We observed staff supporting residents to wash their hands, clean spectacles and hearing aids. Staff were knowledgeable about individual needs. There was a low incidence of pressure sores in the home. The Care Homes for Older People Page 12 of 26 Evidence: treatment of these was well documented. Statistics are gathered weekly showing the grade and progress of all pressure sores, these records confirmed that the sores were superficial and one was obtained prior to the resident entering the home. Pressure relieving equipment was in place and used appropriately. Medication ordering, administration, storage and disposal were examined. All medicines were accounted for though not all of those administered had been signed for. This was mostly lotions and as required medication. Two amounts of controlled drug were checked and were correct. The temperature of the drugs fridge was monitored and was within normal limits. All eye drops had been labeled with the day of opening. The treatment room, though small and cramped, was clean and tidy. Staff were seen to treat residents politely and respectfully. However, we did witness one resident, who was blind, being wheeled backwards in her wheelchair to the lift. When the lift arrived it contained equipment. The carer left the resident without explanation and went to move the equipment. The resident was unaware that she had gone and continued talking to her. Apart from that one incident we observed staff being very polite and understanding when they attended to residents. One resident was unexpectedly transferred to hospital during the day. Staff were very attentive to him and were reassuring him continually. All staff, including the manager, seemed very concerned for his welfare. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to lead a healthy and fulfilling personal lifestyle that takes account of their wishes and diverse abilities. Evidence: There are two staff members in charge of activities. They job share the role and broadly provide some activity every week day. There is a monthly plan of activities which showed that residents are offered things such as bingo, music, crafts, games, shopping, art, quizzes and outings. The manager reported that transport had now been organised with a local firm so taking residents on outings was easier. Local religious leaders do visit the home. Recently an art teacher attended and residents have some canvas pictures to display. A social evening is held monthly, residents have some alcohol and entertainment, photographs of this showed that people seemed to enjoy it and it was well attended. Social history and life stories were in place for residents in care plans and the activities workers kept very good individual records of each residents participation in events. In questionnaires residents said they did not have much to do and only indicated that activities were available sometimes. We thought the monthly schedule was very good and it could be that some residents or relatives were not fully aware of what was on offer. Currently the schedule is posted on a notice board, we suggested that it is broken down to a weekly list and given out Care Homes for Older People Page 14 of 26 Evidence: in bedrooms. The staff were keen to do this. Residents told us they could choose exactly how to spend their day. One resident said that she could choose to have company or peace and quiet. A group of friends who regularly sit together said they sometimes didnt see each other for days if they were off doing other activities. Residents also said they liked the food. The told us that the Cook was the best around and that she did good home baking. We ate the food at the home. It was well presented. The food was hot enough and very tasty. The standard of the cooking was very good. Residents also have a choice of a hot meal at tea time or soup and sandwiches. Dining tables were attractively set as were trays for people eating in their own rooms. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are protected from harm through good protection procedures. Evidence: Staff follow the homes policies and procedures relating to the management of complaints and allegations of abuse. Staff have received training on the protection of vulnerable adults. Residents are told how to complain through the complaints procedure. This was clearly visible within the home. Residents spoken to said they would complain if they needed to but none of them had any current complaints. We spoke to three residents who assured us that all small issues were dealt with immediately. They said they could not find anything to complain about because of this. There have been no complaints recorded since the last inspection. Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a comfortable home that is generally pleasant but not well maintained or fully hygienic. Evidence: The home was generally clean and free from odours. The furniture and general decor provides residents with a comfortable homely environment. New furniture has been provided in communal sitting areas with good results. The first floor lounge is due for redecoration and plans are in place for this. Some redecoration is needed in corridors and bedrooms on door frames which have been scuffed by hoists and electric wheelchairs. The bathrooms in particular need to be upgraded and redecorated. There is one shower room on the first floor which is modern, hygienic and pleasant. The remainder of the bathrooms are dated and require redecorating. On the ground floor, in the Parker bathroom, the door frame is badly scuffed, the tiles are old and have lost some of their grouting and the floor is lifting and buckling away from the wall. Not only is this not hygienic it is becoming a trip hazard. The second bathroom on the ground floor has very scuffed walls, the areas of boxing in have hardly any paint left on them and the flooring is old. The bathroom on the first floor is similar. Care Homes for Older People Page 17 of 26 Evidence: There are several bedrooms with original carpets from when the home opened. In particular rooms 4, 10, 5 and 18 need new flooring because of discoloured areas or odours, but there are many more, the manager has a list of these. Consideration needs to be given to infection control implications and, in nursing areas, hard flooring should be considered. Several of these bedrooms also need to be redecorated. The vanity unit around the wash basin in room 7 has lost its veneer leaving the chipboard exposed, which is an infection control risk. The waste bins in the home are not foot operated. This increases the risk of contamination as they have to be opened by hand. There was a plastic jug in a bathroom that looked as though it was used for hair washing, this should be removed. Residents told us that the home was warm and comfortable. The standard of accommodation does not properly reflect some of the very good care that is given in the home. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported through adequate staff numbers, skill and ability. Evidence: The staffing for the home currently is, one nurse at all times with six carers in the morning and five in the afternoon. At night there is one nurse with two carers. There are 22 residents requiring nursing care. We observed that the nurse was very busy, there were a lot of demands on her time and she was constantly interrupted. The nurse managed to complete her tasks because she was very organised and competent. We were concerned that the nurse did not have much time to complete care plans and was interrupted whilst giving medication, though staff tried not to do this, there was no-one else to ask. Consideration should be given to the provision of two nurses. The manager confirmed that just over 50 of staff had achieved NVQ level 2. Most staff were up to date with essential training, where they were not up to date they were booked onto a training course in the near future. There is a training overview chart, which helps to ensure that staff do not fall behind in statutory training. Some vocational training is planned for the near future and the manager has clear ideas about the direction this should take. Care Homes for Older People Page 19 of 26 Evidence: Four staff recruitment files were examined. These were for three carers and one nurse. All contained good information. Thorough background checks had been carried out before employment. Residents were protected through checking of criminal records information for all employees. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are protected through reflective management that takes account of the diverse needs of the service. Evidence: The home has an experienced registered manager. He has been assessed as having the competency and skills to run the home. Residents told us that the home seems to run well. Staff appeared to be able to communicate with the manager and ask his advice. The relationship between the manager, staff, residents and relatives appears to be good. In questionnaires many relatives and residents said the home felt like a large family of which they were part. Staff receive formal supervision on a regular basis. This gives them an opportunity to contribute to the running of the home and identify any training needs they might have. The home does operate a quality assurance system. Residents, their relatives and Care Homes for Older People Page 21 of 26 Evidence: professionals are consulted about the service provided. The latest consultation has just been collated. The overall satisfaction score was quite high. The negative areas identified were mostly related to the premises. The manager stated that residents and relatives meetings were not well attended. He feels that the home is small enough that he is able to see people on an individual basis regularly and people do not feel the need to come to a meeting. The manager carries out audits of care systems and risks on a weekly basis. The home is also audited on all systems yearly. Servicing and maintenance agreements are in place for facilities and equipment. Risks in the environment and tasks, including safe working practices are assessed and reviewed. All fire safety checks, tests and instructions to staff are conducted at the required frequency and recorded. Fire exits were clear of obstruction and all hazardous fluids locked away. Residents personal money is held by the provider. The money is held in a central account though residents do have the choice to transfer excess money to their own accounts. Some residents have relatives that manage their money for them and this is generally encouraged. The manager checks the finances weekly and signs to say he has done so. The accounts are sent to head office monthly and are audited on an unannounced basis very frequently. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 Replace bedroom carpets in those rooms identified. Redecorate the areas of door frames and corridor walls identified. Regulation 23(2) ensures that residents live in a home that is kept in a good state of repair and reasonably decorated. 01/12/2009 2 26 13 Replace all waste bins with foot operated ones. Remove communal washing jugs from bathrooms Refurbish bathrooms and shower rooms to ensure the walls and floor are impermeable to infection and can be easily cleaned. Replace all damaged vanity units. 01/02/2010 Care Homes for Older People Page 24 of 26 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Regulation 13(3) ensures that residents live in a home where steps have been taken to control and prevent the spread of infection. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 4 9 10 26 27 All medication administered should be signed for Staff should be given training in person centered care and promotion of dignity. Consider hard flooring in bedrooms used by residents requiring high dependency nursing care. Provide two nurses through the day for 22 nursing residents. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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