Care Home: Southdowns Nursing Home

What the care home does well There are robust admission processes to the home which include a full needs assessment by a competent person and they are assured in writing that their needs will be met prior to admission.Southdowns Nursing HomeDS0000041644.V375926.R01.S.docVersion 5.2Some residents were able to confirm that they were visited by the manager prior to admission to the home and two relatives said they had been involved in the admission process. The care plans are person centred and reflect the care given to meet their health, social and welfare in a consistent manner and evidence regular review. The menus evidence a well thought out balanced diet with a varied choice of food in line with residents` preferences. Quality assurance systems are in place which enables the service to monitor and improve their service and ensure that the home is run in the best interests of residents. There is an open-house policy, which welcome visitors at reasonable times. Special arrangements can be discussed with the management team for visiting during the more unsocial hours. Satisfactory arrangements are in place to safeguard residents` finances. Staff provision is well maintained and appropriate numbers of suitably qualified staff are working in the home. The atmosphere of the home is pleasant with good interaction seen between residents and staff. The Comments received from residents and families regarding the care received included `Very caring and kind` `usually very good, but sometimes seem very rushed especially at meal times` `my relative receives excellent nursing care and care workers are kind, considerate and supportive to us as well as my relative`. The training for staff is good, and covers a wide variety of resident related conditions, which give the staff an understanding of the residents needs. What has improved since the last inspection? At the last key inspection, four requirements and three good practice recommendations were made. There has been work done to improve these areas and the requirements were in the main seen to be met. The home have employed a second activity person and therefore provide one to one for the more frail residents and actively encourage participation. The policies in place on both restraint and on adult protection have been developed to provide clearer advice for staff. The home carries out regular environmental assessments and a yearly plan of redecoration and maintenance is formally in place. Southdowns Nursing Home DS0000041644.V375926.R01.S.doc Version 5.2 What the care home could do better: The Statement of Purpose and Service Users Guide should detail all the required information as per Schedule 1 Care Standards regulations to ensure that prospective residents and their representatives have all the information to help make a decision as to where to live. The pre- admission documentation was not completed in a consistent manner with some being detailed and full and others very basic and some were not signed or dated. More detailed information recorded will inform the inspection process and ensure that the home can meet the identified physical and mental health needs of all prospective residents and reduce the possibility of a failed admission. At present the home have a large amount of divan beds in use which need to be reviewed against the needs of the residents to ensure they promote independence and are suitable for each individual in receipt of nursing care and that lifting equipment can be used safely and appropriately. The documentation in respect of complaints needs to evidence that complaints are dealt with effectively and appropriate and that records maintained demonstrate a thorough and robust investigation. The home follows and operates their thorough recruitment procedure that includes the appropriate checks being completed before any person is deployed to work in the home. Key inspection report CARE HOMES FOR OLDER PEOPLE Southdowns Nursing Home The Green St Leonards on Sea East Sussex TN38 0SY Lead Inspector Debbie Calveley Key Unannounced Inspection 24th June 2009 08:30 DS0000041644.V375926.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Southdowns Nursing Home DS0000041644.V375926.R01.S.doc Version 5.2 Page 2 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 Southdowns Nursing Home DS0000041644.V375926.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Southdowns Nursing Home Address The Green St Leonards on Sea East Sussex TN38 0SY 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) 01424 439439 01424 718806 southdowns-home@hotmail.co.uk Paydens Ltd Manager post vacant Care Home 48 Category(ies) of Dementia (0), Mental disorder, excluding registration, with number learning disability or dementia (0) of places Southdowns Nursing Home DS0000041644.V375926.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 - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (MD) 2. Dementia (DE). The maximum number of service users to be accommodated is 48. Date of last inspection 6th July 2007 Brief Description of the Service: Southdowns nursing home is registered to accommodate forty-eight service users. The home is located in St Leonards-on-Sea in a residential area. Shops and transport links are nearby. There are two floors; forty-eight single bedrooms, all with en-suite facilities. There is a passenger lift, communal rooms, laundry and gardens all of which are accessible to service users. The current fee charges range from £500-£1500 per week, with additional charges for hairdressing and Chiropody. It was reported a copy of the home’s brochure and service user guide is sent out to prospective service users and interested parties. Southdowns Nursing Home DS0000041644.V375926.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 stars. This means the people who use this service experience good quality outcomes. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Southdowns Nursing Home will be referred to as ‘residents’. This was a key inspection that included an unannounced visit to the home and follow up contact with residents’ representatives and visiting health and social care professionals. This unannounced inspection was carried out over 6.5 hours on the 25 June 2009. There were forty five residents living in the home on the day of which six were identified for care plan tracking and also met and spoken with. During the tour of the premises eight other residents both male and female were also spoken with. The purpose of the inspection was to check that the requirements of previous inspections had been met and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. Four members of care staff and the cook were spoken with in addition to discussion with the Manager and a registered nurse. Telephone contact was made with visiting professionals following the visit and three relatives were spoken with during the inspection visit The information received verbally has been incorporated into this report An Annual Quality Assurance Assessment AQAA was received from the appointed manager completed competently and in full prior to this key inspection. The information received in the AQAA was measured against the information gathered on the site visit. What the service does well: There are robust admission processes to the home which include a full needs assessment by a competent person and they are assured in writing that their needs will be met prior to admission. Southdowns Nursing Home DS0000041644.V375926.R01.S.doc Version 5.2 Page 6 Some residents were able to confirm that they were visited by the manager prior to admission to the home and two relatives said they had been involved in the admission process. The care plans are person centred and reflect the care given to meet their health, social and welfare in a consistent manner and evidence regular review. The menus evidence a well thought out balanced diet with a varied choice of food in line with residents’ preferences. Quality assurance systems are in place which enables the service to monitor and improve their service and ensure that the home is run in the best interests of residents. There is an open-house policy, which welcome visitors at reasonable times. Special arrangements can be discussed with the management team for visiting during the more unsocial hours. Satisfactory arrangements are in place to safeguard residents’ finances. Staff provision is well maintained and appropriate numbers of suitably qualified staff are working in the home. The atmosphere of the home is pleasant with good interaction seen between residents and staff. The Comments received from residents and families regarding the care received included ‘Very caring and kind’ ‘usually very good, but sometimes seem very rushed especially at meal times’ ‘my relative receives excellent nursing care and care workers are kind, considerate and supportive to us as well as my relative’. The training for staff is good, and covers a wide variety of resident related conditions, which give the staff an understanding of the residents needs. What has improved since the last inspection? At the last key inspection, four requirements and three good practice recommendations were made. There has been work done to improve these areas and the requirements were in the main seen to be met. The home have employed a second activity person and therefore provide one to one for the more frail residents and actively encourage participation. The policies in place on both restraint and on adult protection have been developed to provide clearer advice for staff. The home carries out regular environmental assessments and a yearly plan of redecoration and maintenance is formally in place. Southdowns Nursing Home DS0000041644.V375926.R01.S.doc Version 5.2 Page 7 What they could do better: 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. Southdowns Nursing Home DS0000041644.V375926.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 Southdowns Nursing Home DS0000041644.V375926.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides prospective residents and relatives with a good level of information about the home, its facilities, services and the costs involved. The admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission. EVIDENCE: The Statement of Purpose and Service Users Guide were requested and read during and following the inspection and correlated against the information gathered during the site visit and the Annual Service Review (AQAA) to ensure that the home is meeting its stated purpose and providing accurate information for the people who use the service. Southdowns Nursing Home DS0000041644.V375926.R01.S.doc Version 5.2 Page 10 Currently these documents in particular the Statement of Purpose do not detail all the information to be included as detailed within Schedule 1 of the Care Standards Regulations, and are in need of review. The Service User Guide gave a good level of information about the facilities, the home and service it provides, however as discussed some areas need to be developed to give prospective residents and their families the information and reassurance they need to make an informed choice about where to live. The annual quality assurance assessment (AQAA) was returned completed by the home manager when asked for and stated that they had plans to further improve their brochure and website. The pre-admission documentation was seen in relation to six residents, two of whom has recently been admitted to the home. The format of the preadmission document was seen to be relevant. The documentation however was not completed in a consistent manner with some being detailed and full and others very basic, some were not signed or dated More detailed information recorded will inform the inspection process and ensure that the home can meet the identified physical and mental health needs of all prospective residents and reduce the possibility of a failed admission. The prospective residents are seen either in their home or hospital before admission and it was confirmed that wherever possible the family or representatives are involved. Two visitors confirmed that they were involved in the whole admission process. A recommendation of good practice is that the venue and all the people involved in the assessment are documented. The manager was able to verbally demonstrate his knowledge and awareness of the different specialities required in the home and ensures that carers and trained nurses employed have attended relevant courses to deal with the needs of the elderly suffering from a dementia type illness and also specialised courses for certain diseases and behavioural traits. Trial visits to the home can be arranged if appropriate with the individual resident, as some would find it unsettling. However the manager confirmed that residents are invited to a months trial period to ensure suitability of the home, this is clearly stated in the Statement of Purpose and in the statement of terms and conditions The documentation was not completed in a consistent manner with some being detailed and full and others very basic and some were not signed or dated thus not being useful in monitoring peoples’ needs from admission. The home does not cater for intermediate care. Southdowns Nursing Home DS0000041644.V375926.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning identifies the current health care and personal care needs of the resident and direct the staff to provide this care in a holistic person centred manner. The standard of medication administration safeguards the resident. EVIDENCE: The care documentation pertaining to six residents were reviewed as part of the inspection process: these residents were also visited and spoken with to confirm if their health, social and welfare needs were being met. The care plans were person centred and clearly identified the individual residents health needs with the expected outcome and steps for care staff to follow to ensure these needs are met in a consistent manner. The risk assessments in place are varied and ensure that residents’ health, social and welfare needs are identified and monitored regularly. There are also risk assessments in place for individual Southdowns Nursing Home DS0000041644.V375926.R01.S.doc Version 5.2 Page 12 residents in respect of the environment, furniture and grounds so as to promote their independence. On the whole the care documentation demonstrated that the health social and welfare needs were reviewed and evaluated regularly. There was little evidence of resident or family involvement in the formation of the care plans and promotion of involvement would be beneficial in ensuring that residents’ choice and decision making is promoted. Some minor shortfalls were identified and discussed and these include monitoring and cross referencing of identified weight loss and promotion of continence. One care plan did not provide guidance for staff to deal with isolation due to recent decline in health and confinement to bed, another who communicates by signs, has little in the care plan to promote communication. These shortfalls were acknowledged and will be addressed and therefore a requirement was not made at this time. Since the last key inspection, global care plans for the carers has been introduced which gives care staff basic information about the nursing needs of residents, how to move them safely, how to assist them with food and drink and their personal care needs. There are future plans for care staff to write their own account of residents care daily, but will at present continue to report their observations to the trained nurses. Staff spoken with confirmed that they received a full report on each resident daily and read the care documentation that is kept in the main nurses’ station on each floor. They felt that their views were taken into account when planning residents care. Relatives and residents spoken with were satisfied with the care provided at the home one saying that the home ‘I think they are very good’ ‘my relative receives good care and everyone is very kind’ ’ Lately they seem very busy and rushed’. Those residents spoken with and that were able to share their view said ‘I am content, people are kind’, ‘Bit fussy, but ok’. One resident communicated by signs which indicated that every thing was ‘good’ ‘staff looked after him well’. Residents are registered with a GP from local surgeries. Resident’s are supported to attend the GP surgery if appropriate, home visits are conducted when necessary. Referrals to the psychiatric team, Optician, Occupational Therapist, Physiotherapist, Dietician and Audiologist are made via the GP or the hospital. Residents access private dental surgeries, where able, and access to a domiciliary dentist is also available. A visiting Chiropodist attends residents six weekly, with additional appointments being arranged if necessary. The records in the home evidence that the health needs of the residents are met. Southdowns Nursing Home DS0000041644.V375926.R01.S.doc Version 5.2 Page 13 There are policies and procedures in place for staff to refer to regarding the safe administration, storage, disposal and recording of medication. The systems for recording and checking controlled drugs were found to be thorough. Medication Administration Charts were found to be in the main competently completed and evidence that residents are receiving the medication required to maintain their physical and mental health. The gaps identified were when the home has used an agency nurse and it was discussed that when gaps are seen they are followed up to ensure that residents are getting their prescribed medication. Some areas of good practice were discussed with the senior nurse on duty during the inspection in respect of the PRN (as required) medication guidelines and policy and the usage of codes. From direct observation throughout the site visit staff were seen to be treating residents in a respectful manner and ensuring that their dignity was protected. The interaction between all residents and different roles of staff was seen to be positive and patient at all times. Southdowns Nursing Home DS0000041644.V375926.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities and meals continue to be creative and provide daily variation and interest for people living in the home. Residents are able to make a range of choices about their lives as well as maintaining links with friends and relatives. EVIDENCE: There are two activity co-ordinators working in the home and the activity programme is displayed on the notice boards. The programme evidenced that one to one sessions with residents take place in the mornings and group sessions in the afternoons. The home staff have discovered that visiting entertainers and trips out are very popular with the residents and therefore these are arranged at least monthly. During the morning one activity person was observed interacting with residents in their rooms and was either playing a netball game or with some manicuring their nails, whilst the other was with residents in the lounge area. Southdowns Nursing Home DS0000041644.V375926.R01.S.doc Version 5.2 Page 15 Some thought had been given to providing sensory stimulation to the residents and some resident’s rooms have mobiles hanging from the ceiling and these were also seen in the lounge and dining area. A sensory room has just been completed which includes a reminiscence corner this is not yet up and running but will be in the near future. There is a quiet room available on the ground floor; this is not being used to its full potential due to being over furnished and unwelcoming. The senior co-ordinator is responsible for the social care plan and all families where applicable are sent a questionnaire to complete, it was not clear if simple questionnaires are given to the residents for their input. The documentation in respect of activities does not do the staff justice and this is an area that does need to be developed to demonstrate how the staff meet the wide and varying social and mental needs of their residents. The manager confirmed that he was aware of this and has plans for developing this area in the near future. A religious service is held on a weekly basis and twice a month there is Holy Communion. The range of activities available includes art, bingo, craft, musical bingo, knitting, physical motivation and board games. There is also a visiting hairdresser who visits on a weekly basis. In the reception area there is a photograph album of various festivities enjoyed by residents, but the last photographs were from 2007 and does not give a true reflection of the activities now provided. There is a 4 week rotating menu that changes with the seasons and was seen to be a varied and nutritionally balanced menu. It was confirmed that the menus are devised taking into consideration the likes and dislikes of the people living in the home. The residents are given a choice for all their meals and a member of staff ask each resident the afternoon before what they prefer for the next day. There are two choices of main meal and a vegetarian option every day. In the evening there is a hot meal and a selection of sandwiches. The midday meal was observed and residents were seen to be eating in a variety of areas throughout the building with some being assisted by staff in a helpful and discreet manner. The feedback from visitors in respect of the food was that lately it had not been as good as it used to be and from seeing the meal served there was room for improvement. The latter meals served were unappetising and luke warm with congealed gravy; the pureed meals were visually unattractive due to the consistency and presentation. This was discussed with the chef and manager and will be reviewed as a priority. The chef was knowledgeable regarding the dietary needs of the residents and provides vegetarian, diabetic and other specialist diets when required. The communication between care staff and kitchen staff was said to be in need of improving especially in respect of the residents who are not eating much and in need of fortified food. The staff keep a food diary for all the residents in the Southdowns Nursing Home DS0000041644.V375926.R01.S.doc Version 5.2 Page 16 dining areas, these were not seen but should include the amounts consumed and then shared with the catering team to then fortify food as necessary. Southdowns Nursing Home DS0000041644.V375926.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Practice in the home ensures that complaints are responded to with residents and their representatives being confident that they are listened to and demonstrated that robust procedures are now followed. Practice in the home ensures that adult protection issues are responded to when identified. EVIDENCE: The home management team keep a complaint folder, there are separate files kept: one for staff and one for residents. There were complaints on file from 2008. The complaints were answered, but there was no record of the investigation and outcome and therefore no clear record of whether it was substantiated or not. The documentation viewed evidenced that the latter investigations were more competently completed and this was due to a management change. This was acknowledged and therefore a requirement will not be made. The manager confirmed that the home operates an open door policy and there is a comment and suggestion book in the reception to encourage open communication. Southdowns Nursing Home DS0000041644.V375926.R01.S.doc Version 5.2 Page 18 Four residents spoken with confirmed that they would talk to the nurse if they had a problem. The home’s complaint procedure is on display in the reception area and it is also included in the Service User Guide. The home have a policy on restraint that is updated regularly and all residents that require bed rails, lap straps and recliner chairs to protect and promote the safety of residents have individual risk assessments in place with evidence that it is a multi disciplinary decision. The home has relevant guidelines on the protection of vulnerable adults and staff have received appropriate training. The management team has a clear understanding of adult protection guidelines and are aware of how to initiate an investigation if required. There has been one safeguarding referral since the last key inspection that was fully investigated by Social Services and action taken as required. Southdowns Nursing Home DS0000041644.V375926.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable clean and safe environment for those living in the home and visiting. Residents are enabled and encouraged to personalise their room and rooms are homely and reflect the resident’s personalities and interests. EVIDENCE: The home is well maintained, attractively decorated and safe for the people who use the service and for those visiting. Residents spoken with said that they liked their rooms’ one saying that the home ‘felt like his home now’. Southdowns Nursing Home DS0000041644.V375926.R01.S.doc Version 5.2 Page 20 There is an attractive garden area with seating that is secure which allows residents to wander and enjoy the flowers. From taking to the staff there are plans to plant a sensory garden. There are communal areas on both floors of the home which allow for different uses ensuring residents have a choice of where and how they spend their time. One of the lounges areas is used only for religious services, for meetings with relatives or for staff training purposes. This area whilst decorated well is less inviting due to the layout of chairs and generally not used much by residents despite being a designated quiet lounge for residents. A further lounge on the second floor has recently been converted in to a sensory room, and is due to be opened soon. There are adequate communal bathrooms and shower rooms in the home, with specialist equipment to ensure all residents can have a bath or shower. The home has been assessed by an Occupational Therapist and specialised equipment is available throughout the home to promote independence. However the home has a large amount of divan beds in place which need to be reviewed regularly to ensure they are suitable for the residents in the home and that lifting equipment can be used safely and appropriately. One gentleman who is cared for in bed would benefit from a high/low nursing bed as this would allow him to sit up and would also protect the staff from injury, another resident who is currently unwell would also benefit from being able to sit up to assist her breathing and enable family to offer food and drink without waiting for staff. Call bells are provided in all areas and staff were seen to be attentive and ensured residents had access to these as appropriate to their mental and physical capacity. Evidence in the maintenance folders confirmed that regular audits of the environment are carried out and there is a plan of maintenance and redecoration in place. The maintenance person then keeps a record of all work carried out. In relation to fire safety all records are current and in place to protect the safety of those living and visiting the home. All of the staff team attend regular fire safety training. Good practice in respect of infection control by staff was observed during the inspection visits and there were gloves and aprons freely available in the home. It was confirmed that all staff receive training in infection control and that the policies and procedures are updated regularly and easily accessible to staff. Sluice and laundry areas were found to be clean and safe. Southdowns Nursing Home DS0000041644.V375926.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff training ensures they are aware of their roles and are able to provide the support and care the residents need. EVIDENCE: At the time of the inspection visit 45 residents were living at Southdowns Nursing Home. The staffing rota was viewed and the staffing levels were seen to be sufficient to meet the needs of the residents at this time it was noted that staffing levels fall on some weekends and this needs to be monitored effectively to ensure that this does not impact negatively on the outcomes for the residents. The manager confirmed that the staffing arrangements are flexible and respond to resident’s dependency. Staff spoken to said that there was enough staff to look after the residents to a good standard. One visitor said that she felt more staff would be beneficial especially at meal times. Agency staff are used when required. A selection of staff recruitment files were viewed and demonstrated that the recruitment process needs to be improved to fully evidence that the home is following robust procedures to protect their residents. This was fully discussed Southdowns Nursing Home DS0000041644.V375926.R01.S.doc Version 5.2 Page 22 and will be implemented. Therefore a requirement has not been made at this time but will be reviewed in depth at the next inspection. The documentation in the supported the information supplied in the AQAA that all staff receive a thorough induction to the home, which includes shadowing a senior on their first shifts in the home. Staff spoken with said that training opportunities at the home are good and they are well supported by the senior staff and the management team Staff and the training list seen confirmed that compulsory training such as manual handling, adult protection, first aid and fire safety are being undertaken on a regular basis. Training courses are provided for staff in health related illnesses such as diabetes, dementia and behavioural problems. The manager has a training matrix which enables the management team to track the training needs and ensures that all staff receive the training required to perform their job competently and therefore promoting the health and well being of the residents living in the home. Trained nurses are supported and enabled to attend courses that will update their skills and knowledge so as to promote residents physical and mental well being and supervise the staff team in meeting the residents identified needs. Staff are all encouraged National Vocational Qualification training (NVQ) at present 26 of the 33 permanent staff have a NVQ or are working towards a qualification. Southdowns Nursing Home DS0000041644.V375926.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The overall management of this home is good with effective systems in place to protect and promote the health, safety and welfare of residents and staff. EVIDENCE: The service file evidenced that Southdowns Nursing Home has not had a registered manager since 2006. The key inspection undertaken in 2007 stated that the appointed manager would be submitting his application for registration. This has not yet happened and therefore needs to be addressed. The appointed manager is a Registered Mental Nurse (RMN). He has worked for the registered provider Mr Dennis Charles Pay (Paydens Limited) for some Southdowns Nursing Home DS0000041644.V375926.R01.S.doc Version 5.2 Page 24 years and has been registered as manager in the past. He still has not completed the RMA (Registered Managers Award) and stated he will be enrolling again soon in preparation for registering as manager. He has the necessary experience and competence to ensure that the home is run and managed to meet its stated purpose, aims and objectives, but this needs to be formalised. The recent employment of a deputy manager completes the management team. Whilst there are shortfalls mentioned in the report body, it is felt that the home manager will address them in a timely manner; the requirements made are ones that do not correlate with the information received in the AQAA and from the information gathered at the site visit. Recommendations have been made in the areas that were acknowledged by the manager and will be addressed. There are systems in place to monitor the quality in the home and include the use of questionnaires and internal audits undertaken by the management team and heads of departments. The manager advised that when responses have been received they collate all the information and write to the relatives advising them of any taken as a result. At the last key inspection there were plans to report the audit outcomes in the Service Users Guide; this has not yet been done. Weekly and monthly audits are carried out in the home. These audits cover a variety of areas including, care plans, medication, pressure sores, accidents, environment, kitchen, housekeepers audit. A detailed check is made of each area and if issues are highlighted then an action plan is put in place to address the issues or a record is made on the audit of the action taken. The quality assurance systems in place in the home ensure that home is run in the best interests of the residents. As part of the inspection process, two relatives were approached for their views of the home by telephone following the site visit. In total five relatives were spoken with and two health professionals who are involved in the home were also contacted. The comments were in the main positive and included ‘The staff are committed to providing a caring environment’ ‘They work well with us as an outside agency’ ‘Caring and friendly staff’. There are no residents at present who are responsible for their own finances; relatives and solicitors support the majority, while the home does not handle the financial affairs of residents. The home has robust policies and procedures in place to safeguard residents’ financial interests. Staff supervision was discussed and staff supervision for all staff is in place, but it is acknowledged that the trained staff are behind due to the previous deputy manager leaving, the recently employed deputy manager will be undertaking the trained staff supervision in the near future. Southdowns Nursing Home DS0000041644.V375926.R01.S.doc Version 5.2 Page 25 Accident records were viewed, the deputy manager undertakes monthly audits however these do not reflect the action taken for the recurrent skin tears and recurrent falls and therefore need to be developed t promote residents safety and well being. It was discussed that expert advice be sought regarding those residents that have recurrent falls and skin tears. Good practice was observed throughout the inspection in respect of promoting the safety and well being of the residents whilst they moved around the building. The training matrix evidences that all staff receive training in respect of protecting and promoting the health, safety and well being of all the residents living in the home. Southdowns Nursing Home DS0000041644.V375926.R01.S.doc Version 5.2 Page 26 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 2 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 3 3 Southdowns Nursing Home DS0000041644.V375926.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last 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 OP1 Regulation 4 Requirement The registered person must ensure that the Statement of Purpose is reviewed to ensure that it details all the required Information as listed in Schedule 1 of the Care Standards Act. This will ensure all the relevant parties have the required information to reference and to protect residents. That the registered person ensures that that all service users in receipt of nursing care have a suitable height adjustable bed in place to meet their needs. This will ensure that their independence and safety is promoted. The registered person must ensure that there is a qualified, competent and experienced person in post to run the home and meet its stated purpose, aims and objectives. The appointed manager must apply for registration. Southdowns Nursing Home DS0000041644.V375926.R01.S.doc Version 5.2 Page 28 Timescale for action 30/08/09 2. OP24 16 (1) 30/08/09 3. OP31 9(1,2) 30/08/09 This will ensure that the service users live in a home which is managed by a person fit to be in charge and able to discharge his responsibilities fully. 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 OP3 Good Practice Recommendations That the pre- admission assessments are consistently completed with enough information to make a decision that the home can meet the prospective residents’ needs. That they are signed and dated on completion and include the people involved. The home should clarify the complaints procedure with residents and their relatives/representatives. That the home follow the robust procedures and policies in place for the recruitment of staff. 2. 3. OP16 OP29 Southdowns Nursing Home DS0000041644.V375926.R01.S.doc Version 5.2 Page 29 Care Quality Commission South West Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: 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. 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