Care Home: Steep House Nursing Home

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What the care home does well A relative commented, `we are very pleased with the care and attention mum gets, in particular that she has been provided with a special chair to keep her comfortable and in the correct position`. Steep House Nursing Home DS0000068710.V375199.R01.S.doc Version 5.2 The home provides a wide range of activities and events to provide interest and stimulation for the residents. The home`s vehicle enabled regular access to the local community, and a larger bus was hired for trips to the theatre, and to more distant places of interest. A resident commented, `keeping me active and entertained is something the home does well`, and another stated, `providing activities that include relatives is appreciated`. Residents, whose files were sampled, had memory diaries, which included photographs of their life histories, which their relatives had been involved in compiling to promote reminiscence. The home`s own quality assurance comments included, `I appreciate the twenty-four hour nursing care father receives and being immediately informed of changes to his health`, `I just wish there was a bigger word than `excellent`, need I say more?` `We are so pleased that my mother is at Steep House. She is very happy in all respects and we think the care and attention provided by your wonderful staff could not be bettered`, `nothing is too much trouble and you make my mother feel like an individual by the daily interest and support provided,` `we are impressed by the amount of activities you put in for the residents and visitors` and `it`s a pleasure to visit Steep House with its good hum of laughter and friendliness to the residents and visitors`. A resident wrote in the survey they completed, `Steep House gives me a wonderful warm and happy home` and a staff member commented, `It is a very happy place to work`. What has improved since the last inspection? Since the previous site visit pre-admission assessments had been reviewed to include more detail with respect to equality and diversity to ensure the individual needs of prospective residents are taken into consideration in the initial care planning exercise. The complaints procedure had been reviewed to include a more realistic timescale to report investigation findings back to the complainant and up to date contact details for the Care Quality Commission (CQC) had been included. Measures had been put in place to ensure that all staff receive training in the Protection of Vulnerable Adults and they had been provided with a clear local policy reflecting the local authority Safeguarding Adults Policy and Procedure to make them aware of their individual responsibility in preventing residents from being harmed, suffering from abuse or being placed at risk of harm or abuse. The building of a new wing had not only added sixteen bedrooms with en-suite facilities, but also included an extra lounge with a dining area, a quiet room for private meetings, a well-equipped laundry room, an extra large lift, good quality bath and wet room facilities and offices for the staff on all floors. Steep House Nursing Home DS0000068710.V375199.R01.S.doc Version 5.2 Since the previous site visit, the Skills for Care Common Induction Standards had been introduced and new staff had accessed this training. Evidence confirmed that staff employed at the home had received mandatory and specialist training appropriate to the work they perform and to meet the needs of the residents. Records confirmed that at least 50% of the staff had achieved a National Vocational Qualification at level 2 or above in Health and Social care or were working towards one. Since the previous site visit, a new manager had been appointed and had applied and been accepted as the Registered Manager for the home. What the care home could do better: No requirements or recommendations were made at this site visit. Key inspection report CARE HOMES FOR OLDER PEOPLE Steep House Nursing Home Tilmore Road Petersfield Hampshire GU32 2HS Lead Inspector Christine Bowman Key Unannounced Inspection 12th May 2009 10:30 DS0000068710.V375199.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. Steep House Nursing Home DS0000068710.V375199.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 Steep House Nursing Home DS0000068710.V375199.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Steep House Nursing Home Address Tilmore Road Petersfield Hampshire GU32 2HS 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) 01730 260095 01730 233038 steep@lrh-homes.com London Residential Healthcare Ltd Ms Marion Jane Flett Care Home 62 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0), Physical disability (0) of places Steep House Nursing Home DS0000068710.V375199.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: Old age, not falling within any other category (OP) Dementia (DE) 2. Physical disability (PD) The maximum number of service users who can be accommodated is 62. 28th May 2008 Date of last inspection Brief Description of the Service: Steep House is a care home, providing nursing and personal care for 62 older people, who may have physical disabilities, dementia or both. A major variation to increase the number of residents accommodated at the home, by 16 (from 46 to 62), was approved in March 2009. The large country house is situated in a peaceful, rural location on the outskirts of the market town of Petersfield, surrounded by gardens and woodland. The main route from London to the South Coast and a main route to Winchester are close by. The recent development of the home to include an additional wing has increased the number of single bedrooms with en-suite facilities to 44. Six double rooms are also available. Accommodation is on three floors and two passenger lifts allow access to all floors. Communal areas include two large lounges, one of which includes a dining area, a separate dining room, a reception area, and a quiet room. The new extension includes upgraded bathrooms, a new laundry and improved office accommodation over the three floors for the staff. The gardens, with patio areas around the home, are accessible to the services users with mobility needs. The current fee charged is £500-£800 per week. Steep House Nursing Home DS0000068710.V375199.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 the service experience good quality outcomes. This inspection report includes information gathered about the service since the previous site visit on 28th May 2008 under the Commissions Inspecting for Better Lives (ILB) process. The registered manager, Ms Marion Flett, completed an Annual Quality Assurance Assessment (AQAA) giving up-to-date factual evidence about the running of the home and informing us of what they think they are doing well, how they have improved the service and of their plans for further improvements. Residents completed six service user surveys, some with support from their relatives and representatives, giving their views on the running of the home. Three staff members and one healthcare professional also completed surveys, giving their views on the care and support given to the residents. An unannounced site visit was conducted by Ms Christine Bowman, Regulation Inspector, on 12th May 2009, to assess the outcomes of the key inspection standards for older people with respect to the residents living at the home. The registered manager was interviewed and provided support for the inspection process by making residents and staff files and other documents available to be sampled. A tour of the premises was undertaken and communal areas and some of the residents bedrooms were viewed. A number of staff and residents were spoken with throughout the day and observations were made of the residents and of staff as they carried out their duties. Residents and staff records, maintenance certificates and complaints and compliments records were sampled and the Statement of Purpose, the Service User Guide and some policies and procedures were viewed. Since the previous site visit, an application for a major variation to increase the number of residents accommodated at the home from 46 to 62 had been received by the CSCI on 6th January 2009. A site visit was carried out on 27th February by Registration Inspector Ms Isolina Riley to look at the suitability of a new extension to fulfil the needs of the sixteen additional older residents, who may have physical disabilities, dementia or both. Information gathered, recommendations, and matters for consideration at this site visit, have been incorporated in this report. What the service does well: A relative commented, we are very pleased with the care and attention mum gets, in particular that she has been provided with a special chair to keep her comfortable and in the correct position. Steep House Nursing Home DS0000068710.V375199.R01.S.doc Version 5.2 Page 6 The home provides a wide range of activities and events to provide interest and stimulation for the residents. The homes vehicle enabled regular access to the local community, and a larger bus was hired for trips to the theatre, and to more distant places of interest. A resident commented, keeping me active and entertained is something the home does well, and another stated, providing activities that include relatives is appreciated. Residents, whose files were sampled, had memory diaries, which included photographs of their life histories, which their relatives had been involved in compiling to promote reminiscence. The homes own quality assurance comments included, I appreciate the twenty-four hour nursing care father receives and being immediately informed of changes to his health, I just wish there was a bigger word than excellent, need I say more? We are so pleased that my mother is at Steep House. She is very happy in all respects and we think the care and attention provided by your wonderful staff could not be bettered, nothing is too much trouble and you make my mother feel like an individual by the daily interest and support provided, we are impressed by the amount of activities you put in for the residents and visitors and its a pleasure to visit Steep House with its good hum of laughter and friendliness to the residents and visitors. A resident wrote in the survey they completed, Steep House gives me a wonderful warm and happy home and a staff member commented, It is a very happy place to work. What has improved since the last inspection? Since the previous site visit pre-admission assessments had been reviewed to include more detail with respect to equality and diversity to ensure the individual needs of prospective residents are taken into consideration in the initial care planning exercise. The complaints procedure had been reviewed to include a more realistic timescale to report investigation findings back to the complainant and up to date contact details for the Care Quality Commission (CQC) had been included. Measures had been put in place to ensure that all staff receive training in the Protection of Vulnerable Adults and they had been provided with a clear local policy reflecting the local authority Safeguarding Adults Policy and Procedure to make them aware of their individual responsibility in preventing residents from being harmed, suffering from abuse or being placed at risk of harm or abuse. The building of a new wing had not only added sixteen bedrooms with en-suite facilities, but also included an extra lounge with a dining area, a quiet room for private meetings, a well-equipped laundry room, an extra large lift, good quality bath and wet room facilities and offices for the staff on all floors. Steep House Nursing Home DS0000068710.V375199.R01.S.doc Version 5.2 Page 7 Since the previous site visit, the Skills for Care Common Induction Standards had been introduced and new staff had accessed this training. Evidence confirmed that staff employed at the home had received mandatory and specialist training appropriate to the work they perform and to meet the needs of the residents. Records confirmed that at least 50 of the staff had achieved a National Vocational Qualification at level 2 or above in Health and Social care or were working towards one. Since the previous site visit, a new manager had been appointed and had applied and been accepted as the Registered Manager for the home. 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. Steep House Nursing Home DS0000068710.V375199.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 Steep House Nursing Home DS0000068710.V375199.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): Standards 3,6 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. Prospective residents have the information they need to make an informed decision about the suitability of the home to meet their needs, and the home carries out an assessment of the prospective residents needs to ensure they can be met at the home. EVIDENCE: The homes Service User Guide and Statement of Purpose gave detailed information about the home to help prospective residents, their relatives and representatives to make up their mind about its suitability to meet their needs. The Service user Guide was available in large print, audiotape or in other languages on request and contained comments made by residents about the Steep House Nursing Home DS0000068710.V375199.R01.S.doc Version 5.2 Page 10 home and photographs and drawings to illustrate the care and support provided. The registration report had recommended that the documents be amended to include the changes in numbers, accommodation and the name of the registered manager. This information had been added to provide up to date information to prospective residents. Five of the six residents, who completed surveys, confirmed that they had received enough information to help them decide if this home was the right place for them, before they moved in. The files of two residents, admitted since the previous site visit, were sampled. Since the previous site visit the pre-admission assessments had been reviewed to include more detail with respect to equality and diversity to ensure the individual needs of prospective residents were taken into consideration in the initial care planning exercise. Important information with respect to the prospective residents physical and health needs, including dietary preferences, mobility needs, continence, oral care, history of falls, communication and mental state were explored. Religious, cultural, social needs, interests, hobbies and family history had also been recorded. Full nursing assessments had been carried out by a Registered Nurse to ensure that specialist clinical requirements such as moving and handling equipment and equipment to reduce the risk of pressure sores had been made available for residents with these needs. Steep House Nursing Home DS0000068710.V375199.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): Standards 7,8,9,10 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 plans address the residents health, personal and social care needs and residents are involved in compiling them. Safe arrangements were in place for the handling of medication to protect the residents and the staff and the residents right to privacy was upheld and their dignity maintained. EVIDENCE: The two residents, whose files were sampled, had comprehensive care plans generated from the assessment documentation. Residents care needs and goals were recorded and the interventions to be carried out by the staff to meet those needs. One residents care plan recorded that their religion was Steep House Nursing Home DS0000068710.V375199.R01.S.doc Version 5.2 Page 12 Church of England and that they attended a church service on a regular basis. Each resident had a record of the activities of daily living, which was a guide to the care staff of the actions they needed to take, and recorded the likes and dislikes of the residents with respect to receiving the care provided. Care plans had been reviewed on a monthly basis and, when changes had been made, the care plans had been signed by relatives to confirm acceptance. Three of the six residents, who completed surveys, recorded that they always received the care and support they needed and three that they usually did. A relative commented, we are very pleased with the care and attention mum gets, in particular that she has been provided with a special chair to keep her comfortable and in the correct position. One residents dietary requirements included the need for foods to be pureed and for thickened fluids. Records showed that nutritional screening had been undertaken and an up-to-date record was kept of the residents weight. A resident had been admitted with a pressure sore and a plan was in place to ensure the resident was turned at two hourly intervals to promote healing and to prevent further sores from developing. Photographs had been taken to show the status of the sore and the healing process. Records confirmed that a General Practitioner had attended to this resident, that a specialist nurse had also attended and that the resident had been supplied with a special mattress to protect their fragile skin. Another residents psychological needs had been reviewed by a Community Psychiatric Nurse. Moving and handling and falls risk assessments had been carried out and equipment to promote mobility was recorded in residents care plans. Key worker meetings are held monthly, the manager stated, and residents are allocated a key nurse and key carers, and when the home is fully occupied, the staff will be working in three groups, according to the floors on which the residents live, to ensure continuity and consistency. All the residents, who completed surveys, confirmed that the home always makes sure they get the medical care they need. A healthcare professional, who completed a survey, recorded that the home always monitors, reviews and meets the social and health care needs of the residents properly, and that the home always seeks advice and acts upon it to meet the social and healthcare needs of the residents, to improve their well-being. Medication administration records inspected had been completed in a satisfactory manner, showing that residents had received the required dosage of their prescribed medication, as set out by their medical practitioners, and there were no unexplained gaps in the recordings. Medication was administered by the trained nurses, who had received training in the safe handling of medication. A controlled drugs register was held, two staff signed each time drugs were administered and running totals of remaining drugs were recorded. A sample of one residents medication, matched the totals recorded in the controlled drugs register. Medication was stored appropriately in a metal cabinet, secured to a Steep House Nursing Home DS0000068710.V375199.R01.S.doc Version 5.2 Page 13 wall, and a fridge was available to ensure that medication was stored at the correct temperature. Since the previous site visit, the Skills for Care Common Induction Standards had been introduced, and the staff training matrix showed all that all the care staff, recruited since that time, had accessed this training, which provides an introduction to the caring role, and promotes the residents rights to be treated as an individual, and have their right to privacy and dignity respected at all times. Visiting health and social care professionals could meet with residents in the privacy of their own bedrooms or in the new quiet room. The new bedrooms had been fitted with telephone points and a cordless telephone was also available to enable resident to receive private telephone calls in their bedrooms Steep House Nursing Home DS0000068710.V375199.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): Standards 12,13,14,15 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. Residents individual lifestyle experiences match their expectations and preferences. Their contact with relatives and friends, access to the local community, and choice and control over their lives is promoted. Residents are offered a wholesome, appealing and balanced diet, in pleasing surroundings. EVIDENCE: The homes activities organiser was on annual leave at the time of the site visit, but there was plenty of evidence of their innovative approach to providing a stimulating programme for the residents to enjoy, and good records were kept of their involvement. The weekly schedule, which was displayed on the notice board in the lounge area, included two hairdresser visits, live musical entertainment on the piano and the guitar, trips out to local places of interest, bingo, manicure and hand massage, music and movement, film matinee and quizzes. A poster invited residents, their family and friends to Steep House Nursing Home DS0000068710.V375199.R01.S.doc Version 5.2 Page 15 a Spring Picnic and a newsletter, included photographs and a write up on recent social activities and events. These included a visiting farm, Valentines Day tea, a Western theme day with line dancing and fancy dress, Mothering Sunday and Easter celebrations, and trips to Staunton Park and Winchester Cathedral. A forthcoming theatre trip to see Guys and Dolls was advertised, the date of the next visit from the mobile library, and the minutes of the last residents meeting were posted for all to see. An electronic board in the reception area also displayed the weekly activities and forthcoming events to inform residents, their relatives and friends. Three of the six residents, who completed surveys, thought that the home always arranges activities that they can take part in if they want to, and the other three recorded that it usually did. Comments included, keeping me active and entertained is something the home does well, and providing activities that include relatives is appreciated. Residents, whose files were sampled, had memory diaries, which included photographs of their life histories, which their relatives had been involved in compiling. Daily records of residents interests and participation in group, and one to one activities, were also viewed in files sampled, confirming that individuals were supported to attend church services, according to their wishes, and that social interaction was promoted. The AQAA recorded that, visitors are welcome and can be entertained in residents own rooms if they wish. The new accommodation also included a quiet room, which provided a private space, which could be used for private meetings. Each of the three lounges contained televisions, videos and DVDs offering a choice of entertainment for the residents. The two dining areas provided pleasant and comfortable spaces for the residents to enjoy their meals. The manager stated that, the menus are changed on a five week rolling rota and demonstrate a wide variety of choice at each meal. Picture cards are used to enable residents with dementia or communication needs to make choices. Residents were observed enjoying their lunch. Most of the residents in the dining room were able to eat independently, but sensitive support was offered by the staff, to residents who required intervention. Pureed food, arranged attractively, was available for those needing soft diets, and fortified food supplements in a variety of different flavours, made receiving a balanced diet more interesting for those who were not able to access the full menu. One of the six residents, who completed surveys, recorded that they always liked the meals at the home, and five that they usually did. A system of comment cards for feedback on meals was used to evaluate them and to keep the cooks informed of their popularity. Drinks and snacks, including fresh fruit, were available in the lounges throughout the day. Steep House Nursing Home DS0000068710.V375199.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16,18 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. Residents, their relatives and representatives are confident their complaints will be listened to, taken seriously and acted upon and measures are in place to protect them from abuse. EVIDENCE: The complaints procedure was available in the service user guide and on notice boards throughout the home to inform the residents, their relatives and representatives on the process to follow should they wish to make a complaint. The procedure had been reviewed to include a more realistic timescale to report investigation findings back to the complainant and the up to date contact details for the Care Quality Commission (CQC) had been included. The AQAA recorded that four complaints had been received over the previous twelve months, that they had been responded to within twenty eight days and that one had been upheld. The six residents, who completed surveys, recorded that there was someone they could speak to informally if they were not happy and five confirmed they Steep House Nursing Home DS0000068710.V375199.R01.S.doc Version 5.2 Page 17 knew how to make a formal complaint. Records sampled, confirmed that complaints had been responded to appropriately. The home had also received a number of compliments including, to all the staff – You have been so good to our relative during his stay with you. Thank you for your patience and understanding, it means a lot, I would like to express my thanks for the wonderful care, that mum received from Steep House. Her last twelve months brought her so much joy and happiness, and we would like to thank the team at Steep House for the wonderful way mum was cared for during her time with you. It was lovely to know she was so well looked after. Measures had been put in place to ensure that all staff received training in the Protection of Vulnerable Adults and they had been provided with a clear local policy reflecting the local authority Safeguarding Adults Policy and Procedure to make them aware of their individual responsibility in preventing residents from being harmed, suffering from abuse or being placed at risk of harm or abuse. Over the last twelve months, the AQQA recorded that there had been two Safeguarding Investigations, which the home had responded to appropriately. A social care professional recorded in the survey they completed, the team has been working with Steep House to improve care standards over the last eighteen months, and as a team, we have seen significant improvement in the standards. Steep House Nursing Home DS0000068710.V375199.R01.S.doc Version 5.2 Page 18 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): Standards 19,26 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. Residents live in safe and well-maintained environment, which meets their needs and is pleasant, clean and hygienic. EVIDENCE: The large country house, which had been adapted to provide nursing care for sixty two elderly residents, was situated in a rural position in the village of Steep and accessed by a drive, which was well maintained. A good-sized car park, adjacent to the entrance of the home, was included in the pleasant, mature grounds, which surrounded it. The reception area was a conservatory which provided seating for visitors and residents and was manned by an Steep House Nursing Home DS0000068710.V375199.R01.S.doc Version 5.2 Page 19 administrator. Blinds had been pulled down to protect the residents from the heat of the sun and a French door was open to the enclosed garden. A digital screen welcomed visitors and gave them important information about the home. The menu of the day was also displayed here along with hard copies of information about the home. A partial tour of the home, which included the communal spaces, the new laundry, and some of the residents bedrooms, was undertaken. The communal spaces had been expanded since the previous site visit, by the completion of a building project to add a new wing to the home. The two large lounge areas provided light, bright and comfortable spaces in which the residents could relax and enjoy pleasant views of the surrounding gardens and woodlands beyond. The large sitting rooms were divided into sections around a central area. These spaces were open to walk through, but provided separate areas for groups of residents to gather or sit with their visitors. Comfortable seating was arranged around the rooms and occasional tables had been supplied with bowls of fruit and drinks. A staff member is always on hand to provide support and to ensure fluid charts are kept up to date, the manager stated. The good quality soft furnishings were colour co-ordinated and there was a pleasant, calm and peaceful ambiance. Large windows provided natural light and modern ceiling spotlights enhanced this, giving the room a light and airy feel. Large widescreen televisions and a good supply of videos, DVDs and books provided entertainment for the residents. The new lounge incorporated a dining area with laminated flooring and circular tables, set for four to enable the residents to socialise. A resident was observed being sensitively supported to eat their lunch in this area. A smaller, quiet room was also available for the residents to use. It was equipped with suitable seating and provided with a television and domestic lighting. This room provided a space where confidential meetings could be conducted in private and for residents to entertain their visitors. The garden, which was fenced around the perimeter for safety, included a terrace with outdoor seating, sunshades, and raised flower beds for the enjoyment of the residents. The original dining room had been extended by using the area, which had been a nurses station, to include extra tables. This area had been refurbished to match the dining room. Bedrooms in the new wing had been built with en-suites (toilets and hand basins only). Occupied residents bedrooms had been appropriately personalised. Some residents had brought items of their own furniture, pictures, photographs, decorative items such as ornaments and lamps and had their own televisions, radios and telephones. The furniture provided by the home was attractive and of good quality. Adjustable beds were seen in residents bedrooms and the manager stated that the home was in the process Steep House Nursing Home DS0000068710.V375199.R01.S.doc Version 5.2 Page 20 of replacing all beds with these models, which supported residents mobility needs and facilitated carers in the carrying out of personal care tasks. The new lift was large enough to accommodate a stretcher, and the three new bathrooms, one on each floor, were also spacious. Assisted baths had been provided on the ground and first floor and a large wet room shower facility had been provided on the second floor. The large laundry, located on the ground floor, was well equipped with two industrial washing machines and two industrial tumble dryers. In this area, and throughout the home, good hygiene practices were observed. Infection control equipment was available, in the form of aprons and gloves, liquid soap, hand gel, paper towels and pedal bins. The staff training matrix confirmed that the majority of staff had accessed infection control training over the previous year and the AQQA recorded that policies and procedures had been reviewed to keep the staff up to date with current practise. Five of the six residents, who completed surveys, thought the home was always fresh and clean and one that it usually was. A healthcare professional wrote in a survey that the thought the home was particularly clean. Steep House Nursing Home DS0000068710.V375199.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): Standards 27,28,29,30 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. Sufficient, safely recruited, trained staff and competent staff provide care to the residents and fulfil their needs. EVIDENCE: The manger had increased the staffing levels to provide a, one to four ratio, of staff to residents over the last twelve months. The staff rota recorded that two Registered General Nurses (RGNs) were on duty twenty four hours per day and that senior management was supernumerary. Between six and eight carers were on duty in the daytime and four at night. Additional staff included an activities co-ordinator, an administrator, a housekeeper, two assistant housekeepers, a chef, an assistant chef, kitchen assistants, a laundry assistant and a maintenance person. Plans were in place to increase the staffing levels as new residents were admitted to the new wing, to three RGNs and eight to ten carers during the day, and 2 RGNs and six carers at night. There were thirty eight residents living at the home at the time the AQAA was completed. Two of the six residents, who completed surveys, confirmed that the staff were Steep House Nursing Home DS0000068710.V375199.R01.S.doc Version 5.2 Page 22 always available when they needed them and four recorded that they usually were. Comments included, they look after us very well, the home does everything well, the staff are helpful, and the home is like a hotel with happy nurses. The AQAA recorded that fifteen of the twenty one care staff had achieved a National Vocational Qualification at level 2 or above in Health and Social Care and that four were working towards one. This is above the 50 target set to be achieved in the National Minimum Standards. The staff training matrix recorded that the cook and a kitchen assistant had also achieved a NVQ at level 2/3 in Catering. The staff personnel files of two staff, recruited since the previous site visit, were sampled. Personnel files were very well organised and information, confirming that recruitment checks had been carried out satisfactorily, was easy to locate. Three staff, who completed surveys, also confirmed their employer had carried out checks, such as Criminal Record Bureau checks and references, before they started work. An on-going recruitment campaign had provided a better balance of local and overseas carers. Since the previous site visit, the Skills for Care Common Induction Standards had been introduced, in addition to the homes own induction. The staff training matrix showed all that all the care staff, recruited since the previous site visit, had accessed this training, which provides an introduction to the caring role and promotes the residents rights to be treated as an individual with respect to their equality and diversity issues. The staff training matrix recorded that the staff had benefited from accessing Moving and Handling, Fire Safety, Safeguarding Adults, Food Hygiene, Health and Safety (including the Control of Substances Hazardous to Health (COSHH), the Mental Capacity Act, Dementia Awareness and Equality and Diversity. Most of the staff had received training in Challenging Behaviour and Infection Control, and sufficient staff had been trained in First Aid to ensure there would always be a trained person on duty in an emergency. The manager stated that the Registered Nurses attended specialist training in wound care, care planning, the administration of medication, end of life care and other clinical practice to keep themselves up to date with current practice. A staff member commented, all the carers are well trained and provide a good standard of care, another thought, there is good team work, and a third, I feel the home is very much a home to a lot of our clients and they seem happy to be there. I feel that we treat people as individuals and recognise their diversity. A health care professional recorded in the survey they completed, I find the staff kind and sympathetic to the needs of their clients. Steep House Nursing Home DS0000068710.V375199.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): Standards 31,33,35,38 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. Residents live in a well managed home, in which their opinions are sought and acted upon for the improvement and development of the service. Effective systems are in place to promote the residents health, safety and welfare creating a safe environment for them to live in. EVIDENCE: Since the previous site visit, a new manager had been appointed and had applied and been accepted as the Registered Manager for the home in July Steep House Nursing Home DS0000068710.V375199.R01.S.doc Version 5.2 Page 24 2008. Ms Marion Flett was well qualified, having achieved a National Vocational Award (NVQ) at level 4 in Care, and the Registered Managers Award (RMA). She had many years of experience of working with older people in residential settings, but was not a Registered General Nurse (RGN). To provide a clinical lead for the nurses and to support the manager, two RGNs had been appointed to the Head of Care position. One RGN had also achieved an NVQ Award at level 4 and the RMA, and had been promoted within the home. The more recently recruited Head of Care had more than 25 years of experience in nursing care in residential settings and was in the process of completing the NVQ at level 4 in Care and the RMA. A system was in place to ensure the views of the residents, their relatives, representatives and other stakeholders were sought. Completed quality assurance questionnaires had been returned to the home and were available to be viewed. Seventeen of the forty five surveys sent out, had been returned with a high level of satisfaction recorded. A high proportion of scores of excellent were achieved for attitude to residents and visitors, care and attention to the needs of the residents and environmental cleanliness. Comments included, I appreciate the 24 hour nursing care father receives and being immediately informed of changes to his health, I just wish there was a bigger word than excellent, need I say more? We are so pleased that my mother is at Steep House. She is very happy in all respects and we think the care and attention provided by your wonderful staff could not be bettered, nothing is too much trouble and you make my mother feel like an individual by the daily interest and support provided, we are impressed by the amount of activities you put in for the residents and visitors and its a pleasure to visit Steep House with its good hum of laughter and friendliness to the residents and visitors. Regular newsletters also kept residents, their relatives and representatives up to date with respect to events and information about the home and regular meetings were also held for residents to enable them to give their views on the running of the home. The home did not manage any of the residents money. The administrator sent invoices to their representatives for all financial transactions. A lockable facility was available to residents in their bedrooms and they were advised to keep only small amounts of cash in the home. The health, safety and welfare of the residents was promoted by staff training in moving and handling, fire safety, first aid, food hygiene and infection control. The staff training matrix confirmed that mandatory training had been accessed by the majority of the staff within the previous twelve months. The Annual Quality Assurance Assessment, completed by the manager recorded that policies and procedures with respect to health and safety were in place to keep the staff informed, and that the essential maintenance of equipment had been carried out according to manufacturers recommendations to ensure it Steep House Nursing Home DS0000068710.V375199.R01.S.doc Version 5.2 Page 25 was safe to use. A sample of certificates, seen on the day of the site visit, confirmed that maintenance checks had been carried out in a timely fashion. Steep House Nursing Home DS0000068710.V375199.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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Steep House Nursing Home DS0000068710.V375199.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Steep House Nursing Home DS0000068710.V375199.R01.S.doc Version 5.2 Page 28 Care Quality Commission Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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