Care Home: The Carnarvon Nursing Home

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What the care home does well The standards of nursing and personal care are good. There is good access to specialist health care through visits from health professionals and attendance at outpatient appointments. Tissue viability needs are fully assessed and preventative measures taken to prevent further breakdown and encourage healing. There is appropriate provision of specialist pressure relief equipment and good access to specialist advice. There is a good range of equipment to aid daily living, for example provision of perch stools. Standards of assessment and care planning are robust with regular review of needs undertaken. A relative told us `the staff overall give a high level of concern and care for the residents, very often above what one could expect`. Food menus are widely consulted with residents, choices accommodated and efforts made to ensure nutritional needs are appropriately met. We received the following comments from residents, `the salads especially are super`; `the food is like home cooking and attractively presented`; ` they make lovely puddings`. Staff work well as a team and are viewed as friendly by residents and their relatives. Social activities are a main feature of the home and themed events enhance residents` daily lives. Residents are encouraged to personalise their rooms, for example some residents have their own furniture or fridge. The home`s atmosphere is friendly and welcoming. Residents are able to have their own pets, subject to a risk assessment (i.e. one resident has a dog and the home has a cat). Relatives and family members are made welcome and visiting times are unrestricted. What has improved since the last inspection? Pre-admission assessments have improved with the introduction of the QUEST assessment tool (now updated to include the Mental Health Act). Staffing levels were observed to be sufficient to meet the needs of residents during the site visit having an additional registered nurse on shift since the previous key inspection. However one resident reported having to wait longer than they would like to receive assistance during the morning. A recommendation to this effect has therefore been made. There is an improved range and choice of stimulating activities offered by staff that are motivated and who encourage residents to take part. Storage of medication had improved. Risk assessment for bed rails was undertaken and recorded. Training records had improved and included a training matrix to evidence courses held and staff who had attended. Food choices were on offer with ` night bites` available for residents out of hours. What the care home could do better: CARE HOMES FOR OLDER PEOPLE The Carnarvon Nursing Home 22-24 Carnarvon Road Clacton on Sea Essex CO15 6QF Lead Inspector Diana Green Unannounced Inspection 19th August 2008 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Carnarvon Nursing Home DS0000015320.V370339.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Carnarvon Nursing Home DS0000015320.V370339.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Carnarvon Nursing Home Address 22-24 Carnarvon Road Clacton on Sea Essex CO15 6QF 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) 01255 426628 F/P 01255 426628 www.bupa.co.uk BUPA Care Homes (ANS) Ltd Ms Carol Anne Johnson Care Home 57 Category(ies) of Old age, not falling within any other category registration, with number (20), Physical disability (14), Physical disability of places over 65 years of age (57), Terminally ill (3), Terminally ill over 65 years of age (3) The Carnarvon Nursing Home DS0000015320.V370339.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 57 persons) Persons of either sex, aged 45 years and over, who require nursing care by reason of a physical disability (not to exceed 11 persons) Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 20 persons) Persons of either sex, aged between 60 - 65 years, who require nursing care by reason of a physical disability (not to exceed 3 persons) Three persons, over the age of 45 years, who require nursing care by reason of a terminal illness The total number of service users accommodated in the home must not exceed 57 persons 24th September 2007 Date of last inspection Brief Description of the Service: The Carnarvon Nursing & Residential Home is in the seaside town of Clacton on Sea and is accessible via public transport that passes the front of the premises. The home is a former Victorian hotel that has been extended and modified. The nearest railway station is Clacton, which is within easy walking distance, as is the seafront. The home has a small amount of car parking spaces to the front of the home. The home provides care for older people of both sexes, who need both personal and nursing care. The home is also registered to provide nursing care, for up to 14 service users, aged 45 years and above with a physical disability, within the total bed compliment of 57. There are three floors accessible by stairs and a lift. All rooms are well furnished and pleasantly decorated. Bedrooms are all 10sqm or over. There is a large combined lounge/ dining room leading out onto a small, but well maintained garden. Various outings and shopping trips are organised for service users and regular entertainment is provided. The proprietor of this home is BUPA Homes Ltd. Current fees range is: £383.04 to £660. Additional costs apply for chiropody, toiletries, sundries, hairdressing and newspapers. This information was provided to CSCI on 19/08/08. The home has a statement of purpose and service user’s guide available. The Carnarvon Nursing Home DS0000015320.V370339.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 3 star. This means the people who use this service experience excellent quality outcomes. This was an unannounced key inspection lasting 6 hours and took place on 19th August 2008. All of the Key National Minimum Standards (NMS) for Older People, and the intended outcomes, were assessed in relation to this service during the inspection. The report has been written using accumulated evidence gathered prior to and during the site visit, including the home’s Annual Quality Assurance Assessment (AQAA) and surveys distributed to residents, relatives, staff, and health and social care professionals. The Annual Quality Assurance Assessment (AQAA), a self-assessment that focuses on how well outcomes are being met for people using the service, was completed by the home and returned to us prior to the visit to the home. Information received in the AQAA provided us with some detail to assist us in understanding how the registered persons understand the service’s strengths and weaknesses and how they will address these. The inspection process included reviewing documents required under the Care Home Regulations. A number of records were looked at relating to the residents, staff recruitment and training, staff rotas and policies and procedures. The inspection process included: discussions with the Head of Nursing, the administrator, four residents, four care staff, one relative and feedback from health and social work professionals; a tour of the premises including a sample of residents’ rooms, bathrooms, communal areas, the kitchen, the laundry/sluice-room; an inspection of a sample of policies and records (including any records of notifications or complaints sent to the CSCI since the last inspection. The staff were welcoming and helpful throughout the inspection. What the service does well: The standards of nursing and personal care are good. There is good access to specialist health care through visits from health professionals and attendance at outpatient appointments. Tissue viability needs are fully assessed and preventative measures taken to prevent further breakdown and encourage The Carnarvon Nursing Home DS0000015320.V370339.R01.S.doc Version 5.2 Page 6 healing. There is appropriate provision of specialist pressure relief equipment and good access to specialist advice. There is a good range of equipment to aid daily living, for example provision of perch stools. Standards of assessment and care planning are robust with regular review of needs undertaken. A relative told us ‘the staff overall give a high level of concern and care for the residents, very often above what one could expect’. Food menus are widely consulted with residents, choices accommodated and efforts made to ensure nutritional needs are appropriately met. We received the following comments from residents, ‘the salads especially are super’; ‘the food is like home cooking and attractively presented’; ‘ they make lovely puddings’. Staff work well as a team and are viewed as friendly by residents and their relatives. Social activities are a main feature of the home and themed events enhance residents’ daily lives. Residents are encouraged to personalise their rooms, for example some residents have their own furniture or fridge. The home’s atmosphere is friendly and welcoming. Residents are able to have their own pets, subject to a risk assessment (i.e. one resident has a dog and the home has a cat). Relatives and family members are made welcome and visiting times are unrestricted. What has improved since the last inspection? Pre-admission assessments have improved with the introduction of the QUEST assessment tool (now updated to include the Mental Health Act). Staffing levels were observed to be sufficient to meet the needs of residents during the site visit having an additional registered nurse on shift since the previous key inspection. However one resident reported having to wait longer than they would like to receive assistance during the morning. A recommendation to this effect has therefore been made. There is an improved range and choice of stimulating activities offered by staff that are motivated and who encourage residents to take part. Storage of medication had improved. Risk assessment for bed rails was undertaken and recorded. Training records had improved and included a training matrix to evidence courses held and staff who had attended. Food choices were on offer with ’ night bites’ available for residents out of hours. The Carnarvon Nursing Home DS0000015320.V370339.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Carnarvon Nursing Home DS0000015320.V370339.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 The Carnarvon Nursing Home DS0000015320.V370339.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good based upon sampled inspected standards 1 and 3. Standard 6 does not apply to this service. Residents were well informed, and had their needs fully assessed prior to moving in to the home to ensure they could be appropriately met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s statement of purpose and service user guide are combined in one document that had been produced for registration of the service. A copy was displayed in the entrance of the home for visitors’ information and was viewed during the site visit and confirmed to meet regulatory requirements. We were told that all residents were provided with a resident’s information pack on admission to the home detailing the facilities provided and a copy of this was also viewed during the site visit. Five residents who completed surveys stated they had received sufficient information to enable them to make a decision about moving into the home. The Carnarvon Nursing Home DS0000015320.V370339.R01.S.doc Version 5.2 Page 10 The Head of Nursing stated that she or the manager undertook pre-admission assessments either at home or hospital where possible to ensure needs could be met at the home. Care management assessments were obtained where relevant and seen on the care records viewed. Residents were also invited to the home for lunch or coffee to enable them to meet with staff and residents before deciding if the home was suitable for them. The AQAA stated that a comprehensive pre-admission assessment ‘QUEST’ documentation had been introduced that had proved to be a valuable tool to assist in gathering more comprehensive information and now include the Mental Capacity Act. This was seen on the assessments viewed and a copy was provided during the site visit. The home does not provide intermediate care. The Carnarvon Nursing Home DS0000015320.V370339.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good based upon sampled standards 7, 8, 9, 10 and 11. People living at Carnarvon Nursing Home can expect to have their health and personal care needs well met through care planning that is closely monitored and regularly reviewed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four residents’ care files were viewed. All files contained a pre-assessment form completed prior to admission and used to develop care plans. Additional individual assessments had been completed in regard to specific needs (e.g. risk of falls, moving and handling, continence, nutrition, skin condition, etc.) and regularly reviewed. The records included evidence that nutritional intake was monitored with weight monitoring undertaken two weekly and appropriate action taken to provide supplements as needed. A range of care plans were present on the care files viewed, and these contained a good level of detail of the action required by staff to help the person meet their needs. The Carnarvon Nursing Home DS0000015320.V370339.R01.S.doc Version 5.2 Page 12 The records confirmed evidence of good monitoring of health care needs with prompt referral to GPs and health care professionals and appropriate follow up action being taken. The AQAA stated that the service had strong links with the Primary Care Trust (PCT) for tissue viability with two link tissue viability nurses at the home. There was also good liaison with the local hospice and plans for staff to undertake palliative care training. The records confirmed that residents were enabled access to chiropodists, dentist, district nurses, GPs and opticians. A resident who completed a survey told us ‘I can’t fault the care I get’. The medication systems were discussed with the Head of Nursing during the site visit. The home had a medication policy and procedures that were available for staff guidance and had recently been updated. Registered nurses administered all medication at the home and all had current NMC registration. The suppliers had recently changed due to some issues (incorrect labelling) and was now supplied through another pharmacy in pre-dispensed packs and individual containers. Appropriate ordering and disposal procedures were in place. Supplies were stored in locked trolleys on each of the three floors of the home; all trolleys were secured to the wall as required. The ground floor medication system only (located in the clinical room) was observed at the site visit. Additional storage was provided in wall cupboards and a Controlled Drugs (CD) cupboard . The drug fridge was also stored in the clinical room and regular monitoring and recording of room and refrigerator temperatures were undertaken ensuring medication was stored within safe recommended levels. Medication administration records and supplies for four residents were inspected. All medication with exception of one item was available as prescribed and the medication administration records (MAR) were well recorded. However one item had been recored as given but was still present in the blister pack. Medicines with a short shelf life did not always have the date of opening recorded to ensure they were taken within date. CD drugs were recorded in the CD register and advice was given to ensure that the name as well as the address was recorded on receipt and disposal. During the site visit, staff were observed to be friendly towards residents whilst treating them with courtesy and dignity. One resident who completed a survey told us ‘the staff are all kind to me’ and when asked what the service does well? a relative told us ’allows residents to maintain their dignity and provides a clean and homely atmosphere. The Carnarvon Nursing Home DS0000015320.V370339.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good based upon sampled inspected standards 12, 13, 14 and 15. People living at Carnarvon Nursing Home can expect to mantain contact with their family and friends and to have a lifestyle that satisfies their cultural expectations and needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Discussions were held with the home’s activities co-ordinator during the site visit. She explained that she worked 20 hours per week and a second coordinator worked 18 hours per week. A weekly programme of activities was displayed for residents and visitors’ information. This was seen to include a range of group and individual activities comprising craftwork, painting, quizzes, scrabble, bingo and crosswords. Entertainment was arranged twice a month and included singers, musicians playing the piano, drums. Karaoke was arranged for residents to join in. Themed activities were organised, for example a John Wayne quiz on his birthday. During the site visit a board was observed displaying different games representing the Olympic games. We were told that a ceremony was being arranged to award prizes and certificates to residents. The Carnarvon Nursing Home DS0000015320.V370339.R01.S.doc Version 5.2 Page 14 Relatives were invited to help with some activities and volunteers helped to take residents on outings to the seafront etc. The activities co-ordinator said that they had attended an annual training day named ‘Activities Best’ that was organised by BUPA where they exchanged ideas with other activities co-ordinators employed by the company. Residents interests were discussed with them following admission and efforts made to provide an activity they enjoyed. Relatives were requested to help produce a ‘map of life’ to give information of the resident’s life history and inform staff of their life experiences. There were various photographs displayed around the home showing activities that had taken place throughout the year and during the site visit several residents were observed taking part in a discussion reviewing newspapers. Five residents completed surveys and one told us ‘I like going out on the mini bus and playing bingo’ and another said ‘I enjoy playing bingo and board games’. Two relatives completed surveys and one told us ’they always try to improve the quality of life for residents’. The home’s statement of purpose included the policy on visiting. Several relatives including some with children were observed visiting during the site visit. Several visitors were seen to come and go throughout the inspection. The home’s statement of purpose and service user guide detailed the arrangements made for residents to maintain their faith by representatives of different faiths attending the home as relevant. The AQAA stated that use of the QUEST pre-admission assessment tool had provided staff with an awareness of residents’ spiritual and cultural needs. Residents’ records viewed also confirmed how the service planned to meet residents’ religious and cultural needs. Residents were observed to have some choice about their daily life in the home, especially in regard to where they spent their day, ate their meals etc. Many of the rooms seen were well personalised, showing that people could bring their own possessions into the home with them. Information on advocacy services was included in the statement of purpose and available in the home. The menus were discussed with the chef and were seen to include a varied range of healthy option meals that included the recommended five fruit and vegetables per day with alternatives available. Specialist diets (diabetic, soya, soft, liquidised and vegetarian) were currently provided. The chef explained that he attended residents meetings where the choice of meals was reviewed with them and suggestions made. The meeting was usually followed by cheese and wine. A full choice of alternatives was made available and a list of food for ‘night bites’ was offered to residents. The AQAA stated that all residents were assessed on admission using the Malnutrition Universal Screening Tool (MUST) to identify their needs and ensure their nutritional intake was specific to their needs. Residents spoken with said they enjoyed the food at the home. A resident who completed a survey said ‘they make lovely salads’ and another said ‘the food is like home cooking and attractively presented’. The Carnarvon Nursing Home DS0000015320.V370339.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good based upon sampled inspected standards 16 and 18. People living at Carnarvon Nursing Home can expect to have their complaints listened to and acted upon and to be protected from abuse by robust policies, procedures, staff training and practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a complaints procedure that was included in the statement of purpose/service user guide and displayed in the entrance of the home. The procedure included the timescales within which complainants can expect a response. We were told that all complaints are now referred through the Regional Manager for investigation. The AQAA stated that during the last twelve months BUPA Care Homes have employed a Director of Quality and Compliance and have a national team of quality and compliance experts who are responsible for promoting quality and achieving best practice within the care homes. The AQAA also stated that the manager operated an open door policy to enable residents and their representatives to feel comfortable to raise any issues. A resident also told us ‘Carol visits my room most days to see if I am happy’. Discussions were held with the Head of Nursing during the site visit with regard to the home’s safeguarding procedures. The home had comprehensive policy and procedures and whistle blowing procedures that were kept under regular review and were viewed. Information/guidance for staff published by the Essex The Carnarvon Nursing Home DS0000015320.V370339.R01.S.doc Version 5.2 Page 16 Safeguarding Authority was available but not the recently reviewed local Essex procedures and advice was given to obtain this guidance. There had been no allegations made since the previous inspection. From previous knowledge of the manager and feedback from health and social care professionals it was evident that any allegations would be appropriately referred. The Carnarvon Nursing Home DS0000015320.V370339.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate based upon sampled inspected standards 19, 22 and 26. People living at Carnarvon Nursing Home can expect to live in a comfortable, homely environment that is generally well maintained but is in need of redecoration and refurbishment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was made during the site visit that included communal areas, several bathrooms, and a number of residents’ rooms, the kitchen, the sluices, clinical rooms and the laundry. There were some maintenance issues that had been on hold until the maintenance person returned from sick leave and were being addressed at the time of the site visit. The home was in a poor state of decoration. Paintwork generally looked tired throughout with damage from equipment evident in corridors and residents’ rooms. Carpets were worn and shabby in several areas. We were told that a full refurbishment of the home was planned in the next year. The Carnarvon Nursing Home DS0000015320.V370339.R01.S.doc Version 5.2 Page 18 Some electrical light fittings were in the process of being changed in preparation for this and were causing some disruption, particularly impacting on communal space and equipment storage. This was taken into account during the inspection. The gardens were located to the rear of the premises and had a large patio area with tables and seating for residents and raised beds and were fully accessible to wheelchairs. Records provided evidence that the building complied with the requirements of the local fire and environmental health department. The home had stairs and a passenger lift to enable access throughout the premises. There were grab rails and aids in bathrooms and toilets to meet the needs of residents. Assisted baths and toilets were provided. Since the previous inspection a wet room had been provided. Call systems were provided throughout all individual and communal rooms. A range of specialist pressure relief equipment was available to meet the needs of residents. All equipment was serviced as per manufacturers recommendations and confirmed from the records inspected. The home was generally clean although some bathrooms and en-suites required further attention. There were no malodorous smells evident apart from one room that smelled of urine. From discussion with the Head of Nursing it was clear that the continence needs of the resident were being addressed, but efforts were still needed to remove the smell remaining from the carpet. The laundry was not inspected during the site visit. However all linen and personal clothing was observed to be well laundered. The home had three sluices, one on each floor of the home with mechanical sluices in each of them. Staff hand washing facilities (liquid soap and paper towels) were provided in clinical areas and in rooms where personal care was provided to ensure adherence to safe infection control practices. A relative told us ‘generally the overall conditions are very good although very often there is a lack of hand towels in the toilet in the room and the commode is very often not cleaned out properly’ and a resident told us ‘the girls are very chatty when they clean, that’s nice’. The Carnarvon Nursing Home DS0000015320.V370339.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good based upon sampled inspected standards 27,28, 29 and 30. People living at Carnarvon Nursing Home can expect to be cared for by a stable and skilled staff team who are employed in sufficient numbers to meet their needs at most times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were fifty-four residents at the home. Staffing levels comprised three registered nurses and eight care assistants. We were told that an additional registered nurse had been employed on shift since the previous inspection. From inspection of the staff duty rota and observation, there was evidence that staffing levels were well maintained and met the needs of residents. However one resident said ‘I have to wait longer than I would like when I need the toilet in the morning”. Staffing levels and deployment of staff should therefore be reviewed to ensure there are sufficient at key times to ensure residents do not have to wait unduly to receive assistance. Ancillary staffing comprised of an administrator, a maintenance person, one chef, one catering assistant, one laundry assistant and three domestic staff. A resident told us ‘they are very kind to me’ and ‘I am very happy here’ and another told us ‘even when I have not rang they still pop in to see me’. The Carnarvon Nursing Home DS0000015320.V370339.R01.S.doc Version 5.2 Page 20 The AQAA stated that the home employed 28 care staff of which 15 had NVQ level 2 qualifications or above which is marginally below the 50 needed to meet the standard. The percentage of staff with NVQ level 2 training or equivalent was therefore less than the 50 needed to meet the standard. The home also employed registered nurses and a further 3 care staff were undertaking NVQ level 2 training. The recruitment files for three members of staff that had been employed since the previous key inspections were viewed. These included evidence that the required checks had been obtained (two satisfactory references, CRB/POVA checks) and evidence of identification and photographs obtained before the individuals commenced employment at the home. The file also included evidence that the home’s induction had been provided to Skills for Care standards. The records confirmed that training had been provided in fire safety, manual handling and health and safety as is required for all staff. The home had an established training programme and a designated trainer. The training records were viewed and confirmed that since the previous key inspection a good range of training had been provided. This included abuse awareness/safeguarding adults, basic food hygiene, pressure area care, fire safety, understanding dementia care, infection control, moving and handling, tissue viability, Parkinson’s Disease and health and safety. The AQAA stated that BUPA Care Homes had a ‘Personal Best’ programme that encourages care staff to provide a ‘truly individual ‘ service to residents and that had won the Chartered Institute of Personnel and Development Annual People management Award. Staff awareness training on understanding cultural, ethnic, spiritual, religious and other needs are incorporated into the ‘Personal Best/Abuse ‘ training. The Carnarvon Nursing Home DS0000015320.V370339.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent based upon sampled inspected standards 31, 33, 35, 36, 37 and 38. Carnarvon Nursing Home is well managed and run in the best interests of residents. The health and safety of residents and staff is promoted by robust policies, procedures and practices at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is an experienced registered nurse with considerable experience of management both in the health service and independent sector and had managed the home for a number of years. The home’s manager was on holiday at the time of this inspection and the Head of Nursing was covering her position. Residents spoken with said they regularly saw the manager and felt the home was well managed. The Carnarvon Nursing Home DS0000015320.V370339.R01.S.doc Version 5.2 Page 22 One resident who completed a survey told us ‘I see the manager every day when she does her rounds’ and another told us ‘Carol visits me most days’. The senior nurse explained the quality assurance programme. This included an annual resident customer satisfaction survey to obtain the views of residents on how they were satisfied overall and in areas for example in staffing, being treated as an individual, cleanliness, food, activities and the environment. A copy of this was provided during the site visit. We were told that the manager then produced an action plan from the report ensuring continuous improvement of the service. The AQAA stated that the following changes had been made as a result of consultation with residents and their representatives with meals, holding newspaper reviews and providing the activities programme in larger print. The arrangements for handling resident’s monies were discussed with the administrator and clarified with the manager following the site visit. The manager/administrator was appointee for one resident at the home. All other residents either managed their own finances or had a representative/advocate to manage their finances on their behalf. Personal allowances were held in safe keeping for some residents and records and receipts were appropriately maintained and audited. From discussion with the Head of Nursing and the staff records viewed it was evident that staff supervision was provided for all staff. The manager, Head of Nursing, the day senior nurse and the night senior nurse were responsible for undertaking regular (two monthly) supervision of designated staff. We were told that a range of topics such as infection control, care planning etc. were discussed during supervision. Annual appraisals were held where training needs and opportunities were discussed. Records held on behalf of residents were kept up to date and were stored safely in secure facilities. Records viewed at this inspection included: the statement of purpose, service user guide, assessments/care plans, medication records, a sample of policies and procedures, complaints, residents meetings, staff meetings, staff recruitment and training records, residents personal allowance records, maintenance records and fire safety records. The home had health and safety policies and procedures that were regularly reviewed. The AQAA stated that regular health and safety meetings took place within the home. This ensured that health and safety was promoted and staff knowledge of health and safety issues improved, making them more diligent in recognising risks and taking appropriate action. The records confirmed that staff had attended relevant health and safety training. Evidence of a sample of records viewed showed that there were systems in place to ensure the servicing of equipment and utilities and there The Carnarvon Nursing Home DS0000015320.V370339.R01.S.doc Version 5.2 Page 23 was evidence of appropriate weekly and monthly internal checks being carried out (e.g. checks on fire equipment fire alarms and emergency lighting etc.). All accidents, injuries and incidents were well recorded and confirmed that appropriate action had been taken. The Carnarvon Nursing Home DS0000015320.V370339.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 3 X X X 2 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 4 X 3 X 3 x 3 4 The Carnarvon Nursing Home DS0000015320.V370339.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement Timescale for action 15/09/08 2. OP26 13(3) To ensure the safe administration of medicines: 1. Staff must only sign that medication has been given immediately following administration to individual residents. 2.Medicines with a limited shelf life must have the date of opening recorded. 3.Medication must be available as prescribed. 4.Risk assessments must be undertaken where residents are self-medicating. To ensure the home is clean, 30/09/08 hygienic and odour free: 1. Paper hand towels must be available at all times. 2. The malodorous smell must be removed from the room identified at inspection. 3. Commodes must be thoroughly cleaned. The Carnarvon Nursing Home DS0000015320.V370339.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP19 OP27 Good Practice Recommendations A plan of refurbishment of the premises with timescales should be provided to the CSCI to demonstrate that residents will have an improved environment. Staffing levels and staff deployment should be reviewed to ensure residents do not have to wait unduly to receive assistance with personal care. The Carnarvon Nursing Home DS0000015320.V370339.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Carnarvon Nursing Home DS0000015320.V370339.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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