Random inspection report
Care homes for older people
Name: Address: Churchfield Court Care Home Millers Court Radford Nottingham Notts NG7 3DP zero star poor service 28/06/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Linda Hirst Date: 0 7 0 9 2 0 1 0 Information about the care home
Name of care home: Address: Churchfield Court Care Home Millers Court Radford Nottingham Notts NG7 3DP 01159424051 01159790074 churchfieldradford@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Trinity Care Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 40 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Conditions of registration: 40 40 The maximum number of service users who can be accommodated is 40 The registered person may provide the following categories of service only: Care home with nursing Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia: Code DE Mental Disorder, excluding learning disability or dementia: Code MD Date of last inspection Brief description of the care home 2 8 0 6 2 0 1 0 Care Homes for Older People Page 2 of 11 What we found:
We did this inspection as part of the work we have remaining under the Care Standards Act 2000 before we use the new Law, the Health and Social Care Act 2008 which will mean we work with services in different ways. This service was given a 0* (poor) rating on 28 June 2010 and we made a number of requirements. The service sent us an improvement plan with timescales for compliance and we have done this visit to check that our requirements have been met. We also wanted to check whether we need to take continuing action to secure compliance under the Health and Social Care Act. Part of this inspection looked at the quality of care people with dementia experience when living at Churchfield Court. Because we are unable to communicate effectively with all of the people with dementia, we have used a formal way to observe people in this inspection to help us understand their experiences of life at the service. We call this, the Short Observational Framework for Inspection (SOFI). This involved observing 5 people who live at the service over two hours and recording their experiences at regular intervals. We made judgements about their state of well being, and how they interacted with staff members, other people who use services, and the environment. We discreetly observed people in the dining room, during the lunchtime period. Since our last visit to the service, there has been a further management change and a relief manager is in post. The Area Manager has advised us that a new home manager has been appointed and will be in post by the end of September. We have not set a requirement about registering a manager as this will be dealt with legally as part of the new registration process. Our overall findings are that the service is improving but there remain key areas to do with having a consistent manager at the service, the staffing levels and ensuring the competence of all staff which mean the service has not improved to a sufficient standard to achieve compliance. What the care home does well:
We found clear evidence through our observations that the team leader is taking an active role in managing the performance of staff when they carry out their duties. She corrected staff on several occasions and pointed out where she wanted their work to improve. We brought a couple of issues to the attention of the Deputy Manager during our observations and these were dealt with immediately with the staff concerned. This is a clear improvement. We found that when staff do interact with people living at the service, the general quality of this is better, there are some very capable and kind staff working at the service. When we did witness poor practice (please see below) we brought this to the attention of the management and it was addressed immediately. We found there were almost as many good, positive interactions between staff and people living at the service as those around more practical matters.
Care Homes for Older People Page 3 of 11 We found the provision of activities in the absence of the activity organiser has got better and we observed staff making sure that people had appropriate entertainment and relaxation available to them. We did not see any examples of staff restricting peoples liberty, and the providers have told us training is planned on this subject for all of the staff. We observed lunch being served and people were offered a choice of dishes. Catering staff were interacting with people and helping them decide what they want. The food was plentiful and well-presented. Each floor of the home also has a kitchen where a range of snack food is kept. The recording of complaints has significantly improved and staff told us they know that they need to report all complaints to the manager. The relief manager carries out a weekly surgery which gives relatives the opportunity to discuss the home and raise any concerns they might have. Relatives made a number of positive comments about the Relief Manager including, things are beginning to move on now. There have been small changes and improvements already. The new (Relief) Manager is good, she has shaken things up. The service are referring all safeguarding allegations to us as a matter of course, and the records of safeguarding investigations are being recorded properly now, along with who is investigating and the outcomes. Systems have been put in place to ensure that we have access to all of the records we need to see on inspections and this requirement has been fully met. In the absence of a registered manager the Area Manager and the Quality Team are visiting twice a week to assess improvements to the service and to check how the service is being managed and conducted. The monthly visits and reports are comprehensive and incorporate the views of people living at the service and staff. There have been audits conducted on the use of bed rails, on people who are nutritionally at risk and on medication. There are also monthly unannounced outcome audits taking place to check on the quality of the service. What they could do better:
We found mixed evidence about whether staff follow the plans of care. In some cases they do follow the plans of care but in others they do not. For example, one persons plan states they do not like loud noises, yet the person was observed sitting very near to someone who shouted out a great deal. There were clear and observable signs that the person found the noise distressing and their response was to become agitated. This could have been avoided. In another case, the plan of a person who is nutritionally at risk because of restless behaviour states that the person should be offered finger foods to try and increase calorie intake. We did not see the person being offered any food at all. The biscuit tin was brought through on the mid morning tea trolley but only one person was offered a biscuit. This is of concern as a number of people are at risk nutritionally and are being assessed by the dietician. Care Homes for Older People Page 4 of 11 We found that the temperature in the medication room is still too high. We found evidence that although staff have noted a high reading on several occasions, nothing seems to have been done to bring the temperature down. We discussed this with senior care staff and they were unsure how to address this issue. The relief manager told us that there are fans in place to bring the room temperature down, but she has found these in the main part of the home on occasion. The relief manager will seek advice from the Pharmacist about the temperature of the room. We found that there are still low levels of engagement between staff and the people we observed as part of the SOFI (76 timeframes where there was no staff engagement as opposed to 29 timeframes when engagement took place.) There were higher levels of engagement between staff and people living at the service on the mens unit, but there remains a disparity which still needs to be addressed. Relatives we spoke with told us, sometimes the staff are all watching television rather than talking with the residents. Another said, some of the staff are lackadaisical, bordering on lazy. We brought these comments to the Relief Managers attention who said she would look into these concerns and bring about improvements where necessary. We found there are still some staff who do not treat people with respect and dignity. We witnessed a particularly poor moving and handling technique, where a member of staff pushed and pulled a very frail person around in a very rough manner to get a sling around her. We brought this to the attention of the Deputy Manager who dealt with it straight away. We found during our observations that some people were smartly dressed, but in other cases, peoples personal care had been neglected. A relative told us, (my relative) sometimes looks disgraceful and has obviously not had a wash or a shave. He needs to look smart and clean for his dignity. We discussed this with the nurse in charge who said she would take it up with the relevant key workers. Another relative told us there was a shortage of aprons for people to wear at mealtimes, and as a result some clothing was becoming stained. Staff members told the shortage was caused by delays at the laundry. The Relief Manager said she would look into this situation and, if necessary, purchase more aprons. We found the staff still need reminding to make sure that information about people living at the service is discussed confidentially. We observed discussions concerning personal information taking place in communal areas. In interviews staff responses show that they know the correct procedures to follow, but this is not always happening in practice. The catering manager has been on training and has been learning how to prepare culturally appropriate diets, the correct spices have been bought in and he is trying out different dishes. The chef said the new menu would be introduced in October 2010 and would include a wider range of culturally appropriate dishes. We still have concerns about staff making sure people have the correct nutritional intake. We saw the team leader asking staff who had received their nutritional supplements, the staff said no-one had. The team leader then listed a group of people who should have been given supplements. Some of the staff we observed are better at encouraging people to eat and drink than others, some of the people we observed drank very little. We found there was an obvious odour in some parts of the home. All of the relatives we spoke with commented on this. One told us, there is a smell of urine as soon as you come in here. Its always there. The nurse in charge told us that the home was short of cleaning staff, but a new cleaner had been interviewed and was awaiting their Criminal
Care Homes for Older People Page 5 of 11 Records Bureau clearance. Although the timescale for ensuring there are sufficient staff to meet the dependency needs of people living at the service has not yet expired, we found this is still an area needing development. As we have said, our observations show levels of engagement are not good enough, and we noticed that two people we observed had not been offered their lunch by 13:00. Neither person had been given a mid morning snack and both are nutritionally at risk. When we spoke with the Team Leader she told us 11 people on the ground floor need assistance with eating and this takes time if people are to be supported appropriately to take a good diet. The Relief Manager informed us that this should not be an issue as they have introduced protected lunch times. We observed some staff refusing to assist people to eat, and the managers addressed with them during our visit. Since the last inspection a new system has been put in place to help ensure all new staff have the necessary documentation in place before starting work. However, we found some existing staff files have documentation missing. For example, one member of staff has no evidence of a Criminal Record Bureau check on file. The person also has no previous employers reference, and gaps in their employment history have not been explored. The senior staff told us that previous recruitment practices have not been effective, they are now working to address this issue and in the process of reviewing and improving all staff files. Bi monthly staff supervision have been introduced, along with annual appraisals. The records we saw show that 10 staff have already had supervision sessions, although the records of these have not been typed up yet and so were not available. We saw evidence in individual files that concerns about staff performance are addressed and appropriate steps taken. 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 set out on page 2. Care Homes for Older People Page 6 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 7 12 Care staff must make sure they deliver care in line with the plan of care To make sure people receive help in a consistent way. 31/08/2010 2 9 13 Action must be taken to 31/08/2010 make sure the temperature of the medication room does not exceed 25 degrees Celcius To ensure medication is stored in line with the manufacturers instructions and maintains its efficacy 3 10 18 Staff must be properly supervised and their performance managed To ensure that they treat people with respect and dignity at all times. 31/08/2010 4 10 12 Staff must engage with all of 31/08/2010 the people living at the service appropriately To make sure their needs are properly met. 5 13 12 Staff must make sure that they show due respect for the confidentiality of people living at the service 13/08/2010 Care Homes for Older People Page 7 of 11 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action To make sure their privacy is respected. 6 14 12 Peoples capacity must always be assessed before any decisions are made in respect of resuscitation, and the Resuscitation Councils guidelines followed To make sure that people have the right to life saving treatment where appropriate. 7 14 18 Staff must be given training and information on the Mental Capacity Act and the Deprivation of Liberty Safeguards To make sure they are acting legally and upholding peoples right to make their own decisions where possible. 8 15 12 Steps must be taken to make 31/08/2010 sure a culturally appropriate diet is available. To make sure the cultural needs and preferences of people living at the service are catered for. 9 19 23 Bedrooms must be able to be 08/10/2010 secured To ensure the privacy, dignity and security of peoples belongings can be maintained.
Care Homes for Older People Page 8 of 11 31/08/2010 08/10/2010 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 10 19 23 The unused ground floor 31/01/2011 bathroom must be upgraded and made safe for use. To make sure there are sufficient, appropriate and safe bathing facilities for people living at the service. 11 26 13 The home must be clean and 13/08/2010 measures taken. To effectively prevent cross infection 12 27 18 The dependency levels of 30/09/2010 people living at the service must be kept under constant review, along with the staffing levels which are required to meet these needs To ensure that people receive help and interaction as soon as possible and do not wait for long periods of time without assistance. 13 29 19 All staff must have two written references. To ensure they are suitable to work with vulnerable people. 31/08/2010 14 31 9 The management of the service must improve To ensure the service runs in the best interests of people living there. 30/09/2010 Care Homes for Older People Page 9 of 11 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 10 of 11 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 11 of 11 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
