Inspection on 14/07/10 for The Andover Nursing Home

This is the latest available inspection report for this service, carried out on 14th July 2010.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Andover Nursing Home 06/07/09

The Andover Nursing Home 08/07/08

The Andover Nursing Home 25/04/06

The Andover Nursing Home 13/12/05

The Andover Nursing Home 04/07/05

The Andover Nursing Home 14/02/05

The Andover Nursing Home 26/05/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Random inspection report Care homes for older people Name: Address: The Andover Nursing Home Weyhill Road Andover Hampshire SP10 3AN zero star poor service 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: Kima Sutherland-Dee Date: 1 4 0 7 2 0 1 0 Information about the care home Name of care home: Address: The Andover Nursing Home Weyhill Road Andover Hampshire SP10 3AN 01264333324 01264332063 manager@andovernursinghome.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr B J Puddepha,Mr P J Puddepha Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 87 Number of places (if applicable): Under 65 Over 65 0 0 0 dementia old age, not falling within any other category physical disability Conditions of registration: 0 0 0 The maximum number of service users to be accommodated is 87. The registered person may provide the following category/ies of service only: Care home only - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical Disability (PD) Old age, not falling within any other category - (OP) Dementia (DE) Date of last inspection Care Homes for Older People Page 2 of 16 Brief description of the care home The Andover Nursing Home is a privately owned, purpose-built care home for service users over the age of 65. The home is registered to provide personal and nursing care to service users who are physically disabled or who have dementia. The home is divided into two units. One unit is on the lower ground and ground floors and provides care for older people with physical disabilities. The second unit is on the first and second floors, providing care for residents with dementia. Each unit has sitting and dining areas and there is a large lounge off the front entrance. The home is in a residential area of Andover, on a main road and close to local amenities. The home has a large garden to the rear and a small seating area at the front; there is a car park at the front of the home. Care Homes for Older People Page 3 of 16 What we found: We carried out a Random Inspection at the home on the 14th July 2010 to find out if the service had complied with the 15 requirements we made during the Key Inspection on the 13th May 2010. We spoke to the new acting manager, the independent care consultant and one of the providers. We also spoke with residents, relatives and staff. We reviewed a sample of the documents and records and observed the care practices. We found that the home had not admitted any new residents since March 2010. This is because the local authority ceased to fund places at the home due to concerns about the systems and care. The providers also agreed to voluntarily cease admissions after we wrote to them. We looked at one pre admission assessment from February 2010. This contained the information the staff would need to get to know this resident. We asked to see another pre admission assessment but the staff could not locate this. The senior staff had developed a new form to use when people are admitted and they informed us that this would be used in future. At the last inspection we required that the service ensures that all of the residents health care needs were recorded and met and that staff maintained daily records of the care. We saw a range of care practices during the day which caused us concern. We saw that one resident had a cold cup of tea on a table well out of their reach. The fluid balance chart recorded one sip of water between 8a.m and 11a.m. This persons care plan stated that they needed to be offered fluids frequently. We asked the staff to explain why the drink had not been given and were told that this person spilled their drinks. When we asked staff to explain a carer came into the bedroom and did not acknowledge or speak to the resident during that time. This is despite this persons care plan stating that they can be anxious and they needed staff to explain what they were doing and offer reassurance. When they were asked if one sip of water in 3 hours was enough to prevent dehydration they did not respond. The staff served a fresh drink after 11a.m and assisted the person to drink. We noted at 11.30 the staff had filled in the fluid chart. At 11.35 we spoke to the resident again and they were then eating a whole chocolate and seemed calmer. Their care plan stated that they required pureed food due to the risk of choking. Later at 3.45 we went to see the same resident and they said they were sore. They had been sitting in their chair between 10.45a.m and 3.45 p.m. The staff came to assist this person to go to the toilet after they were prompted to do so. Again this persons care plan said that they required assistance to use the toilet every two hours. When asked, a senior carer said that this persons plan stated that due to their condition they were at risk of getting pressure sores and they required moving every 2 hours. The senior carer stated that this had not been happening in practice. The staff had not known about this need until they were asked to go and check the care plan. There was no record of any occasions when the resident had been assisted to move to relieve their pressure areas. We saw that after we had raised concerns about the recording of care, staff were gathering in groups around the home and filling in charts that should be completed as the care is given. We then saw that large amounts of fluid usually consisting of 200mls had been filled in where before only sips had been recorded. When asked, one carer said they did not always fill in the charts like that. We looked at the care plans for four other residents and they had not been improved Care Homes for Older People Page 4 of 16 since the last key inspection. We were told that other care plans had been improved. The plans did contain some guidance for the care staff but two members of staff said they did not have time to read the plans. This means the staff were not always aware of the residents needs. One resident said their care plan had been reviewed on the 28th June 2010 and they remembered because they had asked on that day to have their fingernails cut. They had asked several times since that their plan be updated to include their request that their nails be cut regularly. they had their nails cut on the afternoon of the inspection. This person also said that agency staff on duty on the day of the inspection did not know their needs and had not read their care plan. The agency staff had been told to ask the resident who was able to communicate well verbally. The resident said this made them feel uncomfortable. They added that staff who had been at the home for some time did know their needs. We observed call bells ringing for a while before they were switched off. We asked the acting manager what was their interpretation of an unacceptable time for call bells to be ringing before they were answered. The manager said No more than six minutes. We noted a bell ringing for just over six minutes and pointed out that this is a long time if you have called for assistance with a personal care need such as needing to use the toilet. We asked how, and who monitors the times taken to answer call bells, the acting manager said that are recorded on the computer and she checks. There were no records of these checks or what action has been taken to address excessive call bell time. At the last inspection we required that medication must be given as it is prescribed and this included PRN or as required medication. We also required the service to ensure that medication was only recorded as given, after the medicines had been given to the residents, and not before. We observed part of the medication administration. The trained nurse administering the medication was following the correct procedure. They also said that they give medication which is prescribed as needed if a resident says they are in pain or if they judge that a resident needs the pain relief. The home does not have a procedure to follow for judging when they administer this non regular medication. At the last inspection we required the service to seek the views of the residents about their preferred activities. The service have recorded these but they are not available to staff, and are kept in the activities room. The residents said that they are offered a variety of social opportunities and activities and they could follow their own hobbies or interests. The home displayed photos of events. A PAT dog visited some residents and they said they enjoyed this. On the day of the inspection some residents were out on a canal boat trip. At the last inspection we required the service to consult the residents about their dietary likes, dislikes and needs and record these. During lunch service a carer was sitting near the food trolley and reading out the food choices of each resident. The carer stated a name and said dairy free. The cook was about to serve a pasta dish in sauce. When asked, the cook did not know if this was dairy free. They stated that the resident sometimes ate porridge or chocolate so they were not really on a dairy free diet. This persons care plan stated a dairy free diet. The cook then said they would scrape the potato off a Shepards pie and just serve the mince meat. They were asked if the potato was dairy free and they could not confirm this, They said it is instant mash. They continued to scrape the potato off but the spoon was covered in potato. They said they prepare boiled potatoes for this person. The staff serving food in Danesbury unit were seen taking a plate of food containing whole sprouts to a resident whos care plan states Care Homes for Older People Page 5 of 16 they must have pureed food because of a risk of choking. We questioned this and the pureed meal from another resident was taken to the resident who required a pureed diet. One carer was assisting a resident with their lunch and they were standing over the seated resident feeding them from above and not talking to the resident. When asked if this was normal practice the carer said I have been told how to help the residents properly but there are not enough chairs to sit next to them. I dont know where the chairs have gone. They were later seen kneeling on the floor beside the residents chair. Another carer said they had asked where the chairs were but had not received an answer. One resident said they enjoyed the food at the home and they could speak to the cook in meetings or informally about alternatives to less popular menu items. There was a list of preferred breakfast and two residents had their food choices listed in their bedrooms. The staff said they would ask all the residents about their likes and dislikes for other meals but this had not recorded. At the last inspection we required that the service follows their own complaints procedure. We found that one new complaint had been recorded in June 2010 and appropriate action had been taken. The acting manager had introduced a new form for recording complaints. One care plan contained a printed email complaint from a relative. This had not been recorded using the complaints procedure and their was no record of whether the complaint had been dealt with. We spoke with two relatives and a resident who said they were confident that complaints would be taken seriously and dealt with eventually. At the last inspection we required that the manager and the staff always reported any suspicions of abuse. We found that the staff were clear about reporting any suspicions of abuse and they had received training. During the inspection a resident told staff about an incident of possible abuse and this was dealt with appropriately and social services were informed. At the last inspection we required the home to be kept clean and tidy and any rubbish to be removed. We found that domestic staff were cleaning the home and all the areas were tidy. The domestic staff said they had not been given any new instructions about cleaning since the last inspection. At the last inspection we required the home to be kept free from offensive odours. We found several areas of the home including the front reception area and outside two bedrooms and corridors still had unpleasant odours. We spoke to two relatives, one of who visits at least once a week, they said it often smells. One service user said Im used to it. One of the domestic staff was spraying quantities of air freshener. They said Ive just sprayed some new spray so it smells better now. At the last inspection we required that the manager ensured the staff were putting their training into practice by competently maintaining the care plans and daily records. We found that the care staff are not involved in updating the care plans, this is done by the trained staff. The carers were not reading the plans or using them to guide their care of the residents. One carer said they had not had time to read the care plans for all the residents. The care staff have had training in maintaining the daily care records but we found they were failing to fill in the records to show that the care had or had not been given to the residents. The independent care consultant stated that the staff have been instructed to complete the records at the time the care is given. The records were being kept in each residents rooms so that the care staff could complete them properly. This Care Homes for Older People Page 6 of 16 was not being achieved and records were incomplete, or could not be found. At the last inspection we required that the registered person must establish and maintain a system for reviewing and improving the quality of care and nursing. This system must provide for consultation with the residents. We found that the residents did have a number of ways in which they could contribute their views. The service had various ways of obtaining information regarding quality, such as meetings, surveys, daily walk around forms and monthly audits by heads of departments and the providers. The acting manager said that the daily walk around forms were introduced three days before the inspection and we found that two forms had been completed but one day had not been monitored or recorded. After the inspection the providers wrote to the commission to tell us that the forms were introduced in March 2010 but they had not been used regularly since June 2010. No other forms apart from the two that were seen were offered or made available during the inspection. The findings of these quality review exercises are not being collated, and therefore the quality is not being monitored effectively. At the last inspection we required that the registered person must ensure that the staff are appropriately supervised. We asked for the supervision records of eight staff. We were told two had left, one was on long term leave. We were given one record of supervision dated 25th May 2010 for one carer. It was unclear if the supervisor had received any training to ensure they were competent in this role as the record of that meeting was brief and unfocused. We were informed that the supervision dates were on the computer system. We looked for these but were then informed they had not been updated. At the last inspection we required that risk assessments must be developed to guide staff in the safe use of wheelchairs when they assist residents to move around the home. We looked at two care plans for residents who use wheelchairs and there were no risk assessments available. There was one general risk assessment. One carer said they had been instructed in how to assist residents who use wheelchairs. On two occasions we saw staff assisting residents to use wheelchairs and in both instances the wheelchairs were being used incorrectly. One carer said that one resident could not use the foot plates. They added that the foot plates for another wheelchair could not be found and there was some disagreement with a relative about the wheelchair. This was not recorded in their care plan. During our inspection it was apparent that proper record keeping was an issue. Each time we requested something it took time to find, and often involved more that one person to locate. Records were stored in cardboard boxes and previous records of care given were stored loose leaf ,and bundled together for each service user, so it was difficult to find. On the 5th August the providers informed us in writing that they had met this requirement by the 31st july 2010. this will be assessed during the next inspection. What the care home does well: We found that the service had met 8 of the 15 requirements that were made during the last inspection. However we found that there were still changes that needed to be made to improve the outcomes for the residents. Changes to practice and recording have not Care Homes for Older People Page 7 of 16 been made within the timescale we required and any changes made had not been embedded into practice. What they could do better: The following requirements were made during the last inspection in May 2010 and the service had failed to meet these by the required times. We will consider what further actions we need to take to ensure that the registered person complies with these, so that the outcomes for the residents can be improved. The service should have ensured that every resident had a detailed care plan that the staff use when they assist with the residents care. This is because the staff need to have guidance about how to meet the needs of every resident. The staff should have maintained daily records of the care they gave. This is so that the care and the condition of the residents can be monitored. The service has not been conducted to promote the health and welfare of the residents. This is because each resident should be cared for according to their individual needs. The service had not developed a written protocol for the staff to follow when they are assessing whether they should administer PRN or as needed medication that had been prescribed. This should have been developed so that the residents are given their prescribed PRN medication if they require it. It is important that the staff are able to consistently assess residents who cannot verbally communicate whether they are in pain. The residents should have been consulted about their dietary likes, dislikes and needs and these should have been recorded. The catering staff must be made aware of these needs and preferences and supply appropriate foods to the residents. The service should have been following their own written complaints procedure and recording the actions they take to address complaints. This is because the residents have a right to make a complaint and for this complaint to be responded to appropriately. The service should have been making sure that the home is free from offensive or unpleasant odours. The residents have a right to live in a home that is clean and fresh at all times. The service should have been ensuring that the staff are appropriately supervised. This is because the residents must have their needs met and recorded by appropriately managed staff, whos practice is monitored. The service should have made sure that risk assessments are in place and that staff use these to minimise the risks when they assist residents who use wheelchairs to move around the home. This is because the residents have a right to be protected from injury when they are being helped to move around the home. The following requirement is a new requirement that we made during this inspection. The service must make sure that the records are maintained accurately,properly and that they can be located. This is because the records about the care and the management of the home are important and they protect the rights and best interests of the residents. Care Homes for Older People Page 8 of 16 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 9 of 16 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 3 14 Prospective residents must have all of their needs assessed prior to moving to the home, unless they are admitted in an emergency situation. Prospective residents need to know that their needs can be met at this home before they move in. The provider must tell us in writing when this requirement has been met. 30/06/2010 2 7 15 Every resident must have a detailed care plan. The care that is given needs to be recorded daily. This is so that the care plans give the staff the guidance they need to meet the residents needs. And also so that the residents health and welfare can be monitored. The provider must tell us in writing when this requirement has been met. 30/06/2010 3 8 12 The registered person must 30/06/2010 ensure the care home is conducted so as to promote the health and welfare of the service users. The residents must have their health care needs met and recorded. Page 10 of 16 Care Homes for Older People 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 So that the residents are cared for according to their individual needs. The provider must tell us in writting when this requirement has been met. 4 9 13 Medication must be 30/06/2010 administered as it is prescribed. If the medication is prescribed PRN, or as required, a qualified person needs to ask the resident if it is required or make an assessment of their need for the medication. So that the residents get their medication regularly and on time. The provider must tell us in writting when this requirement has been met. 5 9 13 The staff must record the medications that they have given to the residents. So that the records of medication administered are accurate and people recieve the medication they are prescribed. The provider must tell us in writing when this requirement has been met. 6 12 16 The residents must be asked 12/07/2010 about the programme of activities. So that the residents are able to choose to take part in Care Homes for Older People Page 11 of 16 30/06/2010 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 suitable activities, in groups or individually. The provider must tell us in writing when this requirement has been met. 7 15 16 The residents must be 30/06/2010 consulted about their dietary likes, dislikes and needs and this must be recorded. So that the residents dietary needs are met. The provider must tell us in writing when this requirement has been met. 8 16 22 The manager and staff must 30/06/2010 always follow the complaints procedure. This is because the residents have a right to make a complaint and for this complaint to be be responded to appropriately. The provider must tell us in writing when this requirement has been met. 9 18 13 The manager and staff must 30/06/2010 always report any suspicions of abuse. This is because the residents have a right to be protected from abuse, harm or neglect. The provider must tell us in writing when this requirement has been met. 10 26 16 The home must be free from 30/06/2010 unpleasant odours. Care Homes for Older People Page 12 of 16 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 This is because the residents should live in a home that is clean and fresh at all times. The provider must tell us in writing when this requirement has been met. 11 26 23 The home must always be kept tidy and clean and any rubbish must be removed. This is because the residents have the right to be protected from cross infection. The provider must tell us in writing when this requirement has been met. 12 27 18 The manager must ensure that the staff are putting their training into practice and they are competently maintaining the care plans and the daily records. This is because the residents need to have their daily care accurately recorded so that there is evidence that this care was given. The provider must tell us in writing when this requirement has been met. 13 33 24 The registered person must 30/06/2010 establish and maintain a system for reviewing and improving the quality of care and nursing. This system must provide for consultation with the service users. So that people have a say in their care and their views are Care Homes for Older People Page 13 of 16 30/06/2010 30/06/2010 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 recorded. The provider must tell us in writing when this requirement has been met. 14 36 18 The registered person must 30/06/2010 ensure that persons working at the care home are appropriately supervised. So that residents recieve care from staff who are appropriately managed. The provider must tell us in writing when this requirement has been met. 15 38 13 Risk assessments must be 13/07/2010 completed for staff to follow when they are assisting residents to move around the home. This is because the residents have a right to be protected from injury when they are being helped to move around the home. The provider must tell us in writing when this requirement has been met. Care Homes for Older People Page 14 of 16 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 1 37 17 The registered person must ensure that accurate and up to date records are maintained and that these are available and accessible in the home. 30/07/2010 This is because the residents rights and best interests are protected by the correct record keeping procedures. 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 15 of 16 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. 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