CARE HOMES FOR OLDER PEOPLE
Crown Hills Nursing Home Rowlatts Hill Road Leicester Leicestershire LE5 4UH
Lead Inspector Janet Browning Unannounced 15th April 2005 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 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. Crown Hills Nursing Home Version 1.10 Page 3 SERVICE INFORMATION
Name of service Crown Hills Nursing Home Address Rowlatts Hill Road Leicester Leicestershire LE5 4UH 0116 2760600 0116 2761428 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) GB Care Ltd 36 Heybridge Road Leicester Vacant Care Home (CRH) 49 Category(ies) of Dementia - over 65 years of age (49), Learning registration, with number disability over 65 years of age (1), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (49) Crown Hills Nursing Home Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: To be able to admit the named person of category LD named variation number V8757 dated 11/06/04. To be able to admit the named person category DE as identified in variation application No. V7975 dated 2 June 2004 for periods of respite care. To be able to admit named person of category MD/PD named in variation application number V12445 dated 28/09/04 for a limited period from 12/11/04 until the final date 10/12/04. Date of last inspection 02/09/04 Brief Description of the Service: Crown Hills Nursing and Residential Home is a care home offering accommodation for up to forty nine older people. The home is registered to admit older people with dementia and/or mental disorders. The home is located in a quiet residential area to the east of Leicester. The centre of Leicester is approximately fifteen minutes away by car. A bus service is available from outside the home. More frequent bus services are available near to the home. The buses Number 54 and Number 16 supply a service passing every ten minutes. The home is easily accessed by road using the outer ring road.The building itself is a purpose built modern property offering accommodation on three levels. The majority of rooms available are situated on the ground and first floors. The home is equipped with a slow moving lift. The home has parking to the front of the property and has a large garden area to the rear. The garden offers a lawned garden with established plants and trees. A patio area is available with seating. All areas of the home and outside areas are accessible for people with mobility impairments. Crown Hills Nursing Home Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 9 hours and was unannounced. A partial tour of the premises took place and some staff and care records were inspected as well as some home records and policies and procedures. Three comment cards had been received from visiting health professionals. None were received from both residents and relatives. There was an opportunity to talk with some residents who were able, visiting community nurses, two relatives and five members of staff. The acting manager of the home (who is waiting for completion of her registration) was present throughout most of the inspection. What the service does well: What has improved since the last inspection?
The acting manager has been at the home for eight months and in that time she has built links with another professional to assist in an audit system she has developed to audit both her own and the home’s practice. The acting manager had built links with the Community Infection Control team as suggested at the last inspection, with infection control training programmes being implemented. There is a comprehensive induction programme for new staff which is completed with a mentor over a three month period. At present an external college performs moving and handling training but six members of staff are going to become trainers themselves. The training of staff will improve the safety and welfare of residents as well as motivating staff. Crown Hills Nursing Home Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Crown Hills Nursing Home Version 1.10 Page 7 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 Standards Statutory Requirements Identified During the Inspection Crown Hills Nursing Home Version 1.10 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4 Although improvement have been made to the admission procedure, risk assessments in existing residents’ records are inadequate and insufficient and thus there is no assurance that all needs are being identified or met, potentially placing residents at risk of serious harm. EVIDENCE: Individual records indicated that some assessments for moving and handling were either missing or not up-dated to reflect their current needs and not all assessments had all aspects of care addressed. These residents were not able to voice their needs and therefore a robust admission assessment including all risk assessments was essential for staff to generate care plans. A resident was identified from his psychiatric assessment as being at risk of harming himself with aerosols when agitated. He was admitted to the home two days prior to the inspection and this risk had not been assessed or addressed. The resident was becoming agitated during the day, the nurse in charge of his care was not aware of this risk. and this lack of knowledge caused a potential for harm. Crown Hills Nursing Home Version 1.10 Page 9 The Registered Manager is starting to use a new assessment process and it was noted that another resident did have a generally good assessment in place using this new process. There is three Gujarati speaking care staff during the day to communicate with a resident whose first language is not English and the manager was trying to recruit a Gujarati speaking carer for night, but stated that she was finding this difficult Crown Hills Nursing Home Version 1.10 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 9 The home demonstrates shortfalls in ensuring that all the health care needs of residents are identified and met, which has the potential to place the residents’ health and welfare at risk. EVIDENCE: Individual plans of care are available but are insufficient to ensure that all aspects of health, personal and social care needs are identified and planned for. Some plans are not updated both in their risk assessments and the care plans are not reviewed to reflect the residents current condition. Visiting community professionals also raised concerns regarding moving and handling and wound care. For example one resident had a risk assessment for pressure area care in place, which indicated that she was at medium risk of developing pressure sores. However this did not reflect the resident’s current condition. There was no care plan to indicate the equipment required to assist in relieving pressure and wound care plans did not document how a pressure sore was being evaluated in terms of size and healing as per relevant clinical guidelines. Discussions with care assistants suggested that although some needs not identified in the care plans were being addressed, if the carers required
Crown Hills Nursing Home Version 1.10 Page 11 clarification, then they would speak to senior members of staff or read the care plans. All of this approach to care planning is dependent on staff memory and good communication. Although there had been some attempt to ensure that creams prescribed for residents were being signed for as identified at the last inspection, there were still issues raised surrounding the storage of creams. The record of the temperatures of the fridge used to store certain medications had been higher than the recommended temperature and discussions with the nurse in charge of medication indicated that she did not know what the correct temperature should be. Medications not being stored as per the manufacturers’ instructions could cause the effectiveness of the medication to be reduced. There was evidence in the notes of consultation with other health professionals for advice such as the District Nurses for advice on wound care and the visit of a Community Psychiatric Nurse. Not all of these visits were documented. Crown Hills Nursing Home Version 1.10 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13, 14 and 15 Contact with relatives is supported by the home and meals provide choice and variety, all of which assists residents in maintaining their independence and control over their lives. EVIDENCE: Residents were observed having a variety of choices of hot and cold breakfasts and the mid-day meal looked nutritious and one resident commented on how they were enjoying it. Carers were observed assisting two residents in the dining room with their breakfast discreetly and sensitively. The atmosphere in the dining room was relaxed with music playing. Discussions with relatives visiting suggested that residents were encouraged to maintain their independence and visiting was not restricted. For instance one relative spoke with the manager about her sister’s recent visit to the shops with a member of staff. A folder with information regarding the use of advocacy services was in the manager’s office and leaflets were in the reception area. One relative spoken to was not aware of advocacy services and did not look at leaflets in the reception area. Notice boards around the home had very sparse information but due to the condition of some of the residents it was difficult for the home to ensure that notices put up on boards would remain there in place.
Crown Hills Nursing Home Version 1.10 Page 13 Observations of general communication between staff and residents displayed a warm friendly approach, which residents responded to positively. There was a lot of laughter noted from the residents and residents and relatives comments were : • “Its wonderful here.” • “The staff are kind and I like the food.” • “My husband thinks that xxxx is the bees knees.” • “The staff are very friendly and I think they have a lot to contend with.” Crown Hills Nursing Home Version 1.10 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 and 18 Complaints are handled objectively and relatives are confident that their concerns are listened to. The residents’ legal rights are protected and the home is mainly aware of the correct response to any suspicion or allegation of abuse. EVIDENCE: Discussion with relatives visiting the home suggested that they knew who to complain to if they needed to complain. One relative stated, “I don’t feel that I would ever need to complain, but if I did I would go to Matron or the head nurse”. Although CSCI details were noticed in the home foyer, relatives were not aware of CSCI involvement if unsatisfied with complaints. The complaints record showed that the manager always responding to complaints either in person or phone, but did not send out letters to complainants, which could cause some confusion as to outcomes of complaints. Postal votes were obtained for residents unable to get to polling stations and the manager stated that they arranged for advocates for those who required one. Discussions with staff suggested that staff were mainly aware of what constitutes abuse and the correct procedure for reporting in line with “No Secrets” publication. The home has just re-written a comprehensive adult protection policy with an accompanying training programme, which was to commence for all staff. . Crown Hills Nursing Home Version 1.10 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 26 The home was generally clean and pleasant presenting overall a homely environment for residents to live in. EVIDENCE: The rooms inspected all had hand washing facilities and paper towels for staff to use when dealing with clinical activities. There were policies and procedures for dealing with clinical waste but this required up dating. There were adequate gloves and aprons for the use of care staff. The up stairs lounge had comfortable furniture and the carpet had been recently cleaned. Generally the home was pleasant but there were a few areas that still required attention. For instance the stairs from the ground to first floor in the main area of the home appeared grubby and the stairs at the back of the home looked dirty with a layer of dirt and dust noted on the wall light. The provider stated that the first floor had been recently re-decorated and ground floor area was next to under take re-decoration. Crown Hills Nursing Home Version 1.10 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30. Overall staffing levels were in sufficient numbers to meet residents’ needs, however the deployment of staff at busy times of the day did leave residents unsupervised for long periods potentially putting them at risk of harm. EVIDENCE: Although staffing levels were sufficient to meet the residents’ needs at the point of inspection, it was noted that during meal times the deployment of staff indicated that supervision of residents was inadequate. At one point seven members of staff, including both nurses on duty, were in the dining room at breakfast. This left only one member of staff supervising the other twenty-one residents. At lunchtime, it was observed that seven dependent residents in the first floor lounge were left un-supervised for over thirty minutes. Discussions surrounding staffing levels with staff members suggested that care of residents at was an issue. “I think we need more staff during the day” “More staff at tea-time, although not unsafe, would be ideal”. The three staff files checked during the inspection showed that a satisfactory recruitment process is undertaken. The manager checks with the Nursing and Midwifery Council for any de-registrations of nurses. The manager is currently instigating new training programmes for staff using external organisations and other professionals. There is a robust induction programme, which new starters have to complete within the first three months
Crown Hills Nursing Home Version 1.10 Page 17 of employment, with essential items covered within the first few days. Four care assistants have obtained NVQ level 2 since the last inspection and the manager stated that all of the rest of the care assistants are currently undergoing NVQ training. Crown Hills Nursing Home Version 1.10 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 34, 35, 36, 37 and 38. New leadership and guidance is taking time for changes to become effective, which has resulted in practices that do not promote the health, safety and welfare of those people who use the service. EVIDENCE: The manager is waiting for her registration to come through from CSCI. She is a qualified nurse with previous management experience and is undertaking the NVQ level 4 management qualification. One staff member stated “She is the best manager we’ve ever had, down-to-earth, knows her job” The manager has introduced an internal audit system based on the National Minimum Standards so that her own practice and that of the home can be improved. This she has done by seeking views and opinions from other professionals Crown Hills Nursing Home Version 1.10 Page 19 The manager stated that fire alarms were tested every week but this was not reflected in the records. Fire records inspection indicated that regular tests of neither emergency lighting nor fire alarms had not been carried out. Accident records were completed but in some instances action taken to reduce risk of the incident re-occurring was either not completed or unclear. There were clear procedures for the safe handling of residents’ money with clear accounts held for individual accounts. Although records indicated that training had taken place for moving and handling and infection control, observation of staff indicated that this knowledge was not being put into practice. For instance, one member of staff was observed coming out of a resident’s room carrying an uncovered soiled continence pad along the corridor and disposing of it in the clinical waste bin and then not washing his hands. This is poor practice, which puts both residents and staff at risk of infection. Crown Hills Nursing Home Version 1.10 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 1 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 3
COMPLAINTS AND PROTECTION x x x x x x x 3 STAFFING Standard No Score 27 x 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 x 3 3 3 2 1 1 Crown Hills Nursing Home Version 1.10 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 Regulation 15 Requirement Assessments of residents with high risk needs identified either prior to admission to the home or on admission must have care plans written without delay as to how these needs in respect of health and welfare are to be met. Residents plans must be in place and in sufficient detail as to provide guidance to staff on the actions to be taken to meet their needs. The residents plans must be reviewed regularly. All risk assessments for all health needs must be in place for all residents and reviewed regularly by staff suitably trained. The registered person must ensure that the home is conducted as to protect the health and welfare of residents. Equipment used in the relief of pressure areas of residents must be used correctly. The registered person must ensure arrangements are made for the safe administration of medication and that care plans are written to provide safe
Version 1.10 Timescale for action Immediate 2. 7 15 Immediate 3. 7 14; 15 Immediate 4. 8 12 Immediate 5. 9 13; 15 Immediate Crown Hills Nursing Home Page 22 6. 18 13; 7. 9 13 8. 9 13 9. 28 12 10. 38 13 11. 38 13 12. 38 13 13. 38 23 guidance on the use of as required medication. The registered person must make arrangements by training staff or by other measures to prevent residents being harmed or suffering abuse or being placed at rsik of harm or abuse, in particular reference to Whistle Blowing. The registered person shall ensure the safe-keeping of all medication including prescribed creams. The registered person shall ensure that all staff are aware of the correct temperature required for the medication fridge and the action to take if the fridge temperatures are not within the required range. The registered person must ensure proper provision is made to supervise residents, especialy at meal times. The registered person shall ensure that correct procedures for infection control are followed by all staff within the home. The registered person shall ensure that suitable arrangements are made to provide a safe system for the moving and handling of residents. The registered person must ensure that unnecessary risks to health and safety are identified and eliminated in regard to the use of a residents seating The registered person must ensure that adequate arrangements are made for the reviewing fire precautions and testing fire equipment at suitable intervals. This is in relation to the testing of fire alarms and emergency lighting and correct
Version 1.10 25/07/05 25/07/05 25/07/05 Immediate Immediate Immediate Immediate Immediate Crown Hills Nursing Home Page 23 documentation.. 14. 38 13 The registered person must ensure that unnecessary risks to residents are indentified and so far as possible eliminated. This is in relation to risk assessing accidents effectively and documenting using the accident reporting procedure. 25/07/05 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. 3. Refer to Standard 9 7 36 Good Practice Recommendations It is recommended that creams kept in the treatment room should be stored efficiently to avoid errors in their use. It is recommended that wound care should follow relevant clinical guidelines. It is recommended that the Registered Provider should provide formal and recorded supervison at least six times a year. Crown Hills Nursing Home Version 1.10 Page 24 Commission for Social Care Inspection 5 Smith Way Grove Park Enderby LE19 1SX National Enquiry Line: 0845 015 0120 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 Crown Hills Nursing Home Version 1.10 Page 25 - 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!
