Inspection on 15/05/07 for Addison Court Nursing Home

This inspection was carried out on 15th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Addison Court Nursing Home 06/10/08

Addison Court Nursing Home 28/04/08

Addison Court Nursing Home 08/11/07

Addison Court Nursing Home 15/11/06

Addison Court Nursing Home 26/06/06

Addison Court Nursing Home 08/03/06

Addison Court Nursing Home 12/10/05

Addison Court Nursing Home 20/04/05

Addison Court Nursing Home 07/09/04

Addison Court Nursing Home 14/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Addison Court Nursing Home Addison Street Accrington Lancashire BB5 6AG Lead Inspector Mrs Susan Hargreaves Unannounced Inspection 15th May 2007 09:30 X10029.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 Addison Court Nursing Home DS0000022489.V333124.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 and Care Homes for Adults 18 – 65*. 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. Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Addison Court Nursing Home Address Addison Street Accrington Lancashire BB5 6AG 01254 233821 01254 393628 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) Speciality Care (Rest Homes) Limited Vacant post Care Home 50 Category(ies) of Dementia - over 65 years of age (25), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (25), Old age, not falling within any other category (25), Physical disability (25) Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Staffing for service users requiring nursing care will be in accordance with the Notice issued dated 16 August 2000 The home is registered for a maximum of 50 service users to include: Up to 25 service users in the categories OP or PD requiring nursing care Up to 25 service users in the categories DE(E) or MD(E) requiring nursing care Up to 25 service users in the category of OP requiring personal care Up to 10 service users in the categories DE(E) or MD(E) requiring personal care 15th November 2006 Date of last inspection Brief Description of the Service: Addison Court is a purpose built home situated in a small cul-de-sac in a mainly residential area. It is close to a number of shops and a church. The centre of Accrington is approximately 10 minutes walk away. The home has a small garden, which is accessible to residents who wish to sit outside when the weather permits. There is adequate parking for staff and visitors. Addison Court offers 24 hour nursing and personal care for up to 50 residents. This includes the Baxenden unit, which offers care for up to 25 residents who suffer from mental health problems or dementia. Accommodation is provided in single en-suite rooms. A passenger lift facilitates access to all areas of the home. The current fees charged at Addison Court are £325 - £698 per week. Additional charges are payable for private chiropody, hairdressing, toiletries and newspapers. A copy of the statement of purpose and service user guide was available to prospective residents and their relatives on request. Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted at Addison Court Nursing Home on the 15th and 16th May 2007. No additional visits have been made since the last random inspection on 1st February 2007. Five completed surveys were received from residents three of these stated they usually received the care and support they needed. Surveys about the home were also received from two GP’s. One of these GP’s expressed concerns about an occasion when she had advised staff that a resident should be taken to hospital for an x-ray and the resident wasn’t taken until the following day. The GP also expressed concerns about staff not always knowing why the doctor had been called. She also found it very difficult to communicate with some members of staff because of language problems. At the time of this inspection 40 residents were living at the home. A tour of the premises took place and staff files and care records were inspected. Members of staff on duty, residents and visitors were spoken to. Discussions also took place with the manager regarding issues raised during the inspection. Wherever possible the views of residents were obtained about their life at the home. Due to memory and communication difficulties, many of the residents accommodated on the dementia unit were unable to make any comments about their experience of living in the home. Therefore, a period of two hours was spent making close observation of how staff communicated and attended to certain residents and how they reacted to this. What the service does well: What has improved since the last inspection? Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 6 Members of staff consulted said there had been a lot of changes since the new manager was appointed. The home was being managed better and training was encouraged. There nave been some improvements to care planning, the manager has written to the relatives of residents inviting them to be involved in care planning and a pressure sore risk assessment was in place for each resident. Detailed records of the care given to residents during the night including fluid intake were also seen. A second part-time activities organiser has been employed. She was observed doing meaningful activities with residents suffering from dementia. Following the appointment of a new cook the standard of meals has improved. Blended meals are served with the food items blended separately. The cook also asks residents about their likes and dislikes. One resident said, “The food’s excellent.” Another resident explained that the cook would make her anything she asked for. A structured induction programme was in place for new members of staff and training for all staff is actively encouraged. To ensure food is stored safely fridge, freezer and food temperatures are recorded daily. What they could do better: It is essential that further improvements to care planning must be made in order to provide person centred care for all residents. Care plans must clearly identify and address the individual needs of each resident. Care plans must be reviewed monthly and up dated when the needs of the resident changed. It is of serious concern that privacy and dignity for all residents is not being promoted. Residents must be dressed in a dignified manner and not in stained clothing or wrinkled stockings. Residents must also wear shoes or slippers, which fit properly. Razors must not be used communally. Arrangements must be made to ensure each resident has their own razor. Urgent action must be taken in order to promote the wellbeing of residents suffering from dementia. It is important that staff sitting in the lounge should make every effort to engage residents suffering from dementia in conversation. Members of staff must also approach these in a sensitive manner and clearly explain any moving and handling procedures before attempting to change the resident’s position. It is vital that an effective system for ordering medication be developed to ensure medication for individual residents is not ‘out of stock’. Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 7 It was of serious concern that a nurse was observed signing the medication administration records in the utility room after she had completed the drug round. To prevent medication errors this practice must cease. The nurse must sign the medication administration records at the time the medication is given to the resident. It is of serious concern that requirements made at previous inspections to improve the environment on both floors of the dementia unit have not been addressed. Urgent action must be taken to ensure sufficient resources are made available in order to complete the necessary redecoration and refurbishment of these areas within the given timescales. Staff absence and sickness remains an ongoing problem. It is essential that this problem be urgently addressed to ensure there is always a sufficient number of staff on duty to provide effective care for all residents. Regular supervision and annual appraisals for all care staff are still not taking place. It is important that members of staff have proper support and have the opportunity to discuss their work and any problems with a senior member of staff. This makes staff feel valued and helps to increase morale and improve the standard of care for the residents. It is of serious concern that members of staff were observed using incorrect moving and handling procedures on two occasions when changing the position of residents. Action must be taken to ensure that correct methods for moving and handling residents are always used. 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. Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (older people) & 2 (adults 18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A thorough admissions procedure ensured the needs of people using the service were identified and met. EVIDENCE: The individual records of six residents were inspected. These contained a detailed personal assessment. The manager visited and assessed prospective residents prior to admission. Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 10 The care records of the most recently admitted resident included a preadmission assessment carried out by the manager and a nursing assessment completed by nursing staff at the hospital prior to discharge. These assessments provided important information for the care plan. Prospective residents or their relatives received confirmation in writing that their needs could be met at the home. A copy of this letter was seen in the care records of the most recently admitted resident. Standard 6 is not applicable to this service. Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 (older people) and 6,9,16,18,19, and 20 (adults 18-65) Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Deficiencies in care planning, medication procedures and the attitude of some members of staff means residents do not always receive person centred care. EVIDENCE: The individual care plans of six residents were inspected. These plans did not identify and address all the care needs of each resident. One resident was Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 12 identified as having a high risk of falling but a care plan providing clear guidance about how to manage this risk was not in place. Some care plans were generic and did not specify the needs of individual residents, e.g. a care plan for eating and drinking stated, ‘offer appropriate utensils’ without stating which utensils were appropriate, ‘refer to dietician if required’ again without any explanation for staff about when this would be necessary. Care plans about religious needs did not indicate if the resident practiced a particular religion. Care plans for residents suffering from dementia did not give clear guidance for staff to follow about how they should be approached or how their psychological needs were to be met. The care plan for one resident did not address behavioural problems or incontinence when these were clearly issues, which needed to be addressed. One resident had a dressing on their arm but there this was not documented in the resident’s care plan. The moving and handling plan for one resident did not provide information about the equipment to use. The care plan about mobility had not been up dated for a resident on discharge from hospital following a fall. A nutritional assessment had not been carried out for a resident who had been losing weight since January. A pressure sore risk assessment was seen in the six care records inspected. Four of the care plans inspected had not been reviewed since March 2007. To make sure the needs of each resident are met these must be reviewed monthly. A new format for care planning was being implemented. These had a more person centred approach and were seen in the files of two residents accommodated on the general unit. However, the risk assessment for the use of bed rails did not identify the risk factors and nutritional risk assessments were not in place. The manager has written to the relatives of residents asking if they want to be involved care planning. Evidence of their involvement was seen in the care records of one resident. Residents were registered with a GP and had access to other healthcare professionals. Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 13 One of the two GP’s who completed a survey expressed concern about staff not always knowing why the doctor had been called. Medication was stored correctly and administered by registered nurses. Records for the management of medication were seen. However, it was evident from the medication administration records for one resident that medication had been out of stock from the 9th to the 13th May. Medication for two more residents had almost run out without evidence of a further supply having been ordered. Handwritten instructions on one medication administration record was signed but not witnessed. Controlled drugs were stored securely and a stock check was satisfactory. One nurse was observed signing the medication administration records in the utility room after she had completed the drug round. To prevent medication errors these must be signed at the time of administration. Various creams and ointments had been left out in a number of resident’s bedrooms. This puts residents at risk if they inadvertently wander into a room and use or eat some any of these products. All medication including creams and ointments must be stored securely. Personal care was carried out in the privacy of the resident’s own room or the bathroom. One member of staff explained in detail how she promoted privacy and dignity for all residents. However, on the first day of the inspection one resident on the first floor was wearing wrinkled stockings and ill-fitting shoes. Another resident was wearing tracksuit trousers, which were badly stained. During a tour of the premises an electric razor labelled Baxenden House was found in the top floor shower room. This suggested that the razor was being used communally. This is undignified and unhygenic and can result in the spread of infection. During the detailed observation period some members of staff were seen to approach residents in a kind and caring way. However, two carers were observed changing the position of two residents. Both of these residents were asleep. The carers did not rouse either of the residents to explain what they were going to do before attempting to move them. As a result one lady, who was lifted into a standing position was unable to cooperate. Moreover, the incorrect under arm lift was used. A member of staff was also observed giving a resident a drink, wiping her face and removing her bib without speaking to her. The television was on in the lounge without the volume turned up. One resident was watching the television but members of staff did not ask him if he wanted the sound turning on. The volume was not increased until the activities organiser came in half an hour later. Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14, and 15 (older people) and 12,13,15 and 17 (adults 18-65) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents were consulted about menus and activities. Some residents were supported to have a fulfilling lifestyle. EVIDENCE: Two members of staff were employed on a part-time basis to organise activities for the residents. These included, playing dominoes, flower Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 15 arranging, manicures, chatting to residents, craft activities for special occasions e.g. making Valentine cards and Easter bonnets and listening to music. Outside entertainers regularly visited the home. Trips out to local amenities e.g. Oswaldtwistle Mills were also arranged. Resident’s involvement in activities was recorded on their ‘diversional therapy’ plans. However, these plans did not clearly identifiy the leisure interests of the resident. Although there were some positive comments in these plans others were unhlepful e.g. ‘won’t join in.’ The recently appointed activities organiser was observed approaching residents suffering from dementia in a pleasant and positive manner. She engaged them in meaningful activities e.g. folding dusters. She also chatted individually with residents about holidays, films, music, pets etc. and discussed a book about ‘Old Accrington’ with one gentleman. On the second day of the inspection the other activities organiser was observed playing played dominoes with three residents from the general residential unit. During the detailed observation period members of staff working on the first of the home came to sit in the lounge on several occasions. These staff made no effort to engage any of the residents in conversation. A resident’s committee has been set to enable the activities organisers to obtain the views of residents and plan suitable leisure activities. Care plans for religious needs were in place but these were generic and did not clearly state the needs of individual residents. Visitors welcomed into the home at anytime and offered refreshments. The manager explained that visitors could also stay and have a meal with their relative or friend. Discussion with residents and members of staff confirmed that the daily routine was flexible in order to meet their needs and preferences. One resident said, “I get up at 9am, that’s fine for me. They come and tell me what time it is and ask me if I want to get up.” Since the last inspection a new cook has been appointed. Menus offered a choice at each meal. Alternatives to the menu are also readily available. The cook talked to the residents and asked about their individual likes and dislikes. A list of these was kept in the kitchen. A sufficient supply of fresh fruit and vegetables was in stock. Brown and white bread was available. The cook made high calorie smoothies for residents with poor appetites. Pureed meals Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 16 looked appetising because all the components were separate. Night staff had access to bread, cereals, meat, cheese and yogurts to enable residents to have a snack during the night if requested. Almost all of the residents asked said the food was good. Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 (older people) and 22 and 23 (adults 18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents felt able to express their concerns. Staff had the training necessary to ensure the safeguarding of vulnerable adults. EVIDENCE: A copy of the complaints procedure was displayed in the home and included in satement of purpose. Since the last inspection two complaints have been to the manager and two to CSCI. These complaints have been investigated by the manager or the area manager for Craegmoor. Records of the complaints and investigations carried out by the manager were seen. Policies and procedures about the safeguarding of vulnerable adults were in place. Training in the safeguarding of vulnerable adults is included in the induction programme for all new employees. The manager explained that although most members of staff have recently received training in safeguarding she had arranged another session in June to ensure all staff understood the procedures. Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 18 The ‘Whistle Blowing’ policy had been amended and clearly explained how the ‘whistle blower’ would be protected. Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The environment in some areas of the home was not conducive to the wellbeing of residents suffering from dementia. EVIDENCE: The ground floor lounge and dining area was clean and odour free. Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 20 On the top floor the dividing wall between two smaller rooms has been removed. This room has been recorated and will become the lounge when a new carpet has been fitted. The windows are low enough for residents see outside when they are sitting down. The original lounge will then be used as a dining room. The handyman has left and although the manager has identified a suitable replacement she is waiting approval from head office before he is appointed. This means that minor repairs are not being done. These included repairs to door locks, handles and trims to bedroom furniture and a squeaking door. Although some areas of the first and top floors have been redecorated there is an urgent need to complete the redecoration and refurbishment of all areas on these floors. Some carpets are badly stained and some bedrooms are in a poor decorative order. A number of light shades were also missing in the bedrooms. The home was clean but a number of rooms had an unpleasant odour. This was probably due to incontinence and the poor condition of the carpet. The kitchenettes on the dementia unit were cleaner than at previous inspections. Laundry facilities were suitable for the size of the home. An infection control policy was available. Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Members of staff were encouraged to acquire the skills and knowledge needed to provide effective care for the residents. A high rate of staff absence frequently affected staffing levels. EVIDENCE: It was evident from examination of the duty rota, discussions with members of staff and the manager that staff absence was a continuing problem. The manager said she was recruiting more care assistants to ensure appropriate staffing levels were maintained and cover for absence more readily available. Agency staff was frequently used to cover for staff absence. One member of staff said not all shifts were covered. Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 22 Discussion with the manager and members of staff confirmed that training was actively encouraged. This included a structured induction programme for all new employees, moving and handling, fire awareness, health and safety, COSHH, basic food hygiene, safeguarding vulnerable adults, infection control and challenging behaviour. In addition to this the manager has arranged training later in the year for dementia care, falls prevention and end of life care. Twelve care assistants (55 ) have an NVQ level 2 and one care assistant is working towards NVQ level 3. All members of staff have an individual training record. The files of four members of staff appointed since the last inspection were examined. These files indicated that all the required pre-employment checks to ensure protection of the residents had been completed prior to appointment. Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 (older people) 27,39 and 42 (adults 28-65) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The new manager is making improvements in the care and services provided for the residents. Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 24 EVIDENCE: The manager is an experienced nurse and has applied to be registered with CSCI. Since her appointment as manager she has completed training in health & safety, employing people and information technology. She is willing to do an NVQ level 4 in management and keeps up to date with current nursing practice by reading appropriate nursing journals. The manager audits all aspects of the care and services provided at the home. These audits are evaluated at head office. Feedback from the relatives of residents is encouraged at their meetings, which are held every four to six weeks. Minutes of the meeting held on 22 March 2007 were seen. The manager explained that a resident’s meeting had been scheduled for the previous week but on one wanted to attend. The activities organiser has set up a residents committee in order to obtain their views. A quality improvement plan, including timescales, dated January 2007 was in place. Annual questionnaires were distributed to residents and their relatives from head office. The manager encouraged residents and their relatives to talk to her at anytime about the care provided. Records of transactions involving resident’s money were seen to up to date and accurate. Discussion with members of staff and the manager confirmed that a system for annual appraisals and regular formal supervision was not in place. A fire risk assessment was in place. Fire alarms, emergency lighting and fire doors were checked regularly. Records of the routine servicing of equipment were seen. These included an up to date gas safety certificate, the testing of small electrical appliances and servicing of the hoists and lift. Records maintained by the cook included fride, freezer and food temperatures. A cleaning schedule was also available. A diary of the food served including cooking times was kept and a record of the food served to individual residents. Accident records were seen, these were filed in resident’s individual care plan folders. During the inspection members of staff were observed using incorrect moving and handling techniques. A resident’s position was changed by lifting him manually using the hoist sling. The underarm lift was also used to help another resident to change her position. Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 25 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 X 2 X 3 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 1 20 X 21 X 22 X 23 X 24 X 25 X 26 2 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 3 36 1 37 3 38 2 Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15(1) Requirement To ensure the care needs of all residents are met. Care plans must accurately identify and address the care needs of each resident. Timescales of 02/12/05, 01/01/06, 03/02/06, 28/04/06, 25/08/06, 29/12/06 and 02/03/07. To ensure staff have the information necessary in order to meet the needs of all residents care plans must be reviewed monthly and up dated when the needs of the resident change. Timescale of 15/11/06 and 02/03/07 not met. In order to identify and prevent residents from becoming malnourished a nutritional assessment must be completed for all residents. The dignity of all residents must be promoted. Residents must not wear dirty clothes, wrinkled stockings or ill-fitting shoes. Timescale of 01/02/07 not met. Timescale for action 29/06/07 2 OP7 15(2)(b) 29/06/07 3 OP8 13(4)(c) 29/06/07 4 OP8 12(4)(a) 29/06/07 Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 27 5 OP8 13(3) 6 OP9 13(2) 7 OP9 13(2) 8 OP9 13(2) Razors must not be used communally for residents, this is undignified and unhygienic and put residents at risk of infection. Systems must be in place to ensure an adequate supply of prescribed medication is available for all residents. To ensure all members of staff administer medication safely MAR charts must be signed at the time of administration. To prevent harm to any residents due to misuse of creams and ointments they must always be stored securely. To promote the wellbeing of residents especially those suffering from dementia members of staff must attempt to engage residents in conversation. They must also clearly explain at level and pace suitable for that resident what they are going to do e.g. a moving and handling procedure in order to minimise any distress and encourage the resident to cooperate with the staff. (see also standard 8) To promote the wellbeing of residents and provide a homely environment the first and top floors of the home must be redecorated and the floor covering renewed. Timescale of 27/04/07 not met. To provide a pleasant environment for residents, staff and visitors all areas of the home must free from offensive odours. Timescale of 25/08/06, 29/12/06 and 30/03/07 not met. 29/06/07 29/06/07 26/05/07 29/06/08 9 OP12 12(5)(b) 29/06/07 10 OP19 23(2)(d) 31/08/07 11 OP26 16(2)(k) 29/06/07 Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 28 12 OP27 18(1)(a) 13 OP36 18(2)(a) 14 OP38 13(5) A sufficient number of staff must be on duty at all times to ensure the assessed needs of the residents are met. Staff shortages due to absence levels must be addressed. Timescale of 28/04/06, 28/07/06 and 30/03/07 not met. To ensure all members of staff are working to the required standard they must have an annual appraisal and regular formal supervision. Timescale of 29/09/06, 26/01/07 and 25/05/07 not met. To prevent residents from being injured members of staff must always safe moving and handling procedures. 27/07/07 25/05/07 29/06/07 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 12 OP12 Refer to Standard OP9 Good Practice Recommendations Hand written instructions on the medication administration record should be signed and witnessed. Diversional therapy plans should be written sensitively and negative comments about residents avoided. Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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. Addison Court Nursing Home DS0000022489.V333124.R01.S.doc Version 5.2 Page 30 - 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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