Inspection on 15/11/06 for Addison Court Nursing Home

This inspection was carried out on 15th November 2006.

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

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 15/05/07

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 November 2006 9:40 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.V313719.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.V313719.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 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.V313719.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 26th June 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.V313719.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 by two inspectors at Addison Court on the 15 and 16 November 2006. No additional visits have been made since the last inspection. At the time of this inspection 46 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 a visitor were spoken to. Discussions also took place with the manager regarding issues raised during the inspection. What the service does well: What has improved since the last inspection? What they could do better: It is essential that residents be assessed before admission in order to make sure their needs can be met at the home. To prove this has been carried out before admission the assessment must be signed and dated. Prospective residents or their relatives must then receive confirmation in writing that their care needs can be met at the home. Addison Court Nursing Home DS0000022489.V313719.R01.S.doc Version 5.2 Page 6 Failure to address requirements made about care planning at previous inspections is of very serious concern. Care plans must clearly identify and address all the care needs of individual residents. A care plan and appropriate risk assessments must be in place for all residents from the day of admission. Care plans and risk assessments must be up dated when the needs of the resident change. The resident, if possible, or their relatives must be involved in care planning. Risk assessments for moving and handling must be in place for all residents who need this sort of assistance. Suitable weighing scales must be provided to ensure the weight of all residents is monitored to ensure appropriate action is taken if this varies. It is essential for accurate records to be kept for the administration of medication. This helps to promote safety and prevent mistakes. The reason for not giving a dose of prescribed medication must be written on the medication administration record. A record of all medication received into the home must be kept. All hand written instructions on the medication administration records should be signed and witnessed. A supply of homely remedies should be obtained. The controlled drug’s book should be amended to ensure a page per resident is used. Any errors should be corrected by using a single line instead of correction fluid. It is of serious concern that privacy and dignity for all residents is not promoted. Personal care must be carried out in private with doors closed and locked if this takes place in a bathroom. Action must be taken to ensure residents have access to a supply of their own stockings and socks are returned from the laundry to their owner. Urgent action must be taken to plan and implement a programme of leisure activities suitable for all residents including those suffering from dementia. Leisure activities must be advertised in all areas of the home. It is of concern that there has been no improvement in the quality of the meals. The dietary likes and dislikes of all residents must be catered for. Residents must be consulted about the meals and alternatives made available for any resident who dislikes the meals provided. Blended meals should look attractive and have each item blended separately. An up to date menu should be displayed. It is important that training in the safeguarding of vulnerable adults is included in induction training for all new members of staff. The whistle blowing policy should be amended to explain clearly the protection available for the whistle blower. This should give members of staff the confidence to report poor practice. It is vital that urgent action is taken to improve the environment. The top floor lounge continues to be dimly lit. Lighting must be improved sufficiently to enable residents to read if they wish. The corridors on the first floor are gloomy and would benefit greatly from improved lighting. The drawer and cupboards in the top floor kitchenette must be kept clean and the drawer Addison Court Nursing Home DS0000022489.V313719.R01.S.doc Version 5.2 Page 7 handle repaired. The floor of the dining room on the top floor was dirty and must be cleaned. The odour problem in several bedrooms must be addressed. To prevent injury to residents the door to room 46, which is being used for storage, must be locked. Staff absence and sickness is 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 the residents. Staffing levels on the top floor dementia unit must be increased to ensure the care needs of the residents are fully met. This includes proper supervision of the residents to prevent harm or injury. It is of very serious concern that three members of staff had started working at the home before a POVA/CRB check had been obtained. This helps to safeguard residents from abuse. Recruitment records and proof of identity for all members of staff must be kept at Addison Court. To ensure all members of staff are competent to care for residents it is essential that a structured induction programme be developed. It is of concern that a manager has been registered with the commission for over a year. Action must be taken to address this issue and ensure a manager is registered within the next four months. Regular supervision and annual appraisals for all care staff are still not taking place. It is important that members of staff have the 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. Records of the food provided for individual residents must be kept in order to determine if all residents are receiving a nutritious, well balanced diet. It is of very serious concern that a requirement made at the last five inspections to address this issue has not been met. The microwave oven and the fridge in the top floor kitchenette must be kept clean. To promote the health and safety of all residents it is important that fridge, freezer and food temperatures are recorded daily. Fire alarms and emergency lighting must be checked regularly and records must be kept. Fire drills must take place at regular intervals to ensure all members of staff are familiar with the procedure. 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 Addison Court Nursing Home DS0000022489.V313719.R01.S.doc Version 5.2 Page 8 contacting your local CSCI office. Addison Court Nursing Home DS0000022489.V313719.R01.S.doc Version 5.2 Page 9 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.V313719.R01.S.doc Version 5.2 Page 10 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 to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (older people) & 2 (adults 18-65) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Admission procedures were not thorough. It was difficult to determine if sufficient information had been obtained before admission to ensure demonstrate individual needs could be fully met. EVIDENCE: The individual records of four residents were inspected. These contained a detailed personal assessment. However, one of these was not signed or dated making it impossible to determine if the assessment had been carried out before or after admission. Another resident had been admitted in an Addison Court Nursing Home DS0000022489.V313719.R01.S.doc Version 5.2 Page 11 emergency and the personal assessment had been completed following admission. There was no evidence to suggest that residents received written confirmation that their care needs could be met at the home. Standard 6 is not applicable to this service. Addison Court Nursing Home DS0000022489.V313719.R01.S.doc Version 5.2 Page 12 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 to be inspected at least once during a 12 month period 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. Care plans did not contain detailed information relating to all aspects of health and personal care. Some procedures relating to medication were not managed correctly, putting residents at risk. Privacy and dignity was not promoted for all residents. EVIDENCE: Addison Court Nursing Home DS0000022489.V313719.R01.S.doc Version 5.2 Page 13 The individual care plans of four residents were inspected. These plans did not identify and address all the care needs of each resident. Some care plans were generic and did not specify the needs of individual residents. It was difficult to establish from one nutritional assessment how the overall risk had been determined. A moving and handling plan was in place for one resident but a risk assessment had not been carried out. This risk assessment would have provided important information and clearly identified the risks associated with moving and handling procedures. The care plans and risk assessments for a resident admitted for respite care had not been reviewed since a previous admission in September. The nutritional assessment for this resident stated she was not at risk. However, a care plan to address the risk of malnutrition was in place. Care plans and risk assessments for a resident, who was admitted in an emergency, were not completed until several days following admission. These care plans did not address all the resident’s needs and the risk assessment relating to pressure sores did not accurately identify the risk. The night intervention record for a resident in a frail condition stated the time care had been given, hourly. However, positional changes were not recorded and there was no evidence to suggest that this resident had been given anything to drink during the night. It was evident from reading the daily report that some members of staff were not fully informed about the needs of all residents. One report written by the night staff stated that a resident had been watching television. This resident was blind. Another care plan stated that the resident wore glasses. When the resident was asked about this she said that she did not wear glasses. Another care plan stated that the resident should be nursed on an air mattress when in bed and sit on an air cushion when in a chair. At the time of the inspection this resident was sitting in the lounge but not on an air cushion. It was apparent from one care plan that a resident was losing weight. However, due to the lack of suitable weighing scales staffs were unable to monitor her weight. Although care plans were reviewed monthly they were not updated when the needs of the resident changed. There was no evidence to suggest that residents or their relatives were involved in care planning. However, relatives were involved in making decisions about healthcare e.g. flu vaccination. Residents were registered with a GP and had access to other healthcare professionals. Medication was stored correctly and administered by registered nurses. Addison Court Nursing Home DS0000022489.V313719.R01.S.doc Version 5.2 Page 14 Records for the management of medication were seen. However, the amount of medication received for one resident was not recorded. There were also gaps in the medication administration record for two residents without any reason being given for omitting the medication. Some hand written entries on the medication administration records were not signed or witnessed. Controlled drugs were stored appropriately. The controlled drug’s book needed amending to ensure a page per resident was used. Any errors should be corrected by using a single line instead of correction fluid. Homely remedies were not available. Although members of staff were observed speaking to residents in a polite and friendly manner privacy and dignity was not promoted for all residents. The door of resident’s room was left open when the resident was sitting on the commode. The door to a bathroom was unlocked when two members of staff were inside attending to a resident. One resident said she had not been washed and was still in her nightclothes at lunchtime because only male carers had been available to help her. On the top floor residents were sitting on paper incontinence sheets. This is undignified. One resident was not wearing stockings. A care assistant was asked if there was a reason for this and explained there was a problem with the supply of stockings for the ladies. Two male residents said their own socks were not returned from the laundry even when they had been named. One visitor said, “I don’t think they wash their hair and feet properly. I do this myself so I know that it’s done.” Addison Court Nursing Home DS0000022489.V313719.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 (older people) 12, 13, 15 and 17 (adults 18-65) Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Leisure activities were not routinely organised. Visitors were welcomed into the home at anytime. Meals were wholesome but residents were not consulted about menus. EVIDENCE: The manager explained that two members of staff had recently received training on therapeutic activities for older people. However, there was no evidence in the four care plans inspected of details of the resident’s interests Addison Court Nursing Home DS0000022489.V313719.R01.S.doc Version 5.2 Page 16 and hobbies. It was also apparent from these records that a regular programme of activities had not taken place since April. Discussion with residents, staff and a visitor also confirmed that activities were not regularly organised at the home. One visitor said, “ there’s never anything going on when I come. They’re all just sat round staring at the wall.” One resident said, “There’s no regular activities, we read and watch TV.” Another resident said, “ I do crosswords to amuse myself. I join in when they play bingo. I’ve been on a couple of trips out and enjoyed that.” Care plans for religious needs were in place but these were generic and did not clearly state the needs of individual residents. Residents who were able to express their preferences e.g. daily routine, meals etc. had their choices respected. One resident said, “They ask what you want at lunch time.” Residents were encouraged to personalise their rooms with photographs, ornaments etc. Visitors were welcomed into the home at anytime. On the first day of the inspection members of staff working on the dementia unit did not know what was for lunch. This prevented them from discussing the choices available with the residents. The meal served was soup, jacket potatoes with either cheese or tuna, beef sandwiches and fruit salad or yoghurt. This meal did not look appetising and several residents on the ground floor expressed their dissatisfaction with this meal. One resident said, “Cheese and potato that’s all, they’ve no idea what a dinner is. I’ve had to go upstairs to fetch my Worcestershire sauce.” This resident was asked about the meal served at teatime and replied, “we get a cooked meal later on but sometimes it’s sandwiches.” Another resident said, “The food’s rubbish.” Two residents asked said they had never been consulted about the meals or menus. A number of other residents said the meals were good. One resident said, “Everything’s cooked all right and there’s enough to eat.” Another resident said, “The food’s usually good.” A member of staff on the dementia unit explained that blended meals were very unappetising and sometimes they didn’t know what it was. The meal served at lunchtime on the second day of the inspection was a traditional dinner of meat and vegetables. The menu displayed on the ground floor was written in small print and was inaccurate. Addison Court Nursing Home DS0000022489.V313719.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 (older people) 22 and 23 (adults 18-65) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A complaints procedure is in place. Training in safeguarding vulnerable adults was available but not as part of induction training. EVIDENCE: A copy of the complaints procedure was available. No complaints have been made to the home or the commission since the last inspection. Policies and procedures relating to the safeguarding of vulnerable adults were in place. The manager explained that members of staff had received training in abuse procedures from an external provider. However, there was no evidence to suggest that safeguarding was included in the induction programme for new members of staff. A ‘whistle blowing’ procedure was displayed in the home. This procedure needed amending to clearly explain how the ‘whistle blower’ would be protected. Addison Court Nursing Home DS0000022489.V313719.R01.S.doc Version 5.2 Page 18 Addison Court Nursing Home DS0000022489.V313719.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 and 26 (older people) 24, 27 and 30 (adults 18-65) Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some areas of the dementia unit are dimly lit, in need of repair, redecoration and cleaning. This environment is not conducive to the wellbeing of residents suffering from dementia. The laundry was appropriate for the size of the home. EVIDENCE: Addison Court Nursing Home DS0000022489.V313719.R01.S.doc Version 5.2 Page 20 At the time of the inspection work was in progress to refurbish all the bathrooms. Refurbishment of the shower room on the top floor was complete and in use. The manager explained that to further improve the environment thirty-four bedrooms were to be redecorated and new carpets were to be fitted in some areas. Although the manager said lighting in the top floor lounge was being upgraded at present it continues to be inadequate. In addition to this there was condensation between the double-glazing on the windows. The corridors on the Baxenden unit were gloomy and would benefit from improved lighting. Several bedrooms smelt very strongly of urine and most were in need of redecoration. One bedroom was being used for storage and the lock had been removed from the door. This put residents at risk of injury if they inadvertently wandered into this room. The dining room floor on the top floor was dirty and in urgent need of cleaning. In the kitchenette on the top floor the drawer handle was still missing and the drawer and cupboards were dirty. The ground floor lounge was clean and odour free. Laundry facilities were appropriate for the size of the home. An infection control policy was available. Addison Court Nursing Home DS0000022489.V313719.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 (older people) 32, 34 and 35 (adults 18-65) Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels were not sufficient to meet the needs of the residents. Recruitment procedures were not thorough. More that 50 of care assistants have an NVQ 2 qualification in care. Induction training for new employees is not in place, putting residents at risk of not receiving a consistent standard of care. EVIDENCE: It was evident from discussions with members of staff and residents that staff absence levels were high. One resident said, “They’re short staffed all the time. People keep leaving and they replace them with people who don’t know what you’re saying and you can’t tell what they’re saying.” Another resident said, “They’re very short staffed. Sometimes they can’t help people when they need it because they say it needs two and there’s only me here at the moment. Staff are always leaving as well. Just as you make a friend of them, Addison Court Nursing Home DS0000022489.V313719.R01.S.doc Version 5.2 Page 22 they’re off.” One member of staff said, “we’re still working short staffed because of people are not turning in. Makes you tired and demotivated. You can’t deliver the care you should and that makes you feel depressed.” Another member of staff said, “We’re short staffed almost everyday.” Examination of the duty rota confirmed that staffing levels on the dementia have not been increased. Only two care assistants are on the rota to work on the top floor dementia unit. The nurse in charge of the dementia unit gives out the medication on the top floor and checks if there are any problems. The care assistants working on the top floor expressed their concerns about the lack of supervision for confused residents, who may be inclined to wander, when they were attending to other residents. They explained that seven out of the twelve residents needed the assistance of two carers for all personal care needs. One member of staff said, “Mealtimes are horrendous, with the confused behaviour of the residents it’s difficult to ensure that all the residents get fed.” Another member of staff said, “There’s not enough staff, we’re still getting people up at 12.25pm. Not because they’ve been asleep until then but because that’s how long it takes to do everything.” The files of three members of staff appointed since the last inspection were examined. These files only contained evidence that a POVA/CRB check had been obtained. However, the duty rota stated that all three members of staff had worked their first shift before the POVA/CRB checks had been obtained. The manager explained that all the recruitment records for these members of staff were at head office. It was evident from discussion with the manager and members of staff that training opportunities were available. This included moving and handling, fire safety, basic food hygiene, first aid and infection control. Ten care assistants (55 ) had NVQ level 2 in care. One care assistant was working towards NVQ level 3 in care. Although the manager said a new induction programme was in place there was no evidence to support this. One member of staff said she had not received any induction training and had no previous experience of caring for older people. Addison Court Nursing Home DS0000022489.V313719.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 (older people) 36, 37, 39 and 42 (adults 18-65) Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A system to monitor the quality of the care and services provided was in place. Members of staff were not having an annual appraisal or formal supervision. The standard of hygiene in the top floor kitchenette was poor. Detailed Addison Court Nursing Home DS0000022489.V313719.R01.S.doc Version 5.2 Page 24 records of the food provided for individual residents were not kept. Procedures to safeguard the health, safety and welfare of residents require further development. EVIDENCE: The manager is an experienced nurse. However, it is over year ago since the home had a manager that was registered with the commission. The home had achieved the nationally accredited Investors in People award. A policy document for quality monitoring was available. A questionnaire about the meals had recently been distributed to residents. Four of these had been returned. The manager explained that a questionnaire from head office would be given to residents and their relatives in December. Completed questionnaires would be sent directly back to head office for evaluation. The manager completed a quality audit every month. The manager said she had tried to arrange a meeting for residents and relatives in September but there had been very little interest in this. Transactions involving resident’s money were seen to be well maintained and up to date. It was evident from discussions with the manager and members of staff that annual appraisals and regular formal supervision were not taking place. Records kept in the home did not include details of the food provided for individual residents. The fridge and microwave oven in the kitchenette on the top floor were dirty. Fridge, freezer and food temperatures were not checked and recorded daily. Although the manager said fire alarms were tested weekly and emergency lighting monthly records to support this had not been kept since 14/08/06. Fire drills did not take regularly. The last recorded fire drill had taken place on 26/07/06. A fire risk assessment was in place. Records of the routine servicing of equipment were available, including gas safety and electrical installation certificates. Addison Court Nursing Home DS0000022489.V313719.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 2 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 ENVIRONMENT Standard No Score 19 1 20 X 21 3 22 X 23 X 24 X 25 X 26 2 STAFFING Standard No Score 27 1 28 4 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 X 33 3 34 X 35 3 36 1 37 2 38 1 Addison Court Nursing Home DS0000022489.V313719.R01.S.doc Version 5.2 Page 26 YES 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 OP3 Regulation Requirement Timescale for action 15/11/06 14(1)(a)(b)(c)(d) The registered person shall not provide accommodation to a service user unless, so far as it shall have been practicable to do so (a) the needs of the service user have been assessed by a suitably qualified or suitably trained person; (b) the registered person has obtained a copy of the assessment; (c) there has been appropriate consultation regarding the assessment with the service user; (d) the registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service user’s needs in respect of his health and welfare. Timescale of 13/01/06, 08/03/06 and 26/06/06. DS0000022489.V313719.R01.S.doc Addison Court Nursing Home Version 5.2 Page 27 2. OP7 15(1) 3. OP7 15(2)(b) 4. OP7 15(2)(c)(d) Unless it is impracticable 29/12/06 to carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. Care plans must accurately address all identified needs including prevention of pressure sores and falls, hygiene, nutrition, wearing stockings and spiritual needs. Residents or their relatives must be involved in care planning. Timescales of 02/12/05, 01/01/06, 03/02/06, 28/04/06 and 25/08/06 not met. All residents must have a care plan in place from the day of admission. 29/12/06 The registered person shall - (b) keep the service user’s plan under review. All care plans and risk assessments must be reviewed monthly and on each admission for residents in receipt of respite care. Timescale of 1/7/05, 2/12/05, 01/01/06, 03/02/06, 28/04/06 and 25/08/06 not met. The registered person 15/11/06 shall – (c) where DS0000022489.V313719.R01.S.doc Version 5.2 Page 28 Addison Court Nursing Home 5. OP7 13(4)(c) 6. OP8 12(1)(a) 7. OP9 13(2) appropriate and, unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service user’s plan and (d) notify the service user of any such revision. Care plan’s must be up dated when the needs of the resident change. The registered person shall ensure that – (c) unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. A moving and handling risk assessment must be in place for all residents who need such assistance. The registered person shall ensure that the care home is conducted so as (a) to promote and make proper provision for the health and welfare of service users. Residents weight must be monitored to ensure action is taken to address weight loss. Suitable scales must be provided. Detailed records must be kept of the care given to frail residents including drinks given during the night. The registered person shall make DS0000022489.V313719.R01.S.doc 29/12/06 15/11/06 15/11/06 Addison Court Nursing Home Version 5.2 Page 29 8. OP10 12(4)(a) 9. OP12 16(2)(n) 10 OP15 12(3) arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. There must be no gaps on the MAR charts, if medication is omitted a reason for this must be given. Timescale of 14/07/06 not met. A record of all medication received into the home must be kept. The registered person 15/11/06 shall ensure that the care home is conducted (a) in a manner which respects the privacy and dignity of service users. 26/01/07 The registered person shall having regard to the size of the care home and the number and needs of service users - (n) consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation, fitness and training. Timescale of 25/08/06 not met. The registered person 26/01/07 shall for the purpose of providing care to service users, and making proper provision for their health and welfare, DS0000022489.V313719.R01.S.doc Version 5.2 Page 30 Addison Court Nursing Home 11. OP18 13(6) 12. OP19 23(2)(p) 13. OP19 23(2)(d) so far as practicable ascertain and take into account their wishes and feelings. Residents must be consulted about the food provided. Timescale of 25/08/06 not met. The registered person 26/01/07 shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. Induction training for all staff must include the protection of vulnerable adults. Timescale of 27/06/06 not met. 26/01/07 The registered person shall having regard to the number and needs of the service users ensure that (p) ventilation, heating and lighting suitable for service users is provided in all parts of the care home which are used by service users. The lighting in the top floor lounge must be improved sufficiently to enable residents to read if they wish. Timescale of 30/12/05, 31/03/05 and 29/09/06 not met. The registered person 26/01/07 shall having regard to the number and needs of the service users DS0000022489.V313719.R01.S.doc Version 5.2 Page 31 Addison Court Nursing Home 14 OP19 13(4)(a) 15. OP26 16(2)(k) 16. OP27 18(1)(a) ensure that (d) all parts of the home are kept clean and reasonably decorated. In the top floor kitchenette the cutlery drawer must be cleaned and the handle replaced. The cupboard must be kept clean. Timescale of 03/02/06 24/04/06 and 25/08/06 not met. The registered person 08/12/06 shall ensure that (a) all parts of the home to which service users service users have assess are so far as reasonably practicable free from hazards to their health and safety. The door to room 46, which is being used for storage must be locked. 29/12/06 The registered person shall having regard to the size of the care home and the number and needs of service users (k) keep the care home free from offensive odours and make suitable arrangements for the disposal of general and clinical waste. All areas of the home must free from offensive odours. Timescale of 25/08/06 not met. The registered person 29/12/06 shall, having regard to the size of the care home, the statement of purpose and the number and needs of service DS0000022489.V313719.R01.S.doc Version 5.2 Page 32 Addison Court Nursing Home 17. OP29 19(1)(b) Schedule 2 18. OP30 18(1)(c)(i) 19. OP31 8(1)(a) users - (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. Staff shortages due to absence levels must be addressed. Timescale of 28/04/06and 28/07/06 not met. Staffing levels on the top floor dementia unit must be sufficient to ensure residents are properly supervised. Timescale of 28/07/06 not met. The registered person 15/11/06 shall not employ a person to work at the care home unless (b) he has obtained in respect of that person the information and documents specified in (i) paragraphs 1 to 9 of schedule 2 The registered person 26/01/07 shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users – (c) ensure that the persons employed by the registered person to work at the care home receive (i) training appropriate to the work they are to perform including structured induction training. The registered provider 30/03/07 DS0000022489.V313719.R01.S.doc Version 5.2 Page 33 Addison Court Nursing Home 20. OP36 18(2)(a) 21. OP37 17(2) Sch 4 22. OP38 16(2)(j) shall appoint an individual to manage the care home where – (a) there is no registered manager in respect of the care home. The registered person 26/01/07 shall ensure that (a) persons working at the care home are appropriately supervised. All care staff must have an annual appraisal and regular formal supervision. Timescale of 29/09/06 not met. Records of the food 15/11/06 provided for service users in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and any special diets prepared for individual service users. Accurate records of the food provided must be kept for all residents. Timescale of 18/11/05, 4/12/05, 13/01/06, 08/03/06 and 26/06/06 not met. The registered person 08/12/06 shall having regard to the size of the care home and the number and needs of service users - after consultation with the environmental health authority, make suitable arrangements for maintaining satisfactory DS0000022489.V313719.R01.S.doc Version 5.2 Page 34 Addison Court Nursing Home 23. OP38 13(3) 24. OP38 23(4)(c)(v) 25. OP38 23(4)(e) standards of hygiene in the care home. The fridge and microwave oven in the top floor kitchenette must be cleaned. The registered person 15/11/06 shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. Fridges, freezers and food temperatures must be recorded daily. The registered person 29/12/06 shall after consultation with the fire authority – (c) make adequate arrangements (v) for reviewing fire precautions, and testing fire equipment at suitable intervals. The testing of fire alarms and emergency lighting must take place regularly with records kept. The registered person 29/12/06 shall after consultation with the fire authority (e) to ensure, by means of fire drills and practices at suitable intervals, that the persons working at the care home and, so far as practicable, service users, are aware of the procedure to be followed in case of fire, including the procedure for saving life. Fire drills must be held regularly. DS0000022489.V313719.R01.S.doc Version 5.2 Page 35 Addison Court Nursing Home Timescale of 25/08/06 not met. 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. 4. 5. 6. 7. 6. Refer to Standard OP8 OP9 OP9 OP9 OP15 OP15 OP18 OP19 Good Practice Recommendations Risk assessments relating to nutrition should clearly state how the overall risk has been determined. Hand written instructions on the medication administration record should be signed and witnessed. Correction fluid should not be used in the controlled drug’s book. In consultation with the GP’s homely remedies e.g. paracetamol, cough medicine etc. should be made available to residents. Blended meals should look attractive and have each item blended separately. The menu displayed should accurately reflect the meals served and be printed in a size that can easily be read by the residents. The whistle blowing policy needs amending to include details of the protection available for the ‘Whistle Blower’. Action should be taken to deal with the condensation between the double-glazing in the top floor lounge. Addison Court Nursing Home DS0000022489.V313719.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB 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. Addison Court Nursing Home DS0000022489.V313719.R01.S.doc Version 5.2 Page 37 - 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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