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Inspection on 26/06/06 for Addison Court Nursing Home

Also see our care home review for Addison Court Nursing Home for more information

This inspection was carried out on 26th June 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The daily routine was flexible in order to meet the needs and preferences of the residents. One resident said, "I like to be up for my porridge at 8.00am. I have a TV and watch things that are special on it." Another resident said, "I`m quite happy here." Training for care assistants to NVQ level 2 is encouraged and 50% of them have this qualification.

What has improved since the last inspection?

Since the last inspection a new manager has been appointed. Although she had only been in post for a short time she was providing effective leadership for the home. She also expressed her intention to address the problems identified during this inspection. Several new beds with integral cot sides have been purchased. This will improve the safety of residents who need cot sides.

What the care home could do better:

Prospective residents should be given as much information as possible about a care home. This must include confirmation in writing their care needs can be met at the home. It is of serious concern that care planning has not improved since the last inspection. A falls risk assessment, which clearly identifies the level of risk, must be completed for each resident. Care plans must address all identified needs and clearly state the individual preferences of the resident. Records about the care of wounds and pressure sores must give detailed information about their treatment and condition. It is essential that these records are kept up to date. All care plans and risk assessments must be reviewed monthly and up dated when the needs of the resident change. The resident, if possible, or their relatives must be involved in planning their care. In order to promote safety and prevent medication error a record of the administration of all creams must be kept. The reason for not giving a dose ofAddison Court Nursing Home DS0000022489.V300636.R01.S.doc Version 5.2 Page 6prescribed medication must be written on the medication administration record. It is important that the stock of homely remedies, paracetamol etc. is checked regularly to ensure they are not out of date. The records of the disposal of unwanted medication must state which resident they had been prescribed for. All hand written instructions on the medication administration records should be signed and witnessed. The criteria for the administration of medication prescribed when required should state how staff will recognise when the resident needs this medication. The privacy and dignity of all residents must be respected. The list residents and the incontinence product to be used must be removed from the disabled toilet. The unnamed toiletries in the first floor bathroom cupboard must be removed and not used communally. Staff must ensure that each resident has their own supply of suitable toiletries. Urgent action must be taken to provide suitable leisure activities for residents on the dementia unit. Leisure activities must be advertised in all areas of the home. It is important that all residents dietary likes and dislikes are catered for. Residents must be consulted about the meals and alternatives made available for any resident who dislikes the meals provided. Immediate action must be taken to protect residents on the dementia unit from abuse. Residents on the dementia unit must not be handled roughly. The protection of vulnerable adults must be 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. The environment on the top floor of the home was unpleasant and requires urgent improvement. The drawer and cupboards in the kitchenette must be kept clean and the drawer handle repaired. The lounge continues to be dimly lit. Lighting must be improved sufficiently to enable residents to read if they wish. Appropriate and sufficient bathing and shower facilities must be provided on this floor. The exposed wires seen near the floor outside one of the bedrooms on the top floor must be covered. Hand washing facilities for members of staff must be provided on the top floor. It of serious concern that requirements made to address these problems at previous inspections have not been met. 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 dementia unit must be increased to ensure residents are properly supervised and time is allowed to take them out into the garden. The manager was advised to explore and obtain a satisfactory explanation of any gaps in employment history for new employees prior to appointment. One of the written references should be from the applicant`s last employer. This will ensure that residents are protected by thorough recruitment procedures. A formal system for obtaining the views of residents and their relatives and reviewing the quality of the care and services provided must be developed. Records of the food provided for individual residents must be kept in order to determine that all residents are receiving a nutritious, well balanced diet. A requirement made at the last four inspections to address this issue has not been met. To prevent injury to residents and staff correct moving andAddison Court Nursing Home DS0000022489.V300636.R01.S.doc Version 5.2 Page 7handling techniques must always be used. It is important that records of all accidents involving residents are kept.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Addison Court Nursing Home Addison Street Accrington Lancashire BB5 6AG Lead Inspector Mrs Susan Hargreaves Key Unannounced Inspection 09:40 26 and 27th June 2006 th 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.V300636.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.V300636.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.V300636.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. A maximum of 25 service users requiring nursing care who fall into the category of either OP or PD A maximum of 25 service users requiring personal care who fall into the category of OP A maximum of 25 service users requiring nursing care who fall into either the category of DE(E) or MD(E) A maximum of 10 service users requiring personal care who fall into the category of either DE(E) or MD(E) Staffing for service users requiring nursing care will be in accordance with the Notice issued dated 16 August 2000 Total number of service users within the categories not to exceed 50 (fifty) 8th March 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 £324.50 - £698.22 per week. Additional charges are payable for private chiropody, hairdressing 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.V300636.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection took place over two days by two inspectors. An officer from the health and safety executive accompanied the inspectors on the first day. One complaint has been made to the Commission since the last inspection. The provider was asked to investigate this complaint. At the time of this inspection 45 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. What the service does well: What has improved since the last inspection? What they could do better: Prospective residents should be given as much information as possible about a care home. This must include confirmation in writing their care needs can be met at the home. It is of serious concern that care planning has not improved since the last inspection. A falls risk assessment, which clearly identifies the level of risk, must be completed for each resident. Care plans must address all identified needs and clearly state the individual preferences of the resident. Records about the care of wounds and pressure sores must give detailed information about their treatment and condition. It is essential that these records are kept up to date. All care plans and risk assessments must be reviewed monthly and up dated when the needs of the resident change. The resident, if possible, or their relatives must be involved in planning their care. In order to promote safety and prevent medication error a record of the administration of all creams must be kept. The reason for not giving a dose of Addison Court Nursing Home DS0000022489.V300636.R01.S.doc Version 5.2 Page 6 prescribed medication must be written on the medication administration record. It is important that the stock of homely remedies, paracetamol etc. is checked regularly to ensure they are not out of date. The records of the disposal of unwanted medication must state which resident they had been prescribed for. All hand written instructions on the medication administration records should be signed and witnessed. The criteria for the administration of medication prescribed when required should state how staff will recognise when the resident needs this medication. The privacy and dignity of all residents must be respected. The list residents and the incontinence product to be used must be removed from the disabled toilet. The unnamed toiletries in the first floor bathroom cupboard must be removed and not used communally. Staff must ensure that each resident has their own supply of suitable toiletries. Urgent action must be taken to provide suitable leisure activities for residents on the dementia unit. Leisure activities must be advertised in all areas of the home. It is important that all residents dietary likes and dislikes are catered for. Residents must be consulted about the meals and alternatives made available for any resident who dislikes the meals provided. Immediate action must be taken to protect residents on the dementia unit from abuse. Residents on the dementia unit must not be handled roughly. The protection of vulnerable adults must be 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. The environment on the top floor of the home was unpleasant and requires urgent improvement. The drawer and cupboards in the kitchenette must be kept clean and the drawer handle repaired. The lounge continues to be dimly lit. Lighting must be improved sufficiently to enable residents to read if they wish. Appropriate and sufficient bathing and shower facilities must be provided on this floor. The exposed wires seen near the floor outside one of the bedrooms on the top floor must be covered. Hand washing facilities for members of staff must be provided on the top floor. It of serious concern that requirements made to address these problems at previous inspections have not been met. 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 dementia unit must be increased to ensure residents are properly supervised and time is allowed to take them out into the garden. The manager was advised to explore and obtain a satisfactory explanation of any gaps in employment history for new employees prior to appointment. One of the written references should be from the applicant’s last employer. This will ensure that residents are protected by thorough recruitment procedures. A formal system for obtaining the views of residents and their relatives and reviewing the quality of the care and services provided must be developed. Records of the food provided for individual residents must be kept in order to determine that all residents are receiving a nutritious, well balanced diet. A requirement made at the last four inspections to address this issue has not been met. To prevent injury to residents and staff correct moving and Addison Court Nursing Home DS0000022489.V300636.R01.S.doc Version 5.2 Page 7 handling techniques must always be used. It is important that records of all accidents involving residents are kept. 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. Addison Court Nursing Home DS0000022489.V300636.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.V300636.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 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. Residents were not informed in writing that their needs could be met at the home. EVIDENCE: The individual records of four residents were inspected. These contained a detailed pre-admission assessment. However, 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.V300636.R01.S.doc Version 5.2 Page 10 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, 10 (older people) 6, 9, 16, 18, 19, 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. Personal care was carried out in private. Care plans did not identify and address all aspects of health and personal care. This meant there was the potential for some needs not to be fully met. Some procedures relating to medication were not managed correctly. EVIDENCE: The individual care plans of five residents were inspected. These plans did not identify and address all the care needs of each resident. A falls risk Addison Court Nursing Home DS0000022489.V300636.R01.S.doc Version 5.2 Page 11 assessment was not in place for one resident. Falls risk assessments did not clearly identify the level of risk. Two residents were identified as having a high risk of developing pressure sores but care plans were not in place to address this problem. Care plans relating to personal hygiene, nutrition, wearing stockings and spiritual needs were generic and did not specify the needs of individual residents. A care plan relating to the treatment of pressure sores for one resident did not include an up to date detailed description of the sores. Information about the condition of these sores was not recorded at each dressing change. Another care plan relating to wound care had not been up dated when the type of dressing being used was changed. Information about the condition of this wound was not recorded each time it was redressed. Not all care plans were reviewed monthly or up dated when the needs of the resident changed. There was no evidence to suggest that the residents or their relatives were involved in care planning. Residents were registered with a GP and had access to other healthcare professionals. Medication was stored correctly and administered by registered nurses. Records for the management of medication were in place. However, there was no record of the administration of a cream for one resident. The criteria for the administration of medication prescribed when required did not state how to recognise when the resident was in pain. There were gaps in the medication administration record for one resident without any reason being given for omitting the medication. Some hand written instructions on the medication administration records were not signed or witnessed. Controlled drugs were stored correctly and a stock check was satisfactory. All the stock of homely remedies, paracetamol, senokot etc. stored in the home were out of date. The records of the disposal of unwanted medication did not state which resident they had been prescribed for. Personal care was carried out in private. However, there was evidence to suggest that privacy and dignity was not promoted for several residents who suffered from incontinence. There was a notice in the disabled toilet giving the name of the resident and the size of pad worn. In the first floor bathroom cupboard there was a selection of unnamed partly used toiletries, which suggests these were used communally. Addison Court Nursing Home DS0000022489.V300636.R01.S.doc Version 5.2 Page 12 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 adequate. This judgement has been made using available evidence including a visit to this service. Leisure activities were limited and did not take place on the dementia unit. Visitors were welcomed into the home at anytime. The daily routine was flexible to meet the needs of the residents. Meals were wholesome but not to the liking of all residents. EVIDENCE: A range of leisure activities were organised by the activities co-ordinator on three days a week. These activities usually took place on the ground floor and were not advertised in the home. Activities included, dominoes, craft, videos Addison Court Nursing Home DS0000022489.V300636.R01.S.doc Version 5.2 Page 13 and reminiscence. One resident said, “I just sit here except for Monday, Tuesday and Wednesday when OT here. Then I play dominoes and other games. There’s only one or two of us can play.” There was no evidence to suggest that activities took place on the dementia unit. An outside entertainer visited the home regularly. On these occasions residents from the dementia unit were invited to attend. Visitors were welcomed into the home at anytime and offered refreshments. Discussion with members of staff and residents confirmed that the daily routine was flexible. One resident said, “I can go to bed at 7.00pm. That’s because I’m up early. I like to be up for my porridge at 8.00am.” Residents were encouraged to personalise their rooms with photographs, ornaments etc. The meal served at lunchtime on the day of the inspection looked wholesome and appetising. One resident said, “ The food is good here. They give us a choice, you can pick what you want.” Another resident said, “I’m happy with the food and I’m not the easiest one to suit.” However, several residents were dissatisfied with the meals. One resident said, “The food is not cooked well. All the potatoes are boiled or mashed. All the soup is powered, not homemade.” Another resident said, “The food’s atrocious.” Lunch was unhurried allowing residents time to chat and enjoy their meal. Members of staff were observed standing up to feed residents. The menu displayed was written in small print and inaccurate. The cook explained that new menus were to be introduced. A copy of the draft menu was seen. This offered more choice based on the known likes and dislikes of residents. Drinks and snacks were available between meals. However, the food left out at night, cold meat, and cheese etc. was not refrigerated. Addison Court Nursing Home DS0000022489.V300636.R01.S.doc Version 5.2 Page 14 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 poor. This judgement has been made using available evidence including a visit to this service. A complaints procedure is in place. Arrangements for protecting residents on the dementia unit are unsatisfactory placing them at risk of harm or abuse. EVIDENCE: A copy of the complaints procedure was available. One complaint has been made to the Commission since the last inspection. Policies and procedures relating to the protection of vulnerable adults were in place. Several members of staff said they had seen residents on the dementia unit handled roughly. One member of staff said she had reported this to the nurse in charge on that unit but no action had been taken. Protection of adults was discussed with one member of staff. She was aware of the procedure from previous NVQ training but this issue had not been included in her induction to Addison Court. 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.V300636.R01.S.doc Version 5.2 Page 15 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. The general unit was clean and well maintained providing a pleasant environment for the residents. Areas of the top floor had an unpleasant odour, the lounge was dimly lit, all bathing facilities were out of order and there were no hand washing facilities for staff. The laundry was appropriate for the size of the home. Addison Court Nursing Home DS0000022489.V300636.R01.S.doc Version 5.2 Page 16 EVIDENCE: The manager explained that recently all areas of the home, except the bathrooms, had been thoroughly cleaned by contract cleaners. However, there were localised areas of unpleasant odour on the top floor corridor and one bedroom. In the kitchenette on the top floor the drawer handle was missing and the drawer and cupboards were dirty. Lighting in the top floor lounge continues to be inadequate. In addition to this there was condensation between the double-glazing on the windows. Exposed wires were seen near the floor outside one of the bedrooms on the top floor. All facilities on the top floor for residents to have a bath or a shower remain out of order. The bathroom has been unusable for sometime and the shower is broken. The hand basin has been removed from the office on the top floor. Staff said they had nowhere to wash their hands except in the resident’s bedrooms. One bedroom door did not have a door handle and could not be opened from the inside by the resident. Part of the window was covered with Perspex and in need of repair. The manager took this room out of use at the time of the inspection. She said it would not be used again until all repairs were completed. Laundry facilities were appropriate for the size of the home. Addison Court Nursing Home DS0000022489.V300636.R01.S.doc Version 5.2 Page 17 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 adequate. 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 thorough. Training, including NVQ’s was encouraged for all members of staff. EVIDENCE: It was evident from discussions with members of staff and the manager that staff absence levels were high. This meant the home was frequently understaffed. The lack of bathing facilities on the top floor meant staff had to leave the floor to take residents for a bath. Two members of staff on the dementia unit explained that staffing levels did not allow time for residents to be taken out into the garden. Another member of staff on the dementia unit explained there was insufficient staff to properly supervise residents who liked to wander. The records of five members of staff appointed since the last inspection were examined. Four of these indicated that all the required pre-employment Addison Court Nursing Home DS0000022489.V300636.R01.S.doc Version 5.2 Page 18 checks to ensure protection of the residents had been completed. However, the records for the other employee did not explain gaps in employment history. Although there were two written references neither were from the previous employer. It was evident from discussion with the manager and members of staff that training opportunities were available. This included health and safety, basic food hygiene and infection control. Thirteen care assistants (50 ) had NVQ level 2 in care. The manager explained that a new induction programme, which complied with the ‘Skills for Care’ standard, had been developed. Addison Court Nursing Home DS0000022489.V300636.R01.S.doc Version 5.2 Page 19 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, 37 and 38 (older people) 37,39 and 42 (adults 18-65) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager was an experienced nurse. A system to monitor the quality of the care and services provided was not in place. Detailed records of the food provided for individual residents were not kept. The standard of hygiene in the first top floor kitchenette was poor. Addison Court Nursing Home DS0000022489.V300636.R01.S.doc Version 5.2 Page 20 EVIDENCE: The recently appointed manager is an experienced nurse and working towards the ‘Registered manager’s Award’. The home had achieved the nationally accredited Investors in People award. However, a formal system for obtaining the views of residents and their relatives about the care and services provided was not in place. Transactions involving resident’s money were seen to be well maintained and up to date. It was evident from discussions with members of staff that annual appraisals and regular formal supervision were not taking place. Records maintained by the cook did not include a daily record of the food provided for individual residents. The fridge, microwave oven, the drawer and storage jars in the kitchenette on the first floor were dirty. Policies and procedures relating to safe working practices were available. Fire alarms were tested weekly and emergency lighting was tested monthly. Fire drills did not take regularly. Records of the routine servicing of equipment were seen, including an up to date gas safety certificate. However, an electrical installation certificate was not available. Testing of small electrical appliances had taken place in January 2006. During the inspection members of staff were observed using an inappropriate moving and handling technique when transferring a resident from their wheelchair to an armchair. Accident records had not been kept for several weeks. Safety notices were displayed in the home. Addison Court Nursing Home DS0000022489.V300636.R01.S.doc Version 5.2 Page 21 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 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 ENVIRONMENT Standard No Score 19 2 20 X 21 1 22 X 23 X 24 X 25 X 26 2 STAFFING Standard No Score 27 1 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 1 34 X 35 3 36 1 37 2 38 2 Addison Court Nursing Home DS0000022489.V300636.R01.S.doc Version 5.2 Page 22 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 26/06/06 2. OP7 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 not met 15(1) Unless it is impracticable to 25/08/06 carry out such consultation, the registered person shall, after consultation with the DS0000022489.V300636.R01.S.doc Version 5.2 Page 23 Addison Court Nursing Home 3. OP7 13(4)(b)(c) 4. OP7 15(2)(b) 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 and 28/04/06 not met. The registered person shall 25/08/06 ensure that- (b) any activities in which service users participate are so far as reasonably practicable free from avoidable risks; and (c) unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. All residents must have a falls risk assessment, which clearly identifies the level of risk. Timescale of 01/01/06, 03/02/06 and 28/04/06 not met. The registered person shall 25/08/06 - (b) keep the service user’s plan under review. All care plans and risk assessments must be reviewed monthly. Timescale of 1/7/05, 2/12/05, 01/01/06, 03/02/06 and 28/04/06 not met. DS0000022489.V300636.R01.S.doc Version 5.2 Page 24 Addison Court Nursing Home 5. OP8 17(1)(a) Sch 3(n) 6. OP8 17(1)(a) 7. OP9 13(2) The registered person shall- 14/07/06 (a) maintain in respect of each service user a record which includes the information, documents and other records specified in Schedule 3 relating to the service user. (n) a record of incidence of pressure sores and the treatment provided to the service user. Detailed and up to date records relating to the condition and treatment of pressure sores must be kept. The registered person shall- 14/07/06 (a) maintain in respect of each service user a record which includes the information, documents and other records specified in Schedule 3 relating to the service user. (k) a record of any nursing provided to the service user, including a record of his condition and any treatment or surgical intervention. Records relating to wound care must be kept up to date. Timescale of 08/03/06 not met. The registered person shall 14/07/06 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. A record of the administration of creams must be kept. There must be no gaps on the MAR charts, if medication is omitted a reason for this DS0000022489.V300636.R01.S.doc Version 5.2 Page 25 Addison Court Nursing Home 8. OP10 12(4)(a) 9. OP12 16(2)(n) 10. OP15 12(3) must be given. Homely remedies kept in the home must not be out of date. The record of the disposal of unwanted medication must state the name of the resident they were prescribed for. The registered person shall 14/07/06 make suitable arrangements to ensure that the care home is conducted – (a) a manner which respects the privacy and dignity of service users. The list of residents and the pads to be used must be removed from the disabled toilet. Toiletries must not be used communally. The registered person shall 25/08/06 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. Activities must be advertised and organised in all areas of the home. The registered person shall 25/08/06 for the purpose of providing care to service users, and making proper provision for their health and welfare, so far as practicable ascertain and take into account their wishes and feelings. Residents must be DS0000022489.V300636.R01.S.doc Version 5.2 Page 26 Addison Court Nursing Home 11. OP18 13(6) 12 OP19 23(2)(d)(p) 13. OP19 13(4)(a)(c) 14. OP19 23(2)(d)(p) consulted about the food provided. The registered person 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. Residents on the dementia unit must not be handled roughly. Induction training for all staff must include the protection of vulnerable adults. The registered person shall having regard to the number and needs of the service users ensure that (d) all parts of the home are kept clean and reasonably decorated. The cutlery drawer must be cleaned and the handle replaced. The cupboard must be kept clean. Timescale of 03/02/06 and 24/04/06 not met. The registered person shall ensure that – (a) all parts of the home to which service users have access are sot far as reasonably practicable free from hazards to their safety; (c) unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. The exposed wires on the top floor must be covered. Timescale of 31/03/06 not met. The registered person shall having regard to the number and needs of the DS0000022489.V300636.R01.S.doc 27/06/06 25/08/06 25/08/06 29/09/06 Addison Court Nursing Home Version 5.2 Page 27 15 OP19 23(2)(b) 16. OP21 23(2)(j) 17. OP26 16(2)(k) 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 and 31/03/05 not met. The registered person shall 25/08/06 having regard to the number and needs of the service users ensure that – (b) the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally. Room 46 must not be used until the door handle and window have been repaired. The registered person shall 29/09/06 having regard to the number and needs of the service users ensure that (j) there are provided at appropriate places in the premises sufficient numbers of lavatories, and of wash basins, baths and showers fitted with a hot and cold water supply. The shower on the top floor must be repaired or replaced. Timescale of 03/02/06 and 28/4/06 not met. The registered person shall 25/08/06 having regard to the size of the care home and the number and needs of service users (k) keep the DS0000022489.V300636.R01.S.doc Version 5.2 Page 28 Addison Court Nursing Home 18 OP26 13(3) 19. OP27 18(1)(a) 20. OP33 24(2) 21. OP36 18(2)(a) 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. The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. Hand washing facilities must be provided for staff on the top floor. The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service 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 28/04/06 not met. Staffing levels on the dementia unit must be sufficient to ensure residents are properly supervised. The registered person shall establish and maintain a system for evaluating the quality of the services provided at the care home. The registered person shall ensure that (a) persons working at the care home DS0000022489.V300636.R01.S.doc 14/07/06 28/07/06 29/09/06 29/09/06 Addison Court Nursing Home Version 5.2 Page 29 22. OP37 17(2) Sch 4 23. OP38 16(2)(j) 24. OP38 23(4)(e) are appropriately supervised. All care staff must have an annual appraisal and regular formal supervision. Records of the food 26/06/06 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 and 08/03/06 not met. The registered person shall 14/07/06 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 standards of hygiene in the care home. The fridge, microwave, drawer and storage jars in first floor kitchenette must be cleaned. Timescale of 16/12/05, 20/01/06 and 31/03/06 not met. The registered person shall 25/08/06 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 DS0000022489.V300636.R01.S.doc Version 5.2 Page 30 Addison Court Nursing Home 25. OP38 13(4)(a) 26. OP38 13(5) 27. OP38 17(2) Sch 4(12) 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. The registered person shall 25/08/06 ensure that (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their health and safety. An up to date electrical installation certificate must be obtained. The registered person shall 25/08/06 make suitable arrangements to provide a safe system for moving and handling service users. The registered person shall 26/06/06 maintain in the care home the records specified in schedule 4 12(a) Any accident. 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. Refer to Standard OP9 OP9 Good Practice Recommendations Hand written instructions on the medication administration record should be signed and witnessed. The criteria for the administration of medication prescribed when required should state how to recognise when a resident is in pain if they are unable to communicate verbally. The menu displayed should accurately reflect the meals served and be printed in a size that can easily be read by the residents. DS0000022489.V300636.R01.S.doc Version 5.2 Page 31 3. OP15 Addison Court Nursing Home 4. 5. 6. 7. 8. OP15 OP18 OP19 OP29 OP29 Members of staff should sit down to feed 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. Any gaps in employment history should be explored and a satisfactory explanation given prior to appointment. One of the written references should be from the applicant’s last employer. Addison Court Nursing Home DS0000022489.V300636.R01.S.doc Version 5.2 Page 32 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. 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