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Inspection on 28/04/08 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 28th April 2008.

CSCI found this care home to be providing an Adequate service.

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

Members of staff were observed attending to residents in a caring manner. The relative of one resident said, "They look after people very well." Another visitor said, "I can`t fault the care." One resident explained he had been in several care homes, but Addison Court was definitely the best. He said he was happy living in the home and liked the meals and the staff. Another resident described the staff as "grand". This resident also said he liked his bedroom and it was always kept clean. A district nurse said she had a good relationship with staff at the home and thought the residents were well care for.

What has improved since the last inspection?

Care plans identify the care needs of each resident and explain what members of staff have to do in order to provide person centred care. Wound care records provided detailed information about the care and condition of the woundMedicines handling has improved, records of medicines receipt, administration and disposal were clear and accurate. Checks showed that medicines were usually administered correctly. This helps ensure the good health and wellbeing of residents. To help improve the care given to residents the manager has appointed two supernumerary clinical managers one for the general unit and one for the dementia unit. The manager was recruiting two senior care assistants in order to increase staffing levels at night. The recent appoint of a manager has improved management of the home. Discussion with members of staff confirmed that morale had improved. One member of staff said, "We`ve a good crew at the moment." A member of the domestic staff said, "Everyone is just so friendly and the staff are so helpful, it`s a good atmosphere and a good place to work".

What the care home could do better:

To promote the health and welfare of resident`s members of staff must follow the instructions written in residents care plans. This includes changing dressings as often as stated unless a reason for not doing so is documented and recording positional changes on a turn chart. When necessary, information on `when required` medicines should form part of the residents` care plans to ensure they are administered correctly. It is important that members of staff promote the wellbeing of residents, including those suffering from dementia, by attempting to engage them in meaningful conversation. Members of staff should make every effort to promote good relationships between residents by intervening to prevent and deal with offensive behaviour. Action must be taken to provide the support necessary for residents to have a fulfilling lifestyle. All residents must be offered the opportunity to participate in meaningful leisure activities of their choice. Members of staff should be given information about the food they are serving at mealtimes. This will enable members of staff to offer a choice of meal to residents and explain to residents who are being fed what they are eating. Ensuring mealtimes are a pleasant social occasion promotes the health and wellbeing of residents. To prevent injury or harm to residents the rooms used for storing equipment must be kept locked. Items of equipment for example wheelchairs must not be stored in bath and shower rooms. All broken or missing doorknobs toAddison Court Nursing HomeDS0000022489.V359872.R01.S.docVersion 5.2Page 7wardrobe doors must be and the trim to the small chests of drawers must also be repaired. It is essential that privacy and dignity be promoted for all residents. A privacy lock must be fitted to the to the toilet door on the first floor Baxenden unit. Locks should also be fitted to bedroom doors, which do not already have one to enable all residents to lock their doors if they wish to do so. To promote the wellbeing of residents and provide a homely atmosphere the odour problem in the first floor Baxenden toilet and several bedrooms must be addressed. It is important to ensure the safeguarding of residents from abuse by thorough recruitment procedures. A written reference should be obtained from a previous employer and any gaps in employment history explored. The manager should also have information of the details of any previous criminal convictions of employees. To ensure the home is a safe place to live the testing of small electrical appliances should be carried out by the date stated on the certificate.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Addison Court Nursing Home Addison Street Accrington Lancashire BB5 6AG Lead Inspector Mrs Susan Hargreaves Unannounced Inspection 28th April 2008 09:30 X10029.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Addison Court Nursing Home DS0000022489.V359872.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.V359872.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 (Addison Court) Ltd Mrs Kathleen Mary Payton Care Home 50 Category(ies) of Dementia (25), Old age, not falling within any registration, with number other category (25) of places Addison Court Nursing Home DS0000022489.V359872.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 25) Dementia - Code DE (maximum number of places: 25) The maximum number of service users who can be accommodated is: 50 Date of last inspection 8th November 2007 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 £332 - £483 per week. Additional charges are payable for private chiropody, hairdressing, toiletries and newspapers. A copy of the service user guide was available to prospective residents and their relatives on request. Addison Court Nursing Home DS0000022489.V359872.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. A key unannounced inspection, which included a visit to the home, was conducted at Addison Court Nursing Home on the 29 and 29 April 2008. One random inspection has been made since the last key inspection in November 2007 to monitor compliance with the requirements made at that inspection. Two completed surveys were received from residents. At the time of this inspection 37 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 and the area manager regarding issues raised during the inspection. What the service does well: What has improved since the last inspection? Care plans identify the care needs of each resident and explain what members of staff have to do in order to provide person centred care. Wound care records provided detailed information about the care and condition of the wound. Addison Court Nursing Home DS0000022489.V359872.R01.S.doc Version 5.2 Page 6 Medicines handling has improved, records of medicines receipt, administration and disposal were clear and accurate. Checks showed that medicines were usually administered correctly. This helps ensure the good health and wellbeing of residents. To help improve the care given to residents the manager has appointed two supernumerary clinical managers one for the general unit and one for the dementia unit. The manager was recruiting two senior care assistants in order to increase staffing levels at night. The recent appoint of a manager has improved management of the home. Discussion with members of staff confirmed that morale had improved. One member of staff said, “We’ve a good crew at the moment.” A member of the domestic staff said, “Everyone is just so friendly and the staff are so helpful, it’s a good atmosphere and a good place to work”. What they could do better: To promote the health and welfare of resident’s members of staff must follow the instructions written in residents care plans. This includes changing dressings as often as stated unless a reason for not doing so is documented and recording positional changes on a turn chart. When necessary, information on ‘when required’ medicines should form part of the residents’ care plans to ensure they are administered correctly. It is important that members of staff promote the wellbeing of residents, including those suffering from dementia, by attempting to engage them in meaningful conversation. Members of staff should make every effort to promote good relationships between residents by intervening to prevent and deal with offensive behaviour. Action must be taken to provide the support necessary for residents to have a fulfilling lifestyle. All residents must be offered the opportunity to participate in meaningful leisure activities of their choice. Members of staff should be given information about the food they are serving at mealtimes. This will enable members of staff to offer a choice of meal to residents and explain to residents who are being fed what they are eating. Ensuring mealtimes are a pleasant social occasion promotes the health and wellbeing of residents. To prevent injury or harm to residents the rooms used for storing equipment must be kept locked. Items of equipment for example wheelchairs must not be stored in bath and shower rooms. All broken or missing doorknobs to Addison Court Nursing Home DS0000022489.V359872.R01.S.doc Version 5.2 Page 7 wardrobe doors must be and the trim to the small chests of drawers must also be repaired. It is essential that privacy and dignity be promoted for all residents. A privacy lock must be fitted to the to the toilet door on the first floor Baxenden unit. Locks should also be fitted to bedroom doors, which do not already have one to enable all residents to lock their doors if they wish to do so. To promote the wellbeing of residents and provide a homely atmosphere the odour problem in the first floor Baxenden toilet and several bedrooms must be addressed. It is important to ensure the safeguarding of residents from abuse by thorough recruitment procedures. A written reference should be obtained from a previous employer and any gaps in employment history explored. The manager should also have information of the details of any previous criminal convictions of employees. To ensure the home is a safe place to live the testing of small electrical appliances should be carried out by the date stated on the certificate. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Addison Court Nursing Home DS0000022489.V359872.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.V359872.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (older people) 2 (adults 18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A thorough admissions procedure ensured sufficient information was obtained in order to identify the needs of each resident. EVIDENCE: The manager has reviewed the service user guide in order to ensure residents and prospective residents and their relatives have detailed information about the care and facilities provided at the home. The manager explained that when the area manager had approved the new service user guide a copy would be placed in each bedroom and made available to anyone on request. Addison Court Nursing Home DS0000022489.V359872.R01.S.doc Version 5.2 Page 10 The individual records of five residents were inspected. Each contained a detailed pre-admission assessment. These assessments provided important information for the care plans. There have been no new admissions to the home since the last inspection. However, the manager said that she or a senior member of staff would visit and assess prospective residents in hospital or their own home prior to admission to ensure their social and healthcare needs could be met at Addison Court. Standard 6 is not applicable to this service. Addison Court Nursing Home DS0000022489.V359872.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service Users, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 (older people) 6,9,16,18,19, and 20 (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 personal and healthcare needs of each resident were identified and met. Medication was managed safely. Dignity was not promoted for all residents. Addison Court Nursing Home DS0000022489.V359872.R01.S.doc Version 5.2 Page 12 EVIDENCE: The individual care plans of five residents were inspected. These care plans identified the personal and healthcare needs of each resident and gave directions for staff to follow to ensure their individual needs were met. Appropriate risk assessments including ones for falls, nutrition and the development of pressure sores were in place. Information for staff about how to manage identified risks was also included in the care plans. The care plan for one resident stated that her position should be changed every two hours in order to prevent the formation of pressure sores. Although it stated that these positional changes should be recorded on the turn chart this document was not available. Wound care records for one resident provided information about the condition of the wound and guidance for staff to follow about the care needed to promote healing including changing the dressing every three days. Records indicated that the dressing had been changed on 21st and 27th April but there was no evidence to suggest this had been done on 24th April. Not changing dressings as directed in the care plan could seriously affect the health and welfare of the resident. Care plans and risk assessments were reviewed monthly and updated when the needs of the resident changed. The relative of one resident said he was involved with his wife’s care and discussed the care plan each month with the nurse in charge. A written report about the care given to individual residents was completed during each shift. There were records of the involvement of GP’s and other healthcare professionals in the care of the residents. These included podiatrist and McMillan nurses. As part of the inspection a specialist pharmacist inspector looked at how medicines were handled because previous inspections had found some serious shortfalls. We carried out checks on a random sample of medicines and found that these added up, this is a significant improvement from the last inspection, which showed they had been given to residents correctly. We checked the timings of medicines and found that most medicines were now given at the right time, notably medicines that need to be given before meals were now being given correctly. Addison Court Nursing Home DS0000022489.V359872.R01.S.doc Version 5.2 Page 13 We looked at the care plans of several residents that had been prescribed medicines to treat agitation and anxiety on a ‘when required’ basis. We found some information to support their use but noted that it was not always clear under what circumstances these medicines should be administered. Having detailed written care plans is important to help ensure residents receive their medicines correctly. We checked the paperwork and systems to support a resident that was looking after one of their own medicines and these had been improved. A clear care plan had been written along with a risk assessment that was regularly reviewed; this helps ensure residents receive the right amount of support. We saw evidence of regular monthly checks being carried out by the senior managers. These checks had identified some mistakes and action had been taken to help prevent them happening again. Nursing staff had also recently had a competency assessment by senior managers to ensure they were following the right procedures. Checks on medicines handling are important because they help ensure medicines are administered as prescribed and help ensure staff are competent. Personal care was carried out in the privacy of the resident’s own room or the bathroom. Members of staff were observed attending to residents in a polite and professional manner. However, on the first day of the inspection between 10:10am and 11:30am there was very little interaction between residents and staff in the lounge on the first floor Baxenden unit. The only conversation observed were members of staff giving instructions to residents when carrying out moving and handling procedures for example, “Please put your arms in.” when using the hoist. When seven residents were sitting in the lounge no members of staff came into the room until 11:30am when the nurse spoke very briefly to two residents. This took approximately thirty seconds. The nurse returned at 11:46am with a tray of drinks. The television was on in one corner of the lounge but the volume was very low making it difficult to hear. Only one resident appeared to be watching the programme. This meant that residents were left for over an hour with nothing to do and no meaningful social interaction. Several residents on the ground floor were observed shouting at each other and members of staff tried to calm the situation. One resident said she found another resident’s behaviour offensive and wanted staff to intervene more to tell him to stop insulting her. One resident said the staff were “Grand”, another resident said she liked the staff and especially her key worker. Addison Court Nursing Home DS0000022489.V359872.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 (older people) 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. A lack of suitable leisure activities means some residents do not have the opportunity to participate in meaningful activities of their choice. Mealtimes for residents on the Baxenden unit are not conducive to their wellbeing. Addison Court Nursing Home DS0000022489.V359872.R01.S.doc Version 5.2 Page 15 EVIDENCE: One member of staff was employed on a part-time basis to organise activities for the residents throughout the home. However, on the first day of the inspection the activities organiser was not on duty and there was very little evidence that any leisure activities had been organised. One member of staff working on the ground floor said no activities were organised apart from background music for the residents to listen to. The activities organiser was on duty on the second day of the inspection and she was observed helping an individual resident to plant seeds. A lack of suitable leisure activities for residents can seriously affect their wellbeing. Although a programme of activities was displayed in the first floor Baxenden unit lounge this was difficult to follow and some activities were unclear e.g. “senses”. This meant residents did not have enough information to enable them to understand the activities provided. No activities were observed taking place on the first floor dementia unit during the inspection. On the top floor of the home several residents were sitting in the lounge. They were obviously enjoying listening to music and a member of staff discussed the music she put on with the residents. Another resident was colouring. One member of staff said they sometimes played dominoes or watched old films. One resident said that activities were sometimes arranged for instance a singer or comedian, but on the whole there was not much to do other than sleep. Several residents said they were happy living at the home. Regular contact for residents with their family and friends was considered to be an important part of their life. The visitors interviewed said they were welcomed into the home at anytime and offered refreshments. Some of the residents said the meals were good. One resident said she had enjoyed a vegetable burger for lunch but often bought her own meals from the Spar or Asda. On the first floor Baxenden unit at lunchtime the food arrived in a heated trolley from the kitchen but none of the staff on duty knew what the food was. The menu was not displayed and members of staff did not have any information about what was for lunch. This made it difficult to offer a choice of meal to the residents. The nurse on duty was asked to explain the meals in the trolley. She did not know if the pie was sweet or savoury or recognise the dessert as egg custard. Another member of staff thought the vegetable burger was part of the vegetables. Blended meals were served on plastic plates with each item of food blended separately so residents could identify the food and experience the individual flavours. However, the blended meal for one lady was transferred into a bowl with all the components mixed together. The care worker was asked why she had done this and said it was because the resident only wanted a small portion. The care worker then realised this was poor Addison Court Nursing Home DS0000022489.V359872.R01.S.doc Version 5.2 Page 16 practice and changed the bowl for a separately blended meal. Members of staff were observed assisting residents with their meal. However, there was very little conversation between the staff and the residents. They were warned the meal was hot but there was no explanation of the content of the meal and residents were not informed what was being put into their mouths. This mealtime was not the pleasant social occasion residents should be encouraged to enjoy. Addison Court Nursing Home DS0000022489.V359872.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service Users feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 (older people) 22 and 23 (adults 18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints were taken seriously and investigated. Staff had the training necessary to ensure residents were protected from abuse. EVIDENCE: A copy of the complaints procedure was displayed in the home and included in the service user guide. One visitor said she knew how to complain and any problems were dealt with. Records of any complaints were kept including information about the investigation and action taken. Since the last inspection the area manager had investigated and resolved two complaints made to the Commission. Policies and procedures about the safeguarding of vulnerable adults were in place. Discussion with four members of staff confirmed they had received training in safeguarding vulnerable adults. They also knew what to do if allegations of abuse were made. Addison Court Nursing Home DS0000022489.V359872.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 (older people) 24 and 30 (adults 18-65) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements to the premises are being made to ensure the residents have a comfortable and homely place to live. EVIDENCE: The home is currently in the process of being refurbished to make it a nicer place for residents to live. Since the last inspection the ground floor lounge Addison Court Nursing Home DS0000022489.V359872.R01.S.doc Version 5.2 Page 19 has been redecorated and new floor covering fitted. Improvements to the lounge and corridors of the first floor Baxenden unit included redecoration of communal areas and the fitting of laminate flooring. The manager said this was unfinished and needed pictures putting back on the walls to make these areas look homely. There was an overpowering smell of urine from the toilet on the first floor Baxenden unit. This made it unpleasant for anyone to use and was not dealt with until lunchtime. The door to this toilet did not have a privacy lock, which allowed access to other residents or staff when in use. In the top floor shower room a carpet sweeper, wheelchair and other items of equipment were stored, which could be hazardous for residents and staff. Wheelchairs, cushions and coat hangers were also stored in one of the assisted bathrooms. One room on the first floor and two rooms the top floor of the home were used for storage. These rooms were not locked and could put residents at risk if they inadvertently entered them. Several of the bedrooms had badly stained carpets and nasty odours making them unpleasant for the resident. In another bedroom the knob on the wardrobe door was missing. Part of the trim was missing to the small chest of drawers in some of other bedrooms. There were no privacy locks to the ground floor bedroom doors, which meant other residents, members of staff and visitors could invade a resident’s privacy. Residents had personalised their rooms with items important to them or to reflect their interests. One resident had a collection of DVDs and books. Other residents had photographs, ornaments and pictures in their rooms. One resident commented on the cleanliness of his room. Laundry facilities were suitable for the size of the home. The laundry assistant all the equipment was working well with no problems. Addison Court Nursing Home DS0000022489.V359872.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 (older people) 32, 34 and 35 (adults 18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Members of staff were encouraged to acquire the skills and knowledge needed to provide effective care for the residents. Recruitment procedures did not fully protect residents. EVIDENCE: Discussion with the manager and members of staff during the inspection confirmed that staffing levels have increased in order to improve the care given to residents. The manager explained that two supernumerary clinical managers had been appointed one for the general unit and one for the dementia unit. Two senior care assistants were being recruited so that staffing levels could increase throughout the night on the ground floor. One member Addison Court Nursing Home DS0000022489.V359872.R01.S.doc Version 5.2 Page 21 of staff said, “We’ve a good crew at the moment.” One of the two residents who completed the survey considered there was always enough staff available. Discussion with members of staff, the manager and inspection of training records confirmed that training was encouraged. This included induction for new employees, moving and handling, basic food hygiene, safe handling of medication, first aid, safeguarding vulnerable adults and infection control. More than half the care workers have NVQ qualifications at level 2 or above and three are working towards NVQ level 3. The files of five members of staff appointed since the last inspection were examined. These files indicated that all the pre-employment checks to ensure protection of the residents had been completed prior to appointment. However, the administration associated with recruitment was mostly carried out at head office, which meant some information was not available to the manager and some documents were photocopies. One member of staff had ticked the box indicating a previous criminal conviction but the manager had no knowledge of this. It was evident from one application form that a reference had not been obtained from the last employer. The application form for another recent employee did not provide details of employment after 2006. There was no written evidence to explain this gap in employment. Addison Court Nursing Home DS0000022489.V359872.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 (older people) 37,39 and 42 (adults 18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is effectively managed and the views of residents are considered when decisions about the care and facilities provided are made. Addison Court Nursing Home DS0000022489.V359872.R01.S.doc Version 5.2 Page 23 EVIDENCE: The recently appointed manager is a registered nurse with experience of caring for older people. She is in the process of applying to become registered with the Commission. The manager expressed her intention to improve the quality of the care given to residents suffering from dementia and was arranging for registered nurses and care workers to attend appropriate training. One member of staff said the manager was approachable. The manager said she frequently walked round the home and talked to residents and was always available to talk to visitors. To monitor the quality of the care and facilities provided the relatives of residents were asked to complete a satisfaction questionnaire every six months. Copies of these completed in December 2007 were seen. Several of these expressed problems with laundry but it was unclear whether action had been taken to address the problems. Residents and relatives meetings took place regularly. The items discussed at these meetings included leisure activities and menus. The next meeting was arranged for 7 May 2007. The manager carried out monthly audits for all aspects of the care and services provided at the home. Any shortfalls identified during this process were included in the quality improvement plan. The plan for April 2008 was seen. A number of residents had money kept at the home to pay for hairdressing, chiropody and other personal needs. Records of transactions involving resident’s money were seen to be to date and accurate. Health and safety policies and procedures helped to ensure the home was a safe place to live. Fire alarms and emergency lighting were checked regularly. Fire drills were held every few months and staff attendance records were kept to ensure all members of staff received this training. The manager said the fire risk assessment was out of date and she had asked a fire prevention company to review this. Records of the routine servicing of equipment were seen. These included the lift and hoists. However, the electrical installation certificated dated 15/01/08 stated that work needed to be carried out as a matter of urgency. The manager confirmed this was to be done next week. Although the certificate for the testing of small electrical appliances was out of date the manager confirmed engineers were booked to carry out the tests later in the week. Records maintained in the kitchen included fridge, freezer and food temperatures and a cleaning schedule. This ensures food is stored correctly and handled safely. Addison Court Nursing Home DS0000022489.V359872.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 2 20 X 21 2 22 X 23 X 24 2 25 X 26 2 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 3 36 X 37 X 38 2 Addison Court Nursing Home DS0000022489.V359872.R01.S.doc Version 5.2 Page 25 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 OP8 Regulation Requirement Timescale for action 30/05/08 12(1)(a)(b) To promote the health and welfare of resident’s members of staff must follow the instructions written in residents care plans. This includes changing dressings as often as stated unless a reason for not doing so is documented and recording positional changes on a turn chart. 12(5)(b) To promote the wellbeing of residents, especially those suffering from dementia, members of staff must attempt to engage residents in conversation. To enable residents to have a fulfilling lifestyle a range of suitable leisure activities must be organised in all areas of the home. To prevent injury to residents the rooms used for storing equipment must be kept locked. Items of equipment e.g. wheelchairs must not be stored in bath or shower rooms. 2 OP10 30/05/08 3 OP12 16(2)(n) 27/06/08 4 OP19 13(4)(a) 30/05/08 Addison Court Nursing Home DS0000022489.V359872.R01.S.doc Version 5.2 Page 26 5 OP19 23(c) 6 OP21 and OP24 12(4)(a) 7 OP26 16(2)(k) To ensure residents have easy access to their wardrobes broken or missing doorknobs must be repaired. To promote the wellbeing of residents the trim to the small chests of drawers must be repaired. Timescale of 28/12/07 & 28/03/08 not met. To promote the privacy and dignity of all residents a lock must be fitted to the toilet door on the first floor Baxenden unit and to all bedroom doors. To promote the wellbeing of residents and provide a homely atmosphere the odour problem in the first floor Baxenden toilet and the bedrooms must be addressed. 27/06/08 25/07/08 30/05/08 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 Refer to Standard OP9 Good Practice Recommendations When necessary, information on how medicines should be used should form part of the residents’ care plans to ensure they are administered correctly. Members of staff should make every effort to promote good relationships between residents by intervening to prevent and deal with offensive behaviour. Blended meals should always be served with each component separate to enable the resident to identify the food served and enjoy the different flavours. Members of staff should ensure mealtimes are pleasant social occasions by talking to residents. Members of staff should also know what is on the menu and be able to identify all items of food served. 2 3 OP10 OP15 Addison Court Nursing Home DS0000022489.V359872.R01.S.doc Version 5.2 Page 27 4 OP29 5 6 OP38 OP38 In order to cater for individual tastes all residents should be offered a choice of menu. To ensure recruitment procedures are thorough a written reference should be obtained from a previous employer and any gaps in employment history explored. The manager should also have information of the details of any previous criminal convictions of employees. To ensure the home is a safe place to live the testing of small electrical appliances should be carried out by the date stated on the certificate. The fire risk assessment should be reviewed and up dated as soon as possible. Addison Court Nursing Home DS0000022489.V359872.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Addison Court Nursing Home DS0000022489.V359872.R01.S.doc Version 5.2 Page 29 - 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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