Inspection on 08/11/07 for Addison Court Nursing Home

This inspection was carried out on 8th November 2007.

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

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

Other inspections for this house

Addison Court Nursing Home 06/10/08

Addison Court Nursing Home 28/04/08

Addison Court Nursing Home 15/05/07

Addison Court Nursing Home 15/11/06

Addison Court Nursing Home 26/06/06

Addison Court Nursing Home 08/03/06

Addison Court Nursing Home 12/10/05

Addison Court Nursing Home 20/04/05

Addison Court Nursing Home 07/09/04

Addison Court Nursing Home 14/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Addison Court Nursing Home Addison Street Accrington Lancashire BB5 6AG Lead Inspector Mrs Susan Hargreaves 8 &9 th th Unannounced Inspection November 2007 10:00 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.V350577.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.V350577.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 - 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.V350577.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Staffing for service users requiring nursing care will be in accordance with the Notice issued dated 16 August 2000 The home is registered for a maximum of 50 service users to include: Up to 25 service users in the categories OP or PD requiring nursing care Up to 25 service users in the categories DE(E) or MD(E) requiring nursing care Up to 25 service users in the category of OP requiring personal care Up to 10 service users in the categories DE(E) or MD(E) requiring personal care 15th May 2007 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 £332 - £483 per week. Additional charges are payable for private chiropody, hairdressing, toiletries and newspapers. A copy of the statement of purpose and service user guide was available to prospective residents and their relatives on request. Addison Court Nursing Home DS0000022489.V350577.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted at Addison Court Nursing Home on the 8th and 9th November 2007. Three random inspections have been made since the last key inspection in May to monitor compliance with the requirements made at that inspection. Five completed surveys were received from residents, four from the relatives of residents and two from members of staff. Surveys about the home were also received from a GP and a social worker. At the time of this inspection 42 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 support manager and the manager from another Craegmoor who were responsible for managing the home in the absence of the registered manager, regarding issues raised during the inspection. What the service does well: What has improved since the last inspection? Since the last inspection action has been taken to ensure the food and fluid intake of residents who are losing weight is monitored. These residents are also receiving high calorie snacks between meals. Addison Court Nursing Home DS0000022489.V350577.R01.S.doc Version 5.2 Page 6 During the inspection care workers were observed using correct procedures when moving and handling residents. One care worker explained they had received training in moving and handling and always used correct methods now. Extensive redecoration and refurbishment of the home is in progress. When this is complete all areas of the home should provide a comfortable and homely environment for the residents. What they could do better: Failure to address the requirements about care planning made at previous inspections is of very serious concern. Urgent action must be taken to ensure all care plans provide clear guidance for staff to follow to ensure the needs of the resident are met. Care plans must be up dated when the needs of the resident change. It is essential that medication be managed safely. Medication administration records must not be signed if medication has not been given. Tablets must not be left in medicine pots with only a scrap of paper to identify which resident they are for. This practice is dangerous; greatly increases the risk of medication error and must cease. Medication must be given at the time prescribed by the doctor and at the correct time in relation to food. Failure to do so could have an adverse effect on the health and wellbeing of the resident. It is strongly recommended that written instructions explaining when medication prescribed ‘when required’ should be given. This is especially important for residents suffering from dementia who are unable to say if they are in pain. It is important that privacy and dignity for all residents is promoted. Residents must not receive treatment from the chiropodist or any other healthcare professional in communal rooms. Several members of staff said there were not enough leisure activities organised for the residents. One care worker said some resident’s do nothing all day. The relative of one resident commented on the survey that he was bored. A range of activities suitable for residents on both the general and dementia units should be available. To prevent injury or harm to residents the broken doorknobs on wardrobe doors must be repaired and the door to the bedroom currently used by the decorators to store paint must be kept locked. It is of very serious concern that staffing levels on the top floor of the dementia unit do not meet the needs of the residents. It is not acceptable for domestic staff and decorators to be asked to watch residents while the only member of staff working on that floor goes for help. Residents and the care worker are also put at risk from residents with challenging behaviour. Urgent Addison Court Nursing Home DS0000022489.V350577.R01.S.doc Version 5.2 Page 7 action must be taken to ensure a sufficient number of care workers are on duty for all shifts to ensure the needs of all residents are met. It is vital that the recruitment procedure involves questioning applicants about previous employment with vulnerable adults. This must include the reason for leaving that employment and obtaining a reference from the last employer. It is essential that the home be effectively managed. Action must be taken to ensure members of staff are properly supervised and supported in order to raise morale and provide person centred care for all residents. 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.V350577.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.V350577.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 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: A copy of the service user guide was available in the entrance hall. However, this needed updating to include detailed information about the care and facilities provided at the home. A senior member of staff visited and assessed prospective residents in hospital or their own home before admission. The care records of a recently admitted Addison Court Nursing Home DS0000022489.V350577.R01.S.doc Version 5.2 Page 10 resident included a pre-admission assessment. This assessment provided important information for the care plan. Standard 6 is not applicable to this service. Addison Court Nursing Home DS0000022489.V350577.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): 7,8,9,10 and 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Deficiencies in care planning means residents do not always receive person centred care. Unsafe procedures in the management of medication put residents at risk. EVIDENCE: Addison Court Nursing Home DS0000022489.V350577.R01.S.doc Version 5.2 Page 12 The individual care plans of five residents were inspected. These plans identified the needs of each resident but did not clearly explain how these needs were to be met. One care plan for a resident on the dementia unit was about the treatment of angina but did not did not provide any information about how to recognise if this resident had chest pain or what to do about it. The care plan about eating and drinking for one resident gave conflicting instructions to staff. It stated ‘offer blended meals at all times’ and ‘likes jam butties for breakfast’. One care plan about incontinence did not give clear guidance about how to manage this problem. Care plans for three residents suffering from dementia or mental health problems did not explain how care staff might recognise the various moods and behaviours associated with these conditions. Moreover, they did not give directions for staff to follow about how to approach the resident and respond to these problems. The daily report for one resident stated that bed rails had been put in place one night. However, a risk assessment for their use had not been carried out. The record of a visit by the GP for a resident in October indicated that the medication had been changed but the care plan had not been updated with this information. Appropriate risk assessments for pressure sores, falls and nutrition were in place. Residents were weighed regularly and their food and fluid intake monitored if weight loss was a problem. Care plans were reviewed monthly. Where possible 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, on a number of medication administration records the nurse had not signed to indicate the medication had been given to the resident and a reason for it’s omission was not recorded. One resident was prescribed Diazepam at night but the medication administration record on one occasion had been signed to show this had been given at 2pm. The tablet was still in the blister pack for 10pm. Addison Court Nursing Home DS0000022489.V350577.R01.S.doc Version 5.2 Page 13 One resident had been prescribed medication to be given at night but the medication administration record had been altered by hand to say give in the morning. It was also stated on the box of this medication ‘to be taken before a meal’. Clear instructions were not available explaining when medication prescribed ‘when required’ should be given. One resident suffering from dementia was prescribed medicine for indigestion. The criteria for giving this medication did not state how members of staff would recognise when this resident, who was unable to tell them, had indigestion. Another resident was prescribed Diazepam when required for agitation without information for staff about how to recognise the behaviour that warrants Diazepam being given. According to the medication administration record this resident was given Diazepam every night. Medication to relieve pain was written twice on the medication administration record for one resident. This could be confusing for staff and result in the resident being given an overdose. In the medicine trolley on the dementia unit at 2.20pm on the second day of the inspection there were two medicine pots containing tablets. The name of the resident had been written on a scrap of paper and put in each medicine pot. The medication administration records for these residents had been signed by the nurse on duty to indicate that the residents had taken their medication at 10am. The nurse said she had put them out and then had to put them in the trolley because these residents were still asleep. Taking tablets out of the containers in which they were dispensed and leaving them in medicine pots in the trolley is dangerous and greatly increases the risk of a medication error. The nurse was unable to explain why the medication administration records had been signed before the residents had taken their tablets. An immediate requirement was made to ensure medication was administered safely. Although a record of medication received into the home was kept the person in charge was advised to record the amount of medication remaining from a previous prescription on the new medication administration records. Members of staff were observed attending to residents in a pleasant and caring manner. However, one resident was receiving chiropody treatment in the ground floor lounge. Addison Court Nursing Home DS0000022489.V350577.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s decisions about their lifestyle were respected. Some residents were supported to have a fulfilling lifestyle. EVIDENCE: One member of staff was employed on a part-time basis to organise activities for the residents. A programme of activities was displayed in each unit. This programme indicates that there are activities going on each weekday on all Addison Court Nursing Home DS0000022489.V350577.R01.S.doc Version 5.2 Page 15 three floors of the home. However, on the first day of the inspection the activities co-ordinator was not on duty and there was no evidence to suggest that any activities were taking place. On the morning of the second day of the inspection the activities co-ordinator was on duty but no activities were seen to be taking place. An entertainer visited the home that afternoon and residents were obviously enjoying themselves. Care workers were observed encouraging residents to join in the singing and dancing. Several members of staff said there were not enough activities organised for the residents. A number of staff said they had taken residents out on their days off. Residents interests and hobbies were recorded in their individual care plans. Discussion with residents and members of staff confirmed that the daily routine was flexible in order to meet their needs and preferences. Visitors were welcomed into the home at anytime and offered refreshments. Since the last inspection a new cook has been appointed. Menus offered a choice at each meal. Alternatives to the menu are also readily available. A sufficient amount of fresh fruit and vegetables was in stock. The likes and dislikes of residents were recorded on individual diet notification sheets. The meal served at lunchtime on the first day of the inspection looked wholesome and appetising. Pureed meals also looked appetising because all the components were separate. Night staff had access to food which enabled residents to have a snack during the night if requested. One resident said, “The food’s good, there’s always enough to eat.” Addison Court Nursing Home DS0000022489.V350577.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents felt able to express their concerns. Staff had the training necessary to ensure the safeguarding of vulnerable adults. EVIDENCE: A copy of the complaints procedure was displayed in the home and included in satement of purpose. The previous manager has recently investigated two complaints. Detailed records of these complaints, the investigation and outcome were seen. Policies and procedures about the safeguarding of vulnerable adults were in place. Discussion with three members of staff confirmed they had received training in the safeguarding of vulnerable adults. They also knew what to do if allegations of abuse were made. Addison Court Nursing Home DS0000022489.V350577.R01.S.doc Version 5.2 Page 17 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 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: At the time of the inspection the home was clean and with the exception of one bedroom free from offensive odour. Improvements to the home since the last Addison Court Nursing Home DS0000022489.V350577.R01.S.doc Version 5.2 Page 18 inspection include the creation of a safe storage area for hot trolleys outside the kitchen. Refurbishment of the dementia unit is ongoing and at the time of the inspection bedrooms on the top floor were being redecorated. However, in three of the bedrooms doorknobs were missing or broken on the wardrobe doors. On one wardrobe door a screw was exposed which could put the resident at risk of being injured. One bedroom door did not close properly and another bedroom was being used by the decorators to store paint. The door to this bedroom did not lock and residents could be at risk if they inadvertently wandered into this room. The shower room on the top floor was cold and had not been fitted with a heater. This could cause discomfort for residents especially when they had just had a warm shower. The door to the first floor shower room was not fitted with a privacy lock. Several doors were squeaking and in need of attention. Laundry facilities were suitable for the size of the home. An infection control policy was available. Addison Court Nursing Home DS0000022489.V350577.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Training for all members of staff was encouraged. Low staffing levels on the dementia unit put residents and staff at risk. Recruitment procedures did not fully protect residents. EVIDENCE: Examination of the duty rota and discussion with members of staff confirmed that staff absence was a problem and they were frequently short staffed. One care worker said there was frequently only one member of staff working on the top floor dementia unit. She said that on one occasion a resident had been cared for in bed because this resident needed the help of two care workers to get her up. On another occasion she explained how she had managed when a resident had become aggressive putting her and other residents at risk. This care worker also said that several times she had asked the domestic staff or Addison Court Nursing Home DS0000022489.V350577.R01.S.doc Version 5.2 Page 20 the decorators to watch the residents so she could go for help or get items from the kitchen. Discussion with members of staff confirmed that training was encouraged. This included induction training for new employees, moving and handling, fire safety, health and safety, basic food hygiene, safeguarding vulnerable adults, infection control and first aid. Twelve care workers have an NVQ level 2 or above and three care workers are working towards NVQ level 3. The files of ten members of staff appointed since the last key inspection were examined. These files indicated that all the required pre-employment checks to ensure protection of the residents had been completed prior to appointment. Although two references had been obtained for one member of staff one of these was not from her last employer. Addison Court Nursing Home DS0000022489.V350577.R01.S.doc Version 5.2 Page 21 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Ineffective management provision means staff morale is low and absence levels are high preventing some residents from receiving person centred care. Addison Court Nursing Home DS0000022489.V350577.R01.S.doc Version 5.2 Page 22 EVIDENCE: The registered manager has recently resigned her position. A business support manager and the area manager are currently responsible for managing the home. Members of staff said morale was low and they felt unsettled because the registered manager had resigned. Staff said they had been told a new manager was coming. One member of staff explained she had received regular supervision from the previous manager but nobody had picked this up since she left. All the staff spoken to commented on staff shortages due to staff leaving and ringing in sick. Staff also said there was little organised activity for the residents and several members of staff were coming in on their days off to take residents out. Audits for all aspects of the care and services provided at the home were carried out monthly. A quality improvement plan, which was reviewed on 31 October 2007, was available. Feedback from residents is encouraged at their meetings. The last one was held in May 2007. Annual questionnaires were distributed to residents and their relatives from head office. Staff meetings were held regularly. Records of transactions involving resident’s money were seen to up to date and accurate. A fire risk assessment dated 13/05/05 was in place. This should be reviewed and up dated if necessary. Fire alarms, emergency lighting and fire doors were checked regularly. A fire drill was held on 8 October 2007 a record of the staff present and the actions taken was available. Records of the routine servicing of equipment were seen. These included an up to date gas safety certificate, the testing of small electrical appliances and servicing of the hoists and lift. Records maintained by the cook included fride, freezer and food temperatures. A cleaning schedule was also available. A diary of the food served including cooking times was kept and a record of the food served to individual residents. Accident records were kept, these were filed in resident’s individual care plan folders. Addison Court Nursing Home DS0000022489.V350577.R01.S.doc Version 5.2 Page 23 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 2 2 X 3 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 2 20 X 21 X 22 X 23 X 24 X 25 2 26 3 STAFFING Standard No Score 27 1 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 1 32 X 33 2 34 X 35 3 36 X 37 X 38 2 Addison Court Nursing Home DS0000022489.V350577.R01.S.doc Version 5.2 Page 24 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 OP7 Regulation 15(1) Requirement To ensure the care needs of all residents are met. Care plans must accurately address all the care needs of each resident. Timescales of 02/12/05, 01/01/06, 03/02/06, 28/04/06, 25/08/06, 29/12/06, 02/03/07 29/06/07 and 28/09/07 not met. To ensure staff have the information necessary in order to meet the needs of all residents care plans must be up dated when the needs of the resident change. Timescale of 15/11/06 02/03/07, 29/06/07 and 28/09/07 not met. To promote the safety of residents a risk assessment for the safe use of bed rails must be carried before they are used. Immediate requirement issued during the inspection. You must ensure medications are administered in a safe manner at all times. Immediate requirement issued Medication must be given as prescribed by the doctor and at the right time in relation to food in order to promote the health DS0000022489.V350577.R01.S.doc Timescale for action 28/12/07 2. OP7 15(2)(b) 28/12/07 3. OP7 4. OP9 13(4)(c) 30/11/07 13(2) 09/11/07 5. OP9 13(2) 30/11/07 Addison Court Nursing Home Version 5.2 Page 25 and wellbeing of residents. 6. OP9 Schedule 3 17(1)(a) 3(i) 12(4)(a) OP10 To prevent medication errors an accurate record must be made of the date and time medication is administered to each resident. If medication is omitted a reason for this must be recorded. Privacy and dignity must be promoted for all residents. Treatment from healthcare professionals including the chiropodist must not be carried out in communal rooms. To ensure residents have easy access to their wardrobes and are not injured from exposed screws the broken or missing doorknobs from wardrobe doors must be repaired. To prevent injury to residents the door to the bedroom were the decorators are storing paint must be kept locked. To promote the privacy and dignity of all residents a lock must be fitted to the door of the shower room on the first floor. Timescale of 28/09/07 not met. To ensure the residents are not cold when they have had a shower, action must be taken to ensure the shower room on the top floor is heated. A sufficient number of staff must be on duty at all times to ensure the safety of residents and staff and to meet the assessed needs of the residents. To ensure new employees are suitable to work with vulnerable adults a written reference relating to the applicants last period of employment which involved working with vulnerable adults must be obtained. To ensure the residents receive person centred care from DS0000022489.V350577.R01.S.doc 30/11/07 7 30/11/07 8 OP19 23(c) 28/12/07 9 OP19 10 OP19 13(4)(a) 23/11/07 12(4)(a) 28/12/07 11 OP25 23(2)(p) 25/01/08 12 OP27 18(1)(a) 23/11/07 13 OP29 19 schedule 2 23/11/07 14 OP31 Addison Court Nursing Home 10(1) 30/11/07 Version 5.2 Page 26 properly supervised staff action must be taken to improve staff morale and address absence levels. 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 OP1 2 OP9 3 OP9 4 OP12 5 OP38 Refer to Standard Good Practice Recommendations The service user guide should be updated and include the information listed in standard 1.2 of the National Minimum Standards. It is strongly recommended that detailed instructions for staff to follow stating when medication prescribed ‘when required’ should be given to the resident. The amount of medication remaining from a previous prescription should be recorded on a resident’s new medication administration records. A programme of activities suitable for residents on both the general and dementia unit should be implemented. The fire risk assessment should be reviewed and up dated if necessary. Addison Court Nursing Home DS0000022489.V350577.R01.S.doc Version 5.2 Page 27 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. 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