Inspection on 15/10/06 for Adelaide Nursing And Residential Care Home

This inspection was carried out on 15th October 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Adelaide Nursing And Residential... 03/06/08

Adelaide Nursing And Residential... 09/07/07

Adelaide Nursing And Residential... 18/11/05

Adelaide Nursing And Residential... 22/04/05

Adelaide Nursing And Residential... 06/11/04

Adelaide Nursing And Residential... 29/04/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Adelaide Nursing And Residential Care Home 35 West Street Bexleyheath Kent DA7 4RE Lead Inspector Ms Pauline Lambe Key Unannounced Inspection 15th October 2006 18:00 X10015.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 Adelaide Nursing And Residential Care Home DS0000006752.V298139.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. 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. Adelaide Nursing And Residential Care Home DS0000006752.V298139.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Adelaide Nursing And Residential Care Home Address 35 West Street Bexleyheath Kent DA7 4RE 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) 020 8304 3303 020 8301 0133 www.schealthcare.co.uk Southern Cross Healthcare Services Limited Post vacant Care Home 76 Category(ies) of Dementia (42), Dementia - over 65 years of age registration, with number (1), Old age, not falling within any other of places category (34) Adelaide Nursing And Residential Care Home DS0000006752.V298139.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 1 place registered for nursing care for a service user with dementia under 65, as agreed with CSCI. 1 place registered for service user category DE(E) in the general residential unit for named service user only. 18th November 2005 Date of last inspection Brief Description of the Service: The Adelaide Care Centre is a purpose built nursing and residential care home. It was first registered in July 1997 and was then purchased by Southern Cross Healthcare in September 1998. The home is situated in a side road off Bexleyheath Broadway near the railway station, bus services and the shopping centre. There is car parking space to the front of the property. The home is registered to provide care and accommodation to 76 older people. The home has two floors divided into four separate units providing care for the different categories of service users. On the ground floor, there are 20 general nursing beds and 14 beds for conventional residential care. On the first floor, there are 25 nursing beds and 17 beds for residential care, all for older people with dementia. All of the bedrooms in the home have en-suite facilities. The laundry is sited in a separate building to the side of the home. At the rear of the building there is an enclosed garden. The current fees range from £462.00 - £705.00. Residents pay privately for personal items such as hairdressing, newspapers and chiropody care. Adelaide Nursing And Residential Care Home DS0000006752.V298139.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors from the commission completed the site visit for this unannounced inspection over three separate dates. The inspection commenced on 15th October 2006 for 2 hours, continued on 19thh October 2006 for 7.5 hours and was completed on 27th October 2006 over a period of 5.25 hours. Throughout these visits the manager and staff assisted with the inspection. On the day of the final visit there were seventy-three residents in the home and three vacancies. Also on this visit time was spent talking with the operations manager. The service was last inspected on the 2nd February 2006. The inspection included a review of information held on the service file, a tour of the premises, a review of records, talking to residents, staff and visiting professionals and reviewing compliance with previous requirements. Addressing concerns raised with the Commission by relatives particularly in relation to staff shortages. Information provided in comment cards from residents and relatives were also reviewed. Since the last inspection the Commission have been made aware of concerns about staffing levels and standards in the home in the home and there have been three allegations of abuse investigated by social service. There was no evidence found during investigations to show that abuse had taken place; however each case resulted in recommendations being made to the provider. This report contains a number of requirements, which the registered person must address to meet and raise standards in the home. What the service does well: Nine out of twelve resident comment cards and seven out of ten relative comment cards showed they were satisfied with the overall standard of care provided. Comments made included ‘staff are excellent’, ‘staff do everything the can to make our life pleasant’, ‘ very pleased with the care’ and ‘care fluctuates depending on the staff on duty, some staff are very dedicated others less so’. The food provided in the home was varied and well balanced and eleven out of twelve resident comment cards showed they were usually satisfied with the food. Residents had access to a varied programme of activities and entertainment. Some of the bedrooms seen were personalised with the resident’s own possessions, which made the rooms feel homely and welcoming. The garden was well maintained and provided a pleasant and relaxing area for residents. Health and safety issues were addressed promptly and action was taken to safeguard resident’s personal money. Adelaide Nursing And Residential Care Home DS0000006752.V298139.R01.S.doc Version 5.2 Page 6 Complaints and concerns were dealt with according to the homes procedure and appropriate action was taken to protect residents from abuse. Staff had access to a planned training programme. What has improved since the last inspection? What they could do better: 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. Adelaide Nursing And Residential Care Home DS0000006752.V298139.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Adelaide Nursing And Residential Care Home DS0000006752.V298139.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 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, 4 and standard 6 did not apply to the service. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to the service. Adequate information was provided about the service. Residents were admitted to the home based on an assessment of care needs. Residents did not receive written confirmation that based on assessment the home was suited to meeting their needs. EVIDENCE: All care plans viewed included pre-admission assessment of care needs and some contained care manager assessments. A senior member of staff from the home completed pre-admission assessments. Comment cards received from residents indicated they had adequate information about the service prior to admission. Following assessment residents did not receive written confirmation that the home was suited to meeting their assessed needs. Requirement 1. The home did not provide intermediate care but did provide respite care on occasions. Adelaide Nursing And Residential Care Home DS0000006752.V298139.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. 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 feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 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 – 10. Quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to the service. Care plans were prepared but improvements were needed to wound management records. Records seen showed residents were supported to access healthcare. Medicines were generally well managed with some improvements needed on the residential units. In general residents and relatives were satisfied with how staff treated residents. EVIDENCE: Care plans were viewed on all units. Care plans seen included assessment of needs and risk assessments. On the residential units care plans were generally satisfactory and showed how assessed needs would be met. However one resident with continence problems did not have a relevant assessment completed on this. On the nursing units again care plans and assessments were in place. However there were issues noted with wound management records. Many of these were unclear and difficult to follow to see what was the current treatment and frequency of dressings. This applied to the wound care plans seen on both nursing units. There was little evidence in the records seen to show what steps should be taken to prevent residents assessed as being at Adelaide Nursing And Residential Care Home DS0000006752.V298139.R01.S.doc Version 5.2 Page 10 risk from developing pressure sores from developing these. Records seen for residents with pressure sores indicated that no action had been taken until they had developed a pressure sore. It would assist staff to find information in care plans if they included an index and if the records only included the up to date and relevant information. Many files seen still contained out of date information which should be stored elsewhere. Ten comment cards were received from relatives and seven indicated an overall satisfaction with the care provided with three indicating dissatisfaction. Some relatives seen during the inspection raised concerns with aspects of care and some said they felt they had to visit every day as they lacked confidence in the care provided. Other comments made included ‘I am really pleased with the care my mum receives, she really thinks of this as home now’ and ‘we’re very happy with the care provided by the home, and are always kept informed of important issues about our relative’. Requirement 2 and recommendations 1. All residents were registered with a GP. Residents on the residential units could access the service of the district nurse team as needed. Care plans seen on all units included a record of professional visits. This included visits from the GP, district nurse, tissue viability nurse and others as needed. Residents were also supported to access dental and optical services. The tissue viability nurse had assessed residents with pressure sores and advised on appropriate treatment. On the nursing units four residents had pressure sores. Two residents were admitted with these and for two they developed following admission. Medication management was viewed on both residential and the dementia nursing units. The home had a policy and procedure in relation to medicine management. A system was in place for the receipt, administration and disposal of medicines. On the residential units hand written entries made on the medicine administration charts by staff had not been dated and were not countersigned. There were unexplained gaps on the administration charts. The medicine storage area on the ground floor residential unit was seen unlocked on two occasions during the inspection. This could pose a risk to residents as not all medicines were in a locked cupboard. The inspector was told that senior staff on the units completed regular medicine audits. The medicine trolley on the dementia residential unit was stored secured to a wall in the corridor behind the nurse’s station. On the dementia nursing unit safe systems were in place to manage medicines. Adequate and appropriate storage was provided and records seen were up to date. Medicine records checked for three residents were found to be correct. Medicine management was not fully assessed on the nursing unit. When staff were administering medicines they wore a tabard saying not to disturb them while they were doing this task. Requirement 3. On the residential units staff were seen knocking on bedroom doors and asking permission to enter bedrooms. Good interaction was seen between staff and Adelaide Nursing And Residential Care Home DS0000006752.V298139.R01.S.doc Version 5.2 Page 11 residents and assistance was provided in a calm reassuring manner. A new resident to the home was finding it difficult to settle; a member of staff was observed spending considerable time with them during the day offering one-toone support and reassurance. On the nursing units staff knocked on doors before entering bedrooms. Bathroom and toilet doors had locks fitted. Twelve comments cards were received from residents and ten of these indicated staff listened to them. However some residents seen said staff were pleasant but often did not have time to talk to them. Adelaide Nursing And Residential Care Home DS0000006752.V298139.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. 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 maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 – 15. Quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to the service. Residents seen were generally satisfied with the activities provided however consideration must be given to increasing the activity hours provided. Residents and relatives were satisfied with visiting arrangements. Residents did have some element of choice but more effort was needed to ensure this included resident’s with dementia. There was generally satisfaction with meals provided however the management of meal times must improve particularly in the dementia nursing unit. EVIDENCE: Although there was evidence of social activities took place, for example on the second day of the inspection a church service was in progress in the morning and an outside shoe retailer came in the afternoon to enable service users to choose their own footwear. There was limited written information on service users files to evidence they had regular opportunities to participate in activities, for example no activities at all had been recorded as being offered to a resident on the residential unit between the 5th and 19th of October. The home employed one full-time activity organiser who had a small weekly budget allocated. Since the last inspection the activity organiser had attended a training course specifically designed to provide social activities for people with dementia. It was apparent from discussion with her that she had lots of ideas Adelaide Nursing And Residential Care Home DS0000006752.V298139.R01.S.doc Version 5.2 Page 13 for future activities including taking small groups of residents on outings. However activities were generally held in groups as the activity organiser mainly worked with residents alone because care staff were too busy to assist. The current ratio of one activity organiser to seventy six residents is inadequate to meet the social needs of the residents particularly as so many suffer from dementia and need more time and effort to engage. Residents seen were very complimentary about the activity organiser and the efforts she made to provide stimulating activities. Of the twelve completed resident comment cards received six indicated they were always satisfied with activities provided and six were usually satisfied. One resident commented that ‘we have a good activity lady who lays on something every day’. The home benefited from having its own fully equipped hairdressing salon. The hairdresser said she was in the home five times a week, made efforts to meet new residents and relatives and had training on areas such as moving & handling, fire safety and infection control provided in the home. Requirement 4. Adequate arrangements were in place for residents to maintain contact with family and friends. Residents seen said they enjoyed family visits and relatives were encouraged to attend social functions organised in the home. Relative comment cards received indicated they were made feel welcome when visiting the home. Relatives seen during the course of the inspection confirmed this and some relatives spent almost all day every day with their resident. Some residents seen said they could make choices about issues such as meals, what to wear, where to sit and whether to participate in activities. It was evident that staff discussed employment issues with residents as a number of them raised concerns about staff pay and how hard staff had to work when there were not enough staff on duty. Requirement 5. Lunch was observed being served on the dementia units on the second day of the inspection. On the residential unit tables were laid with cutlery prior to lunch however; there were no tablecloths, serviettes or condiments. Staff said that residents were given the opportunity of an ‘either or choice’ at mealtimes. Staff said that residents were shown the choice of meal provided and could indicate their preference. During the meal observed staff did not give residents the opportunity to see the meals but a member of staff read aloud from the dry board on the dining-room wall the choice available. It was evident that residents spoken with did not comprehend or understand what the member of staff was asking them. On the day of the inspection the choice was between beef stew, mashed potato and green beans with or only two preplated tuna salads provided as an alternative. Resident dignity was respected with staff using tabards to protect resident clothing during lunch rather than bibs. On the dementia nursing unit lunch was a bit chaotic. Many residents were in wheelchairs and one resident was in a large portable armchair, which was difficult to manoeuvre and took up a lot of space in the dining room. Tables Adelaide Nursing And Residential Care Home DS0000006752.V298139.R01.S.doc Version 5.2 Page 14 were not laid prior to serving food and no tablecloths, serviettes or condiments were provided. Drinks of squash and water were provided and one resident indicated the squash was very weak. Residents wore ‘bibs’ to protect their clothes. Food was served from a hot trolley. Staff said that residents choose their meal the day before but there was no evidence to show that this had been done. However this practice seemed inappropriate as the residents had dementia and most likely would not remember what they had requested or understand what was offered unless pictures were provided. It would be preferable to show residents the meal choice on the day to encourage and enable them to make a decision. The menu for the day was not readily available but was eventually located. All of the residents had the same meal. Staff served meals to residents who needed assistance before the staff were ready to assist, no plate covers were used for these meals. One resident had their meal left in front f them for a very long period and it was cold when offered to the resident by the staff. The inspector intervened and staff decided to microwave the meal. However staff seemed unsure how to use this equipment and had to be told by the inspector not to put the meal in the microwave with a metal cover. The dining room was very noisy and the metal chairs used by staff to sit and feed residents added to this. Foods were pureed separately. Despite the comments made about the meal residents seemed to enjoy their food and there was little waste. Staff did offer some residents a choice of dessert by showing them what was available. Feedback from residents during the inspection varied about the quality of meals provided. Some said it was very repetitive and of the twelve comment cards received from residents eight showed they were usually satisfied with the meals and four were always satisfied. Comments included ‘food is good’, ‘food is meagre with little vegetables and meat’, ‘food could be better’ and ‘food is always good’. On the final day of the inspection residents in the nursing unit were seen selecting their meal for the next day. A four weekly menu was provided and copies seen showed this varied with some dishes being repeated over the four weeks. The menus seen did not include a vegetarian choice at lunchtime. The evening meal consisted mainly of soup and sandwiches with the addition of a cooked option on some evenings such as ravioli on toast or cauliflower cheese. Requirement 6 and recommendation 2. Adelaide Nursing And Residential Care Home DS0000006752.V298139.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 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’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 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. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to the service. Adequate procedures were in place to manage complaints. Some work was needed in related to adult protection to ensure there is evidence to show that all staff receive regular training on this topic. Management should ensure staff are aware of and understand the whistle blowing policy. EVIDENCE: An adequate complaints procedure was provided. Systems were in place to record complaints made about the service. Records seen showed complaints had been appropriately managed. Since the last inspection four complaints had been made to management and one to the Commission. Resident comment cards showed that they knew who to talk to if they had a concern and seven of the twelve relative comment cards showed they were aware of the complaints procedure but five were unaware. A copy of the complaints procedure was included in the statement of purpose and service user guide. A policy and procedure was in place in relation to adult protection. Staff spoken with had a good understanding of adult protection and how to manage this. However many of the staff spoken with did not understand what the ‘whistle blowing’ policy meant. A copy of this policy was seen on the wall in the staff room. There was no evidence to show that adult protection training had been provided since the last inspection. However staff had access to this training previously and the on-going NVQ training included this topic. The manager said that some staff had attended an adult protection course held by Bexley Social Services and the organisation’s adult protection coordinator had Adelaide Nursing And Residential Care Home DS0000006752.V298139.R01.S.doc Version 5.2 Page 16 arranged further staff training to take place in the home. Information in relation to adult protection was included in the staff handbook along with the companys grievance process and was this assessed as not being very user friendly. Since the last inspection social services had investigated three allegations of abuse. There was no evidence of abuse identified however recommendations were made to the provider in relation to other concerns identified through the investigations. Recommendation 3. Adelaide Nursing And Residential Care Home DS0000006752.V298139.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 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, 24 and 26. Quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to the service. Although the home looked generally clean and tidy attention to detail was needed. There were concerns identified about the cleaning and laundry staffing hours provided and this must be reviewed. Feedback from residents and relatives varied in relation to the environment. However most residents seen during the inspection were satisfied with the private and communal space provided. EVIDENCE: The home is conveniently situated for Bexley shopping area and public transport. A maintenance technician was employed for five days a week. Routine safety checks he completed included fire safety, hot water temperatures and wheelchairs. He painted bedrooms when they were vacant and addressed repairs and health and safety issues reported by staff on a daily basis. He also provided on-call cover. A facilities manager within the organisation provided other safety service such as fire safety training, food hygiene training and completed the portable appliance testing. Adelaide Nursing And Residential Care Home DS0000006752.V298139.R01.S.doc Version 5.2 Page 18 Adequate bathing and toilet facilities were provided. All bedrooms had ensuite facilities with toilets and washbasins. Bathrooms and toilets seen were clean and had hand-washing facilities provided. However one bathroom on the dementia nursing unit, which had a parker bath, was quite cluttered with items such as a hoist and wheelchairs. There was a leak under the bath, which apparently had been noted some time ago. The domestic staff said they found it difficult to clean this room properly. Requirement 7. Bedrooms seen on the residential units were individually personalised. Bedroom doors had appropriate locks fitted and staff could gain access in an emergency. Not all bedrooms were provided with a lockable draw for service users to keep private and confidential property. In one bedroom a large TV was seen precariously balanced on top of a bedside table. As this could pose a risk to the resident this was brought to the attention of the manager to address. Some bedrooms on the dementia residential unit had an unpleasant odour and efforts must be made to eradicate this. A number of residents had stored suitcases and black bin liners full of belongings on top of wardrobes, not only did this detract from a homelike environment but it was also a potential hazard. Dust was clearly visible on these items and on the tops of bedroom shelves and wardrobes in some of the bedrooms seen. On the nursing units bedrooms seen were generally clean and tidy with no unpleasant odours noted. Issues such as attention to detail when cleaning were needed such as skirting boards and paintwork. Again in these units’ shelves and wardrobe tops needed dusting. Feedback from residents varied with some feeling the environment was kept clean and others saying it could be better. These sentiments were reflected in comments from relatives. Domestic staff said they were very pressured to complete their work due to the hours allocated. During the week there was one domestic allocated to each unit for five hours. However at the weekend there was only one domestic allocated to each floor so they had to clean two units in the five hours. The housekeeper did not have any management time to address issues such as staff supervision or to plan improvements or review the quality of this aspect of the service. Requirement 8. The laundry was situated in a separate building across the drive from the home, which had been converted for the purpose. Staff stated that the equipment provided was adequate. The laundry area was clean and organised with impermeable flooring. Staff said they had two trolleys, which were specifically designed to transport resident clothing. Staff used baskets on wheelchairs to transport items such as linen and towels. When it was raining staff covered laundry with a shower curtain. Management should review the equipment provided to transport laundry to ensure it is fit for purpose. All laundry was done in-house. Again there were concerns regarding staffing hours. There were currently two staff employed to work in the laundry from Monday to Friday. One member of staff worked on a Saturday and no staff worked in the laundry on a Sunday. Requirement 7. Adelaide Nursing And Residential Care Home DS0000006752.V298139.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 – 30. Quality in this outcome area was poor. This judgement has been made using available evidence including a visit to the service. At times there were inadequate staffing levels in the home, which could place residents and staff at risk. Management were committed to providing NVQ training for care staff. Recruitment procedures were good and complied with regulation. Staff had access to training relevant to the work they did however there was a need to provide more dementia care training and more nurses with additional specialist dementia care. EVIDENCE: Prior to the commencement of this inspection concerns were raised with the Commission about staffing levels in the home. Staffing rosters seen on the first visit to the home on 15/10/06 supported this concern. It was noted on the roster that for the four week period ending on 14/10/06 the staffing levels on the nursing units were inadequate on several occasions. It was not possible to assess the staffing on the residential unit as a combined roster was provided for both units. This roster was laminated making it impossible to change. Changes made to this roster were recorded in various ways and places. The end result being there was no record of the actual roster worked. It was also noted on this visit that the nurse in charge of the nursing unit had to answer the phone and open the door to visitors from 5.00pm once administration staff had gone off duty. This took up a lot of time and detracted from resident care, as there was only one nurse on duty. This practice must be reviewed. The issue regarding staff shortage was addressed in writing to the provider during the course of this inspection and an acceptable response received as to the Adelaide Nursing And Residential Care Home DS0000006752.V298139.R01.S.doc Version 5.2 Page 20 action that will be taken to make improvements. Currently the Commission are monitoring the care staffing levels on a weekly basis. See also the comments regarding domestic and laundry staffing hours under the environmental standards. Staff seen during the course of the three visits to the home to complete this inspection raised concerns about staffing levels in the home. The staff team comprised of a full time manager, a deputy manager, unit managers, qualified nurses, care assistants, domestic and ancillary staff. It was noted that only one nurse with a mental health qualification and one general nurse with additional dementia training were employed. Requirements 10 and 11. Recruitment policies and procedures were provided. Four staff files were viewed and found to contain all the information required by regulation. Since the last inspection the number of care staff with NVQ 2 qualification had dropped to 42 . This may be due to staff turnover. However the organisation was committed to continue providing this qualification for care staff. Requirement 12. Since the last inspection a number of staff on the nursing units had received some training on dementia care. It is important that staff on the residential units also receive this training. Staff seen during the inspection said they received training relevant to the work they did. A staff training matrix was provided to the Commission and showed that in the last six months staff had access to training such as fire safety, food hygiene, first aid and domestic staff said they had received training on the safe use of hazardous substances. Requirement 13 and recommendation 2. Adelaide Nursing And Residential Care Home DS0000006752.V298139.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. 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 the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to the service. The home had a new manager who was not yet registered with the Commission. Some quality assurance systems were in place however results of surveys were not available to view. More work was needed to ensure all staff received regular formal supervision. Safety records were well maintained but fire drills must be held at times to include night staff. EVIDENCE: A new manager came into post in April 2006. She had the qualifications and experience needed to manage the service. The manager had not yet applied to register with the Commission. Requirement 14. The manager said her line manager undertook unannounced monthly visits to the home. Reports of these visits were sent to the Commission in line with regulation 26. Regular relative meetings were held and minutes of these were Adelaide Nursing And Residential Care Home DS0000006752.V298139.R01.S.doc Version 5.2 Page 22 seen. The manager said she held ‘a surgery’ one evening a week to enable relatives who may be working to come in and discuss any issues they felt unable to discuss with staff. Notices advertising these sessions were seen on service users’ information boards. The manager said that satisfaction questionnaires were sent out monthly to a revolving sample of relatives. These could be completed anonymously and were returned to the organisation head office. The manager had only been in post since May 2006 and did not know if the results of the survey was published or made available to residents, relatives and other stakeholders. During discussion with relatives and residents the accessibility of the manager was raised as an issue. Residents and relatives felt that the manager did not have a high profile within the home and did not visit them regularly. Requirement 15 and recommendation 5. Management provided assistance with resident personal allowances only. A random sample of personal allowance records for four residents was examined. Money was held in individual named envelopes, stored in a safe and the money checked tallied with the records seen. Receipts were kept for money received and spent. Records were made available to residents and relatives on request. None of the four employee files seen included evidence that staff received regular supervision. A Staff Counselling Form was seen for one member of staff in relation to a practise issue. The manager stated this was not the organisations standard format for routine supervision and she showed the inspector written notes regarding supervision she had completed for a trained nurse. The manager said that care staff received supervision from the qualified nurses and that she supervises the nurses. Some care staff spoken with said they did receive supervision. However in the staff files viewed there was no evidence to show that those staff had received formal supervision. Requirement 16. From the safety records seen attention was given to providing a safe environment for residents and others. Records seen were up to date and showed that service checks had been done when due. Fire safety records seen showed weekly alarm checks were undertaken. Fire drills were held every two months and included comments on staff reaction and the names of those who were on duty. There was no evidence to show that any fire drills were held at times to include night staff. As permanent night staff were employed it is important to hold fire drills at times to include them. Requirement 17. Adelaide Nursing And Residential Care Home DS0000006752.V298139.R01.S.doc Version 5.2 Page 23 Adelaide Nursing And Residential Care Home DS0000006752.V298139.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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 2 X X 2 X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Adelaide Nursing And Residential Care Home DS0000006752.V298139.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No 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 OP4 Regulation 14 Requirement Timescale for action 18/12/06 2. OP7 15 3. OP9 13 The registered person must confirm in writing to residents that based on assessment the home is suited to meeting their needs. The registered person must 18/12/06 ensure wound care plans are kept up to date, include the treatment being provided, up to date information about the state of the wound and the frequency of the dressings. Care plans must show what action is taken to prevent residents identified as being at risk from developing pressure sores. 18/12/06 The registered person must ensure systems are in place to safely manage medicines. • Medicines must be kept securely stored at all times. • Two members of staff must check and countersign hand written entries on medicine charts. • Explanation must be provided for gaps on administration records. DS0000006752.V298139.R01.S.doc Version 5.2 Adelaide Nursing And Residential Care Home Page 26 4. OP12 12 5. OP14 18 6. OP15 16 7. OP21 23 A risk assessment must be completed regarding the storage of the medicine trolley on the dementia residential unit and remedial action taken if needed. The registered person must ensure adequate staffing levels are provided to meet the social needs of the residents. Serious consideration must be given to increasing the activity organiser staff hours provided in the home. The registered person must ensure staff maintain good personal and professional relationships with residents. Staff must not worry residents with employment issues such as salary and staffing levels. The registered person must ensure mealtimes are organised in such a way as to allow all residents to have the assistance they need to enjoy their meal and to have a hot meal. • Efforts must be made to encourage residents with dementia to choose their meal. • Staff must know how to safely use equipment such as a microwave. • Residents must have access to suitable condiments to enjoy their meal. This applied particularly to the residents with dementia. • Menus must show that consideration is given to providing meals to meet specific dietary needs such as meals for vegetarians. The registered person must ensure bathrooms are kept free DS0000006752.V298139.R01.S.doc • 18/12/06 18/12/06 18/12/06 18/12/06 Adelaide Nursing And Residential Care Home Version 5.2 Page 27 8. OP24 23 9. OP26 23 10. OP27 17, Schedule 4 11. OP27 18 of clutter and available to residents at all times. The leak from the Parker bath on the dementia nursing unit must be repaired. The registered person must ensure all areas of the home are kept clean. • Bedrooms must be kept free of offensive odours. • Attention must be given to cleaning paintwork, skirting boards and high dusting. • Storage in resident bedrooms must be reviewed to ensure this does not pose a safety risk to them. • A review of domestic staffing hours must be undertaken and the commission informed of the outcome and action taken to improve this. The registered person must ensure appropriate equipment is provided in the laundry. A review of laundry staffing hours must be undertaken and the commission informed of the outcome and action taken to improve this. The registered person must ensure a copy of the duty roster of persons working at the care home, and a record of whether the roster was actually worked is kept in the home. The registered person must ensure that: • Adequate staffing levels are on duty at all times to meet the needs of the residents. • Any review of staffing levels must include reviewing the night staff DS0000006752.V298139.R01.S.doc 18/12/06 18/12/06 18/12/06 18/12/06 Adelaide Nursing And Residential Care Home Version 5.2 Page 28 12. OP28 18 13. OP30 18 14. OP31 9 15. OP33 24 16. OP33 18 17. OP38 23 on the residential units. This was a requirement made at the last inspection but staffing levels remained unchanged. • The provider must ensure nurses working on the dementia unit have relevant training on dementia to assess and meet resident needs. The registered person must have plans in place to ensure 50 of the care staff have level 2 NVQ qualification. The registered person must have plans in place to ensure all staff including those working on the residential units receive training on dementia care. The registered person must ensure plans are in place to have the new manager registered with the Commission. The registered person must ensure a system is in place to monitor the quality of care provided in the home. A report of any review must be made available to residents, relatives and the Commission. The registered person must ensure a system is in place to provide all staff with formal supervision. The registered person must ensure a system is in place to hold fire drills at times to include night staff. 18/12/06 18/12/06 18/12/06 18/12/06 18/12/06 18/12/06 Adelaide Nursing And Residential Care Home DS0000006752.V298139.R01.S.doc Version 5.2 Page 29 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 OP7 Good Practice Recommendations The registered person should have an index in the resident’s records and care plans to enable staff to easily locate relevant information. Also the information kept on these records should be the most current and up to date. Out of date information should be removed and safely stored elsewhere. The registered person should review mealtime organisation and management, particularly on the dementia nursing unit. The registered person should ensure that all staff are aware of and understand the organisations whistle blowing policy and procedure. The registered person should keep individual training records for staff to evidence they have three days relevant training a year. The registered person should ensure the home manager maintains a high profile in the home and is known and accessible to residents or a regular basis. 2. 3. 4. 5. OP15 OP18 OP30 OP33 Adelaide Nursing And Residential Care Home DS0000006752.V298139.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Adelaide Nursing And Residential Care Home DS0000006752.V298139.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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