Inspection on 19/06/06 for Ainsworth Nursing Home

This inspection was carried out on 19th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Ainsworth Nursing Home 22/04/09

Ainsworth Nursing Home 16/10/08

Ainsworth Nursing Home 30/04/08

Ainsworth Nursing Home 27/11/07

Ainsworth Nursing Home 08/06/07

Ainsworth Nursing Home 02/02/07

Ainsworth Nursing Home 08/03/06

Ainsworth Nursing Home 15/07/05

Ainsworth Nursing Home 06/09/04

Ainsworth Nursing Home 08/06/04

Ainsworth Nursing Home 02/02/04

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

CARE HOMES FOR OLDER PEOPLE Ainsworth Nursing Home Knowsley Road Ainsworth Nr Bolton Lancashire BL2 5PT Lead Inspector Julie Bodell Unannounced Inspection 19th June 2006 07:00 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 Ainsworth Nursing Home DS0000017312.V295097.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. Ainsworth Nursing Home DS0000017312.V295097.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ainsworth Nursing Home Address Knowsley Road Ainsworth Nr Bolton Lancashire BL2 5PT 0161 797 4175 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) Mrs Pooganthai Subbiah Tina Jacqueline Harrison Care Home 37 Category(ies) of Dementia - over 65 years of age (6), Mental registration, with number disorder, excluding learning disability or of places dementia (7), Mental Disorder, excluding learning disability or dementia - over 65 years of age (3), Old age, not falling within any other category (19), Physical disability (2) Ainsworth Nursing Home DS0000017312.V295097.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 37 service users, to include: Up to 19 service users in the category of OP; Up to 2 service users in the category of PD (Physical Disabilities under 65 years of age); Up to 6 service users in the category of DE(E) (Dementia over 65 years of age); Up to 7 service users in the category of MD (Mental Disorder under 65 years of age); Up to 3 service users in the category of MD (E) (Mental Disorder over 65 years of age). The service should employ a suitably experienced and qualified manager who is registered with the Commission for Social Care Inspection. It has been agreed with the registered persons that Ainsworth Nursing Home will work towards the following categories to ensure three specific areas of care provision at the Home, to improve the quality of care provided by the service, without disruption to existing service users: Up to 19 service users in the category of OP Up to 2 service users in the category of PD (Physical Disabilities under 65 years of age); Up to 10 service users in the category of DE(E) (Dementia over 65 years of age); Up to 6 service users in the category of MD (Mental Disorder under 65 years of age). 8th March 2006 2. 3. Date of last inspection Brief Description of the Service: Ainsworth Nursing Home is a care home providing nursing and residential care for older people including older people with mental health and dementia needs. The building is a large, converted former hospital. It is detached and set within its own extensive grounds, with lawned areas and mature trees and shrubs. It is situated at the end of a private access road, in a semi-rural location within the Ainsworth area of Bury. Ainsworth Nursing Home DS0000017312.V295097.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection and took place at 7.00am – 10pm. The inspector spent time interviewing the registered manager, three staff members including night staff, five service users, looking around the building and at key information. Please see previous reports about this service. What the service does well: What has improved since the last inspection? What they could do better: Now the statement of purpose has been finalised a service user guide must be produced to give prospective service users’ the information they need to make a choice about the Home. The present service user contract must be reviewed to ensure that it is legally valid document so that it protects the rights of the service user. The staff team, where appropriate, must receive the necessary training to increase their knowledge and understanding of service users needs so that they can effectively support them, particularly in the areas of dementia, enduring mental health and physical disability. Ainsworth Nursing Home DS0000017312.V295097.R01.S.doc Version 5.2 Page 6 Care plans and risk assessments must be reviewed regularly to ensure that service users’ are receiving the care and support that they need. Regular weight checks must be carried out for those service users’ who are identified through nutritional screening process, as being at high risk of developing pressure areas. The practices around the medication administration system are poor and need urgent attention. This must include an assessment as to the competence of the staff members responsible for this task. Improvements need to be made in the provision of social activities and community contact, so that service users’ have the opportunity to become involved in meaningful, stimulating and fulfilling activities and are encouraged by the staff team to do so. There are major concerns about poor health and safety practices in the kitchen that need to be addressed urgently. This must include an assessment of all the kitchen staff to ensure competence to act in a safe manner. All the staff team and the registered providers’ must attend adult protection training so they understand their responsibilities in safeguarding service users’. The responsible individual must respond to requirements made about POVA issues to ensure the protection of service users’. The registered providers and the registered manager need to work closely together to avoid delays in responding to health and safety matters. Work to improve the physical standards at the Home must continue and a good and safe standard of cleanliness and hygiene must be maintained at all times. The specialist chair needed by a service user that has been outstanding for over a year must be purchased to improve the day-to-day health, safety and comfort of the service user. There need to be clear job descriptions in place to ensure that all members of the staff team are sure about their roles, responsibilities and accountability to ensure the health, safety and wellbeing of the service users’. The need to operate as a unified team is essential. The management arrangements for the Home need to be reviewed and competent nurses identified to take responsibility for the Home when the registered manager is not on the premises. The registered provider must visit the Home on a monthly basis and look at the quality of care provided and address any issues. Confidentiality of service users’ records must be maintained at all times. Ainsworth Nursing Home DS0000017312.V295097.R01.S.doc Version 5.2 Page 7 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. Ainsworth Nursing Home DS0000017312.V295097.R01.S.doc Version 5.2 Page 8 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 Ainsworth Nursing Home DS0000017312.V295097.R01.S.doc Version 5.2 Page 9 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): 1234&5 Quality in this outcome area is poor. This judgement has been made using available evidence from this and previous inspections and includes a visit to the service. The registered manager is clear about her responsibility that appropriate assessments must be undertaken before service users’ moved into Ainsworth to ensure that their needs can be fully met by the staff team. Although steady improvements have been noted at recent inspections there is more work to be done to achieve a good and consistent standard in this area. EVIDENCE: There have been ongoing concerns in recent years about the Home’s admission process and the ability of the staff team to meet the wide-ranging needs of the service user group. In the past service users’ have been admitted on the basis of placement availability rather than the ability of the staff team to meet and support the needs of the service users effectively. The registration certificate has been amended to give clear numbers and categories of service users’ who are able to live at the Home that identifies three specialist areas of care and Ainsworth Nursing Home DS0000017312.V295097.R01.S.doc Version 5.2 Page 10 support. It is going to take time to achieve the long-term categories and numbers and as service users are mixed throughout the building for a range of reasons. A number of service users are reluctant to move within the building and there view has been respected. The registered manager, who inherited this situation, is clear about her legal responsibility to adhere to the certificate and there is evidence at this inspection that further progress has been made in achieving the set conditions. As the aims and objectives and arrangements at the Home become clearer and more focussed, the staff team needed to be provided with the training they need to be able to both understand and support the service users’ needs, particularly in the areas of dementia, enduring mental illness and physical disability. Discussions with service users’ indicated that although they found the staff team generally caring, they were not confident that they understood the conditions they were experiencing and how best they should be supported. Now that most of the mandatory health and safety training has been completed the focus of training in these areas must be given priority. It should also be underpinned by value based training in the areas of choice, independence, privacy, rights and fulfilment, as a starting point to promote equality and diversity. The registered manager said that training in these areas, is to be provided to all staff members on a rolling twelve month cycle. The statement of purpose and service user guide has been reviewed and revised to reflect the conditions. A service user guide now needs to be developed to give prospective service users’ the information they need to make a choice about whether they wish to move into the Home and what services and support that they can expect. The service user contract that is currently in place is very basic. Following discussion about this and other contractual agreements used for staffing it was discussed and agreed that the contract needs to be reviewed to check that it is legally valid document. A sample of care records for three service users’ confirmed that an assessment by either a social worker, community psychiatric nurse or a general nurse is carried out prior to a service user being admitted to Ainsworth. Wherever possible service users and their families, friends and social workers are encouraged to visit the Home. Recent admissions to the Home were discussed with the registered manager. It was clear that where the service user was well and able enough, a prior visit was made before a decision to move into the Home was made. At this time a service user who is moving from another Home in the area is involved in a gradual introduction to the Home with regular planned visits and occasional overnight stays. Ainsworth Nursing Home DS0000017312.V295097.R01.S.doc Version 5.2 Page 11 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 8 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence from this and previous inspections and includes a visit to the service. Care plans and risk assessments examined were in good order but need to be reviewed regularly and that this is evidenced. Improvements have been made to the medication system, which helps to protect the service users by ensuring safer practices. However some very unsafe practices were found during this inspection that are a major cause of concern. EVIDENCE: Three service users’ care plans and risk assessments were examined. Care plans and risk assessments were generally in good order. However out of the random sample examined a number had not been reviewed and updated by the nurses responsible for this task. One incidence was particularly concerning as it involved weight checks not being carried out for a service user who was prone to pressure and had a high risk nutritional assessment. Care must also be taken to use age appropriate language e.g. not cot sides and bumpers when referring to the use of bed rails. Ainsworth Nursing Home DS0000017312.V295097.R01.S.doc Version 5.2 Page 12 Two positive General Practitioner comment cards were received and one stated that they were “very happy with the care the residents receive.” The medication system has been upgraded. Two new medication trolleys that are able to house blister packed medication have been purchased. Training in the new system was undertaken on 27th March 2006. The safety of the medication system was assessed. Both medication trolleys and the treatment room were included in the assessment. A catalogue of shortfalls was uncovered. The assessment took place at 5.15pm and despite nurses being aware that there was a mistake in the medication received from the pharmacist for a service user in the morning, nothing had been done to resolve the problem. Administration records were not being properly maintained e.g. medication given but not signed for, there was no definition as to why medication had not been given to a service user, photographs for identification not in place, use of creams was not recorded and transcribed records were not double signed. The treatment room was unlocked and the door was propped open, despite the fact that nurses knew the inspector had been on site since early morning. The window was open. This window was not lockable and would not restrict access to intruders. The treatment room was poorly organised and needed to be cleaned and tidied. Controlled drugs were in one case overstocked. Out of date rectal Diazepam was in the cupboard and more rectal Diazepam was found on top and to the back of a cupboard. Out of date drawing up needles and iodine strips were also found. Medication for service users who had passed away had not been returned. The present arrangements for keeping prescribed oxygen and who it can be used for needs to be checked out to ensure it is correct practice. Although it is the registered manager’s responsibility to monitor medication systems, nurses too have a professional responsibility and are accountable to ensure the safety of medication administration. Present practice is poor and urgent attention is needed to address the matters raised and check that there are no other unsafe practices are in operation. This must include an assessment of competence of all those responsible for administration of medication. The inspector observed service users’ being treated in a courteous manner throughout this inspection. Care was taken to ensure that service users’ privacy and dignity was maintained whilst involved in personal care tasks. Staff members and service users’ refer to each other on first name terms. It was noted that all staff members knocked on service users’ doors before entering. Ainsworth Nursing Home DS0000017312.V295097.R01.S.doc Version 5.2 Page 13 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 13 14 & 15 Quality in this outcome area is poor. This judgement has been made using available evidence from this and previous inspections and includes a visit to the service. Social activities need to be developed to ensure that all service users’ have the opportunity to engage in meaningful, stimulating and fulfilling activities. The continuing poor practices in the kitchen must be addressed to ensure the health and safety of the service users’. EVIDENCE: The inspector arrived for this inspection at 7.00am. It was noted that most service users’ were still in bed and staff members said that they were under no pressure to get service users’ up. The pace was very relaxed and services users’ who were up were observed being offered a drink whilst waiting for their breakfast. At the last inspection it was noted that the arrangements for eating meals was poor in the main lounge, with only one large table with an array of odd chairs available to service users. A new dining room table and chairs has been given to the Home and this is an improvement. Social activities for service users’ had improved markedly by last summer but this improvement had not been maintained. There has been no activities organiser for sometime and the registered manager had not had time to Ainsworth Nursing Home DS0000017312.V295097.R01.S.doc Version 5.2 Page 14 continue to produce the newsletter that she had introduced. It was noted that a service user is going to see a Tom Jones concert with a member of staff. There were many visitors to the Home during the course of the inspection. Visitors were made welcome. The inspector received one relative and visitors comment card, which expressed satisfaction with the care, provided with comments “ my mother has only been in the home for two and a half months but has settled in well and is very well cared for by the staff.” It has been required previously that then the registered manager has reviewed the menu to ensure that a varied, wholesome and a balanced diet is provided and that choice is available to service users, some of whom had said that they were not happy with the choice of food or the quality of the food that they received. This menu was discussed at a kitchen meeting held on 02.06.06 and the new menu will be finalised by the end of June 2006 and then implemented. At the last inspection the inspector raised many concerns about the condition and work practices of the kitchen, a full list of which can be found in that report. It is therefore of some concern that at this visit that little improvement has been made and many shortfalls were observed. The deep fat fryer was not clean and the surrounding floor was greasy and dirty. The cooker was cleaner than at the last visit but there is still, room for improvement. The fridge was dirty both inside and on top. There was no record of the cleaning schedule being followed since 11.06.06 and no temperature records maintained. Outdated and mouldy food was in the fridge and open jars’ and bottles were not dated. The fly tube was last changed in 2004 and needs to be replaced and the fire extinguisher does not appear to have been checked since November 2005. An environmental health officer visited the Home on 07.06.06 and sited five contraventions and made two recommendations. All these matters must be addressed. It was noted that extra staff had been brought in to address cleaning tasks. The inspector had been on the premises since 7am and went to check the kitchen at 4pm. Despite the fact that the kitchen staff members were aware of the issues raised at the last inspection and that the inspector was on the premises, no attempt appears to have been made to clean the kitchen before the assessment. Practice continues to be poor and urgent attention is needed to address the matters raised and check that there are no other unsafe practices in operation. This must include the competence of all those responsible for the kitchen duties in respect of both cooking and cleaning tasks. Ainsworth Nursing Home DS0000017312.V295097.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 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence from this and previous inspections and includes a visit to the service. The registered provider must ensure that the staff team receive good quality adult protection training. The registered providers’ must also attend this training. The responsible individual must ensure that she complies with POVA legislation. EVIDENCE: There is a complaints procedure in place. There has been one internal complaint since the last inspection, which is under investigation at this time and there have been no complaint investigations conducted by the CSCI. The registered manager is updating adult abuse training. There was a training session held for the staff team at the end of January 2005. This training was undertaken prior to the present manager taking up post. The training was not certificated and was poorly attended. The registered manager is unhappy with the quality of this training and is planning to access local authority training for the staff team. The registered manager has now registered with a local training partnership and has booked 28 places on the POVA course and is waiting for dates. There was a serious incident at the Home last year. The provider has notified both POVA and the NMC/UKCC about the incident and this has been confirmed. However further information requested by the POVA team and CSCI has yet to Ainsworth Nursing Home DS0000017312.V295097.R01.S.doc Version 5.2 Page 16 be received from the registered provider, as requested at an additional visit that took place on 27th January 2006. Relating to the same incident, it was agreed that the registered provider would write a report giving details of contact with the placing authority in respect of lack of social worker input that relates to a small number of identified service users and this includes non payment of fees. Also discussed was the responsibility of the registered provider to produce risk assessments for any person with a criminal conviction and whether they pose a risk to service users. Information requested on how this will be achieved has yet to be received. Ainsworth Nursing Home DS0000017312.V295097.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 22 23 24 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence from this and previous inspections and includes a visit to the service. The physical standards must continue to improve for service users’ comfort and safety. The registered provider must address any health and safety matters, which could have an adverse impact on service users promptly. EVIDENCE: The Fire Officer had issued an enforcement notice at the time of the last inspection. This is not the first time that a health and safety enforcement notice has been served against the registered provider who despite being aware of health and safety matters takes a long time to take action and carry out any necessary work to rectify problems. This work has now been completed but the Fire Officer has given a poor rating to the Home because of the history of non-compliance. The inspector is also aware that enforcement action is pending in respect of the Homes septic tank from the environment agency. Ainsworth Nursing Home DS0000017312.V295097.R01.S.doc Version 5.2 Page 18 The entrance to the building looked welcoming with flowers and hanging baskets and neat and tidy in appearance. The general visual appearance of the building, though set in beautiful surroundings, is poor in parts. Rubbish outside the Home needs to be removed. The inspector is also concerned that many of the large trees surrounding the Home need attention and there was evidence of large fallen boughs on the edge of the driveway. The handymen were repairing damage to a service user’s bedroom caused by a leaking roof. The entrance hall has been decorated. The carpet along the main corridor is fitted in such a way that it is lifting in parts and is presenting a trip hazard, as is the carpet in the main lounge, which needs to be replaced. The main lounge area needs some attention and to look at ways of making it feel more homely. The EMI ramp carpet needs attention. Extra handyman hours are now in place to assist with decorating and maintenance. A lot of equipment such as hoists were being stored in bathroom areas and these needed to be moved to a more appropriate area. Liquid soap and hand towels were not in place in some toilets and used in continence pads were found on a toilet floor. A new toilet seat was needed in one toilet. In the EMI bathroom a restrictor is needed to the bathroom window, the halogen bulb needs to be replaced; a fire door self closer is needed to the door and storage for towels and toiletries needs to be provided. Some towels across all areas of the building were in a poor condition and in need of replacement. Service users’ generally have the specialist equipment they need. However, at previous inspections’ the inspector has requested that an appropriate professional assess the situation in respect of the bucket type chair being used for a service user, in terms of safety, comfort and potential pressure areas. This has been done and an alternative has been identified. It is now available and is waiting to be purchased by the registered provider. This situation has prevailed for over a year. Two service users’ bedrooms have recently been decorated and one bedroom was being decorated during this inspection. It is noted that bedrooms have started to improve due to a more co-ordinated approach in relation to decoration and furnishings. However it was noted again that some bedding was very thin and in need of replacement. More slide sheets have been purchased. No further old and damaged furniture has been replaced since the last inspection. Locks have been replaced to four bedroom doors. Another room is due to be decorated soon and this will involve the service user and their key worker. The first floor landing needs to be decorated. The Home and the standard of hygiene and cleanliness within Ainsworth continue to improve. Training for staff members in control of infection is now underway and must be completed to ensure that all the staff team are aware of their responsibilities to ensure the health and safety of service users’. New products for cleaning have been introduced into the Home. Ainsworth Nursing Home DS0000017312.V295097.R01.S.doc Version 5.2 Page 19 The outside laundry, which has been the subject of previous inspections and a visit by the HSE inspector, was found to have no heating, no hot water and was dirty. The internal laundry on the EMI unit was found to be unlocked and the door propped open despite a “keep lock shut notice.” Liquid soap and hand towels where not in place in some areas of the Home and some bedding was found to be soiled. Ainsworth Nursing Home DS0000017312.V295097.R01.S.doc Version 5.2 Page 20 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 28 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence from this and previous inspections and includes a visit to the service. Adequate numbers of staff were available to ensure that the needs of service users’ could be met. However more work is needed to produce clear job descriptions so that all members of the staff team are clear about their role, responsibilities and accountability to ensure the health, safety and wellbeing of the service users’. The need to operate as a unified team is essential. EVIDENCE: There were adequate amounts of staff on duty to meet the needs of the service users’. However, the inspector is very concerned about the findings identified in this report. Although there was no suggestion that the staff team are uncaring, there were many shortfalls in required health and safety practices in virtually every area of service provision, that raise concerns about the competence of the staff team. This was very disappointing after a period of improvement, coupled with the fact that neither the presence of the inspector on the premise and with ample time available there was no apparent effort made to rectify health and safety issues like the problems with medication, the cleaning of the kitchen, incontinence pads on the floor and dirty bedding to name a few. Also for a time there was no supervision in the EMI lounge. The inspector could not find either the nurse or the carer. They were eventually located bathing a service user quite some distance away from the lounge and certainly not in earshot. Ainsworth Nursing Home DS0000017312.V295097.R01.S.doc Version 5.2 Page 21 All job descriptions and contracts of employment must now be reviewed to ensure that they give all staff members’ clarity about their role, responsibilities and accountability. A clear structure for both day-to-day supervision and delegation for both day and night time care needs to be in place and reinforced. Responsibility for setting high standards and maintaining good occupational standards is the responsibility of the whole staff team. Where shortfalls in competence is identified then appropriate training must be offered and if problems persist then disciplinary measures should be considered if appropriate. The Home employs eight registered nurses and two registered mental health nurses, not including the registered manager. 57 of the staff team hold either an NVQ Level 2 or 3 in care. There should be no reason for such levels of poor occupational practice. The registered manager must look at the practice of all the staff team starting with the qualified nurses and their ability to manage all aspects of the running of Ainsworth in her absence through the planned appraisals and supervision as a matter of urgency. The registered manager informed the inspector that appraisals for nurses are arranged for this month and four nurses are enrolled to attend a day course on assertiveness and leadership skills. Two recruitment files of two staff most recently employed were examined. The standard of recruitment documentation has significantly improved. However two issues were raised following the examination of files. The first was that a new member of support staff had been given a date to start employment by the registered provider without a returned CRB or a Povafirst check. The inspector also requested that the copies of qualifications supplied by a carer were validated to ensure that they were authentic. Given the findings of this report the inspector is requiring that all staff including support staff go through a fresh induction process that is linked to their job description and contract to ensure that staff members are clear about the expectations of the Home. The registered manager has now joined the local Bury Adult Care Training Partnership that is linked to Skills for Care. It is hoped that from now on the staff team will be provided with consistent and good quality training. This arrangement must be followed through. Ainsworth Nursing Home DS0000017312.V295097.R01.S.doc Version 5.2 Page 22 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 37 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence from this and previous inspections and includes a visit to the service The registered manager is fully aware of her role to promote and safeguard the health, safety and welfare of the service users. However the registered providers’ continues to be slow to respond to requirements made by various statutory agencies and has not always kept the registered manager informed. This is to the detriment of service users and the running of the home. The registered providers’ and the registered manager must work together if any further progress is to be achieved. EVIDENCE: The registered manager is a qualified nurse with many years experience of both working and managing residential homes for older people. It has been clear during recent inspections that the registered manager had made an Ainsworth Nursing Home DS0000017312.V295097.R01.S.doc Version 5.2 Page 23 impact in improving the service offered at Ainsworth, in terms of decision making, communication, increasing the responsibility of the staff team, improving relationships with outside agencies, increasing the opportunities for activities for service users and training opportunities for the staff team. The registered manager was said to be approachable and always had a ready smile. The registered manager has been under no illusion that there is much more to do in terms of modernising the Home. Unfortunately at this inspection, although there has been a period of only three months between inspections, progress appears to have stopped and some significant shortfalls have been found during this inspection that suggest that the Homes performance is slipping backwards. Further improvements must continue as the Home has been close to enforcement action being taken in the recent past by CSCI. The relationship between the registered manager and the owners of Ainsworth is key to ensure continued improvements and progress towards a better future for all concerned. Given the performance issues raised at this inspection management of the Home needs to be reviewed and consideration should be given to the appointment of a deputy manager to take responsibility for the Home in the absence of the registered manager. It is clear that improvements cannot be achieved and maintained by the registered manager alone and that a unified team approach is needed. At previous inspections it has appeared that a director of the company rather than the responsible individual appears to be taking responsibility for addressing matters arising within the Home. The Home is registered, as Ainsworth Nursing Home Ltd with Company House and this is not reflected on the Home’s certificate, which indicates a sole trader. The registered providers’ must now submit an application to become registered as an organisation. As required previously the responsible individual in line with Regulation 24 must conduct a review of the quality of care. This process has already started to be addressed by the registered manager. The inspector has also previously required the registered provider to, in line with Regulation 26, conduct unannounced monthly visits. A written report of the visits should be forwarded to the Commission. The registered provider was given a copy of the CSCI format by the inspector to assist in the report writing for this task and has been supported by the registered manager to do so. None have been received since the last inspection. Regulation 26 visits are a good way of identifying and addressing problems that arise, as well as formally addressing issues raised in the monthly managers report, so they do not escalate into enforcement action. This is a failure on the part of the registered providers to comply with the Regulations. The Homes administrative arrangements are poor. The registered manager would benefit from computer access for word processing, email and Internet, as well as administrative support. An administrator has recently been employed but it appears that this person might be undertaking work for the registered providers’ group of Homes and not to support the registered Ainsworth Nursing Home DS0000017312.V295097.R01.S.doc Version 5.2 Page 24 manager and the day-to-day running of the Home. Clarification of the new administrator’s role is needed. Confidentiality of service users’ information is not being maintained and care records were frequently found on the desk at the main entrance throughout the day, where visitors could see them. Policies and procedures for the Home need to be reviewed and updated to link with job descriptions, terms and conditions of employment and supervision as identified in the staffing section. Standards 35 and 38 were not fully assessed at this inspection, however health and safety issues are referred to throughout this report. Ainsworth Nursing Home DS0000017312.V295097.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 2 3 1 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 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 1 2 2 2 1 X 1 X 1 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 1 X 1 1 X Ainsworth Nursing Home DS0000017312.V295097.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES 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. 2. 3. Standard OP1 OP2 OP4 Regulation 5 5 18 Requirement That a service user guide is produced. That the present service user contract is reviewed to ensure that it is legally valid document. That the staff team where appropriate receive the necessary training to increase their knowledge and understanding of service users needs so that effective support is provided. That care plans are reviewed regularly and this is evidenced. That the health care risk assessments are reviewed regularly and this is evidenced. That weight checks are carried out regularly particularly for those service users who are identified as high risk for nutritional screening and at risk of developing pressure areas. That the major health and safety shortfalls that have been identified in this report in respect of the medication system are addressed and include the competence of qualified staff. DS0000017312.V295097.R01.S.doc Timescale for action 30/09/06 30/09/06 30/09/06 4. 5. 6. OP7 OP8 OP8 15 13 13 31/08/06 31/08/06 31/08/06 7. OP9 13 31/08/06 Ainsworth Nursing Home Version 5.2 Page 27 8. OP12 16 9. OP15 16 10. 11. 12. OP18 OP18 OP19 16 37 23 13. 14. 15. 16. 17. 18. 19. 20. OP20 OP20 OP20 OP20 OP21 OP21 OP21 OP21 13 23 23 23 13 13 13 23 That improvements are made to the provision of social activities and community contact so that service users have the opportunity and are encouraged to become involved in meaningful, stimulating and fulfilling activities That the major shortfalls identified in this report in respect of poor practice in the kitchen are addressed and include the competence of all the kitchen staff to act in a safe manner. The requirements of the environmental health officer must also be addressed. That all staff and the registered providers receive protection of vulnerable adults training. That all the copies of documentation requested by the inspector are forwarded to CSCI. That a suitably qualified person examines the trees, surrounding the home, to ensure that they are safe. That the main corridor carpet is replaced or repaired to reduce the presenting trip hazard. That the lounge carpet is replaced as it is a trip hazard in parts. That the main lounge area is decorated and refurbished, to create a more homely environment. The EMI ramp carpet needs to be cleaned or replaced. That bathrooms must cease to be used as storage areas That liquid soap and hand towels are provided in all toilets That incontinence pads are properly disposed of. That a new toilet seat is provided as identified. DS0000017312.V295097.R01.S.doc 30/09/06 31/08/09 31/08/06 30/09/06 31/08/06 30/09/06 30/09/06 31/10/06 31/10/06 31/08/06 11/08/06 11/08/06 11/08/06 Ainsworth Nursing Home Version 5.2 Page 28 21. OP21 23 22. 23. 23. 24. 25. 26. OP21 OP21 OP22 OP24 OP24 OP24 16 23 13 23 23 23 27. 28. 29. 30. 31. OP24 23 23 23 23 23 OP24 OP24 OP24 OP24 32. 33. 34. 35. OP24 OP24 OP26 OP26 23 23 13 13 That in the EMI bathroom a window restrictor is put in place to improve security, the halogen bulb is replaced for a safer bulb, a fire door closer is put on the door and storage for towels and toiletries needs to be provided. That worn towels are replaced. That the floor covering to the toilet on the EMI ramp is replaced. That the suitable chair identified for a named service user is purchased. (Outstanding) That the torn boarder to Room 12 (C) is replaced. That the water tank cupboard in Room 14 (C) is fitted with a lock. That the downstairs bedroom near to the conservatory that was recently decorated is fitted with a lock and is provided with new furniture. That a new vanity unit is fitted to the identified bedroom. That Room 27 (C) has a privacy curtain to the window in the bedroom door. That Room 9 (M) has a new carpet fitted. That Room 12a (M) is decorated That Room 11 (M) needs the chair replacing and the wardrobe doors need attention. That Room 10 needs a new vanity unit, attention is needed to the floor covering, handles are needed on the furniture and the room needs to be decorated. That Room 14 the handles are missing to the bedside cabinet. That the staff team completes the control of infection training that is being provided. The outside laundry is provided with heating, hot water and is thoroughly cleaned. DS0000017312.V295097.R01.S.doc 31/08/06 31/08/06 31/08/06 31/08/06 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 Ainsworth Nursing Home Version 5.2 Page 29 36. 37. OP26 OP26 13 13 38. OP27 19 39. OP28 18 40. OP29 19 41. OP29 19 42. OP30 18 43. OP31 18 44. OP33 7 That the internal laundry on the EMI unit is kept locked when unattended. That the staff member assisting the service user checks that bedding daily to ensure that it is hygienically clean. That all job descriptions and contracts of employment must now be reviewed to ensure that they give the staff member clarity about the role, responsibilities, accountability and a clear structure for both day-to-day supervision and delegation for both day and night time care. That the registered manager must carry out appraisals for nurses and that the four identified nurses enrolled to attend a day course on assertiveness and leadership skills complete the course. That the identified member of support staff does not commence employment without a CRB or a Povafirst check. . That the registered manager validates the authenticity of the copies of qualifications supplied by an identified carer. That all staff members go through a thorough induction training process and attend appropriate training to carry out there job as identified through this process. That the management arrangements for the Home are reviewed and competent nurses identified to take responsibility for the Home in the absence of the registered manager. The registered provider must complete an application form to register the Home as a company and the certificate amended. DS0000017312.V295097.R01.S.doc 31/08/06 31/08/06 30/09/06 30/09/06 31/08/06 11/08/06 31/10/09 30/09/06 30/09/06 Ainsworth Nursing Home Version 5.2 Page 30 45. 24 46. OP33 26 47. OP34 18 48. OP36 4 49. OP37 17 That the registered provider carries out a review of the quality of care and a report produced and forwarded to CSCI. That the registered provider visits the Home unannounced on a monthly basis in accordance with this Regulation and a report produced and sent to CSCI. (Outstanding) That the Home’s management administration arrangements are reviewed. Policies and procedures for the Home need to be reviewed and updated to link with job descriptions, terms and conditions of employment, induction and supervision as identified in the staffing section and in line with the statement of purpose. That the confidentiality of service users’ records is maintained. 30/09/06 31/08/06 30/09/06 30/09/06 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ainsworth Nursing Home DS0000017312.V295097.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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 Ainsworth Nursing Home DS0000017312.V295097.R01.S.doc Version 5.2 Page 32 - 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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