Inspection on 02/02/07 for Ainsworth Nursing Home

This inspection was carried out on 2nd February 2007.

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

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

Other inspections for this house

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 19/06/06

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 06:30 2 February 2007 nd 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.V297775.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.V297775.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) d.subbiah@btconnect.com 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.V297775.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). 19th June 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. The current fee for this service ranges from £339 to £472 per week dependent on the level of need. Ainsworth Nursing Home DS0000017312.V297775.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 6.30am – 6.30pm. Three inspectors were involved in this inspection during the course of the day. One inspector looked at nurse practice, a second inspector looked at the dementia unit, which included 2 hours observing how care staff spoke with and cared for residents. The lead inspector looked at outstanding issues from the last inspections, talked to the registered manager, three staff members including night staff, five residents, looked around the building and at key information. Information requested from the service was received, as well as questionnaires from one resident, two relatives and four health and social care professionals who have contact with the Home. The lead inspector has made two inspection visits to the home on 8th October 2006 and the 3rd November 2006. What the service does well: What has improved since the last inspection? Three quarters of the care staff team have received training in dementia care. Care plans and risk assessments are being reviewed regularly to ensure that service users’ are receiving the care and support that they need. There has been a significant improvement in the provision of activities outside the home. Four residents have recently been to Blackpool for the weekend for a “tinsel and turkey” weekend supported by members of the staff team and more are planned for the future. There is a new menu in place that increases the variety for residents. Practices in the kitchen have improved to help ensure the health and safety of residents. Ainsworth Nursing Home DS0000017312.V297775.R01.S.doc Version 5.2 Page 6 There has been a significant improvement in the training opportunities for the staff team that will help them support and care for residents more effectively and safely. Job descriptions have been updated 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 residents’. What they could do better: The staff team must continue to receive the necessary training to increase their knowledge and understanding of residents specialist needs so that they can effectively support them, particularly in the areas of dementia, enduring mental health and physical disability. This must include ways of positively engaging with residents on a personal level with attention to eye to eye contact, facial expression, language, tone of voice, orientation etc. Residents and/or their representatives must be involved in the development and review of their care plans to ensure their views and wishes are taken into account. The medication system in place does not ensure that the residents receive their medicines safely and correctly. The home does not always keep good records of medicines received into the home. To ensure the residents living on the dementia unit receive regular social and recreational activities that meet their specialised needs, a formal timetable must be developed. The lunchtime routines on the dementia unit should be reviewed to ensure that residents enjoy hot, attractive meals that take place as a pleasant, social occasion. All staff team and the registered providers need to attend protection of vulnerable adults training to ensure that service users are protected from abuse and that staff members know what to do should an incident occur. 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. Adequate numbers of staff must be available to ensure that the needs of residents can be met, at all times. Ainsworth Nursing Home DS0000017312.V297775.R01.S.doc Version 5.2 Page 7 The management arrangements for the Home need to be reviewed and a competent deputy manager be formally identified to take responsibility for the Home when the registered manager is not on the premises to ensure the home is appropriately managed at all times. Formal supervision sessions and appraisals must be undertaken with members of the staff team to ensure good practice and continuous professional development. The registered provider must visit the Home on a monthly basis and look at the quality of care provided and address any issues. The registered provider needs to continue to meet the requirements of registration and comply with insurers for the home to continue to operate. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ainsworth Nursing Home DS0000017312.V297775.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.V297775.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 4 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Assessments of residents are undertaken before residents move into the home to ensure that their needs can be fully met by the staff team. Residents and their families are encouraged to visit the Home to check out that the service is suitable. More work is needed to ensure that the staff team have the skills and ability to work effectively with specific needs of residents. EVIDENCE: Three residents files were examined. Files showed that either a community psychiatric nurse or a social worker had carried out a community care assessment or a community psychiatric assessment, and the home had also carried out an assessment, prior to the resident being offered a place and moving into the home. Ainsworth Nursing Home DS0000017312.V297775.R01.S.doc Version 5.2 Page 10 An inspector spoke with the relative of a resident who was currently using the home for a period of respite. Family members visited the home at various different times unannounced before agreeing to move the relative into the Home. Both the resident and the relative were very happy with the Home, which compared favourably to the previous Home the relative had stayed at. The resident had settled at the Home well and was calm and relaxed. The family had been able to bring in some of the relatives personal possessions and family photographs for the residents bedroom. The registration certificate was amended sometime ago to give clear numbers and categories of residents’ who are able to live at the Home that identifies three specialist areas of care and support. The registered manager is still working towards achieving the set conditions of the registration certificate, a situation that she inherited. Further progress was again noted at this inspection. However care needs to taken around assessments that are borderline to ensure that there is no breach of registration. It is going to take time to achieve the long-term objectives of the new categories and numbers as residents are mixed throughout the building for a range of reasons. A number of residents are reluctant to move within the building and their view has been respected, in one case with the involvement of an advocate. Now that the aims and objectives and arrangements at the Home become clearer and more focussed, the staff team have started to be provided with the training they need to be able to both understand and support the residents’ needs, particularly in the areas of dementia, enduring mental illness and physical disability. Since the last inspection three quarters of care staff members have received dementia training with those outstanding planned. The training includes experiential role-play. A staff member said that they had, “enjoyed the training” and that “it makes you think about residents individual needs.” Training in enduring mental health is being organised through the local partnership and will commence from April 2007. As part of this inspection an inspector, spent time observing the interactions between the residents and staff members on the dementia unit. It was noted that the staff members on duty would not normally spend time on the unit. The interactions between the residents and the staff members were seen to be poor in terms of eye contact, language and tone of voice and many opportunities to engage positively with residents were missed e.g. moving lunch tables in front of residents and putting food in front of residents all without talking to them or explaining what they were doing. The registered manager must ensure that the staff team use the training that they have received and adapt it into good basic day-to-day occupational standards and practices so that the residents benefit from the training. It has been discussed in the past giving the three areas of service delivery new names. This has not yet been done and would be helpful in identifying that there are three distinct areas of specialist care. Ainsworth Nursing Home DS0000017312.V297775.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plans reflected the assessed needs of the residents. Care practices ensured that the residents health care needs were met, that they were treated with respect and their dignity was upheld. The medication system in place does not ensure that the residents receive their medicines safely and correctly EVIDENCE: Care plans were generated from the care management or home’s preadmission assessment. The care plans examined were detailed, clearly setting out action to be taken to address all aspects of the health and personal care of residents. Such detailed plans ensured the staff received the information they needed to satisfactorily meet the needs of the residents. Relatives interviewed said they were aware of the care the person they visited needed. Care plans contained details of all nursing needs and the identified needs were being well met either by the nursing staff employed at the home or by visiting district Ainsworth Nursing Home DS0000017312.V297775.R01.S.doc Version 5.2 Page 12 nurses for the residential residents. Care plans had improved, especially in relation to wound care with recordings showing care and progress made. A body map, initial assessment and a progress record were included in the care plan. However, care plans do need to clearly show that residents, where able, and relatives are being involved in their development and review. Also, as new care plans are written, particularly on the dementia unit, the use of more positive language that recognises residents’ skills and strengths, rather than “problems” and describing residents as “meddlesome” and “attention seeking” was advised. The introduction of brief life stories e.g. jobs done, hobbies and interests, family members, was also discussed. Management of risk takes into account the needs of residents and demonstrates a balanced view in maintaining safety while also offering choice. The rights of others living in the home are also considered when drawing up an assessment of risk. Good daily recordings were seen where staff had identified any areas of concern together with what action was needed to address the problem. Where risk areas had been identified in relation to skin integrity or weight, staff were implementing the care plans i.e. weighing residents weekly and recording gains/losses, using charts to record when pressure relief had been given. Adequate equipment was available for the treatment and prevention of pressure sores. The reviewing system was good with staff undertaking reviews of care plans and risk assessments on a monthly basis, this was particularly well organised on the dementia unit. Records showed that residents had good access to health care professionals, for example, chiropodists, opticians, district nurse, as well as to specialist health care i.e. stoma care, dietician and speech therapy. Improvements in the medication system were noted. Medicines were administered directly from the medicines trolleys on both units. A random check was undertaken and records were found to be inaccurate with evidence that the total that should have been held was not accurate. One record examined indicated that tablets that had been received into the home were missing. The manager was aware of this and had taken steps to determine whether this was an error on the part of the home or the supplying pharmacy. The date medicines are received into the home is not being recorded on the Medicine Administration Sheet (MAR). Good practice was noted with regard to ‘covert administration’; with one resident’s care records showing the extra help they needed and that this had been agreed with their GP and family. Residents interviewed were very positive about the care they received and said they felt safe and cared for. The staff had a good understanding of the residents’ support needs and this was evident from the positive relationships that had been formed between the staff and residents. One visitor said the dementia unit manager and one of the carers (not on duty) treated the residents with warmth and kindness. One staff member who visited during lunch was observed to speak in a warm and friendly manner to residents. Ainsworth Nursing Home DS0000017312.V297775.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Social activities have been arranged to ensure that all service users’ have the opportunity to engage in meaningful, stimulating and fulfilling activities. However, more work is needed to provide a stimulating environment on the dementia unit. Improvements in the menu and health and safety practices in the kitchen have been made. EVIDENCE: The lead inspector arrived for this inspection at 6.30am. It was noted that most service users’ were still in bed and night 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. Social activities for service users’ have improved markedly and the registered manager has started to produce the newsletter again. Activities in December included trips to Smithills Coaching House and Radcliffe Civic Hall. Four Ainsworth Nursing Home DS0000017312.V297775.R01.S.doc Version 5.2 Page 14 residents went on a “turkey and tinsel” weekend to Blackpool, stayed at a hotel and visited Madame Tussard’s wax works. An entertainer came into the Home and local church and school choirs near Christmas and there was also a residents and relatives party. Residents also partook in Christmas Communion with the local vicar. On New Years Eve the carers held a Hogmany dancing, karaoke and bingo evening. There are photographs of trips and events throughout the building. Planned activities for the coming months include a trip on a narrow boat, the possibility of a social evening away from the Home for residents, relatives and staff and more weekends away. The registered manager said that a local authority had made positive comments about the activities and community involvement for some service users’. A service user was receiving reflexology from a complementary therapist. An inspector, spent time looking at what went on in the dementia unit. Although a carer played a board game with two residents in the afternoon, generally there were very little therapeutic activities or stimulation provided. The television was on all morning, but no one watched it, apart from two residents for a very brief period. One relative said there were never any activities when they visited, which was several times a week and they also wished residents could go out on small day trips, as residents from the rest of the home had done. The home no longer employs an activities co-ordinator. Consequently, there was no formal, planned activities timetable. The registered manager was aware that residents should be provided with a range of activities that meet their specialised needs, having bought games and equipment and was also researching suitable places in the community for residents on the dementia unit to visit. The registered manager was also aware that providing residents with the opportunity to carry out ordinary everyday activities could have therapeutic value e.g. providing dusters to do dusting, handbags to hold and explore, newspapers and magazines to hold and look at, or setting the table at mealtimes. There were many visitors to the Home during the course of the inspection. A relative spoken with said that they had been made to feel welcome when visiting the Home. A new menu has been introduced. Improvement was noted in health and safety practices in the kitchen that were identified in the last inspection report. Comments from a recent visit from an environmental health officer said that the home was using the Safer Food Better Business records correctly. Lunchtime was observed in the dementia unit. There is not a separate dining room on the unit. Staff brought a table out into the middle of the lounge. One resident got up to help. Staff noted this but the resident was not given the opportunity to help lay the table. Four residents sat at the table; the remaining residents ate sitting in their lounge chairs. Two specialised dining chairs, with glide rails and armrests, were available, however, staff used these, not the residents. Tablemats, tablecloths and napkins were not provided, Ainsworth Nursing Home DS0000017312.V297775.R01.S.doc Version 5.2 Page 15 although the registered manager later explained these were available. The meal was generally provided in a relaxed and unhurried manner. Where needed, residents were generally given one to one assistance. One resident received a pureed meal. However, this was pureed altogether rather than each food being kept separate, to maintain flavour, texture and appearance. All the residents’ meals were also served at the same time. Consequently, whilst staff members were busy helping some residents, the meal for another resident, who required help went cold. Also, to help maintain residents’ dignity, rather than standing over a resident at the table to cut up their food, this could be done beforehand at the hot trolley. Although ceramic plates and bowls were used, plastic glasses were given to all residents, regardless of ability and many were able to safely manage ceramic cups. The registered manager was aware that the unnecessary use of plastic can contribute to residents feeling patronised. Also, neither glasses nor cups were available in between meal and break times for residents’, one resident drank directly from the tap in their bedroom before the inspector found them a mug to use. Some residents may also benefit from being offered large handled cutlery and plate guards. Ainsworth Nursing Home DS0000017312.V297775.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered provider must ensure that all the staff team continue to receive good quality adult protection training to ensure that residents are protected from abuse. The registered providers’ must also attend this training so that all those connected with the Home know what procedures to follow if an incident occurs. EVIDENCE: There is a complaints procedure in place. There has been one internal complaint since the last inspection, which was partially substantiated, that was under investigation at the time of the last inspection. There has been one complaint since received by CSCI and investigated by the registered manager. Residents spoken with said that they would take any complaints they had to the registered manager and felt that she would listen and act on their concerns. Since the last inspection 50 of the staff team have undertaken the most recent adult protection training with the local authority training partnership. This is good practice. The outstanding staff members have places booked. This also includes the registered providers who will attend this month. There have been no allegations of abuse at the Home. Ainsworth Nursing Home DS0000017312.V297775.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The physical standards must continue to improve for service users’ comfort and safety. EVIDENCE: The general visual appearance of the building, though set in beautiful surroundings, is poor in parts. The entrance hall has recently been decorated. The main lounge area has had a fireplace added, new curtains and a new carpet fitted to make the room more homely. A CD player has also been purchased for the room. On the day of the inspection the handyman was putting new light fittings in. A new chair that is suitable to meet to specific needs of a resident has been purchased for her safety and comfort. Ainsworth Nursing Home DS0000017312.V297775.R01.S.doc Version 5.2 Page 18 Since the last inspection the handyman has left and the registered managers husband is doing the handyman’s tasks for three days a week. A rolling programme of work that the registered provider plans to undertake to improve the physical standards at the home must be provided for all three units. This must include the replacement of old and ill fitting windows. The environmental standards in the dementia unit were the main focus of this inspection. Four bedrooms were seen and good practice was noted, as two were very personalised and homely. Ways of supporting a third resident to personalise their room, with photographs, pictures and posters was discussed. This resident said they sometimes had problems getting into bed and asked for some equipment that may help. This was passed to the registered manager to follow up. This resident also had a commode in their room that was not needed. Its removal was discussed, however the home has long-term storage difficulties. The registered manager explained the storage situation would worsen further when continence equipment began to be delivered by the health trust on a weekly basis for individual residents. There were also no storage facilities in the small, enclosed garden, which would benefit from a shed for garden furniture and tools. The hot water supply to wash hand basins in three bedrooms was not working. The plumber was due to visit later in the day. The temperature was very warm, despite having windows open. Residents said “its very warm in here”. As soon as this was brought to the attention of the registered manager, the outside boiler was adjusted. The unit was clean and tidy, with one relative confirming this was usual, although they felt the lounge was “not pretty” and could do with redecorating. The standard of décor was adequate, with wallpaper used to help make the unit seem more homely and comfortable. The décor in the lounge was starting to look tired and worn, with wallpaper coming off in several places. As noted at previous inspections, the ramp carpet was marked in places and again required deep cleaning or replacing. Material covered armchairs would also benefit from deep cleaning. There was a malodour and staining to the floor in one bedroom. The chairs in the conservatory are also in poor condition. With regard to how the unit’s design and layout meets the specialised needs of people with confusion/dementia, there are limitations as it is not purpose built e.g. the lounge windows are not low enough to see out when residents are either sitting down or standing up; and there is no separate dining room. However, the unit is small, caring for a maximum of 10 residents, which helps promote a more domestic size living arrangement. The registered manager was aware of the need for signs and pictures on toilet, bathroom and bedroom doors, fixed at suitable heights, which will help residents find their way around. Moving the lounge clock and the use of a photo menu board was also discussed. Ainsworth Nursing Home DS0000017312.V297775.R01.S.doc Version 5.2 Page 19 There are a set of double doors immediately outside the lounge and the lounge door itself that are heavy fire doors and need to be kept shut. Unfortunately these are barriers that greatly limit residents’ ability to move in and out of the lounge area and possibly cause frustration and distress. The fire safety officer can advise how these doors can be safely kept open to allow residents to freely move about. The registered manager was aware that the small outside garden did not meet the specialised needs of people with dementia and should be developed to provide a therapeutic and stimulating space, and had very positive ideas such as providing raised garden beds. Facilities for residents to hang out washing could also be considered. The Home and the standard of hygiene and cleanliness within Ainsworth continue to improve. Training for staff members in control of infection has been completed and new products for cleaning have been introduced into the Home. Some improvements have been made to the outside laundry but the problems around security for staff members using the laundry and maintaining high infection control standards remain because of where it is situated. Ainsworth Nursing Home DS0000017312.V297775.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adequate numbers of staff must be available to ensure that the needs of residents can be met, at all times. There has been a significant improvement in the training opportunities for the staff team that will help them support and care for residents more effectively and safely. EVIDENCE: The lead inspector arrived at the home at approximately 6.30am. There were four members of staff on duty. A qualified nurse and three care staff. A rota sent as part of the pre-inspection documentation requested from the home shows that at times there have been only three members of staff on duty at night. This was confirmed with the registered manager. The reason given for the shortfall was that if no one from the permanent staff team was prepared to cover the shift then the registered provider had refused to pay for the agency worker. The justification for this appears to be because a recent independent consultation exercise carried out on behalf of the registered provider had said that the staffing bill was too high. The registered manager said that the staffing costs had been high of late to cover training. This was a temporary situation, as once mandatory training has finished then the costs would reduce again. It is unacceptable not provide adequate staff to meet the needs of the service users. Ainsworth Nursing Home DS0000017312.V297775.R01.S.doc Version 5.2 Page 21 In line with good practice a formal handover took place, conducted by the nurse on nights to the day care staff team coming on duty. There was also a cook on duty, two cleaners, a laundry assistant and a handyman. Training for night staff was being advertised on the notice board planned for the 06.03.07 for a fire safety lecture and end of life pathway training. Two members of staff were attending a course on the death and dying that day. There has been a significant amount of training been undertaken since the last inspection apart from that already mentioned throughout this report, health and safety, moving and handling, first aid refresher training, wound care, PEG feeds, MUST training, continence and safer food better business. The registered manager has now joined the local Bury Adult Care Training Partnership that is linked to Skills for Care. This is good practice and ensures the continuous professional development of the staff team. All job descriptions and contracts of employment have been reviewed to ensure that they give all staff members’ clarity about their role, responsibilities and accountability. Training in supervision, employee review, recruitment and selection, disciplinary procedures and the principles of good record keeping, communication and confidentiality have been provided and are ongoing. 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. One recruitment file of a recently employed staff member was examined. The standard of recruitment documentation has significantly improved. No issues were found in relation to recruitment procedures. The staff member had completed induction training and had already received training in death and dying, control of infection, basic health and safety, communication, record keeping and confidentiality, and POVA training. The staff member had also been given a copy of GSCC code of practice. Ainsworth Nursing Home DS0000017312.V297775.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this 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 which resulted in the refusal of insurance renewal until matters had been addressed. This is to the detriment of service users and the running of the home. The registered providers’ and the registered manager are, at this time, working together to ensure that this does not happen again and to improve service delivery at the Home. Improvements will be closely monitored by CSCI. EVIDENCE: The registered manager is a qualified nurse with many years experience of both working and managing residential homes for older people. The registered Ainsworth Nursing Home DS0000017312.V297775.R01.S.doc Version 5.2 Page 23 manager was said to be approachable and always had a ready smile. The registered manager has been under no illusion that there is more to do in terms of modernising the Home. Staff members said that the registered manager had had a positive impact on the nursing care at the Home and another said that the manager was very supportive and addressed any issues that they raised. The registered manager is concentrating on the strengthening the competence of the staff team to ensure that tasks can be delegated and shared appropriately across the staff team and not fall to a few members of the staff team. This is work in progress and has been hampered by the fact the registered manager is covering nurse shortfalls on shifts. There is no formally identified deputy either and no administrative support available to the registered manager. 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. Formal supervision and appraisal processes need to be developed and put in place. The registered manager, under the present circumstances, must work in a management capacity only until these issues are resolved. Following the last inspection and the report produced insurers refused to renew the insurance certificate for the Home. This could have resulted in the emergency closure of the Home. Two random inspection visits were made to the Home on 8th October 2006 and the 3rd November 2006. CSCI and insurance brokers to ensure that improvements are both made and importantly maintained are closely monitoring this service. 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. The registered manager felt that the relationship had improved of late. The inspector has 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. Disappointingly given that the registered providers have attended a formal meeting with CSCI in November 2006, only one has 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 continuing failure on the part of the registered providers to comply with the Regulations. Two financial accounts for residents were checked and the health and safety certificates for servicing and maintenance were also examined and found to be in good order. Ainsworth Nursing Home DS0000017312.V297775.R01.S.doc Version 5.2 Page 24 Ainsworth Nursing Home DS0000017312.V297775.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 X X 3 1 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 2 X X X 2 2 2 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 1 3 1 X 3 Ainsworth Nursing Home DS0000017312.V297775.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. Standard OP4 Regulation 12 18 Requirement To ensure the specialised needs of the residents who live on the dementia unit are met, the planned dementia and basic skills training must be provided to all staff who work with residents who live on the dementia unit. To benefit residents skills taught must be adopted as everyday practice. Residents and/or their representatives must be involved in the development and review of their care plans to ensure their views and wishes are taken into account The registered person shall make arrangements for the recording, handling, safe keeping, safe administration and disposal of medicines received into the home. Records are kept of all medicines received and administered to ensure there is no mishandling. To ensure the residents living on the dementia unit receive regular social and recreational activities that meet their specialised DS0000017312.V297775.R01.S.doc Timescale for action 30/06/07 2. OP7 12 30/06/07 3. OP9 13 31/03/07 4. 5. OP9 OP12 17 12 16 31/03/07 31/03/07 Ainsworth Nursing Home Version 5.2 Page 27 6 OP15 16 7. OP18 16 8 OP19 23 9. OP19 16 10. OP20 23 11. OP25 23 12. OP25 23 13. OP26 16 14. OP27 18 needs, a formal timetable must be developed. The lunchtime routines on the dementia unit should be reviewed to ensure that residents enjoy hot, attractive meals that take place as a pleasant, social occasion and address the other issues identified in the main body of the report. That all staff and the registered providers receive protection of vulnerable adults training. (Ongoing) That a rolling programme of work that the registered provider plans to undertake to improve the physical standards at the home must be provided for all three units. This must include the replacement of old and ill fitting windows. (Ongoing) The material covered armchairs and ramp carpet on the dementia unit must be deep cleaned or replaced To ensure residents on the dementia unit continue to live in pleasant and comfortable surroundings, the lounge on the dementia unit must be redecorated. The lack of hot water to wash hand basins in three bedrooms on the dementia unit must be addressed To ensure the comfort of the residents, staff and visitors, the temperature of unit must be monitored and action taken as and when necessary The malodour and staining to the floor in one bedroom on the dementia unit must be addressed Adequate and suitably qualified numbers of staff must be DS0000017312.V297775.R01.S.doc 31/03/07 31/03/07 31/03/07 31/03/07 31/03/07 31/03/07 31/03/07 31/03/07 31/03/07 Page 28 Ainsworth Nursing Home Version 5.2 15. OP31 8 16. OP33 26 17 OP34 25 18 OP36 18 available to ensure that the needs of residents can be met, at all times. That the registered manager works only in the capacity of full time manager until a formally identified deputy manager and appropriate administrative support is available to her to ensure that the responsibilities for the day-to-day management of the home can be fulfilled. (Outstanding in part) The registered provider or their representative must visit the Home unannounced on a monthly basis in accordance with this Regulation and a report produced and sent to CSCI. (Outstanding) The registered provider must meet the requirements in this report and comply with the insurers requirements to ensure that the home retains insurance cover that is required to remain registered. That formal supervision sessions and appraisals are introduced across the staff team. 31/03/07 31/03/07 31/03/07 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP4 OP7 Good Practice Recommendations That the three specialist units are name to give them clear identities. To ensure that residents who live on the dementia unit are treated with respect and dignity, and that their strengths and abilities are recognised, the language used by staff both spoken and written should be reviewed. DS0000017312.V297775.R01.S.doc Version 5.2 Page 29 Ainsworth Nursing Home 3. OP19 To ensure residents’ dignity is maintained and that their rooms do not contain unnecessary items, the storage arrangements within the home should be reviewed. Ainsworth Nursing Home DS0000017312.V297775.R01.S.doc Version 5.2 Page 30 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: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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