Inspection on 27/11/07 for Ainsworth Nursing Home

This inspection was carried out on 27th November 2007.

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

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

Other inspections for this house

Ainsworth Nursing Home 22/04/09

Ainsworth Nursing Home 16/10/08

Ainsworth Nursing Home 30/04/08

Ainsworth Nursing Home 08/06/07

Ainsworth Nursing Home 02/02/07

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 Bolton Lancashire BL2 5PT Lead Inspector Rukhsana Yates Unannounced Inspection 27th November 2007 09:30 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.V337681.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.V337681.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ainsworth Nursing Home Address Knowsley Road Ainsworth Bolton Lancashire BL2 5PT 0161 797 4175 0161 797 2168 d.subbiah@btconnect.com 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) Ainsworth Nursing Home Ltd 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.V337681.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). 2nd February 2007 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 £355 to £494 per week dependent on the level of need. Ainsworth Nursing Home DS0000017312.V337681.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out a site visit as part of the key inspection of this service. The visit took place between 9.30am and 5.30pm on 27th November, and we did not tell anyone at the home that we would be visiting. During the course of the day, we talked with people living there about their daily life in the home, watched the ways in which staff supported them, talked with the manager and staff, and looked at paperwork relating to personal care, health care and safety. This key inspection also included a visit to the service by the pharmacist inspector on 4th December so that we could see if people were being properly and safely supported to take their medication. The service was inspected against key standards for homes for older people to see how well it was meeting a range of needs. These standards cover moving in, the care provided, daily routines and lifestyle, complaints, safety, comfort and cleanliness, how staff are employed and trained, and how the service is managed and developed. What the service does well: What has improved since the last inspection? Ainsworth Nursing Home DS0000017312.V337681.R01.S.doc Version 5.2 Page 6 The manager has made a lot of progress in meeting requirements made at the last inspection. For example, training arrangements for staff are better so that they are developing the right skills for their roles. This includes training in how to safeguard people from abuse. People with mental health needs are receiving better care because staff members have received training in understanding how to meet those needs. Senior staff are in the process of developing better care plans that involve people in the home and those close to them, to make sure they know what people like and expect from their life at the home. Medicines were now securely stored, this helps ensure they are not mishandled or misused. Regular checks (audits) on the medicines were carried out, this helps ensure medicines are administered to residents correctly. Medicines were usually administered to residents as prescribed, this helps maintain their good heath and well being What they could do better: People living at the home, 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. To ensure the health of people living at the home is maintained, their weight must be recorded and monitored each month, and more frequently if required. A clear complaints procedure must be produced and given to people at the home and their representatives so they have confidence that their complaints will be listened to and acted on. A shower and toilet facility must be installed in the dementia care unit, that is accessible to and appropriate for people requiring staff support and wheelchair access. Ainsworth Nursing Home DS0000017312.V337681.R01.S.doc Version 5.2 Page 7 Accurate records of medicines received into the home and administered to residents must be made as poor record keeping can lead to serious mistakes when giving medicines. Nursing staff must receive suitable training and supervision to ensure they are competent when handling medicines. Bedside lamps and call bells must be made accessible to people for their use when required. Additional staff must be on duty at busy times of the day to ensure peoples’ needs are met in all areas of the home. Safe recruitment procedures must be implemented to ensure that people are cared for by suitable staff. A quality assurance system must be in place that shows people living at the home and others how their views are used to improve the service. Arrangements must be put in place to ensure people can see how much money they have in their individual bank account, and have reasonable access to their monies. 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.V337681.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.V337681.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: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each person, or their representative has their needs assessed and may visit the home before admission to ensure that the service is suitable for them. EVIDENCE: The pre-admission assessment records for four people were looked at. The assessments showed the help and support people would need in all aspects of their daily life. The assessments were detailed and gave a clear indication of the people’s needs and their capabilities. These records help the manager and staff to consider each person’s support needs before a decision is made about moving in. Where possible, people considering moving to the home are offered the opportunity to visit the home and discuss the service provided. One relative, who visited the home on her husband’s behalf, said “I went round several places. The main reason for choosing it is that it is local and it is not Ainsworth Nursing Home DS0000017312.V337681.R01.S.doc Version 5.2 Page 10 institutionalised looking. The staff are very good with him. I was given a service user guide, and have been in for a review since he moved in.” Standard 6 is not applicable to this service. Ainsworth Nursing Home DS0000017312.V337681.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 & 10: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People receive the basic personal and healthcare they need. Arrangements have improved for ensuring that people are given their medicines correctly. EVIDENCE: People admitted for dementia care had care plans in place. These described their basic care and support needs. We spoke to five visitors about the care and they said “the nursing care is good and they are well looked after”. They all said that some of the staff provide better care and attention than others, so people were receiving an inconsistent quality of service. There are plans to improve the care records with the involvement of relatives of people with dementia. The nurse in charge had recently attended training in developing person centred care plans, and was keen to implement them so that staff would have a better understanding of peoples’ needs and how to meet them. Following admission on the nursing unit, care plans were developed for each person, based on the pre-admission assessment, observations made following their admission and the advice of any health and social care professionals who may support them. Ainsworth Nursing Home DS0000017312.V337681.R01.S.doc Version 5.2 Page 12 The care plans seen contained enough information to show what the person could do, what they needed help with, and how they were to be cared for. There was no evidence to show, however, that either the person or their relative had been involved in drawing up and reviewing the care plan so that their expectations could be clear. The staff looked at whether or not there was any risk in relation to people developing pressure sores and also if they were at risk due to problems with their diet and fluid intake. This enabled then to take action to reduce risks in these areas. Staff members looked at, and wrote down, how each person was to be assisted with being moved around, by how many members of staff, and what equipment, if any, was to be used to assist in safe moving and handling. The staff also assessed whether it was safe for a resident to have rails on the bed, and used these risk assessments to make sure rails were only used if needed. Some risk assessments were not completed fully or not reviewed as often as they should be, and did not therefore give a true picture of peoples’ conditions and any risks involved. Examples of these included assessments about each person’s eating and drinking pattern and their weight. Following training about nutrition, the manager had introduced new forms to document the risks and also record weights. Some staff had received training and others had not. This meant that some staff did not have a good understanding of the ways to record and monitor peoples’ nutritional needs. Not every resident had one of the new forms. Those that did not had the “old” type of form and a chart that recorded their weight. The one we looked at was not reviewed regularly and the person had not been weighed on a regular basis to ensure their health was being fully monitored. We visited three people who were being cared for in bed. They looked clean, warm and well cared for. Equipment necessary for the prevention and treatment of pressure sores was available and in use. People were registered with local GPs and it was evident in the care records that they had access to opticians, chiropodists, and other specialist services that they required for their health. Examples of these were dieticians, community psychiatric nurses and psychiatrists. As part of this inspection the pharmacist inspector visited on 4th December 2007 to ensure improvements in medicines handling had been made since the last key inspection. Medicines polices had been updated and these now provided clearer guidance to nursing staff on how to safely manage medicines. People wanting to look after their medicines were supported to do so. Risk assessments were carried out for the two people currently self-medicating Ainsworth Nursing Home DS0000017312.V337681.R01.S.doc Version 5.2 Page 13 although we found these needed more detail to ensure the right amount of support is given. Supporting people to look after their medicines is important because it helps them keep some of their independence. Some improvements in the systems of stock control and record keeping had been developed that made checking medicines much simpler. This is important because it helps show if medicines have been administered correctly. The manager carried out regular audits and we gave advice on how to improve these further. However we saw some poor record keeping because nursing staff had failed to follow the homes’ own procedures. The manager had found most of this poor practice through her own audits and said appropriate action would be taken against any staff that continually made poor records. We checked medicines records against current stock and found that they were usually administered as prescribed. Some mistakes were still being made but these were due to poor record keeping rather than medicines being incorrectly administered. One person recently admitted did not have clear records of medicines received so detailed checks could not be carried out. This handwritten record also lacked important details such as ‘take with or after food’, this increases the chances of mistakes when administering them. Although the majority of medicines had been given at the correct time we found that some medicines were given after food instead of before and that some medicines should have been given earlier in the day, for example medicines to treat Parkinson’s disease and painkillers. The manager said that these were being reviewed with help from the new supplying pharmacy. Medicines prescribed as ‘when required’ or, as a variable dose, did not have written care plans to support their use. One sleeping tablet had been given every night for the last month even though the instructions on the dispensing label and medicines record said ‘not to be given every night’. If a plan had been developed then this would have been given less frequently. Several other medicines used to treat agitation and anxiety were prescribed as ‘when required’ and no written plans were available. Having clear written care plans helps ensure these medicines are only administered when residents need them. Staff members we spoke with had a good understanding of the principles of privacy and dignity, and the need to promote them for the people they care for. For people on the dementia care unit, the small size of the toilets resulted in people having to use commodes in their rooms instead. Although this maintained privacy for people in that the door to the room could then be closed, dignity was being compromised, and more suitable facilities need to be provided to address this issue. Ainsworth Nursing Home DS0000017312.V337681.R01.S.doc Version 5.2 Page 14 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 & 15: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People feel they are supported in their choice of daily routines, activities and meals. EVIDENCE: We looked at activity provision for people with dementia care needs. One person living at the home said “There’s a lot goes on. One of the staff is taking me to the book sale. I read magazines and books. We can play dominoes and bingo. I painted those two pictures on the wall. I like getting up early, getting washed and dressed and then they bring me a cup of tea.” Weekly activity records are completed on the unit. They show that regular indoor activities include games, bingo, arts and crafts, reminiscence, reading newspapers and watching films. Some people had recently been to Blackpool, and a visit to see a pantomime was being planned. Individual choice with regard to times for getting up and going to bed were respected. This was confirmed by people living there, and their relatives. Visitors said they are made to feel welcome and may speak to their relative in private if they wish to do so. Ainsworth Nursing Home DS0000017312.V337681.R01.S.doc Version 5.2 Page 15 People we spoke with were satisfied with the meals. There was a choice of main course and dessert at the main meal at lunchtime, with a lighter meal in the evening. The tables were nicely set with tablecloths, napkins and salt and pepper. The food in the main lounge area was served from a heated trolley. It looked appetising and the portions were good. Two of the residents said they felt that the food was “ok”, that they enjoyed their breakfasts, and they could have extra servings at mealtimes if they wanted to. Hot and cold drinks were being served throughout the day. A member of staff told us that some food and drinks are available out of hours and that milky drinks are always available. There was evidence that the manager takes account of the cultural and religious needs of people living at the home. For example, the manager and a senior member of the nursing staff were in the process of accessing advocacy and interpreter services in order to promote an individual’s right to choice and decision making. Ainsworth Nursing Home DS0000017312.V337681.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 & 18: Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People do not have information about how to complain and how complaints will be handled. Training for staff helps to ensure the protection of residents. EVIDENCE: The complaints procedure did not give clear information about how the registered persons would handle any complaints made to them. There were no timescales to show when a complainant could expect a response. The manager did keep a log of any complaints made. Since the last inspection of 8/6/07 there had been one complaint. The investigation into this complaint has not yet been completed. Two visitors told us that when they had complained to the manager about their concerns, the manager dealt with them well and resolved the issue. However, a clear, publicised, accessible procedure is needed so that people are confident that they can raise concerns with any member of staff, and know that they will be taken seriously. All of the visitors we spoke to said that some staff listened to them and communicated with them much better than others. Their confidence in having concerns resolved depended on which members of staff were on duty. All staff need to be aware of the complaints procedure, and the importance of listening to people living at the home and their representatives. Ainsworth Nursing Home DS0000017312.V337681.R01.S.doc Version 5.2 Page 17 Training has been provided to the registered persons, and the care staff, so that they know how to recognise signs of abuse, and the procedures to be followed. Ainsworth Nursing Home DS0000017312.V337681.R01.S.doc Version 5.2 Page 18 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): 19 & 26: Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The environment does not effectively meet peoples’ needs. EVIDENCE: People were satisfied with some aspects of the living environment. For example, bedrooms were warm, the lounge area for people with dementia was well decorated and furnished. Ornaments and a fish tank contributed to a homely and relaxing environment. There have been improvements made as a result of requirements made at the last inspection. We saw areas that needed attention to make the environment pleasant and suitable for people living there. For example, bedside lights were not easily accessible, some of the décor was poor, including peeling and damaged paintwork, a first floor bathroom window was dirty and leaking, some baths and toilets did not have adaptations. In the dementia care unit, there was no shower, and the toilets did not allow for individuals to be assisted by staff unless the door to the toilet was kept open. Ainsworth Nursing Home DS0000017312.V337681.R01.S.doc Version 5.2 Page 19 Visitors told us that there have been unpleasant odours in some parts of the home on Sundays. There are no domestic staff to carry out cleaning on Sundays. One person said that the cleaning and odour control could be improved but “the cleaners and laundry lady work hard. The laundry is done properly and nice”. Hand-washing facilities and were available for staff, and we saw staff use aprons and gloves appropriately to prevent cross infection. The registered person had not taken the initiative to carry out an environmental audit of the home or produced a plan for improving the living environment. Actions taken previously have been in response to areas we have highlighted during a site visit. It is recommended that the registered person produces an environmental improvement plan, with priorities and timescales for action, and implements it to ensure people live in a well maintained environment that meets their needs. Ainsworth Nursing Home DS0000017312.V337681.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): 27, 28, 29, 30: Quality in this outcome area is poor.This judgement has been made using available evidence including a visit to this service. The way staff are employed does not ensure they are suitable for the job. Staffing arrangements do not ensure that individual needs are met. EVIDENCE: The staffing complement for general nursing and personal care was sufficient during the day. Between the hours of 5-9pm there is one qualified nurse and 3 carers on duty throughout the home. The evening meal is served at 4.30pm but the cook goes home at either 2.30pm or 3.30pm. This means that the care assistants have to attend to the food, serve and clear away. This takes them away from caring duties and leaves inadequate staffing levels for delivering care. There are two staff on duty providing care for nine people with dementia. Some people require two staff to assist them with personal care, resulting in others being left unattended at times. There is a need to ensure additional staff are on duty at busy times of the day to ensure peoples’ needs are met in all areas of the home. We looked at the file of a member of care staff recently recruited to work at the home. The records showed that the person started working without adequate background checks. There was no employment history provided, one reference was unreliable and another provided insufficient information on which to base a decision to employ. There was no evidence of induction or Ainsworth Nursing Home DS0000017312.V337681.R01.S.doc Version 5.2 Page 21 training, but a note in the file showed that the staff member had worked unsupervised. A safe recruitment procedure had not been followed, placing people at risk of receiving care from someone who is unsuitable or incompetent. Safe recruitment procedures must be implemented to address this. All staff need regular supervision meetings to ensure that they work and develop in a way that meets the needs of people living at the home. As stated, visitors’ comments show that staff attitudes are inconsistent. One said “some pay attention to detail, others can’t be bothered and want to get things over with. A couple are really good and can tell you what is going on (with your relative). Others don’t know or they only tell you things if you ask”. The manager has made good progress in ensuring staff receive the mandatory and refresher training they need to carry out their roles safely. Ainsworth Nursing Home DS0000017312.V337681.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): 31, 33, 35 & 38: Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People living at the home do not have their best interests protected and promoted. EVIDENCE: Since the last inspection, the manager has demonstrated that improvements have been made and most of the requirements met. Visitors told us that she is competent and approachable. The manager has joined the local authority training partnership and has made good progress in accessing training for staff. She showed us that she is willing to continue to put systems in place to improve standards and outcomes for people at the home. There remain areas that need to be addressed however. The registered provider needs to identify and implement improvements based on internal audits and initiate action based on internal monitoring. This would show that Ainsworth Nursing Home DS0000017312.V337681.R01.S.doc Version 5.2 Page 23 getting things right for people living at the home is important to the people running the service. At present there is no review of the quality of care provided at the home. We were told that surveys were sent out 12 months ago but nothing has been done since. There was no evidence to show what the results of the surveys were. Seeking the views of people who use the service can help management take steps to put into practice what has been said about what could be improved. The systems in place for the management of residents’ money were not acceptable. The manager takes responsibility for ensuring that any money received or spent is recorded in a book. Residents have an individual record in the book and their money is stored safely. Inspection of the records showed that whilst residents received the money that was theirs, the actual system for logging the money paid in and out was confusing and not always an accurate record. The manager agreed to change the system. Receipts were kept for any purchases made. Whenever a relative either gave or took money on behalf of a resident they did not always sign that they had done so. The manager agreed to rectify this immediately. The registered provider told us that some of the residents had their savings in a non-interest paying residents account. The money is pooled and the bank statements looked at do not show how much money each resident has and who the residents are. This is not acceptable. Residents need to have accounts belonging to them that they or their representatives can access, and to be able to see how much money they have at any one time. Policies and procedures must be applied to practices at the home, such as recruitment, selection and supervision of staff so that people living at the home are safe and well cared for by staff who are competent and consistent. Ainsworth Nursing Home DS0000017312.V337681.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 3 1 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 2 X X 2 Ainsworth Nursing Home DS0000017312.V337681.R01.S.doc Version 5.2 Page 25 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 OP7 Regulation 12 Requirement People living at the home, 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. (Previous timescale of 30/09/07 not met) To ensure the health of people living at the home is maintained, their weight must be recorded and monitored each month, and more frequently if required. All staff that handle medicines must receive suitable training and supervision to ensure they are competent at handling medicines. All medication records must be accurate and up to date so that it can be evidenced that residents are getting their medicines as prescribed. (Previous timescale of 08/06/07 not met). A clear complaints procedure must be produced and given to DS0000017312.V337681.R01.S.doc Timescale for action 31/03/08 2. OP8 13(4) 30/01/08 3. OP9 18(1)(a) 31/03/08 4. OP9 13(2) 31/01/08 5. OP16 22 31/03/08 Ainsworth Nursing Home Version 5.2 Page 26 6. OP19 23(2) 7. OP19 23(2) 8. OP27 18(1) people at the home and their representatives so they have confidence that their complaints will be listened to and acted on. A shower and toilet facility must 31/03/08 be installed in the dementia care unit, that is accessible to and appropriate for people requiring staff support and wheelchair access. Bedside lamps and call bells 31/03/08 must be made accessible to people for their use when required. Additional staff must be on duty 31/01/08 at busy times of the day to ensure peoples’ needs are met in all areas of the home. Safe recruitment procedures must be implemented to ensure that people are cared for by suitable staff. A quality assurance system must be in place that shows people living at the home and others how their views are used to improve the service. Arrangements must be put in place to ensure people can see how much money they have in their individual bank account, and have reasonable access to their monies. 31/01/08 9. OP29 18(1) 10. OP33 24(1) 31/03/08 11. OP35 16(2) 31/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000017312.V337681.R01.S.doc Version 5.2 Page 27 Ainsworth Nursing Home 1. Standard OP9 Medicines prescribed as “when required” or, as a “variable dose” should have clear written instructions for staff to follow to ensure they are given correctly. A review of the timings of all medicines should be carried out to ensure they are administered at the most suitable time for each individual resident. An environmental improvement plan should be produced and implemented, with priorities and timescales for action, to ensure people live in a well maintained, clean environment that meets their needs. Individual supervision meetings with staff should take place to ensure all staff understand good care practice and communication, and apply them consistently as part of their role 2. 3. OP9 OP19 4. OP36 Ainsworth Nursing Home DS0000017312.V337681.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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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