Inspection on 30/04/08 for Ainsworth Nursing Home

This inspection was carried out on 30th April 2008.

CSCI found this care home to be providing an Poor service.

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 27/11/07

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 Lucy Burgess Unannounced Inspection 30th April 2008 09:00 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.V362761.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.V362761.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.V362761.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). 27th November 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 £369 to £508 per week dependent on the level of need and funding arrangements. Ainsworth Nursing Home DS0000017312.V362761.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was a key inspection carried out by 2 inspectors, which included a site visit and took place over one day, for a period of 10¼ hours. The service did not know that the inspectors were going to visit. During the inspection care and medication records were looked at as well as information about the staff and health and safety including how the home and the equipment were kept safe. The inspectors also looked around the building to check if it was clean and well decorated. As part of the inspection process the provider’s are asked to complete a selfassessment survey information document (Annual Quality Assurance Assessment). This was sent to the home before the inspection and had been completed by the registered manager and returned to us prior to the site visit. Other information was gathered from the feedback surveys we sent out. We received completed surveys from 1 person living at the home and 1 relative. We also spent time speaking with residents and members of staff as well as observing practice. Comments made have been added to the report. At present placements are not being made at the home due to issues which have arisen. Concerns are also being looked at in line with the local authority safeguarding procedures. Due to the on-going concerns about the service we have held six management reviews to look at what action needs to be taken. A meeting is to be arranged with the Providers to discuss the issues identified within the report and their plans to improve the service. An improvement plan has also been requested. Discussion and feedback was held with the registered manager during the visit. We also spoke to the Provider the day after the visit by telephone to advise them of the outcome of the visit. Ainsworth Nursing Home DS0000017312.V362761.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: A good working relationship needs to be established between the owners and manager so that staff are appropriately managed and supported in carrying out their roles and responsibilities and effectively meet the needs of those people living at the home. Staff need to be clear of their responsibilities in reporting and recording all issues and concerns brought to their attention so that people living at the home are not placed at further risk. Ainsworth Nursing Home DS0000017312.V362761.R01.S.doc Version 5.2 Page 7 More attention must be given to ensuring that the care plans give enough information about the residents’ condition and then show how they are to be cared for. A plan of redecoration and refurbishment needs to be developed so that improvements needed to enhance the appearance are addressed and people are provided with a comfortable and pleasant environment in which to live. Standards of hygiene need to be improved to ensure that good infection control procedures are followed so that people are not placed at risk. The provider must ensure that all staff, including nursing staff are clear about their responsibilities in responding and reporting any allegations or concerns brought to their attention so that people are protected from harm. Improvements need to be made to the kitchen environment, cleanliness of appliances, records and food storage. The menus need to be reviewed with those people living at the home to include meals of their choosing as well as providing good nutrition. More opportunities should be provided so that people are provided with a choice of meaningful activities, which offer stimulation and social interactions. More care and attention is needed in maintaining the dignity of people living at the home. A programme of training needs to be developed including NVQ’s so that staff have the knowledge and skill needed to meet the needs of those people who live at the home. Staffing rotas need to clearly identify the hours worked so that it can be identified that sufficient staff are on duty at all times. Nursing staff must receive suitable training and supervision to ensure they are competent when handling medicines. Formal supervision sessions and appraisals must be undertaken with members of the staff team to ensure good practice and continuous professional development. Information gathered as part of the quality monitoring should be used to inform the homes annual development plan. A copy of this should be sent to us. Bedside lamps and call bells must be made accessible to people for their use when required. Ainsworth Nursing Home DS0000017312.V362761.R01.S.doc Version 5.2 Page 8 A fire drill should be carried out so that all staff are aware of the procedure to follow ensuring people are not placed at risk. Arrangements should be made to ensure that the water temperature in the identified shower could be maintained at a safe temperature so that people are not place at risk of scalding. Due to the recent issues and the further changes in management it is strongly advised that monitoring visits are carried out by the provider and copies of the monthly reports are forwarded to CSCI to show that the home is being monitored and where necessary improvements made to the service. 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.V362761.R01.S.doc Version 5.2 Page 9 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.V362761.R01.S.doc Version 5.2 Page 10 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 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information showed that people had been appropriately assessed prior to them being admitted to the home ensuring their needs could be met. EVIDENCE: Since our last inspection in November 2007, 1 person has been admitted to the home from hospital. Information seen included an assessment carried out by the hospital social worker, nursing assessment and discharge information from the hospital. The manager of the home had also completed a further assessment to establish if the person’s needs could be met by the home. This needs to be signed and dated on completion. Information is then held in the persons care file and used to inform the development of the care plan and risk assessments. Ainsworth Nursing Home DS0000017312.V362761.R01.S.doc Version 5.2 Page 11 However at present both Bury and Bolton Local Authority have suspended making any further placements at the home due to safeguarding issues, which have been raised in relation to the care of people living at the home. The strategy group, involving people from the local authorities, the PCT, the police and CSCI, have carried out an investigation. Whilst this has been concluded the service remains under review by the strategy group in order to monitor the improvements required. Standard 6 is not applicable to this service as they do not provide intermediate care services. Ainsworth Nursing Home DS0000017312.V362761.R01.S.doc Version 5.2 Page 12 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 poor. This judgement has been made using available evidence including a visit to this service. The care plans are not always as up to date as they should be and do not always contain enough information about the residents’ condition or needs. This puts the residents’ health and well being at risk. EVIDENCE: Individual care plans were in place for each resident. The care plans of three of the residents were looked at. We found it difficult to find important information in the care plans because there was so much information in them that was no longer needed and could have therefore been filed away. One of the care plans did not contain enough information about how the resident was to be cared for. Despite this resident having problems with eating and at one point losing weight, the care plan about eating and drinking had last been reviewed in June 2007. Also staff at times had written down that they had reviewed a care plan for sleeping but there was actually no care plan to review. Ainsworth Nursing Home DS0000017312.V362761.R01.S.doc Version 5.2 Page 13 It was written in the residents’ notes that due to a mental health problem the resident had, the staff were to closely monitor/observe the resident on an hourly basis. There was no evidence to show that this had been done and when we asked the manager if the problem was still presenting itself we were told that it was and that staff should have been recording their observations. In view of the fact that we had received a complaint about the care of a resident who was no longer at the home we looked at this residents’ care plan. It was shown that this resident was at risk of developing pressure sores from January 2008 however there was no care plan in place for the prevention of pressure sores. A body map showed that the resident did have a small wound on her body and redness elsewhere but there was no date on the body map to show when this had been identified. This resident was being weighed on a regular basis however the weight being recorded was not accurate. One weight recording for the month of January 2008 was different from the weight recorded elsewhere for the same month. It left us uncertain as to whether the resident had lost 11kg or 3kg in one month. We found the care plan of another resident very difficult to read. Trying to find the important information about how she was to be cared for took us some time. This resident had a lot of intensive nursing needs and had to be fed artificially. There was a good plan of care showing how this was to be done. This resident also had pressure sores and there was a good plan of care for prevention, however the documents did not clearly show the condition of each of the sores. So that staff are aware at all times of the condition, progress or deterioration of the pressure sores an accurate record must be in place. The care plan and risk assessments were also looked at for the newest person admitted to the home. As already identified a clear assessment had been completed identifying the level of support required by this person and the potential areas of risk. However the plan lacked detail. The person was at risk of falling however this had not been included within the moving and handling assessment, nor was the information about a referral to the wheelchair assessment service and that the person had prior to coming in to the home been admitted to hospital following a fall. Weight records also showed that the person had been losing weight. Whilst action had been taken to contact the dietician and dentist, additional weight recording were not being made in line within advice provided. Looking through the care files we could see that the residents did have access to other health care professionals. We saw evidence of residents having attended hospital and dentist appointments. GP and chiropody visits were also recorded. Ainsworth Nursing Home DS0000017312.V362761.R01.S.doc Version 5.2 Page 14 We looked at how the medicines are managed on the dementia unit. A safe system of medicine management was in place. Medicines were stored securely and recorded accurately. We did see however that the drugs fridge was not locked and we were told that it doesnt lock and that they were looking at buying a new fridge. A requirement was made during the last inspection that nursing staff should receive suitable training and supervision to ensure they are competent when handling medicines. The manager informed us that an advanced medication training course had been arranged for 21 May 2008 and that all trained staff would be attending. In relation to people’s privacy and dignity more care and attention was needed in supporting people with their personal appearance. Several people seen appeared unkempt with ill-fitting soiled clothing. Another person with very limited mobility was spending time in their own room and had been positioned in such a way that they were unable to access the call bell to call for assistance should they need too. More care and attention is needed in maintaining the dignity of people living at the home. Ainsworth Nursing Home DS0000017312.V362761.R01.S.doc Version 5.2 Page 15 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. More opportunities should be available so that people are provided with a choice of meaningful activities, which offer stimulation and social interactions. Arrangements in relation to food storage, menu choices and the cultural and dietary needs of people could be improved so that meals are appealing and offer good nutrition. EVIDENCE: Whilst staff try to engage some of the people in activities within the home opportunities are minimal. The home does not have an activity worker and due to the layout of the building and staffing numbers there is little time afforded to developing this area. This was observed during the visit. The manager does provide a newsletter for people living at the home, which includes information about work taking place within the home, forthcoming birthdays and events and outings, as well acknowledging fundraising for the residents fund and welcoming any new people, residents and staff, to the home. Ainsworth Nursing Home DS0000017312.V362761.R01.S.doc Version 5.2 Page 16 Four people however had recently enjoyed a weekend away in Blackpool. The manager and 3 carers provided support. Plans were also being made for some people to visit Radcliffe Civic Hall to see the ‘Old Time Music Hall’ and then a full day trip on the New Horizon Canal Boat, including lunch. The home has access to a minibus, which is shared with another care home and helps to minimise some of the costs. During our observations throughout the day, some people were seen to spend time in the privacy of the own rooms, whilst others sat in the lounge areas. People had access to televisions, stereos and newspapers. One of the nurses spoken with had purchased a reminiscence book, which was shared with the people on the dementia unit. Visitors are also welcome. It was identified on the recent surveys collected by the home that improvements had been made when welcoming visitors to the home. Arrangements were also looked at with regards to meals provided and the food stores. There are several areas near to the kitchen where frozen, tinned and dried foods are stored. In one area where the fresh bread is stored the walls were damp and mouldy. The manager stated that this had been a previous issue, which had been addressed however not resolved. More suitable arrangements should be made so that food items are stored in a clean dry area. We also found a child’s birthday cake, which had been bought in preparation for someone’s birthday. When asked whom this was for the manager explained that this had been purchased because it had been reduced in price. This does not demonstrate any consideration about the appropriateness of such things for those people living at the home. On inspection of the fridge and freezers, items, which had been opened, where not always dated, nor had other items that had been separated then frozen. In relation to the cultural needs of one person spoken with, these too were not taken into consideration. The person expressed that they were Hindu and enjoyed meals such as curry and fish however these too were not provided. We were also advised the porridge made for breakfast was prepared using water and not milk. However since our visit we have been advised by the provider that this is not the case and that the cooks only use milk. The provider must ensure that all food prepared for people living at the home offers good nutritional value, particularly those where risk have been identified. Through discussion with the manager it was explained that attempts had been made to review and update the menus however she acknowledged that the catering staff needed to do more to ensure that people living at the home received a varied nutritious diet of their choosing. Ainsworth Nursing Home DS0000017312.V362761.R01.S.doc Version 5.2 Page 17 The kitchen was looked at. This too required attention. The kitchen units were old and warn and some cupboards would not close fully. A number of areas also required cleaning, this included the oven, both hot serving trolleys and the deep fat fryer. The crockery was also in a poor condition. We also found the drinks trolleys used by staff to serve hot and cold drinks throughout the day to be in a poor condition and also needed cleaning. The manager expressed that this was being addressed and two new trolleys had been ordered. Records were being completed by the catering staff in relation to ‘safer food, better business’. However on examination of the records information was poor. Temperature readings had been taken and recorded on the Monday and then a comment stating ‘as above’ recorded Tuesday through to the weekend. The lack of attention made to records did not evidence that information was accurate and ensure that good practice was being followed. These should be improved ensuring people are not placed at risk. As part of the homes quality monitoring feedback surveys were sent out to people living at the home and their relatives. Some people felt that improvements could be made in relation to the quality of food provided. We also received a feedback survey from 1 person living at the home. They state that they like living at the home however ticked only ‘sometimes’ to receiving the care and support needed and the choice of meals provided. Ainsworth Nursing Home DS0000017312.V362761.R01.S.doc Version 5.2 Page 18 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 poor. This judgement has been made using available evidence including a visit to this service. Serious concerns have been identified in relation to the safety and protection of people living at the home. Staff training is needed so that they are clear about their responsibilities in reporting issues, which are brought to their attention. EVIDENCE: As already identified serious concerns have been raised in relation to the care provided at the home, which is alleged to have affected the well-being of some people living at the home. The home is currently being investigated in line with the local authority safeguarding procedure and under management review by CSCI. Since our last visit in November 2007, a serious complaint has been received from several relatives of one person who lived at the home about the lack of professional care, an allegation has been regarding the practice of some staff and further issues in relation to risk management and protection of another person living at the home. Due to these concerns, Bury and Bolton Adult Care Services as well as the PCT have carried out placement reviews. Ainsworth Nursing Home DS0000017312.V362761.R01.S.doc Version 5.2 Page 19 Due to the seriousness of the allegations and concerns strategy meetings are taking place to review the issues and decide on the appropriate course of action. The strategy group also expressed concerns in relation to the delay by trained staff in responding when the allegations were brought to their attention. This information had not been recorded nor acted upon and potentially left people at further risk of harm. The manager has been advised by the group to consult with the Nursing and Midwifery Council regarding action to be taken due to trained staff failing to follow the code of practice. We were informed by the manager that a team meeting has been held with all care staff to discuss the interagency safeguarding procedure and what staff should do if they observe or are informed of any concerns. Arrangements have also been made for someone from the Royal College of Nursing to visit the home to speak with all the trained staff about their responsibilities in line with their code of practice. Ainsworth Nursing Home DS0000017312.V362761.R01.S.doc Version 5.2 Page 20 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 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The décor, furnishing and cleanliness of the home requires considerable improvement so that people live in comfort in an environment, which is clean and well maintained. EVIDENCE: Following our last visit a recommendation was made that a programme of work be provided to CSCI to show what improvements were to be made with regards to the physical appearance of the home. This was not provided. During this visit time was spent again looking at individual bedrooms, communal areas, kitchen, sluices, toilet/bathing facilities and external areas. We found: • Furnishing in poor condition, missing handles, drawers not closing • Work and soiled carpets • Strong odour in 3 rooms Ainsworth Nursing Home DS0000017312.V362761.R01.S.doc Version 5.2 Page 21 • • • • • • • • • General décor in poor condition Call bells not always accessible to where people sat or slept Unclean cooker, hot trolleys and fryer Drinks trolleys were dirty and worn bedside lights and call bell leads were not easily accessible mixed old crockery sluice areas not locked and hazardous substances left out unsuitable door locks to allow easy access in the event of an emergency protective clothing needs to be available in all areas where people are assisted in meeting their personal care needs Previous action in relation to the provision of a shower room on the dementia unit had been addressed however was not complete. Work was still needed in relation to pipe work needing to be boxed, the call bell lead was tied up and not accessible, there was no liquid soap and the door lock was not fitted with a suitable over-ride facility. Protective clothing was in place as well as a suitable shower with chair. We were also told that a bin had been ordered for the disposing of incontinence aids. Improvements are also required to external areas of the home including the guttering, fascias and windows. Whilst we were advised that there was sufficient linen available for people, on examination of bedrooms bedding appeared old and mismatched. Several beds had been made using sheets and duvet covers however there was no duvet provided. Following our visit this was raised by the provider with the night staff. They have explained that this is due to people being warm. The provider has now requested that duvets are placed in each of the rooms so they can be used should they wish to. The home had recently sent out feedback surveys to people living at the home, relatives and visitors and staff. A number of people commented that the environment was in a ‘poor’ condition. In relation to standards of hygiene this too required attention. The manager advised us that a new domestic had been employed, which meant there were 3 domestics covering the home over 7 days. However it was unclear what specific hours were worked, as these had not been specified on the rota. Areas of the home were unclean. Some walls were soiled with dirt or faeces. A number of carpets were also stained and required cleaning or replacing. More care and attention is needed to improve standards of hygiene so that people live in an environment, which is safe and clean. Ainsworth Nursing Home DS0000017312.V362761.R01.S.doc Version 5.2 Page 22 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst new staff are appropriately recruited, staff need to be provided in sufficient numbers and trained so that they are able to meet the specific needs of people living at the home. EVIDENCE: Staffing rotas were looked at to establish what levels are provided and how current vacancies are being managed. Hours worked by ancillary staff and night staff were not specified on the rota. Hours worked should be detailed so that it can be seen what people are working. At present the team comprises of the manager, deputy manager, 7 nurses, 18 care staff, 2 cooks, 2 kitchen assistants, 2 laundry staff, 3 domestic staff and a handyman. Recruitment has taken place with a new domestic having just started and a full time carer due to commence the week following the visit, however there are still vacancies yet to be filled. Agency staff has been kept to a minimum with regular staff being requested so that some consistency in care can be offered. As identified at the previous inspection staffing for general nursing and personal care was sufficient during the day. However there appeared to be little social interaction with people. For a short period of time it was seen also seen that there were no staff supervising people in the large lounge. Ainsworth Nursing Home DS0000017312.V362761.R01.S.doc Version 5.2 Page 23 Between the hours of 5-9pm there is still only 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. Some individuals also require 2 to 1 care so this leaves minimal staff covering the floor. The provider needs 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. Issues have been highlighted within the recent complaint issues about the lack of decision making and accountability held by trained staff in the absence of manager. All staff are responsible in ensuring people living at the home are supported in a way which meets their needs and does not place them at risk of harm. Action was identified following a strategy meeting with regards to the manager contacting the National Midwifery Council regarding nursing staff not complying with the code of practice. We were advised during our visit that arrangements had been made for a visit from the Royal College of Nursing to meet with trained staff to discuss their responsibilities as outlined within the code. In relation to staff recruitment, files of the 4 newest staff members were looked at. Information was found to be orderly and contained all relevant information. This included an application form including a full employment history, 2 written references, copies of identification, POVA 1st check and criminal record checks. The home is currently a member of the Bury Training Partnership Group who provide quality training in line with skills for care. Whilst some staff have undertaken recent training including fire safety, moving and handling, food hygiene, adult protection and infection control we found that other staff had not undertaken any training within the last 6 to 12 months. Suitable arrangements must be made to ensure that staff are equipped with the knowledge and skills required in meeting the specific needs of people living at the home. As already identified the manager has arranged for all trained staff to attend an advanced medication training course for 21 May 2008. One comments made in the home’s feedback survey was in relation to care staff needing to be more aware of dementia care needs when working on the unit. NVQ training has also been provided for care staff. Information showed that of the 18 carers 5 hold level 2 and 2 have completed level 3. Further training also needs to be offered in this area to ensure that the standard is met. We also looked at induction training for new staff. Information in line with the Skills for Care standards is in place. Inductions are completed with a trained member of staff who has been identified as the ‘mentor’ for the new worker. Ainsworth Nursing Home DS0000017312.V362761.R01.S.doc Version 5.2 Page 24 The manager explained that she was also to develop a service specific checklist so that new staff were informed of specific areas about the home. A completed survey was received from a member of staff they expressed that they were ‘always’ provided with relevant information about people’s needs and that communication worked well between the team. They also commented that at times more support was needed. Ainsworth Nursing Home DS0000017312.V362761.R01.S.doc Version 5.2 Page 25 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, 34, 35, 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. An effective management team needs to be in place to ensure that staff are supported and directed in carrying out their duties and that people living at the home receive a quality service, which meets their needs. EVIDENCE: Over a period of time it has been apparent that the relationship between the registered manager and providers has deteriorated. We were advised by the registered manager that she had tendered her resignation at the beginning of March 2008 and would be leaving post at the end of June 2008. However since our visit we have been infomed by the provider that the manager has been asked to leave at the beginning of June and that the deputy manager will cover the management responsibilities whilst they are recruiting for a suitabile replacement. Ainsworth Nursing Home DS0000017312.V362761.R01.S.doc Version 5.2 Page 26 In relation to quality assurance the manager has now put in place weekly and monthly audit forms covering accidents, incidents, complaints, pressure care, admissions etc so that she is able to monitor events in the home. Feedback surveys have also been distributed by the home to people living at the home and their relatives. Some people felt that improvements could be made to the décor, range of activities, privacy, quality of food and staffing levels however generally it was felt that people were cared for. A suggestion box as also been placed near to the reception area so that visitors and people living at the home can leave their comments and ideas. Thank you cards have also been displayed. The Provider is no longer undertaking regulation 26 visits. This has previously been identified as an area of improvement so that evidence can be seen that the Provider is aware of the day-to-day issues within the home. Due to the recent issues and the further changes in management it is strongly advised that these visits recommence and copies of the monthly reports are forwarded to CSCI so that we can clearly see that the home is being monitored and where necessary improvements made to the service. Following our visit we wrote to the provider to request copies of the homes up to date accounts. This was to look at whether they were able to demonstrate current financial viability and to ensure that there was effective and efficient management of the business. Accounts for 2005 and 2006 have been received however more up to date information regarding 2007 were not received. A further requirement has been made in this area. With regards to people finances we identified at the last inspection that suitable arrangements should be made so that people have their own bank accounts. The manager advised us that this has now been done. The manager also stated that individual records are completed showing what money has been spent and can be easily audited. Receipts are now given to relatives for any money received on behalf of their relative. Periodically checks are then carried out by the administrator to ensure that all money held corresponds with the records and receipts. The manager also advised us that a file has been introduced, which identifies those people under appointee etc, information detailing the person’s wishes and any involvement by relatives. In relation to staff supervision and support we were told that some sessions have taken place. The manager had recently held group supervision with the trained staff to discuss general practice issues. A further session had taken place with care staff to explore safeguarding procedures. At present ancillary staff have not been offered supervision. This is an area of improvement so that both trained and care staff are provided with clear direction and support Ainsworth Nursing Home DS0000017312.V362761.R01.S.doc Version 5.2 Page 27 and are made fully aware of their responsibilities in ensuring people living at the home are supported in a way which ensures their safety. A random sample of safety certificates were examined. This included the 5year electric certificate, emergency lighting, gas safety and fire equipment. The home also employs a handyman who carries out the weekly/monthly checks to the fire alarm, emergency lighting, equipment and exits. It was noted that there had not been a recent fire drill. Further checks are made in relation to water temperature. It was evident that these were being monitored and had been regulated accordingly. Records did state that the washbasin in 2 toilets had been identified as ‘cold water only’. Adequate hot water should be provided to ensure the prevention of cross infection. It was noted that in one of the shower rooms on the nursing and residential unit that the shower could not be maintained at a safe temperature. Arrangements should be made to ensure that this can be regulated and maintained at a safe temperature ensuring people are not placed at risk of scalding. Ainsworth Nursing Home DS0000017312.V362761.R01.S.doc Version 5.2 Page 28 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 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 1 X X X X X X 1 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 2 3 1 X 2 Ainsworth Nursing Home DS0000017312.V362761.R01.S.doc Version 5.2 Page 29 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 15(1) Requirement You must make sure that the care plans are up to date and give a clear record of the residents’ condition at any one time and provide detailed information about the care to be provided. Care plans must be in place for any identified need. When it has been identified that a resident has, or is at risk of developing a pressure sore, a pressure sore prevention plan must be in place. In order to ensure that the residents’ health is properly monitored and therefore not put at risk, staff must ensure that the residents’ weight recordings are accurate. (Outstanding requirement 30/01/08) All staff that handle medicines must complete the planned training and supervision to ensure that they are competent at handling medicines. DS0000017312.V362761.R01.S.doc Timescale for action 09/05/08 2. OP7 15(1) 09/05/08 3. OP8 12(1) 09/05/08 4. OP9 18(1)(a) 30/05/08 Ainsworth Nursing Home Version 5.2 Page 30 5. OP10 12(4)(a) More care and attention is need in maintaining the dignity of people living at the home. Opportunities should be provided for people to participate in meaningful activities, which offer stimulation and social interaction. Menus should be reviewed to include nutritional meals, which meet the cultural and dietary needs of people. 30/05/08 6. OP12 16(2)(m) 30/06/08 7. OP15 16(2)(i) 30/06/08 8. OP15 13(3) 23(2) The hygiene standards within the 30/06/08 kitchen need to be improved so that meals are prepared in an environment, which is both clean and safe. Staff need to be clear through 30/07/08 training and other means of their responsibilities in reporting and recording all issues and concerns brought to their attention so that people living at the home are not placed at further risk. Work needs to be completed to the new shower room ensuring that it is safe for people to use. A plan of redecoration and refurbishment needs to be developed so that improvements needed to enhance the appearance are addressed and people are provided with a comfortable and pleasant environment in which to live. Bedside lamps and call bells must be made accessible to people for their use when required. (Outstanding requirement 31/3/08) DS0000017312.V362761.R01.S.doc 9. OP18 13(6) 18(1) 10. OP19 23(2) 30/05/08 11. OP19 16(2) 30/06/08 12. OP19 23(2) 30/06/08 Ainsworth Nursing Home Version 5.2 Page 31 13. OP26 13(3) 23(2) The standards of hygiene throughout the home need to be improved so that people live in an environment which is safe and clean and cross infection is minimised. Additional staff must be on duty at busy times of the day to ensure peoples’ needs are met in all areas of the home. (Outstanding requirement 31/1/08) Staffing rotas need to clearly identified hours worked so that it can be seen that there are sufficient staff on duty at all times. A programme of training needs to be developed including NVQ’s so that staff have the knowledge and skill needed to meet the needs of those people who live at the home. A good working relationship needs to be established between the owners and manager so that staff are appropriately managed and supported in carrying out their roles and responsibilities and the service is not compromised. Information gathered as part of the quality monitoring should be used to inform the homes annual development plan. A copy of this should be sent to the commission. The annual accounts for 2007 in respect of the home, which have been certified by an accountant must be provided to CSCI. DS0000017312.V362761.R01.S.doc 30/06/08 14. OP27 18(1) 30/06/08 15. OP27 17(2) schedule 4(7) 30/06/08 16. OP30 18(1) 30/07/08 17. OP31 12(1) 12(5)(a) 30/06/08 18. OP33 24(1) 30/07/08 19. OP34 25(1)(2) (3) 30/09/08 Ainsworth Nursing Home Version 5.2 Page 32 20. OP36 18(2) Individual supervision meetings with staff must take place to ensure all staff understand good care practice and apply this consistently as part of their role. 30/07/08 21. OP38 13(4) Arrangements should be made to 30/06/08 ensure that the water temperature in the identified shower can be maintained at a safe temperature so that people are not place at risk of scalding. 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 OP9 OP14 Good Practice Recommendations To ensure the safe storage of medications a lockable drugs fridge should be provided. More care and attention is need in maintaining the dignity of people living at the home in relation to their personal appearance and the way in which they are supported. Suitable arrangements need to be made so that food items are stored safely. Records need to be improved in relation to the food preparation and hygiene standards within the kitchen. Work to achieve a good outcome when concerns and complaints are brought to their attention so that this does not impact of people living at the home and relationships with other. It is strongly advised that monitoring visits are conducted and recorded by the provider to evidence that they are monitoring the service in the absence of a registered manager. 3. 4. 5. OP15 OP15 OP16 6. OP33 Ainsworth Nursing Home DS0000017312.V362761.R01.S.doc Version 5.2 Page 33 7. OP38 Arrangements are made for a fire drill to be conducted so that staff particularly those who are new are aware of the procedure to follow. Ainsworth Nursing Home DS0000017312.V362761.R01.S.doc Version 5.2 Page 34 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. Extracts may not be used or reproduced without the express permission of CSCI Ainsworth Nursing Home DS0000017312.V362761.R01.S.doc Version 5.2 Page 35 - 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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