Inspection on 08/06/07 for Ainsworth Nursing Home

This inspection was carried out on 8th June 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 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 Julie Bodell Unannounced Inspection 8th June 2007 06:30 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.V333978.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.V333978.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.V333978.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.V333978.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection which included a site visit and took place between 6.30am – 6.30pm on 8 June. The home did not know that the visit was to take place and three inspectors were involved in this inspection during the course of the day. One inspector looked at the mental health unit and a second inspector looked at the dementia unit. A pharmacist inspector checked the medication system. The lead inspector looked at outstanding issues from the last inspection and talked to the registered manager. Inspectors spoke with five staff members including night staff, five residents, observed what was going on, looked around the building and at key documentation. Information requested from the service was received, as were surveys from two relatives. Inspectors found evidence of many improvements at the home since the last key inspection, which took place in February 2007, with further improvements planned. However there were serious failings in the medication system that means that the overall rating at this key inspection remains poor. This is disappointing given previous improvements in this area. What the service does well: What has improved since the last inspection? Ways of trying find out more about residents’ past lives is starting to happen on the dementia unit. Social activities are starting to happen with residents on the dementia unit. Ainsworth Nursing Home DS0000017312.V333978.R01.S.doc Version 5.2 Page 6 Residents with mental health needs have had more opportunity to become involved in trips out from the home for example a trip on a narrow boat. One resident has purchased an electric wheelchair, which is being used inside the home. Plans are in place for the resident to have driving lessons to enable them to use the wheelchair outside the home competently. This will to increase the resident’s independence, which will be useful when going on holiday later in the year with other residents from the home. A lot of effort has been made by the staff team and in the main the handyman, to improve the physical environment at Ainsworth. These include cleaning the sign to the entrance of the home and repairs to the main drive way, as well as new windows to the reception area and new planters at the front door to create a more welcoming atmosphere. New garden table, chairs and umbrellas have been purchased and a new bench for the memorial garden area that is about to be developed by a group of young people from the Princes Trust. Work has also been carried out to many areas inside the home too. The heavy fire doors near the lounge on the dementia unit and the lounge door itself can now all be kept open. This is a huge improvement as residents can move around. The garden on the dementia unit has been transformed into a pleasant and attractive space for residents and their families. The dementia unit’s lounge and a bedroom have been re-decorated. Pictures and signs have also been put around the unit to help residents find their way around. 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. Meals on the dementia unit are more pleasant, food is kept hot, special diets are presented better and tablecloths, tablemats and napkins are used. Adequate numbers of staff are available to ensure that the needs of residents can be met. There is less reliance on outside agency staffing. There is now an identified deputy manager who will take responsibility for the home in the absence of the registered manager. A system for all staff to have regular, private, individual meetings with a manager was about to start, giving staff support and looking at the work they do. The registered providers have become more involved in the operation of the home and staffing matters. This must continue to happen to ensure that good standards at the home continue and are maintained. Ainsworth Nursing Home DS0000017312.V333978.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ainsworth Nursing Home DS0000017312.V333978.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.V333978.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 and 4 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 and are ongoing as age related and mental health conditions advance. Progress has been made in how the staff team support those service users with specific dementia and mental health needs and further improvements are planned. EVIDENCE: The home provides care and support to a group of residents who have a diverse range of need, including older people some of whom have nursing needs, enduring mental health, dementia and physical disability. Many residents have lived at the home for a long time. When they initially came to the home, where they were placed was dependent on where there was a bedroom available and planning of admissions was poor. This has meant that residents with different needs are dispersed throughout the building, which is a Ainsworth Nursing Home DS0000017312.V333978.R01.S.doc Version 5.2 Page 10 large and has a complicated layout. This has resulted in some residents not being able to be effectively supported and isolated in different parts of the building. The registration certificate was amended sometime ago to give clear numbers and categories of residents’ who are able to live at the Home and 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. But it is going to take time to achieve this objective because some residents are reluctant to move within the building. Their view has been respected, in one case with the involvement of an advocate. It has been discussed in the past giving the three areas of service delivery new names rather than the current two areas. This would be helpful in identifying that there are distinct areas of specialist care within the home. There are still plans to do this involving a local school to help choose the names that have relevance to the local area. Five 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. Further training is planned for the nursing staff in preadmission assessments. Since the last inspection a nursing assessment has been undertaken on a resident by a qualified CPN and the resident has been transferred to the dementia unit. A relative stated that the staff team had helped there relative in, “ getting adjusted with other clients was carried out with great care.” On the day of the inspection a nursing assessment was also being undertaken for a resident with increasing mental health needs to check whether nursing care is now needed. One inspector spent time talking to residents with enduring mental health needs. It was anticipated that conversation would be limited and an observation session was planned. This proved not to be the case and although short-term memory was severely impaired in some cases, what followed was a lengthy and colourful conversation about the residents’ past lives. The residents had known each other for many years either through the area that they originate from or from hospital settings. The view was that the move to Ainsworth at the time had been like moving from one hospital setting to another, rather than it being their home. But they felt that Ainsworth was changing and some of the residents gave examples of being included in outside activities that had been arranged like the narrow boat trip and going on holiday to Blackpool in the Summer. Feedback from a recent review for one resident acknowledges improvements in activity and engagement of the resident in conversation. There are plans for two residents to go fishing and to watch local football matches in the near future, as some of the residents are Bolton Wanderers supporters. They also said that they “Like a good chat with staff.” The staff member supporting the residents knew them well. Training in Ainsworth Nursing Home DS0000017312.V333978.R01.S.doc Version 5.2 Page 11 enduring mental health needs is being organised for the staff team through the local training partnership over the coming year. Ainsworth Nursing Home DS0000017312.V333978.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 reflected the assessed needs of the residents. Care practices ensured that the residents health care needs were generally met and that they were treated with respect and their dignity was upheld. Residents and/or their relatives still need to be more clearly involved with what is written about the help they need and how they like that help to be given. The practices around the administration of medication are unsafe and do not make sure all residents receive the vital medication which is prescribed for them. EVIDENCE: Care plans and risk assessments are developed from a community care or nursing assessment and/or home’s pre-admission assessment. The care plans and risk assessments examined were detailed, clearly setting out action to be taken to address all aspects of the health and personal care of residents and ensure that the staff receive the information they needed to satisfactorily meet Ainsworth Nursing Home DS0000017312.V333978.R01.S.doc Version 5.2 Page 13 the needs of the residents. We advised care files would benefit from old information being archived and dividers being consistently used. We were informed all care and nursing staff would be attending person centred planning training in the coming year. When applied, such an approach should hopefully place the resident more clearly within the care planning process, with thought also given to using more positive language and focusing on residents’ strengths and skills. Good practice was noted, as the dementia unit was about to start gathering information to produce life stories for residents; describing their families, work histories, hobbies and interests. Good practice was noted on the dementia unit, with a new resident’s family being “very impressed” with the support and interest shown by the unit’s manager regarding ‘their’ resident’s welfare. We discussed ways of developing this further, as the family had not been made aware of the care planning and review process, and were keen to be involved e.g. taking part in the monthly review. With regard to general care practices on the unit, we observed staff on duty at this inspection treating residents in a more caring, warm and respectful manner. Residents spoken to throughout the home were generally positive about the care they received. The staff had a good understanding of the residents’ support needs. Some residents have no relatives or limited contact with relatives. It was noted that members of the staff team often attend funerals of residents in this situation. The new memorial garden will be used to place plaques for them. One relative stated on the returned survey, “A thank you to the unskilled staff who are in the main caring for my mother and try to make her comfortable.” And “The unskilled staff are always helpful.” 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. The registered manager was asked to review the care records of one service user with a high level of need and replace the present nutritional assessment with a new MUST assessment, check the condition of the PEG site and the resident’s bedroom to assess levels of hygiene and cleanliness from spilt feeds and bedrail check, if appropriate. 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. the dietician, speech therapist and tissue viability nurse. As part of this inspection the pharmacist inspector looked at all aspects of medication handling to assess how safely it is done. The policies and procedures did not provide clear guidance to staff in the safe handling of medication. Residents’ health is at potentially at risk due to the lack guidance on safe medication procedures. The medication records were poorly completed because the records failed to show that all medicines were accounted for properly. The records did not show Ainsworth Nursing Home DS0000017312.V333978.R01.S.doc Version 5.2 Page 14 clearly how much medicine had been given to residents. These records could not be relied on to show if medicines had been given properly. For example one resident was prescribed Furosemide tablets but none had been signed for during the past 19 days, however there were indications that tablets had been administered. Another example included a resident who had been prescribed Promazine liquid, the doctor increased the dose of this medicine but on the day the doctor did increased the dose the staff had failed to sign the records to indicate if either the lunch time or tea time doses had been administered. The lack of proper records and an audit trail meant that the home could not provide evidence that this resident had been given their medication as prescribed. Residents were not always safe when medicines were given. One resident’s inhaler went out of date in December 2005. Another resident had a problem swallowing, so nurses crushed the tablets and then put the medication in her food. This is poor practice because crushing could change the properties of the tablets and the resident may not receive the correct dose. Residents did not always have medication administered as directed by the doctor. One resident was prescribed Fentanyl patches, a very strong analgesic. The patch should be changed every 72 hours to ensure continuous pain relief, the controlled drug register showed that it had been changed a day late leaving the resident without pain relief for a day. It is of further concern that some residents couldn’t have their medicine because it had run out. For example on one occasion nurses had to ‘borrow’ one resident’s medication to give to another resident because that resident’s medicine had run out. Although the action taken was well recorded and the resident was given vital medication, the concern is serious because the resident had run out of medicine and had potentially deprived another resident of their medication. It was noted that the nurses recorded that they omitted medication because it ‘was not needed’. The nurses had not recorded why it wasn’t needed or if they had asked the doctor if it was safe to omit the medicine. Residents were at risk due to the careless storage arrangements for medicines. The door of the clinical room, which was situated on the dementia unit, did not close properly and residents could go into the store room because it was unlocked. Tablets, which had been refused, were in an open top ‘medication disposal bin’, which anyone entering this room could have free access to. It was also noted on the day of the inspection that there was some prescribed medication was stored on top of the trolley, which was situated in the office; the door to the office was open. All the nursing staff have recently had medication training, however it is of concern that the residents are still not being given their medicines properly. It is also of concern that despite training nurses do not understand which drugs are controlled drugs and need to have special records and storage. Ainsworth Nursing Home DS0000017312.V333978.R01.S.doc Version 5.2 Page 15 The manager said that she audits two residents’ care plans and medication records each month; it is of concern that the auditing system is not sufficiently robust to keep residents safe and ensure they are receiving their medicines safely. Ainsworth Nursing Home DS0000017312.V333978.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. Social activities have been arranged to ensure that all residents’ have the opportunity to engage in meaningful, stimulating and fulfilling activities. Improvements in providing a stimulating environment on the dementia unit have been made. Improvements in the menu and health and safety practices in the kitchen have been maintained. EVIDENCE: The lead inspector arrived for this inspection at 6.30am. It was noted that most residents 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 residents were offered a drink whilst waiting for their breakfast. Night staff members were observed to be very kind and patient with residents and gently encouraged residents to join in conversation with the inspector. Social activities for service users’ continue to improve. The registered manager produces a newsletter, which keeps residents and relatives informed about Ainsworth Nursing Home DS0000017312.V333978.R01.S.doc Version 5.2 Page 17 activities and fundraising events at the home. Recent activities include a trip on the “New Horizon” narrow boat, which proved so popular that another trip is being planned for July. An entertainer came into the home to celebrate St Patrick’s Day and another entertainer came into the home in May. Residents from the dementia unit went on a country drive and visited Heaton Park farm. Some residents are going on holiday to the Bond Hotel in Blackpool during the summer. There are new activity programmes for both units. There are plans in place for the registered manager to employ an activities organiser in the near future. Fundraisers include an Easter draw, which raised £102 and tickets are on sale for a summer draw. Plans are in place for another auction and a car wash to raise further funds for activities. A resident receives reflexology from a complementary therapist regularly. One resident has purchased an electric wheelchair, which is being used inside the home. Plans are in place for the resident to have driving lessons to use the wheelchair, competently, outside the home to increase their independence. This will be useful when going on holiday later in the year. The resident’s Possum communicator was being repaired. Once returned, this will enable the resident to communicate more effectively with the staff team. Since the last inspection, social activities and stimulation had started to improve on the dementia unit. One resident had recently enjoyed a barge trip. The manager had organised for the home to join a national association that provided activity ideas for older people (NAPA) and had also been in contact with the Alzheimers Society. From this, the unit now had a weekly activities timetable and was making preparations for residents to have a ‘memory box’, with items such as photographs, jewellery etc that could be used for reminiscing. We advised a way of recording what social activities were being carried out and with whom and why this was was needed. Suitable activities also needed to be provided for the less able residents on the dementia unit. Good practice was noted, as the television was not left on indiscriminately, rather music was played, with one resident commenting “that’s nice”. Residents were also given newspapers to look at and hold. However, residents had not been given the opportunity to have handbags to hold and explore. The domestic explained that two of the female residents would try to borrow her dusters to clean with. We advised that nursing and care staff, need to act on this, e.g. providing a cleaning basket with feather and cloth dusters for these residents to use with ornaments etc, in communal areas. There were a number of 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. There are now residents and relative’s information boards in both lounges. Ainsworth Nursing Home DS0000017312.V333978.R01.S.doc Version 5.2 Page 18 Breakfast and lunch was observed on the dementia unit. Since the last inspection, a range of practical improvements had been made. A tablecloth, tablemats and napkins were being used. Plastic glasses had been replaced with ordinary glasses and additional ceramic mugs and glasses were now kept on the unit for use between meal times. To maintain dignity, food was being cut up before being placed in front of residents’. Food was not going cold, as meals were now being kept in the hot trolley until needed. We advised plugging the hot trolley in would further help maintain food temperatures. Residents, rather than staff, now used the two specialised glide chairs. The manager stated further glide chairs and a new dining table were to be bought with the remaining money from a recent government grant. Kitchen staff members were now keeping pureed food separate to maintain appearance, texture and flavour. Developing on the training these staff had just completed, we discussed ways of developing the quality of residents’ diet by continuing to buy higher quality brands; carrying out ‘taste tests’ with residents to see what brands/food they prefer e.g. butter or margarine; reviewing the new menu with residents; and trying new foods e.g. a group of residents recently had curry with great success. Improvements in health and safety practices appear to have been generally maintained in the kitchen. There are plans to paint the kitchen in July 2007 and we advised that this would be the ideal time to replace some of the kitchen cupboards. The Safer Food Better Business documentation needs to be completed by all relevant kitchen staff. Cooks had attended the CIEH one-day nutrition course, which is part of the National Skills Framework. Whilst the cooks were on the course a member of staff made a curry for the service users, which the majority of residents really enjoyed. So much so that there were now plans in place to introduce theme nights as fund raising activities for example an Italian and Chinese evening restaurant style. A member of staff was observed supporting a nursing resident to take a meal. This was carried out at a relaxed pace and patience by the staff member, gently persuading the resident, who was very frail, to eat and ensuring good orientation at all times, so that the resident knew what was going to happen next. Ainsworth Nursing Home DS0000017312.V333978.R01.S.doc Version 5.2 Page 19 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 majority of the staff team have received adult protection training to ensure that residents are protected from abuse. One registered provider must also attend this training so that all those connected with the management of the home know what procedures to follow should an allegation be made. EVIDENCE: There is a complaints procedure in place. There has been one anonymous complaint since the last inspection, which was sent to CSCI. The registered provider was asked to respond to the complaint. The registered provider investigated the matter and took statements from the registered manager and two qualified nurses about the matter. It was concluded that the registered manager followed the correct procedures, but the statements reveal a breakdown in communication between members of the staff team. Where the registered manager was aware of incidents CSCI had been appropriately notified. 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. Complaints, concerns and feedback from residents and relatives need to be encouraged and viewed as a means of improving the service. Ainsworth Nursing Home DS0000017312.V333978.R01.S.doc Version 5.2 Page 20 Since the last inspection there have been two allegations of abuse by staff members. Both incidents were brought to the attention of the two local authorities concerned. Although there was a breakdown in safeguarding procedures, the registered manager did ultimately take the appropriate action in the first case and the staff member concerned was suspended and following an investigation was dismissed due to an incident of verbal abuse. In the second allegation of physical abuse, there was a delay on the part of the PCT to implement Local Authority adult protection procedures with no strategy meeting being arranged. The ensuing investigation found no evidence to support the allegation. CSCI are dealing with this matter separately. 90 of the staff team have now undertaken adult protection training with the local authority training partnership and places for the outstanding members of the staff team have been booked. This is good practice. It was required that the registered providers attend this training also. The registered provider acting as responsible individual has undertaken this training. However, the responsible individual’s fellow director of the organisation has not yet attended the training and it is he who generally deals with staffing issues at the home. The requirement therefore stands that he attends the training so that there is no doubt about the registered providers responsibilities in regard to allegations. Ainsworth Nursing Home DS0000017312.V333978.R01.S.doc Version 5.2 Page 21 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 21 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Many improvements to the physical environment have been made and must continue to be made to improve standards for resident’s comfort and safety. EVIDENCE: Although Ainsworth is set in beautiful surroundings with mature trees and wildlife, the general visual appearance of the building, a large former isolation hospital, is poor in parts and hampered further by a complicated layout. A lot of effort has been made by the staff team and in the main the handyman, to improve the physical environment at Ainsworth. These include cleaning the sign to the entrance of the home and repairs to the main drive way, as well as new windows to the reception area and new planters at the front door to create a more welcoming atmosphere. New garden table, chairs and umbrellas Ainsworth Nursing Home DS0000017312.V333978.R01.S.doc Version 5.2 Page 22 have been purchased and a new bench for the memorial garden area that is about to be developed by a group of young people from the Princes Trust. Once completed this garden area will be officially opened by the Mayor. New windows have been fitted to three bedrooms and a bathroom and shower room. New bedroom furniture has been purchased for one bedroom and two more have been decorated and in one new lights and a new vanity unit put in. Two new beds have also been purchased. On the day of the inspection the handyman was decorating a bedroom that had recently become empty. The handyman has worked hard to make improvements but is only employed for three days a week. Due to the layout of the home, there is a lot of long corridor areas, which have an impact on the visual appearance of the home. We advised that it would be worth the registered providers considering to allow a team of decorators to come into the home to repaint the corridor areas to the home to give the handyman time to carryout all the other necessary work. A relative survey stated that, “A lick of paint and brighten up the place would not go amiss.” We were impressed with the major improvements that had taken place on the dementia unit since the last inspection. Automatic door closures have been fitted to the heavy double fire doors near the lounge and to the lounge door itself. Now residents were no longer ‘trapped’ in the lounge and could move freely about the unit. The small outside garden had also been transformed into a pleasant, stimulating space. A small lawn had been created, with the reminding area tarmaced. There was a raised bed, full of flowers and plants. There was a table for squirrels and birds, colourful, musical mobiles and two garden tables, chairs and umbrellas. We saw the garden being used by residents and family visitors. One resident said how much they enjoyed eating their meals out there. A washing line had also been put up, on which one resident was supported to hang out aprons. We spoke with laundry and nursing staff about developing this further, e.g. providing a domestic style, raised laundry basket on wheels, for pillow cases, socks etc, which could then be hung out to dry. We discussed that this task should be seen as a recreational activity, for residents to complete with the support of care and nursing staff. Other improvements that had taken place on the dementia unit were redecoration of the lounge, which now looked fresh and bright, with new window blinds about to be fitted. A bedroom had been decorated for a resident who had moved from another unit in the home. Picture and word signs had been fixed to bathroom, toilet and laundry doors to help residents find their way around. Bedroom doors had been personalised with names, pictures and photographs. A larger lounge clock had been provided and weather signs were being used on the lounge orientation board. The ramp carpet looked clean, with no major stains or marks. The unnecessary commode had been removed from one bedroom and as requested by its resident, grab handles had been fitted to their bed. The malodour and staining Ainsworth Nursing Home DS0000017312.V333978.R01.S.doc Version 5.2 Page 23 to the floor in this bedroom had improved, although it needs monitoring on a daily basis. The dementia unit, as with other parts of the building, was still very warm, although two new ceiling fans helped keep the lounge cool. Once this was brought to the attention of the handyman, the heating was adjusted. The faulty hot water supply previously identified in three bedrooms was still running too cold. Part of the problem was the old boiler system situated in the ceiling. However, once informed, the handyman was able to improve the supply on the day of the inspection. He also lowered the water temperature in another bedroom hand basin, which was too hot. We advised staff on the unit need to take responsibility for monitoring the air and hot water temperatures and informing either the handyman or the manager as soon as practical so action can be taken. Other minor issues were some door closers needed adjusting to stop doors banging shut. The mains cold water pipe that ran through one bedroom was covered in black mould and looked unsightly. We discussed that if the resident in this room (7) and one other (17) gave their consent, both bedrooms would both benefit from redecoration, involving both residents in the choice of décor. As raised at the last inspection, ways of supporting the resident in room 17 to personalise their room was again discussed. Although some bedrooms had towel rails, fitting them in all would prevent towels having to be hung on pipes. Also, overgrown grass and a small pile of rubbish near an outside drain, by bedroom 11, needed addressing. Unfortunately, the home had not been unsuccessful with a grant application to improve washing and toilet facilities, with a planned walk in/assisted toilet and shower room on the dementia unit. Consequently, the dementia unit still did not have a fully accessible toilet. We advised that until this situation was resolved, the unit’s staff received moving and handling training on site; so safe, dignified ways of supporting each resident can be specifically addressed and agreed action recorded in care files. Smoking cigarettes is an important pastime for some residents with enduring mental health needs. The residents are aware of the forthcoming changes in the law in respect of smoking in public places and this will mean that routine and practices at the home are to alter. We advised that further information on smoking in care homes can be found on the CSCI website. Once new arrangements for smoking are in place it is planned that the conservatory area will be refurbished. This will include new chairs. The inspector is concerned about the new settee and the throws to chairs in the conservatory as they present as a fire hazard to residents who smoke, particularly those with shortterm memory loss who are already supervised by staff whilst smoking. The registered manager is also mindful that the residents with mental health needs are also becoming older and are beginning to succumb to age related Ainsworth Nursing Home DS0000017312.V333978.R01.S.doc Version 5.2 Page 24 conditions, which will mean that they will not be able to use the four upstairs bedrooms as there is no access by passenger lift to this area. A rolling programme of work that the registered provider plans to undertake to improve the physical standards at the home is now in place and must be adhered too to maintain an overall quality rating of adequate that is made at this inspection is in recognition for all that has been achieved in such a short time. The Home and the standard of hygiene and cleanliness within Ainsworth continue to improve. Though it was requested that extra care is taken where PEG feeds are in use. 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. We advised that developing the internal laundry could be a way of resolving these issues. It was noted that the registered manager had purchased a number of personal alarms for staff members who were working in isolated parts of the building. Ainsworth Nursing Home DS0000017312.V333978.R01.S.doc Version 5.2 Page 25 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 good. This judgement has been made using available evidence including a visit to this service. Adequate numbers of staff are available to ensure that the needs of residents can be met. 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 night staff on duty, a qualified nurse and three care staff. At the last inspection concerns had been raised about the adequacy of night staff. No further issues were raised at this inspection. In line with good practice a formal handover took place, conducted by the nurse on nights to the day nurse and care staff team coming on duty. There was also a cook on duty, two cleaners, a laundry assistant and a handyman. There are regular training opportunities for all members of the nursing and care staff team. Recent training includes medication training and mentor, continuous professional development and common induction standards training for nurses. There has been in house fire safety training and a visit from a Macmillan nurse to discuss the End of Life Pathway and talk about feelings with Ainsworth Nursing Home DS0000017312.V333978.R01.S.doc Version 5.2 Page 26 the staff team around coping with dying and death. The cooks have attended the nutrition and older people in care homes training and there have also been two manual handling sessions. There has been a new personnel administration system installed on the computer and laptops for learning provided by the local adult training partnership are available. Three staff members attended a presentation evening for the Certificates of Achievement Awards held by the local adult training partnership. 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 major issues were found in relation to recruitment procedures, but more information in this case was needed around employment history. The staff member concerned had only worked at the home for a short time and was now leaving after expressing a reluctance to attend mandatory health and safety training. Ainsworth Nursing Home DS0000017312.V333978.R01.S.doc Version 5.2 Page 27 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 32 33 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made in respect of the registered providers’ and the registered manager working together in taking responsibility for the running of the home, so that it operates in the best interests of service users. There were many examples of improvements in standards at the home by the staff team, but poor communication between them has lead to poor practice being identified. Policies and procedures need to be reviewed and revised to ensure that they demonstrate good practice that reflects current legislation. 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.V333978.R01.S.doc Version 5.2 Page 28 manager was said to be approachable. The registered manager ensures that she maintains continuous professional development. She is a steering committee member of the RCN Older Peoples Forum and has attended the local National Service Framework for Older People as well as Mental Capacity Act training. It is acknowledged and evidence throughout this report that the registered manager and the whole staff team have worked hard to raise standards within the home and further improvements are planned. The registered manager has been concentrating on the strengthening the competence of the staff team to ensure that tasks can be delegated and shared appropriately across the staff team. Since the last inspection, four months ago, the registered manager has been operating as a full time manager. There is now a formally identified deputy manager and more administrative support available to the registered manager. A job description for the deputy manager needs to be developed. A clear structure for both dayto-day supervision and delegation for both day and night time care is now in place. Two senior care posts have been introduced, which are designed to help free up the qualified nurses time to deal with other matters. This is a step forward, but there were still problems with a breakdown in communication and this is evidenced in the medication practices, the complaint and the environment. This is disappointing because the consequences are that improvements that have been made are not always maintained as good care practice, which undermines confidence built up in the service by inspectors. Formal supervision and appraisals are now in place and these matters need to be addressed during these sessions as areas of development initially, but where necessary disciplinary action may also need to be taken. We advised that in light of the new work practices being introduced in the dementia unit, it would be beneficial to hold a specific team meeting for all staff who work on the unit. This would allow staff to be involved in the development of the unit and ensure there is clear understanding of the standards now expected. Policies and procedures must be reviewed and revised to ensure sound working practices to aid both development of good practice and to underpin disciplinary procedures. It was agreed that a good starting place would be to look at Skills for Care arrangements for policies and procedures and common induction standards. The relationship between the registered manager and the registered providers is key to ensure continued improvements being implemented and maintained at the Home. The registered manager said that the relationship had continued to improve and there were a number of examples of the registered providers being supportive. The registered provider has now started to forward copies of Regulation 26 visits to CSCI. Two out of a possible four reports have been received from the registered provider and although information on the reports is brief, it is progress in the right direction. The registered provider must continue to evidence that he is monitoring the home as a means to ensure that the improvements for residents are maintained. Health and safety certificates Ainsworth Nursing Home DS0000017312.V333978.R01.S.doc Version 5.2 Page 29 for servicing and maintenance were examined for fire extinguishers, fire alarm system, gas, electrical fittings and fitments, hoists and waste transfer and were found to be in good order. Ainsworth Nursing Home DS0000017312.V333978.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 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 2 X 2 X X X 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X X 2 X 3 Ainsworth Nursing Home DS0000017312.V333978.R01.S.doc Version 5.2 Page 31 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 have mental health needs are met, the planned mental health basic skills training must be provided to all staff members who work with residents who have mental health needs. 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. (Outstanding from the last inspection.) All medication records must be accurate and up to date so that it can be evidenced that residents are getting their medicines as prescribed. All medication must be administered to residents in exact accordance with the prescribed directions to make sure residents’ health is protected. The storage arrangements for all DS0000017312.V333978.R01.S.doc Timescale for action 31/12/07 2. OP7 12 30/09/07 3. OP9 13(2) 08/06/07 4. OP9 13(2) 08/06/07 5. OP9 13(2) 08/06/07 Page 32 Ainsworth Nursing Home Version 5.2 6. OP9 24(1)(a) (b) 7. OP18 16 8. OP19 23 9. OP19 23(2)(d) 10. OP21 13(5) & 23(2)(j) 11. OP25 23(2)(p) 12. OP32 13 medicines must be reviewed to make sure that medication is stored securely at all times. A system to ensure the quality of care regarding medication administration is established, to make sure that residents health is not at risk. That all staff and the registered providers receive protection of vulnerable adults training. (Outstanding) That a rolling programme of work that the registered provider plans to undertake to improve the physical standards at the home must be carried out for all three units. (Ongoing) To improve its appearance, the cold water pipe in bedroom 7 on the dementia unit must be cleaned. Due to the lack of assisted toilets and to ensure staff and residents’ safety, all staff who work on the dementia unit must receive their moving and handling refresher training on the unit itself. To keep residents safe and comfortable, staff on the dementia unit and other areas of the home, must regularly monitor the unit’s air temperature (carried over from the last inspection) and hot water temperatures, taking appropriate action when necessary. The manager needs to ensure that there are clear lines of accountability and understanding about the need for effective communication to ensure that standards for residents are maintained and that all staff members work as a united team in the best interests and safety DS0000017312.V333978.R01.S.doc 08/07/07 30/09/07 31/10/07 30/06/07 30/09/07 30/06/07 30/06/07 Ainsworth Nursing Home Version 5.2 Page 33 13. OP33 26 14. OP36 13 of residents at the home. The registered provider or their 30/06/07 representative must continue to visit the Home unannounced on a monthly basis in accordance with this Regulation and a report produced and sent to CSCI. To evidence that the home is being effectively monitored on a regular basis The pack of policies and 31/10/07 procedures are reviewed and revised to make clear links with legislation, employment law, common induction standards and good practice to support the development of staff members and underpin disciplinary procedures. 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 OP12 Good Practice Recommendations That the three specialist units are name to give them clear identities. To meet the different needs and abilities of residents on the dementia unit, the new programme of social activities should continue to be developed. To show these activities are being provided appropriate records should be kept. To help maintain and further improve the quality of residents’ diet, ways of involving them in the food they are given should be considered, e.g. holding taste tests, meeting regularly with kitchen staff to review the menu; continuing to try new foods. To ensure new work practices on the dementia unit are understood, a team meeting for all staff who work on the unit should be held. 3. OP15 4. OP32 Ainsworth Nursing Home DS0000017312.V333978.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.V333978.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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