Inspection on 01/09/08 for Airedale Nursing Home

This inspection was carried out on 1st September 2008.

CSCI found this care home to be providing an Adequate 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

Airedale Nursing Home 14/08/09

Airedale Nursing Home 31/08/06

Airedale Nursing Home 05/12/05

Airedale Nursing Home 08/06/05

Airedale Nursing Home 11/01/05

Airedale Nursing Home 10/08/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

CARE HOMES FOR OLDER PEOPLE Airedale Nursing Home 44 Park Avenue Bedford Bedfordshire MK40 2NF Lead Inspector Ms Nicky Hone Unannounced Inspection 1st and 15th September 2008 12:50 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 Airedale Nursing Home DS0000017660.V371039.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. Airedale Nursing Home DS0000017660.V371039.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Airedale Nursing Home Address 44 Park Avenue Bedford Bedfordshire MK40 2NF 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) 01234 218571 01234 215097 airedalenursing@btconnect.com The Airedale Nursing Home Mrs Jean Nichol Dr T Kamyar Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35), Physical disability (35), Terminally ill (5), of places Terminally ill over 65 years of age (5) Airedale Nursing Home DS0000017660.V371039.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To limit the number of persons to be admitted under the category of terminal illness within the home. To limit the number of persons to be admitted in the age range between 45 and 65 years within the home in the category of PD. 31st August 2006 Date of last inspection Brief Description of the Service: Airedale is a care home offering nursing care situated in the centre of Bedford overlooking Bedford Park. The home has been slowly extended over a number of years and is currently registered for 35 people with nursing needs. Accommodation is provided in single and double rooms, all except three of which have an en-suite toilet or en-suite shower. Care is provided at ground floor and first floor levels; stairs or one of the two lifts access the different levels. There are three separate communal rooms plus small reception areas, developed in the hall spaces throughout the home. The garden has been designed as a sensory garden and has full wheelchair access. The home is within walking distance of any bus that stops in Bedford town centre and is on the route of some local bus services. There is limited off-road parking and unrestricted parking on the road outside the home. The fees for this home vary from £650.00 per week, to £750.00 per week, depending on the funding source and assessed needs of the resident. CSCI inspection reports are available in the hallway of the home, with the visitors’ book and service user guide. Airedale Nursing Home DS0000017660.V371039.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 1 star. This means the people who use this service experience adequate quality outcomes. When the provider received this report, they asked CSCI for a review of the quality rating. This was carried out by the Quality Rating Review Service who concluded that the overall rating for this home should remain as adequate. However, QRRS recommended that the judgement for two sections of the report, ‘Daily Life and Social Activities’ and ‘Staffing’, should be changed from adequate to good. For this inspection we (the Commission for Social Care Inspection) looked at all the information that we have received, or asked for, since the last key inspection of Airedale. This included: • The Annual Service Review (ASR) that we completed on 06/03/08. An ASR does not involve a visit to the service but is a summary of information we have collected since the previous key inspection; The AQAA (Annual Quality Assurance Assessment), dated June 2008, that the manager gave to us at the inspection. The AQAA is a selfassessment that focuses on how well outcomes are being met for people living at the home. It gives the manager the opportunity to say what the home is doing to meet the standards and regulations, and how the home can improve to make life even better for the people who live here. The AQAA also gives us some numerical information about the service; What the service has told us about things that have happened in the service, these are called ‘notifications’ and are a legal requirement; Any safeguarding issues that have arisen; and Information we asked the home to send us following our visit. • • • • This inspection of Airedale included two visits to the home, on 01/09/08 and 15/09/08. The first visit was unannounced, so no-one knew we were going to visit on this day. We arranged the second visit with the Mrs Nichol and Dr Kamyar, as they and their administration staff wanted to be available. We spent time talking to the people who live at the home, the manager/owners and some of the staff. Airedale Nursing Home DS0000017660.V371039.R01.S.doc Version 5.2 Page 6 We also looked at some of the paperwork the home has to keep including care plans, risk assessments, medication charts, and records such as staff personnel files, staff rotas, menus and fire alarm test records. What the service does well: What has improved since the last inspection? Airedale Nursing Home DS0000017660.V371039.R01.S.doc Version 5.2 Page 7 At the last inspection Airedale was rated as a ‘good’ home, and there were only two requirements. The home has developed a quality assurance process which includes asking the people who live at the home, their relatives and others about the quality of the service provided. In the AQAA the manager quoted a number of areas in which the home has improved in the last 12 months. She wrote, “We have: • • • • • • • • Trained staff on the Mental Capacity Act and Civil Liberties Included service users own descriptions of life at the home into the Service User Guide Employed an assistant training officer to work with new members of staff Purchased an adjoining piece of land and constructed a barbeque and large open seating area Employed a new activities officer Responded to and printed the results of our quality questionnaires Achieved redecoration of 5 bedrooms; replaced the bathroom with a wet room and shower; purchased a new electric hoist and replaced 3 air mattresses; replaced 2 ensuites; and replaced carpet in 3 rooms. Introduced a new induction package and a 3-month probationary period”. Also, between the two days of our visits, the home met the immediate requirement we made about fire doors only being held open by a means approved by the fire authority. What they could do better: This inspection has resulted in nine requirements being made. The manager/owners were very disappointed with our findings, as previously CSCI had considered Airedale to be a ‘good’ home. We have confidence that they will strive to improve on the areas we have identified. One of the requirements was made the day after the first day we visited, as we had serious concerns about the safety of the people living at Airedale. We found a large number of fire doors wedged open so we consulted the fire safety officer who said that it is not acceptable to wedge fire doors open. We telephoned the home, and wrote to the owners, telling them that fire doors must only be held open by a means approved by the fire authority. On the second day we visited, and from the letter the owners wrote to us, we know that they acted quickly to make sure people were safe. Other areas the home needs to improve on are: • Improve the information in the care plans so that staff have full details about each person, and have guidelines on the care each person needs; Airedale Nursing Home DS0000017660.V371039.R01.S.doc Version 5.2 Page 8 • Make sure that records, for example food and fluid intake charts, bowel charts and so on, when these are required by the care plan, are kept accurately; Make sure there is enough medication in stock for each person so that they are given the medicines they have been prescribed; Remind staff that they must always treat people with respect, and preserve people’s privacy and dignity. For example, knocking on people’s doors before entering a room, remembering this is each person’s home, and so on; Introduce a wider range and number of activities that people would choose to do to make their lives more fulfilling; Improve the way meals are served, especially to people who are more dependent and need assistance with their food; Make sure staff have received all the training they need to do their jobs well; and Stop using correcting fluid on any records so that the original entries can still be read. • • • • • • We have also recommended that the home provides a bath for people who would like one, as currently there are only showers. 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. Airedale Nursing Home DS0000017660.V371039.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 Airedale Nursing Home DS0000017660.V371039.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): 1, 3, 6 People who use this service experience good quality outcomes in this area. Information about the home is available for people thinking about moving in, and people’s needs are assessed before they move in. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has a Statement of Purpose and Service User Guide, which were updated in July 2008. We saw a copy on the table in the hall, by the visitors’ book: it included comments from the people who live at Airedale. A newsletter is also produced every other month. In the AQAA the manager told us that they have contacts to enable them “to have documentation transcripted to braille or foreign languages as necessary” and large print is also available. Airedale Nursing Home DS0000017660.V371039.R01.S.doc Version 5.2 Page 11 On each person’s records we found an assessment. The manager told us that one of these is always completed before the person is offered a place at the home. Some of the assessments were not signed or dated. We looked at the records for the person who had most recently been admitted to the home. There was a very brief assessment of the person’s needs on the file. Intermediate care is a service offered by some homes, which gives short-term, intensive rehabilitation for people leaving hospital before returning to their own homes. This service is not offered at Airedale Nursing Home, therefore standard 6 is not applicable. Airedale Nursing Home DS0000017660.V371039.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, 10, 11 People who use this service experience adequate quality outcomes in this area. Care plans do not contain sufficient information, guidelines for staff are not detailed enough, and daily records of care given are not good enough to evidence that each person’s needs for personal and health care are fully met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home uses a printed system of cards which fit in a holder for a number of the records kept about each person. We saw that staff had based the information in the care plans on the pre-admission assessment, and the plans cover a comprehensive range of needs. However, there is very little space on the cards for writing details about each aspect of care - the information needs to be expanded so that staff are clear about the care each individual needs. The manager said the system had been introduced some while ago to meet staff needs at that time, and had proved very effective. However, she had Airedale Nursing Home DS0000017660.V371039.R01.S.doc Version 5.2 Page 13 recognised that it was no longer suitable and had already made plans to change the way information is recorded, when all the nurses return from their summer breaks so that it is a team effort. The manager told us that none of the people living at Airedale has any pressure sores. She said the only people who had pressure sores had arrived from hospital with them, and the home’s staff had healed them. We saw that there were no guidelines for staff on how to deal with some aspects of care. For example on one person’s notes we read that the person can be “very aggressive, both physically and verbally”, but, even though an ABC chart had been completed (to show what had happened before, during and after the episode) there were no guidelines for staff on what might trigger this, how to avoid it, and what to do if this behaviour occurred. This means there would be little opportunity for staff to work consistently, and share any approaches they find that work. The manager said this is all shared verbally in handovers. Daily written notes gave little information about the care the person had received. For example, on one person’s notes staff had written “15/08/08 A quiet morning”, “18/08/08 A calm morning” and so on. On another person’s notes they had written “26/07/08 No changes”, “27/07/08 Usual day”. On one person’s records we looked at some problems had been noted (redness in skin folds, sore eye and so on), but there was no further information about whether these issues had been dealt with, and if so, how. There were no care plans in place for these issues. The manager said staff would have dealt with these as part of their normal, everyday nursing, so would not have considered recording what they had done. She said they had told her that these matters were no longer problems. Part of the reason for our inspection was because some concerns had been raised with us by the relative of a person who used to live at Airedale. According to the relative, this person had been nursed in bed for 2 years, but on moving to a different home was now up and about, and much improved in health. The manager said this was not a true picture of this person, who, amongst other things, had been getting up while at Airedale. However, we noted that quite a high proportion (nearly a third) of the people who live at Airedale were in bed on both days we visited. We discussed this with the manager who felt that all these people were being cared for in the way that was most comfortable for them, and/or it was their wish to stay in bed or in their room. Because of the lack of information in the care plans we could not work out whether or not any of these people would be better off if they were enabled to get up. In one person’s notes we read that the person had started to be “nursed in bed as she keeps slipping off the chair”. The home had not investigated getting a ‘shaped’ or recliner chair which this person might have found comfortable, so Airedale Nursing Home DS0000017660.V371039.R01.S.doc Version 5.2 Page 14 they could still sit in the shared areas of the home and not be so isolated in their room. The manager said it is not possible to move big, bulky chairs around. We spoke to three people who all said they were more comfortable in bed. One person had broken their leg by climbing over the bed rails on their bed. We did not see a risk assessment in place for bed rails for this person, which should have been updated since the accident, and we did not find that the person (or their representative) had agreed to the bed rails being used. On the day we first visited, this person was confined to their bedroom because the home had not managed to find a way of getting the person out of the room due to the plaster cast on their leg. The care planning documents contain a number of charts, for example a bowel chart. We noted that a number of these had either not been completed correctly, or staff had failed to act when someone had not had their bowels open for several days/weeks (for one person, from 22nd July to 29th August). On one of the plans we looked at, it stated the person “needs encouragement to drink”. We did not find a fluid monitoring chart for this person, or any record of what had been drunk. A Nutritional Risk Assessment was in place for one person but it did not include the person’s likes and dislikes, and no care plan linked to the risk assessment had been drawn up. We heard that a mobile optician visits the home twice a year; people are given the names of local private chiropodists if they want treatment, as only people with diabetes can get NHS treatment; and if people want to see a dentist they have to find one they can go to, as private dentists will not visit the home and there are few NHS dentists available. None of the people who live at Airedale look after their own medication. One of the nurses told us that none of the rooms have lockable facilities so no-one would be able to look after their own even if they wanted to. All medicines are administered by the qualified staff, and one of them is responsible for ordering medication. We looked at the Medication Administration Record (MAR) charts. These were completed reasonably well with only the occasional gap where the person administering the medication had not signed the record. On one chart, “PRN” had been written on the chart, but had not been signed or dated. We saw that medication for one person had been ‘out of stock’ from 30/08/08 to 11/09/08. Some correcting fluid had been used (see Management section of this report). A record is kept as required of Controlled Drugs. Again, correcting fluid had been used, and we saw one gap where the quantity of a drug administered had not been entered. Airedale Nursing Home DS0000017660.V371039.R01.S.doc Version 5.2 Page 15 Some of the staff did not knock on bedroom doors before entering people’s rooms. Staff refer to people as ‘patients’ and to the lounge as ‘the day room’, which gives the feeling that this is a hospital rather than each person’s home, and takes away people’s dignity. One person was moved from her chair in the lounge using the hoist. The blanket was taken off her knees, cushions removed from the chair, and the sling put behind her before anyone spoke to her and told her what was happening. The manager told us that Airedale had been asked to participate in a project to implement the Gold Standards Framework (GSF). This is a framework to enable people who are nearing the end of their lives to receive a gold standard of care. The project had been successful, and the nurses from Airedale had been asked to share what they do with others. A number of the care plans we saw contained an ‘Advance Care Plan’, giving instructions from the person about what they want to happen at the time of their death. Airedale Nursing Home DS0000017660.V371039.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, 15 People who use this service experience good quality outcomes in this area. Visitors are made very welcome, but the range and amount of activities offered to the people who live at Airedale Nursing Home is not good enough to make sure everyone leads a full and satisfying life. Arrangements for meals for the people who are more dependent on staff assistance are not good enough. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home employs an activities coordinator who works extremely hard to try to offer people activities they want to do. She takes 2/3 people out each day for a walk in the park, and arranges activities such as quizzes, music and movement, bingo and so on. She holds ‘Tranquillity afternoons’ which result in pain management through relaxation, and Guide dogs in training visit regularly. She keeps very good records and has a wealth of evidence that lots of activities have taken place. Airedale Nursing Home DS0000017660.V371039.R01.S.doc Version 5.2 Page 17 Forthcoming activities are advertised on a board in the activities room, and the coordinator visits people in their rooms to inform them about what’s going on. On one of the days we visited she was holding a general knowledge quiz. Many of the activities are for people who are more able to join in. On both days we noted that, except for the television being on, there was nothing going on in the lounge where people who are more dependent spend their whole day. Some of these people suffer from dementia: we found little to show that suitable activities for people with dementia are provided. Families of the people who live at the home are encouraged to visit and are invited to any events that are organised at the home, such as a barbeque and a strawberry tea that had both been held recently. People told us that the owner had done the cooking on the barbeque and the food had been delicious! Some relatives visit daily. One relative told us that the staff are very helpful, they always come when they’re needed, and they make visitors feel welcome, finding extra chairs and offering them drinks. The manager said that several relatives of people who no longer live at Airedale still visit, and one of them plays the piano for the people who live here. Several people told us that the food is very good. One relative was very pleased that the home allow them to bring in special food for their relative and staff are happy to heat the food up for them. On the second day we visited, the cook was off sick, so a catering company was providing the meals. There had been a bit of confusion over the menu, but the meals were good quality and the people living at the home had enjoyed them. The manager told us that when the cook is working, there is ‘highlight of the week’ when a different menu, for example French or Italian, is offered. People also get days when they can put their own choice of meal on the menu. The manager said that each day there is a choice of at least five alternatives if people do not want what is on the main menu. Staff told us that one staff member takes three meals to people in their bedrooms upstairs who all need assistance with eating. There is no heated trolley upstairs, therefore we were concerned that the meal might be nearly cold by the time the staff member gets to the third person. On our second visit we observed lunch being served in the lounge area where people are more dependent on help from staff. Nine people stayed in their lounge chairs, with a mobile table in front of them. The dining table in the dining room attached to this lounge was only used by staff. Lunch was roast beef with Yorkshire pudding, potatoes, vegetables and gravy. Pureed food was served well, with each part of the meal pureed separately so that there was an array of colours, textures and tastes on the plate. Airedale Nursing Home DS0000017660.V371039.R01.S.doc Version 5.2 Page 18 Some aspects of lunch time were done well, with staff showing an understanding of good practice, such as sitting down to assist people with their meal. However, there were a number of issues which showed poor practice, and a lack of understanding about how to care for people with dementia. For example, a cup with sugar in it was put on the table in front of each person before the meal started. One person tipped the sugar out onto the table and tried to eat it with their spoon, another tipped the sugar on to her meal. Only four out of nine people were given a cold drink with their meal. After the meal was finished, tea, with the milk already mixed in the pot, was poured into the cups containing sugar on people’s tables. People were not asked whether they wanted tea, if so whether they wanted milk, or if they would prefer for example coffee. A meal of pureed food was put onto the table in front of person A and left there without a word being spoken. Several minutes later a carer stopped assisting person B with their meal to go and start assisting person A. This carer then returned to person B, and eventually a different carer came to assist person A (about half an hour after the food was first put on her table, so it was probably cold). One person was given their pudding but was not given a spoon to eat it with. When the spoon was eventually brought to her, the carer fed her, but this person had been feeding herself earlier. One person’s pudding was chopped up, even though he said he did not want it chopped up. Airedale Nursing Home DS0000017660.V371039.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, 18 People who use this service experience good quality outcomes in this area. People know their concerns will be listened to and staff have received training in safeguarding vulnerable people to make sure that the people who live here are kept safe from harm. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The way in which people can raise a complaint if they want to is described in the service user guide. The manager keeps a folder for complaints but she has not received any. People we spoke with said they would be happy to speak to the manager, or one of the nurses if anything was not right. The manager said that some staff have undertaken the 2-part safeguarding course run by Bedfordshire County Council. One of the SOVA (Safeguarding of Vulnerable Adults) team held a safeguarding training session at the home because it was difficult to get places for staff on the courses run by Bedfordshire County Council. The manager told us that all staff have received this training. Airedale Nursing Home DS0000017660.V371039.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, 20, 21, 22, 24, 26 People who use this service experience good quality outcomes in this area. Airedale Nursing Home offers the people who live here a homely, comfortable, well decorated and exceptionally clean place to live. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager and owner showed us round the home when we arrived on the first day. The home is generally well decorated, comfortably furnished, very clean and smelt fresh throughout. We had arrived on a difficult day as a mobile kitchen had been moved into the car park that morning, and was being attached to the house. The owner explained that he had got planning permission to extend the home, attaching it to the house next door which he bought some time ago. This is going to Airedale Nursing Home DS0000017660.V371039.R01.S.doc Version 5.2 Page 21 involve demolishing the old kitchen, so the owners had spent a lot of money on providing a new kitchen which will last for the 9 to 12 months the extension will take to build. On the second day we visited, the new kitchen was fully operational and had been set up so well it looked as though it had always been part of the house. The manager said that although the extension will increase the number of people who can be accommodated at Airedale, it will mostly mean there are much better facilities. She said that once the extension is built a lot of work will be done on the existing building to bring it up to an even better standard. There are no baths in the home: all the bathrooms have been converted to shower rooms. We noted a bolt on the inside of one of the shower room/toilet doors, which could not be opened from the outside. We asked for this to be removed immediately and replaced with the correct lock. This had been done by the time we returned. We also noted that almost all the bedroom doors were held open, either with wedges or with pieces of furniture (see Management section of this report). Airedale Nursing Home DS0000017660.V371039.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, 30 People who use this service experience good quality outcomes in this area. Staff are caring and work hard and recruitment is satisfactory, but not all staff have received sufficient training to make sure they do their jobs in the best way possible. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager told us “we’ve got a fantastic team here – I’d trust my nurses with my life”. She said the home employs a high number of qualified nurses because of the commitment they show. In the AQAA, and in discussion, the manager told us that the home is accredited as a learning institution with Northampton University and the Bedford Hospital Trust so accepts student placements at the home as part of their nurse training. We looked at the documents which the home had in place before three of the staff started to work here. The majority of information required by the regulations to make sure people are suitable to work with vulnerable people Airedale Nursing Home DS0000017660.V371039.R01.S.doc Version 5.2 Page 23 was in place, for example Criminal Record Bureau (CRB) checks, and written references. One of the qualified nurses is responsible for staff training. She makes sure new staff have a proper induction, and makes sure all staff are up to date with their training. Each new member of staff has an induction session on their first day which covers fire, employment, health and safety, safeguarding, whistleblowing and so on. The person works alongside a qualified nurse for a week or two until they feel confident, and then starts their Skills for Care induction. This nurse has also qualified as a trainer, so delivers moving and handling training to all the staff. She told us she has completed a dementia care distance learning course. When we looked at the training records we found the home does not have a system to give an overview of whether staff are up to date with all the training they should have. From the records we noted that not all staff have had dementia care training, and the AQAA told us that only 7 staff have had training in infection control. External training courses, for example about motor neurone disease with Sue Ryder Care, are advertised on the notice board in the nurses’ office. In the AQAA the manager reported that only 2 staff have been awarded a National Vocational Qualification (NVQ) in care. She told us during the inspection that other staff are working towards the award, and when they have completed it, 50 of the care staff will have an NVQ. Airedale Nursing Home DS0000017660.V371039.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37, 38 People who use this service experience adequate quality outcomes in this area. Management of this home is not as good as it should be to make sure every person who lives here has the best possible quality of life. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager is a qualified nurse, and the owner is a doctor. The manager has also undertaken the Registered Manager Award (RMA). The results of this inspection were as disappointing to the manager as they were to us, as Airedale had always been a good home. Following our feedback, the manager Airedale Nursing Home DS0000017660.V371039.R01.S.doc Version 5.2 Page 25 agreed that it seems there has been a reduction in the quality of some areas of practice. The home’s quality assurance system includes asking people who live at the home and their families, staff and other professionals to complete a questionnaire. Comments are included in the Service User Guide. Meetings for relatives and residents are held. The last one was on 21/08/08 when the plans to extend the home were discussed, and people were asked if there were any other issues, which there were not. The home does not deal with anyone’s finances, and keeps a small amount of cash for one person only. Records of this were satisfactory. Any expenditure, such as hairdressing or newspapers, if people do not have the cash to pay for it themselves, is added to the bill sent to whoever deals with their finances. The manager does not supervise any of her staff. There is a system whereby the nurses supervise each other, and they supervise the staff. We discussed with the manager whether this can work, and how she can know what is going on in the home, and how she can ensure there is good practice going on, if she does not do any supervisions herself. Staff meetings are held every couple of months. We found that correcting fluid had been used on a number of records, including MAR charts, the CD record book, the staff rota, the care plans and so on. Correcting fluid must never be used on any official documents. On the first day we visited the home we found that almost all the bedroom doors, and some other doors, were held open with wedges or items of furniture. The manager told us this had always been acceptable to the fire officer, providing the wedges are removed at night. We advised the home that we would be contacting the fire service for advice, which we did the following day. The fire officer felt it would not be safe to have doors held open in this way. We contacted the person in charge of the home and told her what the fire officer had said, and that we were making an immediate requirement that fire doors must not be held open by any means other than one approved by the fire authority. The fire officer visited the home on 03/09/08 and found that all fire doors were closed. He confirmed that fire doors can only be held open by a device which will allow the door to shut if there is a fire. In his response, and in discussion during our second visit, the owner expressed his surprise as he said he had always been advised in the past that having the doors held open during the day was acceptable. He had already arranged for a company to fit a device to the doors which would hold the door open, but close if the fire alarm sounded. Regular fire drills are held. These are always held on the same day at the same time. The manager explained that as staff work a rolling rota, they Airedale Nursing Home DS0000017660.V371039.R01.S.doc Version 5.2 Page 26 would all eventually be involved in a drill. The maintenance person keeps a copy of the staff rota to make sure that all staff have attended a fire drill at least once a year. The home has a fire risk assessment in place: we did not look at this. The Environmental Health Officer had inspected the home in February 2008, and reported that “good food safety controls are in place”. Airedale Nursing Home DS0000017660.V371039.R01.S.doc Version 5.2 Page 27 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 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 X 3 3 X 4 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 2 X 2 X 3 2 2 2 Airedale Nursing Home DS0000017660.V371039.R01.S.doc Version 5.2 Page 28 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 Requirement Care plans must contain full details of the personal, social, emotional and healthcare needs of each of the people at the home, with detailed guidance for staff on the way each person’s needs are to be met. This is so that people receive the right care to meet their individual needs. This requirement is carried forward. There must always be a sufficient supply of people’s medication in stock, so that people get the medicines they have been prescribed. Staff must respect people’s privacy and dignity, for example by knocking on doors before entering, and by remembering this is each person’s home. This is so that each person is treated with the privacy, dignity and respect they have a right to. Timescale for action 31/12/08 2 OP9 13(2) 15/09/08 3 OP10 12(4)(a) 31/10/08 Airedale Nursing Home DS0000017660.V371039.R01.S.doc Version 5.2 Page 29 4 OP12 16(2)(m) and (n) The range of activities provided 30/11/08 must continue to improve so that each person is provided with activities that suit their preferences and capabilities. Mealtimes must be better for people who are dependent on assistance from others so that each meal time is a pleasant, satisfying occasion for everyone. Evidence must be available to show that all staff have received sufficient training in any topics related to the work they do, so that they are able to do their jobs properly. If the care plan requires records, for example bowel charts, food and fluid intake records and so on, to be kept, these must be accurate, so that there is a true picture of the person’s health. Correcting fluid must not be used in any records, so that the original entry can be seen and read. Fire doors must not be held open by anything other than a means approved by the fire authority, so that people who live at the home are as safe as possible in the event of a fire. We made an immediate requirement regarding this, on the day following the first day of this inspection. 31/10/08 5 OP15 16(2)(i) 6 OP30 18(1) 30/11/08 7 OP37 17 and schedule 3 15/09/08 8 OP37 17 15/09/08 9 OP38 23(4)(d) 02/09/08 Airedale Nursing Home DS0000017660.V371039.R01.S.doc Version 5.2 Page 30 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 Refer to Standard OP21 Good Practice Recommendations At least one bath, plus any equipment needed to assist people to use it, should be provided so that people living at Airedale who prefer a bath are able to have one. Airedale Nursing Home DS0000017660.V371039.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Airedale Nursing Home DS0000017660.V371039.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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