Inspection on 15/11/05 for Arncliffe Court Nursing Home

This inspection was carried out on 15th November 2005.

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

Arncliffe Court Nursing Home 07/09/09

Arncliffe Court Nursing Home 06/07/07

Arncliffe Court Nursing Home 13/03/07

Arncliffe Court Nursing Home 31/05/06

Arncliffe Court Nursing Home 24/05/05

Arncliffe Court Nursing Home 08/11/04

Arncliffe Court Nursing Home 24/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Arncliffe Court Nursing Home 147b Arncliffe Road Halewood Liverpool Merseyside L25 9QF Lead Inspector Mrs Joanne Revie Unannounced Inspection 15th November 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 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. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Arncliffe Court Nursing Home Address 147b Arncliffe Road Halewood Liverpool Merseyside L25 9QF 0151 486 6628 0151 448 1934 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) BUPA Care Homes (CFH Care) Limited No. 2741070 Mrs Joanne Farrell Care Home 150 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (114), of places Terminally ill over 65 years of age (6) Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service Users to include up to 84 OP and up to 30 OP (PC) in Childwall House and up to 30 DE(E) and up to 6 TI(E) That the flexible staffing matrix be used as a guideline for minimum staffing levels only, and that staffing levels are fluctuated to reflect the service users needs and not just occupancy levels. The service shall accommodate one named service user out of category; this variation to cease once this named individual either reaches age 65 or leaves the home. That a variation exist for 1 named service user on Childwall House, this to cease following his departure or once he reaches his 65th birthday. That a variation exists for one named service user for Garston House only 25/05/05 4. 5. Date of last inspection Brief Description of the Service: Arncliffe Court is registered to provide care for 150 individuals. The Home is situated in Halewood, Knowsley, Merseyside. It is on a housing estate close to all local amenities and has good links with public transport. Local shops can be accessed easily; a main shopping area can be reached by bus or car. Arncliffe Court is divided into five units all of which are physically separate and operate on an individual basis. Each unit has access to a secure courtyard garden and all the units are situated in landscaped grounds. The Units all have names and vary in function: Gateacre House: Nursing care for Older People with Mental Health needs, Speke House: Nursing care for older people Childwall House: Residential care (personal care only) for Older people Garston House: Nursing care for older people and palliative care for those who have been diagnosed as terminally ill. Woolton House: nursing care for older people There is a smoking policy in operation across the site and residents who wish to smoke can do so in designated areas. A site manager is responsible for the management of the home with each unit being managed by a unit manager. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was unannounced. Six inspectors assessed the units simultaneously. Woolton House was not assessed as it was closed for refurbishment. Joanne Revie and Pat Carragher assessed Gateacre House Lorraine Farrar assessed Childwall House. Natalie Charnley assessed Garston House Lynn Paterson assessed Speke House. During the visit discussions were held with residents and staff as follows: Childwall House: two members of staff, five residents, a relative and a visiting healthcare professional. Garston House: 3 staff, 3 relatives, 1 activity co coordinator, 8 residents Gateacre House: 3 relatives, and 3 staff Speke House: 16 residents, 2 representatives of residents, five staff members and the nurse in charge. Their views have been reflected within the report A variety of documentation was viewed during the visit, which is referred to in the evidence section of the report Not all national minimum standards were assessed during this visit. For a full overview of the service this report should be read with the unannounced inspection report for May 2005. What the service does well: Childwall House Staff on the unit communicate well with each other and use their recording system well. This means that residents healthcare needs are identified and dealt with quickly and that when a residents needs change a reassessment is arranged. Care plans on the unit are all clear and easy to follow, they are generally kept up to date by staff and reviewed and changed if needed on a regular basis. Resident’s visitors are welcomed and relatives are involved in planning the residents’ care. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 6 The overall appearance of the unit is comfortable and welcoming with seating arranged in groups and residents supported to watch TV, take part in activities or chat as they choose. Bedrooms are comfortable and provide a space for residents to have privacy and lock their personal possessions away if they choose. Staff have good relationships with residents and spend time talking with them. There are activities arranged on the unit throughout the week. Speke House Staff interact well with the residents and display clear knowledge and understanding of the residents individual needs. Care plans and assessment documentation appeared clear and well managed and held full information of how care practices had been agreed and how they would be carried out. This means that staff have clear written instructions available on how to care for a resident according to their needs. Garston House Where ever possible staff try to gain full information about a residents needs before they are admitted to the unit. This means that staff can plan for their care and reduce the risk of a resident living in an environment that does not meet their needs. Following admission a care plan is developed which is reviewed and if necessary updated monthly. This helps to ensure that staff have up to date information to follow. During the visit residents and relatives confirmed that they could visit when they choose and are made to feel welcome. Residents are happy with their bedrooms and believe that the domestic staff work hard to keep their bedrooms clean for them. Gateacre House Trusting relationships have been developed between staff and relatives. Relatives stated that they believe that their loved ones are in safe hands. Positive comments were made about the unit manager who a relative described as “ very nice” and “ tries to resolve issues”. It was evident that some of the longstanding care staff had also developed close relationships with some relatives. Care plans are clear and easy to follow. Efforts have been made to make these individual to the resident. This is important, as some of the residents no longer communicate effectively so staff need clear written guidelines to follow. What has improved since the last inspection? Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 7 Since the last visit the home manager has attempted to promote activities by informing each house of how much money is available in their individual activity budgets. This is done on a monthly basis so that staff can arrange forthcoming activities. Childwall House Since the last inspection the kitchen area on the unit has been updated with new tiles and a new fridge providing a cleaner area for food preparation. Systems on the unit for getting rid of waste, which could be infectious, have improved. A risk assessment has been carried out on the courtyard area and steps taken to warn people of any dangers. There are plans in place to re-lay the flags in this area. This makes the environment safer for everyone. Documents and records on the unit are well organised and kept up to date. Speke House and Garston House Improvements were not noted in the areas inspected during this visit. However staff on Garston Unit did comment that the extra member of staff who was provided when the unit was full made a big difference to their workload. However as occupancy levels have fallen staffing levels have been reduced. Gateacre House Relatives are invited to attend reviews of their loved ones care. This is important as it helps relatives to feel included and gives them the opportunity to discuss what the resident was like, how they lived etc before they needed support and care. This is important, as some residents can no longer express their views. Since the last inspection two days trips out have occurred which were enjoyed by residents and staff. This helps residents to stay in touch with the outside world. The entrance corridor to the unit has been painted and efforts have been made to make this more stimulating for the residents by adding pictures and tactile objects. Links have been made with a dentist and an optician who both visit the unit to carry out dental care and sight tests. All staff that work on the unit permanently have completed a self-learning pack on dementia awareness. This means that they should have a greater insight into the residents needs. A registered general nurse has been employed to work alongside the mental health nurses. A relative commented positively on this by stating that it meant that somebody with medical knowledge of physical needs was available. This is Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 8 important as many of the residents are aging and are developing physical needs, which at times outweigh their mental health needs. This staff member commented that everybody had been supportive and welcomed him to the unit. What they could do better: What the home could do better. Childwall House Staff need to make sure that the resident agrees to them discussing their care plan with their relatives before doing so. This is a concern as it was identified during the last inspection also. Staff stated that it had been addressed but this fact had not been recorded on the plan of care. All care plans should now be reviewed and this information added were needed. Staff also need to make sure that where a resident has a pressure sore there is a written care plan in place stating how they are providing care for that person. This will help to make sure that all staff know exactly the care needed to promote healing and that nothing is missed. Mealtimes on the unit need to be more organised so that residents can eat their meal in peace. The unit must review their system at meal times to ensure residents are provided with privacy and time to enjoy their meal. Staff should also consider assigning staff to tables so that resident’s needs are met in a manner, which respects their choices and is timely. Training should be given to staff around the importance of offering choice and treating residents in a respectful manner when supporting them to eat. Staffing levels and management of staff time needs to be reviewed so that staff are less busy at key times and can provide help to residents with personal care when residents would like it rather than staff taking the lead. This must also include reviewing staff support available at mealtimes. Although activities are provided on the unit the residents had mixed comments about the frequency and suitability. Meetings must be held with residents either individually or as a group to ensure that residents have input into what goes on and is on offer. The lounge could be improved further by either deep cleaning or replacing the lounge carpet. This must be addressed as it spoilt the overall comfort of this area. It was explained that the unit have applied for funding to ensure doors are fitted to the conservatory so that cigarette smoke does not pervade all areas of the communal lounge. This should be followed through to make the area pleasant and to promote the residents health. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 9 In bathroom 32 there was a bath chair over the bath, staff explained that this had not worked for some time and the bath could not be used. The home must arrange for this to be repaired to ensure residents have the equipment they need and that residents can access a sufficient number of bathrooms. Speke House Although staff have worked hard to develop care plans, wound care records viewed were inconsistent. No evidence could be found that other health care professionals (Tissue viability nurse, G.P etc) had been contacted for advice. No evidence could be found of who had prescribed dressings, or when and why. Staff were not photographing or measuring wounds to show improvement or deterioration. This issue had been identified on this unit in the past and during previous inspections it was seen that staff had addressed these concerns and were following good practise. It is matter of concern that the standards have slipped again and this must be rectified without delay. Although staff were able to interact well with residents and carry out their caring role with sensitivity, they demonstrated in discussion that they were poorly motivated and felt let down by their colleagues. Comments from staff indicated that day and night staff were not compatible and that this had badly affected staff moral. Staff said that they did not feel that communication systems were as effective as they could be between management and staff and felt that this in itself created uncertainty and unrest. Management must arrange for staff meetings and other forms of discussions to take place to ensure that staff feel valued and empowered by BUPA Care as these issues could impact on residents care. A recommendation from the previous inspection was that the home should arrange more activity and interest for the residents, however it was noted that this has not been addressed and residents and their representatives advised that there are very few activities arranged. Staff advised that the home had employed an activities co-ordinator specifically for Speke Unit however she was off on long-term absence and her role had not yet been covered. Activities must be arranged to suit the resident’s interests, choices and capabilities without further delay. Residents commented that food was not very good and that they were not offered choices of meals. Food was seen being provided to residents during the visit, which appeared bland and unappetising, and residents confirmed that they did not like what they were being given. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 10 Menus must include choice and should be devised in consultation with the residents and their representatives to make sure that the food provided is good, wholesome, and appetising and suits the individual tastes of the residents. Garston House Although Staff have access to information about residents general needs, information about specific illnesses is not always available. Care plan records must be updated to include all the residents’ needs so that staff have clear direction about all the care and support required by each resident. It was identified that changes in a residents mental health needs had not been acted on despite a request being made by the resident’s social worker. This must be addressed to ensure the resident receives the correct support and care. Although medications were not fully inspected during the visit, staff were observed administering tablets that had been prescribed for morning time. It was noted that the nurse left the trolley open in the lounge and walked away leaving the trolley unattended. This poses a serious risk to the safety of the residents. It was a concern that these tablets were still being administered at 11:30 am. A resident was seen to be receiving oxygen therapy in her bedroom. No warning sign was in place to alert staff and visitors of its presence. This poses a further risk to the resident’s safety, as oxygen is highly combustable. It is a matter of serious concern that following the issuing of an enforcement notice the service made great progress in the management of medications, however these incidents would suggest that standards have slipped. These matters must be addressed without delay. Staff have varying standards on completion of written records. Staff were not renewing forms when they ran out and were documenting progress on the back of forms and on scraps of paper. Staff should be made aware of the need to keep professional, clearly written documentation. One resident was found to have an incomplete risk assessment and staff were not photographing progress of all wounds. Staff need to recognise the importance of identifying and reducing risk to promote the residents safety. Photographs of progress of all wounds should be taken and kept as a matter of good practise. During discussions staff and residents said that they felt the activities and social stimulation provided on the unit was poor. One resident stated that “I wish I could just be helped to have a simple stroll out” another stated,” We don’t do much, just sit and watch T.V”. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 11 An activities programme was displayed on the unit but this would be very difficult for anyone who had failing eyesight to read as it had been produced in small print. The provision of activities on the unit must be explored further. Resident’s must be included in consultations and once decisions have been reached activities must be displayed in larger print so all are aware of their existence. This will help residents to feel in charge of their own lives and to enable them to make choices about how they would like to spend their time. Staff and residents also raised concerns about the food provided. A resident stated,” Food here is basic and I would love to have some homemade foods that were not processed.” These comments should be explored. Concerns were noted about the environment. Some bedrooms were being used to store furniture that was no longer required. Unpleasant smells were evident in some areas visited and despite some residents saying they were happy some areas were not as clean as they could be. It was also noted that some call bells were not working which meant residents had no way of summoning help. These concerns must be addressed to ensure that residents live in a clean, comfortable and well-maintained home. A relative also commented that his loved one had been refused a bath recently due to a lack of hot water and baths were offered infrequently as the resident concerned needed to use specialised nursing equipment. These comments should be explored and rectified. All staff, relatives and residents expressed concerns about the staffing levels on the unit. One resident confided that despite ringing the call bell for fortyfive minutes his call went unanswered. Another commented” they are short staffed mainly during the day. It is very hard for them to manage”. Staff expressed concerns over “ borrowing” staff from other units as that impacted on other staffing levels across site. It became evident that a higher than expected amount of agency staff were being used to fill shortfalls. This is a concern, as residents should be receiving care from a consistent staff team so that relationships can develop. These comments must be explored and addressed. More residents than staff provided require individual support to eat their meals. This poses a problem to both residents and staff and also needs to be addressed. A concern was identified regarding Health and Safety practise. A cupboard, which was used to store substances, which could be hazardous to health, was found to be unlocked, making them easily accessible to residents. Staff must be reminded of the importance of keeping cleaning liquids locked away. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 12 A discussion took place around a request made by a relative, which could severely impact on a resident’s care and support. The legalities of this request must be explored and staff offered guidance. Gateacre House Serious concerns were identified during the visit around the health and personal care of the residents, lack of dignity, Daily life and Social activities, the environment, and some staff practises. All of these were discussed with the home manager and Operations manager at the time of the visit. A requirement was made that an urgent action plan be produced to rectify these concerns. This was complied with and for this reason requirements have not been issued for the following concerns: Although the majority of residents had had their needs assessed, one relative was concerned that this had not happened for her loved one due to a language barrier. If assessments aren’t carried out there is a possibility that residents may receive the wrong care. Staff needed to update themselves on current nursing practise and refrain from “ nursing” residents in bed just because they are becoming older. This form of care can accelerate the aging process and can exacerbate boredom and frustration. Although care plans were well written staff were not acting on the instructions or findings of assessments. Examples of this included assessing a resident as having a high risk of developing pressure sores but not providing a specialised mattress to reduce the risk of sores occurring. Another example was placing a futon mattress on the floor for a resident who was at risk of falls but placing it in such a way that injury could occur from the skirting board. One resident had sustained injuries to her legs. Staff had recorded that the wound appeared infected but had not taken any action to address this. Activities are occurring infrequently and time is not allocated to those residents who can no longer join in group activities. Although residents have been out on day trips during the summer some relatives would like residents to be taken out individually, particularly those who cannot join in group outings. Presentation of food was very poor. Residents did not receive adequate or have appropriate equipment to eat their meal in a dignified manner. Staff seemed to have forgotten the importance of offering choice by making statements such as” choice isn’t a problem here, they eat everything we give them”. Some residents were seen to be wearing clothing that was stained with food and drink. Promotion of dignity is essential to help maintain a persons self esteem. Staff were unaware of the importance of creating a calm atmosphere to enable the residents to eat in a relaxed manner. Mealtimes are an important part of Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 13 any person’s life. Dementia can cause changes in appetite therefore it is important that mealtimes are a pleasant experience. Staff have undertaken training on the safe moving and handling of people. However two staff were observed transferring a resident unsafely and in an undignified manner. The entrance corridor to the unit smelt unpleasant. Chairs in the lounge were dirty and also smelt unpleasant. Standards of cleanliness in some bedrooms were poor. Several commodes were dirty. The lounge has a dining area for mealtimes. Only seven dining chairs were available which is not adequate to meet the needs of the residents. Although dining furniture had been ordered, action should have been taken before the number of chairs became so few. Little effort had been made to make the bedrooms (of those residents who don’t have visitors) inviting. Bedding was thin and worn and didn’t match. Some had torn curtains that required replacing and bedroom furniture was mismatched. Concerns were also raised about bathroom and toilet facilities on the unit. One bathroom was being used to store continence products and other equipment, and another was not in use. One toilet had no lid and was cracked; another had no lid and no lock for privacy. It is important that these areas are addressed so that residents have access to comfortable clean facilities and are offered the opportunity for privacy. A window restrictor was missing which meant that the window could be fully opened. This posed a risk to the resident’s safety, as the unit is ground level only. Senior management have committed to carrying out staff appraisals and implementing training were shortfalls are identified. This should ensure staff have a better understanding of caring and supporting residents with dementia. The registered persons for the home must ensure that the action plan that was developed to address the above concerns is implemented and that regular monitoring (at least monthly) of the unit is undertaken to ensure standards don’t decline further. Generally medicines are managed well on the unit however some concerns were noted regarding the storage of prescribed eye drops. Many eyes drops have a shelf life of 28 days therefore it is vital that once a bottle is used the opening date is recorded so that the timescale can be monitored. This had not been done. Eye drops were stored in the fridge. No manufacturers instructions existed stating that this should be the case. This must be explored. Although the unit was found to have adequate staffing levels residents regularly receive care from different staff. It is important that a resident with memory difficulties receives care from staff that they know to prevent further confusion and distress. Reasons why there is a movement in staff must be explored and staff team consistency promoted. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 14 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. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 15 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 Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 for Childwall, Speke and Gateacre House and 4 for Garston House. Childwall House The unit carries out assessments to make sure they can meet the person’s needs prior to offering them a placement. Where an existing residents needs change the unit arranges for a re-assessment to make sure they are still able to meet the person care and support needs. Speke Pre-admission assessments are carried out by staff that are trained to do so to make sure that the home can meet the assessed needs of all residents in their care. Garston Staff have access to information about residents general needs, but information about specific illnesses is not always available. Staff do not always respond to changes in residents health conditions. Gateacre The unit tries to ensure that most residents receive a full assessment prior to admission. Relatives believe staff are quick to react to residents changing needs, however although staff react, the care delivered is not always appropriate. EVIDENCE: Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 17 Childwall House Two of the staff on the unit explained that before a new resident is accepted, either the unit manager or the homes deputy manager meet with the person and carry out an assessment to make sure the unit can meet their needs. A care plan read for a resident admitted recently contained an assessment carried out by the unit manager. This had been completed with regard to the person’s medication and medical history, other parts relating to their social history and likes and dislikes were not completed. However the activity coordinator explained that once a new resident has settled in she carries out a life biography and activity profile to assess the person’s leisure needs and choices and a copy of this was seen. Letters and daily records also showed that where the persons needs have changed the unit refers them to the Social Worker to be reassessed. Garston House Not all care plans reviewed contained details of pre admission assessments, however some of these plans were from residents who had lived at the home for some time. Those with pre admission assessments in place had plenty of information available for staff to base a second assessment and care plan on. One resident living on the unit had been diagnosed with mental health needs. However it was not demonstrated in the care plan what the exact illness is. Staff appeared under the impression that a specific diagnosis had been reached but this was not recorded. The care notes clearly demonstrated that the resident has had deterioration in mental health over recent months and staff have found that the resident is hiding his medication and sleeping in his chair due to fears related to the mental health condition. The resident only appears to have one nursing need at present and his mental health currently outweighs this. Social service reviews show that they have asked that the home seek advice from psychiatric nurses and doctors, however there is no record of this being done. Speke House Assessment documentation was viewed which was clear and detailed. It showed that a qualified nurse (usually the home manager) had undertaken assessments and identified the resident’s needs and how the unit would meet those needs. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 18 Gateacre House Three care plans were viewed which contained assessment documentation. The unit manager confirmed that he is involved in the assessment of all new residents. Residents have their mental health needs assessed as well as physical needs using a specialised tool. The assessments viewed were found to be clear and detailed. A relative confirmed that they had received written information prior to their relatives move to the unit. Another relative stated that she believed that staff were quick to respond to changes in her loved ones needs. Two residents were being nursed in bed on the day of the visit. It was suggested by the unit manager that this was due to the resident becoming frail. Staff believe that they are acting with kindness by doing this and did not recognise that this practise is outdated. A discussion took place with another relative who stated that her relative’s needs had not been fully assessed which she believed was due to a language barrier. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 (Childwall, Speke, and Garston.) 9 Garston, Gateacre, 10 Gateacre Childwall House Staff have a good understanding of residents health and personal care needs and communicate well with each other to make sure these are identified and met. There are individual care plans for all residents, which are generally kept up to date. Not all identified healthcare needs are recorded on a current care plan. Speke House Care plans are drawn up in partnership with residents and their representatives and hold clear details of what care is necessary to meet assessed social and personal care needs. Wound care records are not consistent and staff are not requesting specialist help to promote healing. Garston House Medicines are not administered safely on the unit. Each resident has a care plan of a good standard. However residents are not always aware of the existence of these plans. The recording of records is not consistent and staff do not have access to all the necessary policies to enable them to provide care. Gateacre House Each resident has a care plan, which is detailed and reviewed monthly with input from relatives as required. This is based on health needs. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 20 Staff don’t always give care as it is written in the care plan. Medicines are generally managed safely on the unit. Resident’s dignity is not respected. EVIDENCE: Childwall Individual care plans are in place for all of the people living on the unit. Three of these were read during the inspection. Completed care plans were in place for most areas where it was identified that the person needs support. This included, hygiene, nutrition and mobility. Up to date assessments and risk assessments were in place for pressure sore areas, nutrition, manual handling and falls. A requirement was given at the last inspection that the unit must wherever possible, get the residents permission before discussing their care plan with their relatives. A member of staff said that this had been done however it was not recorded on the files. Staff spoken with said that they were aware of the parts of residents care plans that they were involved with and a Senior member of staff explained that she had had training in recording and writing care plans. A resident spoken with explained that her Social Worker is in regular contact with her and that her care plan is discussed and reviewed during these visits. One resident had a pressure sore, which was being treated by the District Nurse team. Notes in the home showed that the staff are clear about health care needs and follow up on any issues identified. A health care professional spoken with said that staff contact them appropriately to obtain advice and help and described them as “on the ball”. However although daily records evidenced that the pressure sore was being monitored and dealt with and staff were clear about the care and equipment provided there was no written care plan in place for staff to follow. A senior member of staff spoken with had training in, first aid, recording in health charts and continence, she further explained that if healthcare advice is needed staff contact the manager or deputy manager. One resident was concerned regarding the support she needs with her mobility. Although she has been waiting for this for some time, she explained and staff confirmed that advice was now being obtained. Another resident explained that staff do help with personal care but she is not able to have a bath as often as she would like and “kept asking,” she explained that she had one “booked” for later in the afternoon. The resident’s key worker reviews care plans monthly and one plan evidenced that a review had taken place with the resident and their relative. A visitor spoken with explained that she is able to visit when she wants to and that staff are always welcoming. Residents spoken with also confirmed this. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 21 Garston Whilst medication was not inspected in full during this visit, the inspector witnessed the trained nurse leaving the trolley and medications unattended in the lounge; this was raised with the deputy manager who was on the unit at the time. One resident was in their bedroom and was seen to be using oxygen. However no oxygen warning sign was on the bedroom door. No other records relating to medication were looked at. The morning medication round was still going on at 11.30am on the day of the inspection. A selection of care plans were sampled. These were generally of a good standard and were detailed as to what needs a resident has and how staff are to attend to that need. Plans were being reviewed monthly along with risk assessments. Some plans showed that there were implications of MRSA. However staff were not sure if this information was accurate or not. Residents spoken to were not aware that they had a care plan and had not been involved in developing this plan. Some plans showed that relatives had been invited to attend the home to discuss the care of their relative. Wound care on the unit showed that the home had been involving a specialist nurse. Only some residents had photographs taken of wounds. Staff were not renewing forms when they ran out and were documenting notes on scraps of paper and on the back of forms. One resident was found to have blank risk assessment forms; those that were partially completed had not been signed or dated. Other risk assessments were found to have differing information on them. Staff had observed one resident as having a large bruise on their right wrist which was 10cm x10cm x 5cm. Very little detail was in the care plan or daily notes as to how this bruise had developed and what care was being put in place to monitor the situation. The unit had a policy available on ‘care of the dying resident’, which refers staff to other associated policies. These policies were not available. There was no policy available on the use of subcutaneous fluids. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 22 Speke One resident on the unit had a wound. Wound records were not clear and no photographs were being taken. No evidence was recorded that the unit have involved a tissue viability nurse. Documentation was unclear as to who had prescribed the dressings that were being used and no records were available showing that the GP had been involved in the care of the sore. Other areas of the plans viewed were found to be clear with detailed instructions on how to care for the resident. Care plans held details of health, care needs and health care access to include continence management, dental, optical, chiropody, audio, and weight issues. Health care appointments and outcomes were also recorded on file. The plans showed evidence that they had been complied in partnership with resident/residents representative and other professionals. Risk assessments were viewed which were found to be detailed. Hobbies, interests, choices and preferences of the residents had been recorded. Any necessary restraint methods were detailed and signatures had been obtained to show that discussions had taken place and permission had been given for these methods to be utilised. Gateacre Three care plans were viewed. The plans have been developed since the last inspection. They were found to be detailed regarding the residents health needs and contained risk assessments regarding nutrition, pressure sores and falls. The plans were reviewed monthly and all had input from relatives. The unit manager confirmed that relatives are involved in care plan reviews wherever possible. One resident had been identified as being of a particularly high risk for the development of pressure sores. This resident’s bedroom was viewed. No specialised mattress was in place. Pressure area care had not been identified as a need on the residents care plan. Another plan viewed specified that a resident had sustained wounds to her legs, which staff had observed had become infected. No action had been taken. A new member of staff confirmed that he read the plans and was receiving instruction from the unit manager on how to use them. The plans also contain dependency charts and mental health assessments, which are also updated monthly. Daily records were written by a variety of staff members however all care plans viewed were written by the unit manager. A relative confirmed that the reviews are useful and that the unit manager is helpful. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 23 Each resident has a keyworker who will act as a link person. Keyworker records were viewed which only gave details of care tasks undertaken. The unit manager confirmed he was aware of this and was trying to encourage staff to concentrate on other aspects of the resident’s care/ life. Records have been included to document activities, which the resident may enjoy. Those viewed were not completed appropriately. One plan stated for activities “ nil due to dementia”. Burial wishes or wishes surrounding dying were not recorded on any of the plans viewed. All three plans contained records, which showed input from other health care professionals such as Dieticians, Doctors, chiropodist etc. Since the last inspection the unit manager has accessed an optician and a dentist who will visit the unit. Wound care records were in place for one resident. These were found to be clear and gave a good overview of progress of healing and care required. Advice had been sought from the Tissue viability nurse. Medication storage (treatment room, trolley, cupboards and fridge) were viewed. These were tidy with minimal stock being held by the unit. Two bottles of eye drops were viewed which had not had the opening date recorded on them. Eye drops were found to be stored in the fridge with no written directions advising this type of storage. Staff have access to the British National Formulae to check side affects etc of medications but the issue available was dated 2002. A quantity of controlled medication, which was no longer required, was being stored. The unit manager and the home manager confirmed that they were awaiting the delivery of specialised kits so that these medicines could be disposed of safely. During a tour of the environment a tablet was found on a bedroom floor. Staff were observed during the visit giving care and providing support to the residents. One resident was approached with a bowl of food with no prior discussion regarding choice or the support about to be offered. The staff member did not speak until the food was offered to the residents’ mouth on a spoon. One resident was viewed at 11:30 am to be wearing clothing that was stained with food and drink. A relative confirmed this to be true. Two staff were observed transferring a resident by the back of her trousers from an armchair to a wheelchair. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 24 Two staff were observed when supporting residents with meals to be chatting to each other with no inclusion of the resident. A senior member of staff was overheard chastising one of the staff members involved for this. One resident who only had the use of one hand was observed attempting to eat a fish cake as a whole as this had not been cut up for her Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 25 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15 Childwall Although activities are provided some residents are dissatisfied with the amount offered. Visitors are welcomed to the unit and able to visit at reasonable times. A choice of meals is offered daily but residents find the quality of these variable. Mealtimes on the unit are busy and noisy with residents being served on an ad-hoc basis. Speke Activities are not arranged to meet the interests and to match the capacity of the resident’s .The menu does not offer choice of meals and the food presented is not to the taste of the current residents of the unit. Garston Residents are not satisfied with the provision of activities. Insufficient resources prevent residents receiving support to go out. Visitors are made to feel welcome on the unit. Staff and residents are unhappy with the provision of meals. Gateacre Group activities seldom occur on the unit. Little time is given to individual activities. Staff have made efforts to support residents on day trips out in recent months. Visitors are free to visit when they choose. Presentation of food is poor and staff do not to have the skills or understanding on how to support residents when eating, in a dignified and comfortable manner. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 26 EVIDENCE: Childwall One resident explained that there is entertainment on the unit but said that this was “once in a while” and included bingo and games. Another resident said that there was “nothing” and she would like to go out more. There is an activity co-ordinator who works on the unit 5 half days a week. She explained and records confirmed that activities are arranged and include, films, site bingo, pamper days, discussion and reminiscence cards. Good practice was seen in that the activity co-ordinator also spends time talking 1-1 with people and will make sure that residents who don’t enjoy organised activities have time spent with them and get the opportunity to do things they enjoy such as watching the football etc. Activities that had taken place in November included, Halloween theme day, crossword, sweet trolley, videos, site bingo and quizzes. A member of staff explained that mealtimes are “busy” another, explained that there is a choice of meals and the kitchen will talk with residents if they are not happy with the food and offer alternatives. All of the residents spoken with had mixed views of the standard of the meals provided explaining some were nice “I enjoy the Sunday dinner” and others “not very good”. Good practice was noted in that the chef visited the unit and discussed meals with one resident who said she felt happier after this. Meals are served in the units dining area; they are prepared in the main kitchen and brought to the unit in a heated trolley before being served by staff. Each day residents are given the option to choose their meal for the following day; there are always two main options and several standard options including sandwiches, jacket potatoes and omelettes. Tables were prepared before the meal and looked inviting with nice cloths, crockery and drinks. However the mealtime itself was noisy and disorganised. Staff held conversations with each other and washed up noisily in the small kitchen area. The laundry staff arrived with laundry and the hairdresser was in the dining area talking with staff. The hallway was vacuumed and medication was given out. One resident who could not help herself did not get a drink until the end of the meal, another resident got her drink earlier because one of the resident’s she sat with poured this for her. A member of staff was seen to hand a bowl of soup to a resident who asked for a smaller portion, she agreed to this and later brought a smaller bowl. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 27 However she handed the first bowl to another resident who also requested a smaller portion, the member of staff stated “that’s small” and placed it in front of her without acting on her request. Garston Staff and residents felt that activities and social support was poor on the unit. The unit has an activity co coordinator who visits between 10.30- 3.00 over 4 days. One resident stated, “ I wish I could just be helped to have a simple stroll out” another stated “we don’t do much, just sit and watch TV”. Staff stated that the mini bus only takes 2 static wheelchairs and residents that do want to go out have to go on a waiting list. One resident did confirm that she had been out on a trip to Southport. Staff felt unable to do activities on the unit due to staffing problems. The weekly activities were listed on the notice board outside the office and at the front door, however this was in very small print and not very noticeable. Records are kept for residents who joined in activities but this only showed basic records of ‘sweet trolley’, ‘dominos’ or ‘bingo’. Residents and visitors confirmed they were able to visit the unit at any time. Residents on the unit are asked the night before what they want to eat the following day. Residents felt food was always hot but lacked variety and fresh produce. One resident said, “ food here is basic and I would love to have some homemade foods that were not processed”. Staff expressed concerns that residents who had liquidised diets were only getting mashed potato and soup for most meals and that meals were not nutritionally balanced. They stated that on the unit 3 residents have blended foods and a further 4 needed support with eating. This was causing problems, as there were insufficient staff on duty to provide this support. The unit was found to need further supplies of jugs, glasses and plate covers. Resident’s aprons also need replacing as Velcro straps had worn off. Staff also stated that they felt that the size of the dinner plates was poor as they are only slightly bigger than a side plate, residents agreed with this. Speke Activities on the unit appeared non -existent and staff advised that the activities co-ordinator was on long-term sick leave and as a consequence activities were not arranged. Residents spoken with said that they were sometimes asked if they would like to go to other units to play bingo and have a sing a long but this was not a frequent occurrence. The highlight of the day appeared to be the sighting of the sweet trolley. Case files held details of contacts, which included visits from friends, and family, telephone calls both made and received and community visits. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 28 The visiting policy was one of general open visiting and residents representatives spoken with during the inspection said that they were encouraged to visit and were treated well at all times. Records showed that the local church representatives visited once or twice each week to administer religious blessing, conduct prayers or sing hymns. Residents and their representative said that the food was poor, choices were limited and the food presentation was not good. The food presented at the time of the inspection was provided via a hot food trolley and was a mixture of chips, fish cakes, soup and sandwiches, none of which appeared appealing. Residents confirmed that they were not impressed with the food supplied at this lunch- time meal. Residents said that they were not given choices of menu and comments included “the food has deteriorated since I came here”, “the food was alright at one time but its not good now”, “standards have gone down since BUPA took over”. Gateacre Information available regarding activities on the unit was limited. A member of staff confirmed that activities rarely occur. An activities board is displayed on the unit but it was blank. The unit manager stated that the activities staff try but it is difficult due to the residents mental health needs. He contacted the activities coordinators who confirmed that they do not keep records of activities undertaken on the unit. Two residents were being nursed in bed. One resident stated she was bored. Both residents had radios in their bedrooms, which were playing pop music. Neither residents care plan informed the reader of which type of music they preferred. During a tour of the environment it was noted that no newspapers or magazines were available in the lounge area. A white board had the words “Tuesday” and “November” written on it but nothing else. Since the last inspection the residents have gone out on two day trips, which is an improvement. However a relative commented it would be nice if staff were available to take her loved one out in a wheelchair. Another relative confirmed that her loved one could no longer take part in group activities as she seldom recognised what was going on around her. However the comment was also made that “ it would be nice if someone could give her some one to one time” The lunchtime meal was observed. Residents were offered torn up sandwiches with soup poured over the top or fishcakes with beans on top. All of which was served in bowls. The food served did not look appealing and was not presented in an attractive manner. Seven residents sat at dining tables, which were not set with tablecloths or condiments. Each was wearing a disposable plastic nursing apron. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 29 No other dining chairs were available for seating. When discussed with the unit manager the response was “the residents have torn them so we have thrown them out” and “the residents have dementia”. Dining chairs have been ordered so that all residents can sit at the tables in future. The unit and home manager confirmed this. Staff were not seen to offer choice to the residents. When questioned a staff member said “ that’s not a problem on this unit, they eat what we give them”. Staff did not interact with the residents (as detailed in the evidence section of standard 8) or with each other. Therefore the mealtime appeared disorganised. Some residents struggled to eat independently due to food not being cut up or by trying to use cutlery, which was not appropriate to their needs. One resident struggled to keep their bowl of food still as they attempted to eat. Some residents were observed to be sitting inappropriately and were being assisted by staff to eat while in a reclining position or attempting to eat food from a table that was too low to meet their needs. One resident was asleep in the lounge on arrival to the unit (9:45 am) slept through lunch and was still asleep when the unit was left during mid afternoon. Staff were not observed approaching her to offer diet or fluids. Menus viewed did not reflect a choice of food from overseas. A relative confirmed this to be true. All relatives spoken with thought the food provided was okay as the menu looked nice, however all disclosed that they didn’t usually visit at mealtimes. Many interruptions occurred throughout the meal such as the telephone ringing which is set up so that the call bell can be heard all over the unit. Cleaning and hoovering was being carried out in the adjacent corridor. Staff were shouting from the food trolley to where the residents were sitting, asking if they had enough to eat. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No standards were assessed from this section on this occasion EVIDENCE: Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 31 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,24,26 Childwall, 19,26 Garston, 19 Speke, 19,21,24,26 Gateacre Childwall The unit is well presented with residents able to have privacy in their rooms. Communal areas are arranged so that residents can take part in different activities as they choose. There are sufficient bathrooms within the unit however not all of these were working. The lounge carpet is not as clean as it could be. Speke Residents live in safe and well-maintained environment. Garston Some bedrooms have unpleasant smells and some are not used for their stated purpose. Sufficient bathrooms exist but not all are in working order. Residents cannot summon staff when they wish due to faulty call bells. The unit is not as safe as it could be. Gateacre Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 32 The unit is reasonably decorated. The unit does not have sufficient furniture to meet the resident’s needs. Bedrooms, bedding and furniture are of a poor standard. The standard of cleanliness is not acceptable. EVIDENCE: Childwall A tour was undertaken of the environment. The unit has a large lounge / dining room with an open conservatory. At the time of the inspection smoking was permitted in the conservatory. Staff and the manager explained that there are plans for doors to be fitted to the conservatory area so that those who do not smoke are not exposed to it. The lounge area is well arranged with small groups of chairs and a TV at either end of the room so that people can chat or watch different programmes without disturbing each other. The unit was generally tidy and clean; bedrooms were comfortable with a basin, lamps, furniture and space to lock personal items up in. Residents are able to bring their own furniture in within reason and have TV’s, music centres etc in their rooms. A resident explained that she has a key to her bedroom and a locked drawer where she can lock personal possessions. The kitchen area has been partly refurbished with new tiles and a fridge, presenting a cleaner and more hygienic environment. There is equipment in place to prevent the spread of infection. This includes wipes, disposable gloves and aprons. Staff also use designated disposable yellow bags for items that may be infectious. A resident spoken with felt that the cleanliness of the unit had “gone down”. Another explained that the unit did get cleaned but the lounge carpets were ”dirty things” and needed cleaning or replacing. The carpet did appear grubby and staff spoken with agreed that the lounge area could be cleaner, explaining that domestic staff “do their best” There are domestic staff employed to work on the unit 7 days a week between the hours of 9am-7pm. There are sufficient baths and toilets located around the unit. Bedrooms are not en-suite but have a washbasin and a commode can be provided if needed. One resident explained that she had recently been helped to move bedrooms to be nearer a toilet with a higher seat. In bathroom 32 there was a bath chair over the bath, staff explained that this had not worked for some time and the bath could not be used. Garston Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 33 A full tour of the unit was undertaken with the nurse in charge. Room 3 and 25 were full of furniture, mattresses and general ‘junk’. Toilet 31 was found to have a large hole in the wall where it appears that something has been removed such as a toilet roll dispenser. Bathroom 33 was found to have an electric bath chair that wasn’t working. The kitchen bin wedged the fire door to the kitchen open and malodorous smells were noted in bedrooms 7,34,19 and 18. Bedroom 7 had a resident who was very poorly and being nursed in bed. The room was found to be dirty, especially on the bedside table and the bed rail bumpers were found to be heavily stained. The cleaners store was open and therefore accessible to residents and it was noted that it contained potentially dangerous chemicals and dirty water in a mop bucket. One resident spoken to stated he had been buzzing for help for 45 minutes and his call was still unanswered. On examination, other call bells did not work. The maintenance man was called over and confirmed that the system was in working order. Bathroom 6 is still undergoing refurbishment following a fire. A relative of a resident moving out of the home was concerned to be told that his relative was not able to have a bath over the previous weekend as the home had “run out” of hot water. He went on to say that his relative was often refused a bath as he has a ‘syringe driver’ in place. Residents spoken to were happy with the cleanliness of their bedrooms and were full of praise for domestic staff. Staff confirmed that they had enough stocks of gloves, wipes and aprons, however were unsure if the unit was ever ‘deep cleaned’. Speke A tour of the unit was undertaken. The unit appeared well maintained at the time of the visit and the officer in charge was able to show maintenance book, which was completed, as and when needed. She advised that the maintenance person viewed the book each day and took appropriate action where necessary. The main door to the unit was key coded for extra security and all essential services appeared to be working during the visit. Gateacre Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 34 A tour of the environment was undertaken which included viewing twenty seven bedrooms. Since the last inspection the entrance corridor to the unit has been repainted and efforts have been made to make this more interesting for the residents by adding pictures and tactile objects. Each bedroom has a memory box outside the bedroom door. These were empty. The unit manager explained that he was attending training on the use of memory boxes in relation to depression in the near future. The entrance corridor to the unit smelt unpleasant on arrival. Air freshener had been sprayed which made the smell more pungent. The smell pervaded into the communal lounge. This room is furnished with a variety of armchairs. Three were examined and were found to smell unpleasant and had old food at the back of the seat and down the side of the arms. The dining area was furnished with tables. Only seven chairs were available which was insufficient to meet the needs of the residents. A music centre and TV are available in the lounge. The décor of this area was reasonable but little effort had been made to make it appear homely. A relative commented that the premises were” plain” and “ needed redoing”. The unit has a sufficient number of bathrooms and toilets. However soap was not available in one toilet. Bathroom 18 was being used to store a variety of slings, pads etc. The privacy curtain was found to be stained and dirty and required replacing. The sealant around the bath was perished and required replacing and the doorframe required repair. Toilet 31 had no lid and no lock. Bathroom 39 contained a toilet with no lid. This was also found to be cracked and the sealant around the bath had perished. Bathroom 33 was not in use. Four of the bedrooms viewed were found to have bedding that was thin and faded. None of the bedding viewed in any of the bedrooms matched. One bed had been made with a pillow case from a local hospital. Four of the bedrooms viewed were found to be very dirty. One bedroom smelt unpleasant. On examination this room had a wet mattress placed against the radiator to help it dry out. The furniture in each of the rooms was viewed and in many instances was found to be poor in quality. Six commodes were found to be in poor condition and had stains that looked like excrement around the seat. Three armchairs were found to be torn and stained. A room was viewed which had been recently occupied by a new resident. This contained picture hooks from the last occupant with no pictures. The vanity unit was broken. The curtains were torn and the room contained dead dry flowers in a vase with no water. The floor was very dirty with particles of dirt under the sink. Several bedrooms contained clocks, which belonged to the residents. These all showed the wrong time. One room was found to have no working light or call bell. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 35 One resident was sleeping on a futon mattress on the floor to reduce the risk of falls occurring but this had been placed in close proximity to a pointed wooden skirting board. Some bedrooms have patio doors. The flooring close to these doors was found to be stained in places with what appeared to be mildew growing close to the frame. Some bedrooms were homely. Staff confirmed that these belonged to residents whose family frequently visited and had made efforts to make the room comfortable. A member of staff stated that the premises were” okay, some of the bedrooms could be better. Some relatives make a big effort others don’t come near”. Domestic staff are available on the unit. A relative commented that the unit was not as clean as it could be, “the surface looks okay but scratch the surface and its filthy, its not the cleaners fault as soon as they have finished they need to start again”. The unit manager felt that an increase in domestic staff was needed and that agreed that the unit was not as clean as it could be. Two permanent domestic staff are available. The unit aims to have domestic services from 9am until 7pm each day but the unit manager stated that this wasn’t always happening “although it needs to”. A relative commented that” it could be cleaner but I don’t like to rock the boat. Wheelchairs are often caked in food and are dirty” Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 36 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 all units, 28 Speke 30 Gateacre Childwall The home is maintaining the staffing levels that have always been in place and provide additional staff for cleaning and activities. Staff were noted to be busy around mealtimes and residents needs were not fully met as a result of this. Speke Staffing numbers did not appear adequate to meet the needs of the current residents of the unit and staff interviewed presented as being de-motivated and unsettled by this shortfall. Garston Residents, relatives and staff are unhappy with the staffing levels on the unit. A high percentage of agency staff are used to fill vacancies. Gateacre Staff, and relatives were neutral about the provision of staffing levels. Staff regularly change which does not promote consistency. Staff have received training to undertake their role but they do not always reflect this when giving care. Staff have received sufficient training to help keep the residents safe. EVIDENCE: Childwall Residents spoken with felt that sometimes there are enough staff and at other times there are not. One resident explained, “They do an awful lot of work”. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 37 Staff spoken with felt that as residents needs had changed and their expectations had got higher, there were not always enough staff to meet their needs and choices. There are 3 care staff on each shift and a Senior Carer / Unit manager. Staff explained that in practical terms the senior member of staff is often busy with medication and in the office so they can only provide limited direct help to residents. A relative spoken with said that the staff appear “very caring” During the inspection staff were seen to speak respectfully to residents and to take time to chat with them. However there was a noticeable difference at mealtimes when staff were busier. On one occasion a resident was in conversation when two staff approached her with her wheelchair, told her it was lunchtime and proceeded to help her into the chair. The lady was not asked if she was ready to go to the table or if she had finished her meal. Staff and residents on the unit were complimentary of the new unit manager explaining that she was “getting things sorted” Garston Every resident, relative and staff member spoken with on the unit stated it was short staffed. One resident stated, “ They are short staffed mainly during the day. It is very hard for them to manage”. A visitor told the inspector that finding staff was often hard and that some staff did not seem to know the residents. Staff were concerned that staff from other units were being ‘borrowed’ but that meant other units on site were short staffed. Rotas examined showed that a lot of agency staff were being used and that many shifts over the next few weeks remained not covered. On the day of the inspection 25 residents were living on the unit. Speke There were 21 high dependency residents accommodated on the unit. Staffing levels comprised 4 staff plus one nurse in charge. One staff member advised she was pregnant another agency worker advised that she too was pregnant. Neither was able to advise if a risk assessment had taken place. Staff morale was very low with the nurse in charge advising that she was ill and on strong medication but felt that she had to work. She advised that she had been off work on sick leave and the company knew why she had been absent, however they had made no “back to work” plans for her and had merely returned her to twelve-hour shifts. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 38 This was discussed with the Manager who confirmed that she was aware of the circumstances surrounding the staff member’s absence however it was also stated that support mechanisms had been developed and put in place. Gateacre Twenty-two residents were residing on the unit. Staffing levels were set at six staff in the morning and four staff in the afternoon. A registered general nurse has been recently employed, which a relative stated was an improvement, as it meant that somebody with medical knowledge of physical needs was available. A full time vacancy exists for night shifts. The unit manager stated that he was managing to staff the unit by borrowing staff from other units and when staff were not available, agency staff were used. Another staff member commented,” Its not good -these people need to be cared for by staff that they know”. One relative stated that he thought there were enough staff but “I don’t know many of them anymore”, another stated that they were not sure whether staff were qualified to do their job but that there were “always lots of changes of staff”. Viewing off duties confirmed this to be true. Training records were viewed and discussions held with two staff members. A new staff member stated that everyone had been welcoming and supportive and confirmed that he had received an induction when the job commenced. He also confirmed that training had been arranged on dementia awareness. Viewing records showed that all permanent staff on the unit have undertaken training on dementia awareness. Observing staff as detailed in the above standards did not always reflect this training. The unit manager has recently undertaken a training course that will enable him to teach staff on how to manage challenging behaviour. Plans have also been made for him to attend specialised training on the use of memory boxes. Staff have undertaken mandatory training to help keep the residents safe. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 39 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 Childwall The unit is maintained safely and identified risks are assessed with action taken to reduce risk. Speke The health safety and welfare of residents and staff are promoted and protected by health and safety policies and practices within the home. Garston Staff understand the importance of recording accidents clearly and maintaining confidentiality. Legalities of some family requests require exploration. Cleaning substances, which could be hazardous to health, are not secured safely. Gateacre The unit follows the correct policies to maintain Health and Safety and staff have had appropriate training. The environment is not as safe as it could be and some staff practices need reviewing. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 40 EVIDENCE: Childwall There were up to date risk assessments for general risks including, bed rails, hoists and wheelchairs. The unit have carried out a risk assessment for the courtyard area, which is very uneven. As a result of this, a notice had been put up warning of the dangers. The home manager explained that they have applied for funding to landscape this area next year and to make it safer. Staff explained that they have training in health and safety including fire, first aid and moving and handling. Equipment including bath hoists has been tested recently for safety. Garston Accidents on the unit were recorded and stored correctly. One resident who lives on the unit and is receiving palliative care had a note on file from a relative requesting that she should not be resuscitated. The home needs to seek clarity of the legality of this letter to protect the resident and staff. As identified in the standards relating to the environment the cleaning cupboard was open and contained substances which could be hazardous to health. Speke All mandatory training had been completed and mechanisms were in place re COSSH, and RIDDOR. Full risk assessments of the environment were viewed. Protective clothing was readily available and staff interviewed were able to evidence that they had knowledge and understanding of all issues pertaining to health and safety. Gateacre Training files showed that all mandatory training had been completed. This included Fire safety, food hygiene, Health and Safety, manual handling and abuse awareness. However two staff were observed breaching manual handling legislation by transferring a resident by the seat of her pants. The unit has a fire folder, which is sectioned to include details of all aspects of fire prevention such as testing of equipment and staff training. Details had been recorded on staff training but not on testing procedures as the maintenance officer keeps his own records of this. Accidents are recorded correctly and stored appropriately in accordance with Date Protection guidelines. The environment had been risk assessed and the assessments were found to be current and up to date. However when touring the environment it was noted that a corridor window had no opening restrictor which meant it could be fully opened. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 41 Relatives stated “ yes I think the units safe” and “Yes its safe, people have to ring to get in and (unit managers name) is strict”. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 42 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 2 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 X 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 1 X 2 X X 1 X 1 STAFFING Standard No Score 27 2 28 2 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 2 Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 43 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Timescale for action 31/03/06 2 OP11 12(1)(a) Outstanding Requirement from last inspection-Childwall House - The Responsible Person must add a section in care plans stating how they intend to meet residents needs and choices. (10/09/05) Outstanding Requirement 31/01/06 from last inspection-Garston House-The Responsible Person must ensure that a full index of policies and procedures are available to all staff on Garston unit including those specifically for palliative care and a policy guidance for subcutaneous fluids (25/05/05) Outstanding Requirement from last inspection-Speke House- The responsible person must review the provision of activities for the residents. Individual preferences must be taken into account and activities provided which are suitable for those residents who have memory loss. This must include the provision of trips out. (10/09/05) DS0000005450.V266947.R01.S.doc 3. OP12 16(1)( n) 31/03/06 Arncliffe Court Nursing Home Version 5.0 Page 44 4. OP12 16 (1)(n) Outstanding Requirement from last inspection-Garston House-The Responsible Person must review the provision of activities for the Residents within the home. Individual preferences must be taken into account and Social inclusion must be promoted. (10/09/05) Childwall, Garston, GateacreThe Responsible Person must ensure that all information regarding a residents needs is clearly documented on the care plan including clear instructions on the care required. Garston- The Responsible Person must ensure that changes in resident’s health are acted on and external advice sought from other health care professionals as needed. Speke- The Responsible Person must ensure that clear consistent records are kept regarding wound care and that external advice is sought regarding the management of wounds. Garston- The Responsible Person must ensure that clear consistent records are kept in an appropriate format. Garston- The Responsible Person must ensure that staff receive training on how to assist residents who have syringe drivers to bathe. Garston- The Responsible Person must ensure all personal risk assessment documentation is completed for each resident. Gateacre- The Responsible Person must ensure eye drops are dated when opened and explore whether it is appropriate DS0000005450.V266947.R01.S.doc 31/03/06 5. OP8 15(2)(b) 31/01/06 6. OP8 13(1)(b), 14(2)(b) 31/01/06 7 OP8 13(1)(b), 12(1)(a) 31/01/06 8 OP8OP7 13(1)(b), 15(2)(b) 12(1)(a) 31/01/06 9 OP8 31/03/06 10 OP8 12(1)(a) 31/01/06 11 OP9 13(2) 31/01/06 Arncliffe Court Nursing Home Version 5.0 Page 45 12 13 OP9 OP12 13(2) 16 (1)(n) 14 OP15 16(2)(g) (i) 15 OP19 23(2)(b) 16 OP21 23(2)(j) 17 OP21 13(4)(c) 18 OP26OP21 16(2)(k) 19 OP22 16(2) (c) 21 OP27 18 (1)(a) 22 OP27 18(1)(a) to keep eye drops in the fridge Garston- The Responsible Person must ensure medications are administered safely. Garston- The Responsible Person must be consulted about how they would like to spend their time. Appropriate activities must be developed and programmes displayed on the unit. All Units- The Responsible Person must ensure that the provision, serving and presentation of food is be explored and improved upon. All residents must be offered choices of meals. Mealtimes must be organised to make dining pleasant experience. Childwall- The Responsible Person must ensure that the lounge carpet is deep cleaned/ replaced to make this area comfortable. Childwall- The Responsible Person must ensure that the bath chair in bathroom 32 is repaired/replaced Garston- The Responsible Person must ensure that Staff refrain from using bedrooms as store rooms Garston- The Responsible Person must ensure that the unpleasant smells identified during the visit are addressed Garston- The Responsible Person must ensure that all residents have means of summoning help. Childwall- The Responsible Person must ensue that staffing levels are reviewed to ensure adequate staff provision at key times. Garston- The Responsible Person must ensure that staffing DS0000005450.V266947.R01.S.doc 31/12/05 31/01/06 31/01/06 31/03/06 31/03/06 31/01/06 31/01/06 31/01/06 10/02/06 10/02/06 Page 46 Arncliffe Court Nursing Home Version 5.0 23 OP27 18(1)(a) 24 OP28 18(1)(a), 12(5)(a) 25 OP38 13(4)(a) 26 OP38 13(4)(c) levels are reviewed and increased accordingly Gateacre- The Responsible Person must ensure whenever possible that the unit is staffed by a consistent staff team. Speke- The Responsible Person must ensure that Staff concerns and comments are explored through meetings and discussions and addressed to ensure residents are in “ safe hands” at all times Garston- The Responsible Person must ensure that cleaning substances are locked away securely at all times Garston- The Responsible Person must ensure that advice is sought regarding relatives making requests for residents not to receive care in life threatening emergencies. 31/01/06 31/03/06 31/01/06 31/01/06 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 OP8 OP12 Good Practice Recommendations Speke, Garston- Photographs should be taken of all wounds and repeated to evidence progress/deterioration. Childwall- Comments made by the residents regarding the provision of activities should be explored through consultation. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 47 3 4 5 OP15 OP19 OP33 Childwall, Garston-The manager should consider increasing/reorganising staffing so that adequate staff support is available over meal times. Childwall- The service should carry through its intention to fit doors to the conservatory area. Gateacre – Serious consideration should be given by the Responsible Person to ensure that the action plan dated 17/11/05 addressing the serious concerns is implemented and that the unit is monitored at least monthly to ensure standards are maintained. Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 48 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 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 Arncliffe Court Nursing Home DS0000005450.V266947.R01.S.doc Version 5.0 Page 49 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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