Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 27/01/09 for Barrock Court Nursing Home

Also see our care home review for Barrock Court Nursing Home for more information

This inspection was carried out on 27th January 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

CARE HOMES FOR OLDER PEOPLE Barrock Court Nursing Home Barrock Park Low Hesket Carlisle Cumbria CA4 0JS Lead Inspector Jenny Donnelly Unannounced Inspection 27th January 2009 09:40 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 Barrock Court Nursing Home DS0000038773.V373535.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. Barrock Court Nursing Home DS0000038773.V373535.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barrock Court Nursing Home Address Barrock Park Low Hesket Carlisle Cumbria CA4 0JS 016974 73765 016974 73865 manager.barrockcourt@aermid.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Aermid Health Care Plc Manager post vacant Care Home 28 Category(ies) of Dementia (1), Old age, not falling within any registration, with number other category (28), Physical disability (5) of places Barrock Court Nursing Home DS0000038773.V373535.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE (maximum places: 1) Physical disability - Code PD (maximum places: 5) The maximum number of service users who can be accommodated is: 28 Date of last inspection 17th September 2008 Brief Description of the Service: Barrock Court nursing home is purpose built and is situated near Low Heskett at the end of a long driveway with fields and trees surrounding it. The home has its own internal courtyard that people are able to enjoy in warmer weather. The building is on one level, divided into three units. These units accommodate people of varying levels of dependency and each unit has its own lounge and bathing facilities. Aermid Health Care (UK) Ltd, operates the home. The registered manager left in April 2008 to take up another post within the company. There is currently an acting manager in post. At the time of this key inspection, the weekly fees were advertised as from £511.00 to £651.00 according to the peoples needs. Written information was available in the form of a ‘service users guide pack’. The homes’ latest inspection report was also available in the home. Barrock Court Nursing Home DS0000038773.V373535.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. This was the second key inspection of this service for the year. At the last inspection in September 2008, the service was rated as being poor, and a number of requirements were made. Further to this we (the Commission for Social Care Inspection) met with the registered provider and the area manager for Barrock Court, to discuss the improvements needed. Aermid Health Care (UK) Ltd provided us with an improvement plan setting out how and when improvements would be made in the service. The purpose of this inspection was to monitor Barrock Courts progress against this improvement plan, so not all key standards were assessed. In November 2008 we did a random inspection to see if the management of medicines in the home had improved. At that time there was a new manager in post and some improvements were seen. We were later told that the new manager had left, and an acting manager was in day-to-day charge of the service. We made this unannounced visit to Barrock Court between the hours of 09.40 and 16.40 hours on the 27th January 2009. During this visit we toured the building, spoke with people who live in the home, the staff and the acting manager. We looked at care plans, medicines, staffing and management records. What the service does well: What has improved since the last inspection? Barrock Court Nursing Home DS0000038773.V373535.R01.S.doc Version 5.2 Page 6 Some improvements in the handling of medicines were made at the last pharmacy inspection on 27th November 2008. Unfortunately those improvements were not sustained at this inspection. Many of the care plans had been re-written to a good standard, and peoples assessments for moving and handling, nutrition and risk of pressure sores had been updated. However, there continued to be shortfalls and confusion in the management of peoples wound care, and there was no evidence that people had been consulted about their care plans. The provision of activities and occupation was gradually improving, and people had been asked what they would like to do. There had been some improvement in activities for more able and younger people in the home. There was a programme of dominoes, bingo and carpet bowls on the notice board. The range of regular activities and opportunities for people to get involved with anything outside the home remained limited. Food had been discussed at the residents meeting and a new four-week menu had been devised which was about to be implemented. Some new dishes had been included, and there was less repetition of the same meals. Some environmental improvements had taken place. The home was tidier and there was clear space for people to move about safely. The previously exposed hot water pipes in the bathrooms had been covered, and potentially dangerous items such as work tools had been cleared away. The misleading bathroom signs on store cupboard doors, had been removed. A smoking shelter had been provided in the courtyard so people could smoke outside without having to sit in the rain. Three new mattresses had been purchased. The acting manager was aware of the need for thorough pre-employment checks on new staff that had previously been missed. No new staff had been appointed as yet. Training sessions for moving and handling and safe use of chemicals had been delivered and a training plan had been drawn up for 2009. Staff had been given workbooks to complete, on food hygiene, infection control and safeguarding, but the value of these was questionable. Satisfaction surveys had been completed by people living in the care home about the quality of the service provided. Staff supervision sessions were taking place, although some training on this would be beneficial. A new fire warden had been trained and the fire log showed that all checks were up to date and a number of training sessions had taken place. What they could do better: Nursing care and the management of medicines were not good enough, and placed people at serious risk to their health and well-being. Barrock Court Nursing Home DS0000038773.V373535.R01.S.doc Version 5.2 Page 7 There was conflicting information about the development of, and the treatment of pressure sores, and evidence that treatment plans were not routinely followed. This is poor practice and not in the best interests of the people receiving the treatment. Care plans must be accurate and must be followed by staff. Further to a previous recommendation we did not see any evidence that people had been consulted about their care plan. There were a number of problems with the management of medicines. The manager must make sure that medicines do not run out so that people always have the treatment they need. Medicines must be administered in the way the doctor prescribed them, so that people receive safe and effective treatment. The management of high-risk blood-thinning medication must be reviewed to reduce risk to people from adverse effects of inappropriate dosage. This also includes making sure that all blood tests are performed on time. Care plans need to be more detailed for managing medication so that people receive safe and effective treatment, and the manager must ensure that plans are followed. Staff who handle medication must be properly trained and competent in the task. The system for recording and responding to complaints still needs to be improved, so people can feel confident they are being listened to and their concerns acted on. We were not able to properly assess the water temperatures, because new boilers were being fitted. This will assessed next time. We had recommended that signage and lighting around the home be improved, and this has not yet happened. The external doors remained difficult for independent wheelchair users to manage. There was a shortage of commodes, and people had to wait and share these. We were concerned about the high level of commodes being used, rather than toilets, because the home does not have a sluicing disinfector to properly wash and disinfect the commode pots. There was a shortage of registered nurses and we saw that nurses regularly worked extra hours and did double shifts, which is not conducive to providing a good level of safe care for people. There was a lack of consistent approach between the different nurses, and this was confusing both for care staff and for the people receiving care. Recent training had not been effective in helping staff to understand their role in safeguarding vulnerable people from harm, a number of the staff we interviewed were not able to answer basic questions on adult abuse adequately. Barrock Court Nursing Home DS0000038773.V373535.R01.S.doc Version 5.2 Page 8 It was also difficult to evidence who had completed training, as records only showed that workbooks had been given out, not that they had been completed, or staff were competent. There was no still no registered manager in post, and there had been four different managers or acting managers in the last year. Staff we spoke with felt very unsettled by the changes in management and said they lacked support and continuity. Whilst some quality checks and audits had been carried out on care plans and medicines. These had failed to pick up shortfalls in wound care plans and the serious issues we found with medicines. The nurses carrying out supervision of care staff would benefit from some training on the purpose of supervision and how to make these sessions meaningful for the staff. 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. Barrock Court Nursing Home DS0000038773.V373535.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 Barrock Court Nursing Home DS0000038773.V373535.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admission procedures helped people to know the care home would be suitable to meet their assessed needs before they moved in. EVIDENCE: We looked at the records for a person admitted to the home since our last inspection. These showed that a full pre-admission assessment had been conducted by one of the nurses to look into the persons needs. The assessment was detailed and included good information about the persons health, personal and social care needs. They had also gathered further detailed information from the persons social worker and from the hospital. This enabled staff to know that they could provide the care and support the person needed before they were offered a place in the home. Barrock Court Nursing Home DS0000038773.V373535.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People felt well looked after at Barrock Court and received a good level of basic personal care. However, nursing care and the management of medicines were on the whole poor, and placed people at serious risk to their health and wellbeing. EVIDENCE: Following the last full inspection we required the provider to keep care plans up to date so they accurately reflected the level of support, and nursing care and treatment people needed. Aermid Health Care (UK) Ltd stated in their improvement plan that by 30th October 2008, care plans would be evaluated monthly to ensure entries correspond with the relevant plan of care. They said this would be achieved through monthly auditing. We talk about quality checks and audits in the management section of this report. Barrock Court Nursing Home DS0000038773.V373535.R01.S.doc Version 5.2 Page 12 We looked at a number of care plans and studied three in detail. Many of the plans had been re-written to a good standard using a different format, and peoples assessments for moving and handling, nutrition and risk of pressure sores had been updated. The new manager, who was only in post for a short time, had implemented this new format. Staff were now under the impression that the plans needed to be changed back to the old system. The acting manager told us that some plans were presented in landscape and others as portrait, and she wanted to remedy this. We believe the content of the care plans is more important that the format used. Further to a previous recommendation we did not see any evidence that people had been consulted about their care plan. At the last full inspection we were particularly concerned that wound care plans were confusing and did not give a clear picture of the type of dressing or treatment a person required. We studied the care plan of a person new to the home since the last inspection, who had wound care needs. There was conflicting information about when the persons pressure sore developed. We saw evidence that it was present before the person came to Barrock Court, and also evidence that it was not present at the time of admission. There were two wound care plans in place, both listing different types of treatment (dressings), neither of which has been discontinued as no longer relevant. None of these treatments were prescribed on the persons medicine chart. There was evidence in the persons daily notes, that various different dressings had been applied, and that on one occasion the wrong dressing applied which had caused skin tears to the person. Other notes showed the wound was now only being treated with cream, but there was no plan to this effect. We discussed the treatment of wound care and dressings with a number of staff and with the acting manager. We were told that nurses did sometimes delegate dressings to the care staff, so did not assess the state of the wound for themselves. We were also told that there was a stock of old dressings that some nurses used as they saw fit to treat people with, regardless of what their care plan stated. This is poor practice and not in the best interests of the people receiving the treatment. Through discussions with people and staff, we found that whilst the delivery of basic personal care was good, there was some poor nursing practice taking place. We found that the handling of medication was very poor and this placed peoples health and well-being at risk. Although medication records looked good, a check of medication against administration records showed that they were not always given in the correct dose. For example, on occasions we found more tablets than there should have been showing that sometimes the records were signed but the medication was not given. Records for receipt and disposal of medication also lacked information and needed improvement. Records showed that on many occasions medication ran out and people did not get the treatment they needed sometimes for periods of one week. This Barrock Court Nursing Home DS0000038773.V373535.R01.S.doc Version 5.2 Page 13 included painkillers, muscle relaxants and medication to help breathing. Some peoples records described signs or symptoms that, in our opinion, could have been attributed to the lack of medication. For example, one person was prescribed a medication that helped them pass water. However, when this ran out the record showed that they had “very offensive and dark urine” that required advice from a doctor. Another person was admitted to hospital with a worsening of their illness just days after their medication had run out. Care plans relating to medication were examined and found to be lacking in detail, or not followed, and this could result in people getting unsafe or ineffective treatment. For example, care plans for the use of rescue medication for fits, lacked clear instructions on when it should be used. One person had recently suffered a fit but had not received any medication to help relieve it. Another person had a record of chest pain but did not receive medication that was prescribed to relieve this. Some medication required blood tests, but we found that these were not done at the correct time. This resulted in delayed changes in medication and this could seriously affect health. In particular, the management of a high-risk blood-thinning medication that required regular blood tests was very poor, leaving people at risk of adverse effects such as bleeding or clots. For example, the blood test for one person was more than two months overdue and there was no evidence that the dose of medication being given was appropriate. A blood test for another person was two weeks late and the results were also delayed by a further week. This result was received during the inspection and showed that the person was getting too much medication and the blood was very thin leaving them at high risk of serious bleeding problems. We looked at the care records for this person and found that they had unexplained bruising that, in our opinion, could be attributed to or worsened by thin blood. Although staff had been doing checks, or audits, on medication this had failed to address the serious issues raised at this inspection. We were also concerned that staff lacked training and assessments of competence that enabled them to safely manage medication and this places residents at risk of harm. Barrock Court Nursing Home DS0000038773.V373535.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The provision of activities and occupation that people wanted to partake in was gradually improving, and the new menus offered more variety of foods people wanted to eat. EVIDENCE: Following the last full inspection we required the provider to consult with people and enable them to participate in activities and occupation of their choice. Aermid Health Care (UK) Ltd stated in their improvement plan that by 31st November 2008, a My Life History document would be completed for each person to enable person centred activity plans to be developed. We saw these life histories in some of the care records we looked at, and also saw that activities had been discussed at a residents meeting. A number of people said they would like to go out more and two people had been into town with staff, although they have been dependant on taxis or relatives giving lifts. The acting manager had sought information about local community transport hire, which Aermid Health Care (UK) Ltd had said she could use once a month. This had not yet been used. The acting manager was also collecting local Barrock Court Nursing Home DS0000038773.V373535.R01.S.doc Version 5.2 Page 15 tourist information leaflets on places to visit with good disabled access. We hope these plans come together soon, so that the people, who want to, can enjoy some days out. Since our inspection in September, there had been a trip to the Sands Centre in Carlisle to see a pantomime. An entertainer, who wrote to offer his services, came to play music on one occasion, which people had thoroughly enjoyed. A clothes party and a Christmas party had been held. A new hairdresser had started coming to the home and a mobile library now calls. There had been some improvement in activities for more able and younger people in the home. There was a programme of dominoes, bingo and carpet bowls on the notice board, but no dates were included with these. The activities co-ordinator told us she speaks with people who are less able to join in activities and gives them individual time. She finds that people enjoy reminiscence, but she has had no training for her role and struggles to find new ideas for activities. She is booked on a training course for creative activities for older people in February which she hopes will help her improve the range and quality of opportunities which can be offered to people both inside and outside the home. Activities people have taken part in were being recorded in their care records. We discussed with the activity co-ordinator how to make these records more relevant to the conversations or reminiscence that has taken place rather than just recording chat at breakfast. The range of regular activities and opportunities for people to get involved with anything outside the home remains limited at present. Following the last full inspection we recommended that people be consulted about the choice of food, and their views and wishes be taken into account when planning menus. Food had been discussed at the residents meeting and a new four-week menu had been devised which was about to be implemented. We saw that some new dishes had been included, and there was less repetition of the same meals. Two choices were to be offered at lunch, and the daily menus were to be displayed on the dining tables. Barrock Court Nursing Home DS0000038773.V373535.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Recent training had not been effective in helping staff to understand their role in safeguarding vulnerable people from harm, and complaints were not being recorded to show what action had been taken to put things right for people. EVIDENCE: Following the last full inspection we required the provider to train staff in safeguarding procedures so they could understand their role in protecting people and know how to report concerns or allegations. Aermid Health Care (UK) Ltd stated in their improvement plan that further training had been sourced. Staff said they had been issued with a photocopied workbook on safeguarding vulnerable adults, and had been instructed to read this, and answer the multiple-choice questions. The acting manager was marking these so staff could be issued with a certificate. We looked through the workbook and saw it contained exercises for staff to complete as part of a group discussion with reference to the people they care for, and how they may be vulnerable. Staff told us there had been no discussions or presentation on the subject, and the acting manager confirmed she had not discussed this with people. Barrock Court Nursing Home DS0000038773.V373535.R01.S.doc Version 5.2 Page 17 Staff told us they did not find this method of training useful, and a number of the staff we interviewed were not able to answer basic questions on adult abuse adequately. Only one member of staff recognised that concerns should be reported to social services. The training pack had not been used in the way it’s creators intended and had not given staff adequate knowledge to safely protect the people they work with. At the last inspection we also required the care home to make the complaints system more accessible to people and to ensure any complaints made were properly addressed. Aermid Health Care (UK) Ltd stated in their improvement plan that the complaints procedure is given out to people and a copy is on display in the home. They also said complaints and concerns would be recorded in a log that documented the outcome. We saw that the complaints procedure was clearly displayed on the notice board, along with complaint forms for people to use. We checked the complaint log and found since the last inspection, it contained one entry relating to money, of which we were aware. The acting manager said there had been no other complaints. We were aware of a complaint made about the quality of care during a persons respite stay in the home, which was investigated by the council. We know that several letters were exchanged between the council and Barrock Court over this matter, but there was no record of it in the complaint file. The acting manager thought these would have been put in the persons care records, which were now archived. We also found there had been a complaint about the condition of a bedroom carpet, which was being replaced, and no record had been made of this. The system for recording and responding to complaints still needs to be improved, so people can feel confident they are being listened to and their concerns acted on. Barrock Court Nursing Home DS0000038773.V373535.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a warm and comfortable home, but some improvements would make the environment easier for people to live more independently. EVIDENCE: Following the last full inspection we required the provider to ensure that exposed hot water pipes were covered, the temperature of hot water was to be kept within an acceptable range, and that sharp implements, such as work tools, must be securely stored. Aermid Health Care (UK) Ltd stated in their improvement plan that they would attend to these matters. We saw that the exposed hot water pipes in the bathrooms had been covered, and there were no potentially dangerous items such as work tools left where people could reach them. We were not able to properly assess the water Barrock Court Nursing Home DS0000038773.V373535.R01.S.doc Version 5.2 Page 19 temperatures, because new boilers were being fitted on that day, and the gas was off for periods throughout the day. This will be re-assessed at a future visit once the work is completed. We had also made a number of good practice recommendations. Communal areas had previously been blocked with stored items of equipment and supplies. On this occasion we found the home was tidier and there was clear space for people to move about. There were plans to replace the kitchen flooring, but the company were waiting for better weather, as they may not be able to serve hot food on the day this work is done. We had recommended that signage around the home be improved to help people find their way around. The misleading bathroom signs on store cupboard doors had been removed, and the acting manager said she was looking for picture signs to put up. Lighting in some areas of the home had been poor and the acting manager said she was looking into new lighting for some bedrooms and corridors, but this was not in place yet. The external doors remained difficult for independent wheelchair users, who had to rely on staff to open and close the doors for them. A smoking shelter in the form of a Perspex canopy had been provided in the courtyard so people could smoke without having to sit in the rain. One person told us what a big difference this had made to her quality of life and how pleased she was with the shelter. The home was warm, clean and tidy on the day we visited and people said they were comfortable. We were concerned to hear that there was a shortage of commodes, and people had to wait and share these. Due to their moving and handling needs, not many people could use their ensuite toilet. The acting manager told us she had priced up replacement commodes, but had been instructed to look for the cheaper static type, not the ones that wheeled over the toilet. We were concerned about this because in October 2007 the company requested that they remove their sluicing disinfector, as it was broken. At that time they stated that commode pots (that need thorough washing) were no longer in general use, as commodes were wheeled over the ensuite toilets to promote dignity and assist in safe moving and handling. If commode pots are to be used, there needs to be a sluicing disinfector to ensure they are properly washed and sterilised, to reduce the risks of infection. Three new mattresses had been purchased and the manufacturer was replacing one hoist sling, because the stitching was coming undone. Barrock Court Nursing Home DS0000038773.V373535.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although people said staff were very nice and helpful, shortages meant nurses were working very long hours, there was confusion about working methods and staff training was patchy. EVIDENCE: We looked at staff rotas for a period of three of weeks and found the numbers of care staff on duty to be sufficient for the number of people in residence. There were generally four carers during the morning and three for the afternoon/evening shift. However, the home was short of registered nurses and we saw evidence that nurses regularly worked extra hours and did double shifts. The rota showed that several 15 hour shifts had been worked and staff told us on one occasion a nurse worked a 24 hour shift. On the rotas we looked at, one nurse had worked approximately 64, 70 and 75 hours a week over a three period. This is not good practice for the staff or the people receiving care. The acting manager she said was only allowed to book agency staff with the area managers permission. When we asked, the acting manager said the area manager was aware of the number of hours staff were working. Barrock Court Nursing Home DS0000038773.V373535.R01.S.doc Version 5.2 Page 21 Further to the last inspection, we made a requirement that all new staff must have proper recruitment checks in place, before they started work in the home. There had been no new staff employed since the last inspection, but the acting manager was aware of, and able to tell us about all the preemployment checks needed. One carer and one nurse were in the process of being recruited, and the acting manager was waiting for the completion of their checks. We had also required a staff training plan to be implemented. Since Christmas staff had been given three workbooks to complete, on food hygiene, infection control and safeguarding. Staff said there was no discussion or presentations on any of these subjects, and one said, One of the work books has 105 photocopied pages. A number of staff told us they thought this method of delivering training was ridiculous, and that they got homemade certificates. Training sessions for moving and handling and safe use of chemicals (COSHH) had been delivered by qualified trainers, in September 2008, and we saw some evidence of this. A training plan had been drawn up to show future training for 2009. It was difficult to evidence who had completed training, as records mostly showed that workbooks had been given out, not that they had been completed. The administrator said she had a number of certificates to make up, but did not have a list of who had completed what, saying it was largely in my head. The training plan showed that seven staff had National Vocational Qualifications in care (NVQ) at level 2 and four were working towards this. Three staff had level 3 and one staff had Level 4. Through discussions with staff we found that how things were done on any particular shift was down to which nurse was on duty, and there was no consistency in this. This is confusing both for staff and for the people receiving care. People told us the care staff were very nice and helpful. Barrock Court Nursing Home DS0000038773.V373535.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home still has no permanent manager in post and there is a lack of coherent leadership and oversight of the service, which leaves people at risk. EVIDENCE: At the time of our September inspection, the home had an acting manager who had been in post for six months, but who had not applied for registration with the Commission for Social Care Inspection. We made a requirement that the care home must have a registered manager in post. Aermid Health Care (UK) Ltd later told us that this acting manager had left and a new manager had taken up post in November 2008, and would be applying for registration. In December 2009 we received a letter from Aermid Health Care (UK) Ltd stating Barrock Court Nursing Home DS0000038773.V373535.R01.S.doc Version 5.2 Page 23 the new manager was leaving on 19th December 2008, and one of the nurses would be acting manager. The new acting manager, Moira Chivers, told us she worked four days a week, of this she spent two days in the office and two days as the nurse on duty. She did not demonstrate she had any managerial experience, and said she had little understanding or knowledge of the Care Home Regulations or National Minimum Standards for care homes. Staff we spoke with felt very unsettled by the changes in management and said they lacked support and continuity. We were told there had been a staff meeting with the area manager following the last inspection, but this had been unpleasant and had not provided staff with the support and leadership they hoped for. Staff told us that Aermid Health Care (UK) Ltd had recently conducted interviews for the managers post, but were not aware of the outcome as yet. We also required that an effective quality assurance system must be in place. Aermid Health Care (UK) Ltd told us they would audit care plans and medicines monthly. We saw that since the last full inspection in September 2008, three care plans had been audited in October and three in January 2009. This is not a monthly audit, and failed to pick up shortfalls in wound care plans. The medicines audits had similarly failed to address the serious issues we found. We looked at copies of the monthly regulation 26 reports by the area manager, reporting on her visits to monitor the service. These reports dated back to May 2008 and covered the premises, accidents, activities, care plans, kitchen records, maintenance and finances. None of these reports highlighted any shortfalls in the service. Surveys had recently been completed by people living in the care home about the quality of the service provided. We saw the responses and they were very positive, apart from two negative comments about the décor. We noted that 22 people had completed the questionnaire on the same date with the help of the activities co-ordinator, giving the impression of a rushed process. Staff said they had just been given questionnaires, but we did not see any of these completed. Care staff told us they have had supervision sessions recently, where they completed a set form with their supervisor. Staff told us they thought this was a mechanical exercise at the moment to get the forms completed. They didnt yet view the sessions as a chance to discuss creative ways of working with the people in the home or their own personal development. The nurses carrying out supervision would benefit from some training on the purpose of supervision and how to make these sessions meaningful for the staff. A new fire warden had been trained recently, and was responsible for carrying out checks on fire safety arrangements within the home, and providing some Barrock Court Nursing Home DS0000038773.V373535.R01.S.doc Version 5.2 Page 24 staff training. The fire log showed that all checks were up to date and a number of training sessions had been held for those staff who had not attended the previous session by the external fire trainer. We checked the service records for hoists and saw these were serviced six monthly, and passed as safe at the last service in August 2008. We were unable to assess the provision of hot water due to the boiler works in progress on the day. The kitchen flooring that the environmental health officer recommended be replaced, was on order, to be fitted during a period of warmer weather, as the kitchen would be out of use. We were disappointed that following the poor inspection in September 2008 so much of Aermid Health Care (UK) Ltds improvement plan had not been fully implemented. We judged that senior management had not taken the strong actions needed to sufficiently improve the service and make it safe for people. We will be pursuing the outstanding requirements under our enforcement policy. Barrock Court Nursing Home DS0000038773.V373535.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 3 3 2 X X 2 2 STAFFING Standard No Score 27 2 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 2 X X 2 X 2 Barrock Court Nursing Home DS0000038773.V373535.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12(1) Requirement Care plans must be kept up to date and accurately record the level of personal support, and any nursing care or treatment people require from staff. This was to have been met by 01/01/09 Ordering procedures must be reviewed so that medicines never run out and residents are able to receive the treatment they need. This was to have been met by 01/01/09 Records for receipt, administration and disposal of medicines must be complete and accurate to protect people from errors that could affect health. Staff must be suitably trained and competent in the handling of medication so that medicines are administered safely. This was to have been met by 01/01/09 All medication must be handled DS0000038773.V373535.R01.S.doc Timescale for action 31/03/09 2. OP9 13(2) 10/03/09 3. OP9 13(2) 10/03/09 4. OP9 18(1) 01/06/09 5. OP9 13(2) 10/03/09 Page 27 Barrock Court Nursing Home Version 5.2 safely, monitored appropriately and administered as prescribed so that people receive safe and effective treatment. 6. OP9 13(2) Regular audits of medication 10/03/09 must be done to monitor the management of medicines and to keep people safe. A record of complaints must be kept that shows a summary of any complaints, and the action taken. Staff must be trained in safeguarding procedures to understand their role in protecting people, and to know how to report concerns or allegations. Where nursing equipment such as commode pots are in use, there must be suitable procedures and equipment in place for these to be properly washed and sterilised to prevent spread of infection. The service must have a manager in day-to-day charge, who is registered with the commission. Original timescale of 01/03/09 still applies. The service must have effective quality monitoring systems in place to measure its own performance against its stated aims and objectives. This must include the views of people who use the service and other stakeholders. Water temperatures must be controlled to ensure hot water DS0000038773.V373535.R01.S.doc 7. OP16 22(8) 31/03/09 8. OP18 13(6) 10/04/09 9. OP26 13(3) 01/04/09 10. OP31 8 01/03/09 11. OP33 24(1) 01/04/09 12. OP38 13(4) 01/04/09 Page 28 Barrock Court Nursing Home Version 5.2 temperature is within an acceptable range at the point of delivery. This was to have been met by 01/01/09, extended timescale agreed. 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 OP7 Good Practice Recommendations People who have capacity should be consulted on the content of their care plans, and be consulted on what information they agree can be shared with their friends/family. Care plans relating to medicines such as for “when required” medicines or for people who self-medicate should contain clear detail of how they are managed to ensure people receive safe and consistent treatment. The torn kitchen flooring should be repaired or replaced. The service should consider improving signage around the home so people can find their way more easily, and so toilets and bathrooms are clearly marked. Consideration should be given to making the home easier for people in wheelchairs to navigate independently. Lighting around the home, especially in bedrooms, should be bright enough so that people can see properly to read. Staff training records should be kept up to date, and show in what areas staff have been trained and deemed competent. Staff responsible for supervising others should be trained in how to do this, so that supervision is positive in helping staff to understand their role, identifies training needs and DS0000038773.V373535.R01.S.doc Version 5.2 Page 29 2. OP9 3. 4. OP19 OP22 5. 6. 7. OP22 OP25 OP30 8. OP36 Barrock Court Nursing Home enables them to do their job well. Barrock Court Nursing Home DS0000038773.V373535.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North West Region CSCI Preston Unit 1 Tustin Court Port Way Preston, PR2 2YQ 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 Barrock Court Nursing Home DS0000038773.V373535.R01.S.doc Version 5.2 Page 31 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!