Inspection on 16/05/05 for Beatrice Court and City Gate Lodge Home

This inspection was carried out on 16th May 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

Beatrice Court and City Gate... 31/10/07

Beatrice Court and City Gate... 25/07/06

Beatrice Court and City Gate... 09/11/05

Beatrice Court and City Gate... 18/01/05

Beatrice Court and City Gate... 14/09/04

Beatrice Court and City Gate... 15/03/04

Beatrice Court and City Gate... 23/02/04

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Maple Lodge

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Ravenhurst

Bank House

Inspirations

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

CARE HOMES FOR OLDER PEOPLE Beatrice Court and City Gate Lodge Home 36 St Johns Street Lichfield Staffordshire WS13 6NZ Lead Inspector Sue Mullin with Additional Inspectors Mrs W Grainger, Mrs Y Allen and Mr Dave Cowser Unannounced 16 May 2005 10:00 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 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. Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Beatrice Court and City Gate Lodge Home Address 36 St Johns Street Lichfield Staffordshire WS13 6NZ 01543 418341 01543 418583 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Restful Homes Limited Mrs Rosemary Alison Howell Care Home with nursing 137 Category(ies) of 65 DE(E) registration, with number 22 OP of places 50 PD(E) Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: PD(E) Minimum age 60 years DE(E) Minimum age 60 years 10 PD(E) in the City Gate Lodge Unit 10 DE(E) in the City Gate Lodge Unit 1 DE(E) minimum age 60 years in the City Gate Lodge Unit Date of last inspection 18 January 2005 Brief Description of the Service: Beatrice Court is a Care Home that provides personal and nursing care to service users aged 60 and over in the categories outlined on the previous page. Beatrice Court is the largest of the two establishments and has nursing staff on duty over a 24 hour period. It was built in 1989 and opened and a nursing home in 1991. The Court comprises of a 2 and 3 storey building and has several communal areas and a hairdressing salon. All parts to the home can be accessed via passenger lifts. There are garden areas and there is space for car parking. The home can be easily accessed by visitors using bus services as there is a bus stop not far from the home. City Gate Lodge is set in the same grounds and is a Grade A Listed Alms House and Gardens. This small residential unit offers personal care to service users over the age of 65. Both units share a large, well maintained kitchen and separate laundry. The whole complex is set in a town location close to Lichfield Cathedral and Beacon park. The site is registered for 137 beds. Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken over a period of two days by a total of three inspectors using the national minimum standards as reference. The pre inspection and fieldwork amounted to 23 hours in total, 18 of which were spent at the home on the days of the inspection. The registered care manager was in charge of the home accompanied by a suitable compliment of staff ratio, in line with acceptable minimum levels. The inspection included the following elements: • • • • • • • • • • • Spending time talking to residents, making note of their opinions regarding the standards of care delivered to them in the home. Discussing continuity of care and assessing residents judgments of the suitability of facilities available within their environment Discussions with relatives Observation of staff interaction with residents Sufficient and adequate staffing levels and skill mix Meeting with provider and care manager Reviewing care plans and medication procedures Discussions with all disciplines of staff (registered nurses, care staff, domestic, laundry and catering staff). Tour of parts of the establishment Examination of health and safety records Managerial aspects including, on going quality assurance measures Requirements and recommendations made are identified within this report. This report has been amended following receipt of the ‘providers response’ and subsequent visits to the home by Mr D Cowser inspector on 31 August & 5 September 2005. What the service does well: During the inspection one resident who originally commenced his residency at Beatrice Court, had improved so much that he was well enough to go home. His wife felt that it was the care, medication and his own will power that had enabled her husband to progress so much. Throughout the inspection, staff were observed assisting residents at the establishment in a sensitive and caring manner. Comments from the residents (who were able to comment) confirmed that they felt well cared for and could exercise choice in their life style. Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 Page 6 Following a discussion with a care assistant on the ground floor EMI unit, it was very pleasing to note that she knew all aspects surrounding a particular residents care. When this gentleman became resistive to care intervention, a different care regime was employed to ensure that his personal hygiene requirements were well met. This gentleman looked very well cared for, smartly dressed and groomed, finished off with a shirt and tie and jumper. A credit to the care staff on this unit. What has improved since the last inspection? What they could do better: There is a need for the remaining senior Care assistant on City Gate Lodge to receive training in the safe handling of medicines and first aid. The home must follow their admission procedure, in particular undertake an inventory of belongings and remove all medicines accompanied by each transfer. All medication should be accounted for in the correct manner during a service users admission to the home. The temperature on the medication fridge on the general unit should be recorded weekly. One care plan seen did not fully identify the patient’s current condition and evidence the care being delivered in line with infection control guidelines. Care plans must be current and pertinent to the resident, clearly addressing any identified medical/physical/psychological needs. Bedrail assessments must be completed where used and safety checks maintained. Consistency must be maintained in care plans on the general units and evidence should be documented where there has been consultation with residents or relatives pertinent to their involvement to the care planning process. Residents should be encouraged to use the dining area for meals on the general unit. However it was understood that they were given the choice. This will not only help with the digestion of meals but will increase mobility. Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 Page 7 Quality assurance systems must be developed with audits in place that take into consideration the views of the residents and relatives. Fire alarms must be tested weekly in line with the fire authorities requirements (currently monthly). The temperature of the hot water delivered in residents areas must be maintained at a safe and comfortable temperature of 43.C. 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. Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3,4 Residents were generally assured of a full pre admission assessment to ensure that the home could meet any identified needs. However, one resident’s needs had not been fully documented, as required. EVIDENCE: From the records seen on the inspection at City Gate Lodge it was identified that all residents were only admitted to the home following a comprehensive assessment undertaken by senior members of staff. General Nursing units There was evidence contained within the care plans, of pre-admission assessments having been undertaken. Either the manager or deputy manager had carried out these assessments. There was also evidence of assessments having been performed by Social Workers prior to admission. Where residents had moved between units in the home assessments, had also taken place before the move, to ensure that needs would be met. The manager stated that the home does not accept any emergency admissions. Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 Page 10 On the EMI nursing unit a resident had been recently admitted, and although a registered qualified member of staff undertook a detailed pre admission assessment, not all aspects of the pre admission assessment had been developed into the care plan process. One member of staff on duty on that unit the day the resident arrived, stated when asked that he was not fully aware of all her identified needs. This was a planned admission and the hospital had sent out a transfer document, which indicated her current mental and physical condition, which included that she was infected with MRSA. There were clear instructions regarding administration of medication, details of when another swab specimen should be taken for histology and information that she would need to return to hospital for an out patients appointment, for further investigation of the bladder. This was discussed at length during the inspection and the home must put into place effective communication channels, so that all parties involved in providing holistic care to residents are made fully aware of their individual responsibilities and go on to undertake those duties. Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 Appropriate arrangements were in place at City Gate to meet resident’s health care needs. Appropriate and robust arrangements for meeting resident’s individual assessed needs were in place on the EMI nursing unit, with one exception. General units The style of care planning was clear, concise and comprehensive but will need to be further developed, to ensure consistency and accessibility to residents. Residents could be assured that their individual health care needs would be assessed and monitored, with access to specialist advice and treatment when required. With the exception of one requirement, staff were adhering to the medication policies of the home and the health and welfare of residents was protected by the medication process within the home. Staff delivered care in a dignified and respectful manner. Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 Page 12 EVIDENCE: City Gate Each of the residents had a care plan implemented following their admission. The new format recently introduced, clearly identified any personal hygiene requirements and instructions how to meet those needs. Risk assessment were formulated and there was evidence of reviews on a monthly basis. From the care plan seen it was clear that any intervention of care from other agencies was well documented. The residents spoken with were complimentary about the staff and the care they received. Residents recognised the provider and spoke freely with him. One couple, one of whom was leaving to return home, felt that he could not have regained his independence without the care and support he and his wife had received. One of the residents had her own personal transport, stored at the rear of the home. The systems for the administration of medicines at City Gate Lodge were satisfactory and recorded information seen was accurate. Policies were in place to ensure that medication was administered appropriately. However, from the information provided, there was one remaining member of staff that had not received the appropriate training in the ‘safe handling of medicines’. The registered care manager told the inspector that member of staff at City Gate would be included on the next training course. The care staff were reminded of the importance that the family/resident agrees the plan of care and where possible confirm their agreement in writing. General units A selection of care plans was examined. The system of care planning had recently changed and some of the plans seen, were of the new style whilst others were still in the process of change. The new style of planning was clear and easy to follow, with risk assessments having been developed from an initial assessment of needs. Problems were identified and followed through with evaluations having taken place monthly. However not all plans evidenced consultation with residents and/or their representatives and this will need to be included in individual plans. Individual healthcare needs were assessed and monitored and there was evidence of visits by other healthcare professionals, including GPs, Chiropody and Optician. There were short-term care plans in place for the treatment of acute conditions. There was evidence of pressure relieving equipment around the units and residents were individually assessed for their risk of developing pressure sores. Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 Page 13 The medication procedure was examined on each of the general units. First level trained nurse were administering medication to residents. There were no residents self-medicating at the time of the inspection. Risk assessments were in place in care plans in relation to self-medication. MAR charts were examined and had been completed as required. The storage of medication was found to be as required. The storage and administration of controlled medication was examined and there were no problems identified. The temperature of the drug fridge had not been tested on a regular basis, and, on one occasion, had been missed for 2 months. This is unacceptable practice and temperatures must be tested at least weekly and records maintained. Staff were observed to be treating residents with dignity and respect during the inspection. The newly admitted resident on the EMI unit who had been diagnosed as having MRSA, was found sitting in the lounge with other residents at the time of the inspection. Residents with MRSA can sit in communal areas, following a risk assessment of other residents, which included identification of wounds or open sores etc. This information was contained within the care plan, but no individual risk assessments had been formally written. When this residents room was inspected they were no precautionary signs on display, no linen skip for washing her clothes separately (good practice), no foot operated clinical waste receptacle were seen in the room. Plastic aprons were seen in the drawer along with incontinent pads. There was no liquid soap available in this resident’s room. Suitable hand washing facilities must be available where infected material and/or clinical waste is being handled. The information provided on the transfer document from the hospital clearly stated that she needed a swab specimen sent for histology, on a particular date. That date had since gone by and when this was discussed with the nurse in charge of the unit at that time, she said that she had not been aware that this should have been undertaken. All residents must have access to NHS entitlements. The care plan for this resident had not been fully completed as discussed. On the above patients admission the nurse in charge stated that he made sure she was taken to her room and made comfortable. He did not undertake a personal possessions/medicine inventory and as direct result of this, the resident did not receive her prescribed medication. This resident was seen by the GP the following day, who wrote up the medication on to a MAR sheet. Although a cream specifically used for MRSA was prescribed and did accompany her to the home from hospital, the staff did not find it for two days following her admission. It was then found in with her clothes. Robust arrangements must be in place for the safe receipt, administration and storage of all medicines within the home Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,14,15 Activities and entertainment take place in the home. However the programme of activities advertised at City Gate Lodge were not all realistic and not all provided. Catering aspects were adequate and alternatives were offered. However residents spoken to on City Gate did not know what choices were available for meals throughout that day. General units Routines of daily life were made flexible to suit residents’ personal preferences and individual abilities. On the general units meals are not all taken at dining room tables. Residents should be encouraged to eat their meals in a congenial and social setting. EVIDENCE: There was evidence of the activity programme for the whole establishment. While there was something planned for seven days, the majority of the activities were not available or based on the hobbies/interests of the residents at City Gate. During the inspection the activity organiser played an electronic game of Bingo with the residents on the ground floor. Residents responded to the game, the activity person assisted where necessary. Sunday activity advertised was a Sunday service, on further investigation this was the evening service on the television. Visitors were welcome at any time, and the inspector was told were Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 Page 15 supportive. Residents spoken with told the inspector that they had the option to occupy the communal areas or they could choose to remain in their rooms. Meals would be served to them in their preferred environment. From their comments they were generally content with their particular daily life styles. However, it was a little concerning that no resident at City Gate spoken to was aware of what the kitchen were preparing for their lunch, on the day of inspection. The menus displayed in the lounge were not current and could be quite confusing. As could be expected, some residents were more able than others to make informed choices and it is important that the daily information regarding menus and alternatives were current. The kitchen was inspected and there were some areas that were not as well maintained as they could be and this was discussed with the provider. The cleaning programme records were not very comprehensive and there was evidence that some kitchen staff did not always complete the cleaning schedule. A more robust system must be implemented in line with infection control regulations. The main chef of the home was not on duty on the day of the inspection. The compliment of kitchen staff was adequate to cater for all the preparation and delivery of the meals of the day. Additionally, the inspector was informed that hot/cold meals and snacks were provided upon request from the current menu. EMI Unit A relative spoken to on the day of the inspection confirmed that his wife ‘got a good diet and that she had not lost any weight during the 10 months she had been in the home.’ He also stated he was offered food and drink by the staff when visiting and found them to be ‘friendly and caring’. General units There was a programme of activities and entertainment for the residents on this nursing unit. During the inspection a game of bingo took place with many of the residents participating. A discussion was held with the activities coordinator, who works full time at the home and divides his time between all the units. He explained how he assesses residents when they come into the home, as to their preferences and abilities for activities. Records are then maintained of activities undertaken on an individual basis. These records were seen at the time of the inspection. It is recommended that the co-ordinator attend specific training in relation to the delivery of therapeutic activities. There was evidence, contained within care plans, of personal autonomy and choice. Preferences in relation to the daily routine – bathing, meals, retiring and rising times – were documented. Discussions with residents identified that they had choices and there was evidence of personal items having been Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 Page 16 brought into bedrooms. Some residents preferred to stay in their rooms and enjoyed their own private space, whilst others preferred to socialise in the communal areas. There was an area of concern, in that very few of the residents on the general unit were observed using the dining area for their lunchtime meal. They were seen taking their meals in their easy chairs, where they had been sitting for most of the morning. Over bed and occasional tables were available and generally being used for residents to eat from. However, by observation, the positioning of some of the residents, did not seem very conducive or comfortable for easy digestion of meals. A new resident was sitting with her family and stated that she found it difficult to eat from the chair she was sitting in. She was also sliding down in her chair. When this was brought to the attention of the staff, a special cushion was provided for her, which prevented her from slipping down in the chair. She was asked if she would like to move to the table but on this occasion she stated that she wished to stay with her visitors. It is required that residents are encouraged to use the dining area for meals. This will not only help with the digestion of meals but will increase mobility. Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 Page 17 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 standard(s) 16 The home had a complaints procedure in place on display with all the Commissions details included. The home dealt with all complaints and grumbles as soon as possible and sought local resolution. EVIDENCE: There is one complaint being dealt with by the provider and the Commission at this time, relating to standards of care. This complaint has not yet been concluded. A relative, when asked, stated he did not know of the complaints procedure, but he was sure that he would be assisted should he have cause for concern. Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,23,25,26 City Gate has an environment that continues to be refurbished and redecorated. Bedrooms provided an environment suited to individuals needs. This part of the home was well maintained and clean throughout. Smoking is permitted in a bathroom in the Lodge. EMI areas continue to be upgraded but suitable hand washing facilities were not provided in one bedroom. The general nursing units were accessible, safe and well maintained and were clean and hygienic throughout. EVIDENCE: The accommodation seen during the tour of City Gate Lodge provided residents with rooms to suit their personal choice and was well maintained. Tables in the lounges were well presented, contributing to a comfortable environment. There is a small outside area where residents could sit and enjoy the better weather. Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 Page 19 Bathrooms and toilets were sited around the home on each floor. Bathroom 29 would benefit from the bath seat being replaced or refurbished. It is not ideal that a bathroom was the designated area for one resident to smoke. The small lounge previously used for this activity was taken out of use to prevent the smoke drifting into the larger lounge. However, present arrangements are not thought to be particularly appropriate and the Commission would advocate that the arrangements for residents smoking at City Gate Lodge are reviewed. The laundry was inspected and found to be fully operational and compliant. Those areas seen on the EMI Unit were clean and presentable. A domestic worker engaged in conversation confirmed that cleaning is undertaken over a seven-day basis and cover is maintained during holidays and days off. The domestic worker was aware of COSHH procedures and data sheets and confirmed that she had adequate stocks and supplies of cleaning materials. The EMI unit did not have appropriate hand washing facilities in the room where a resident was being treated for MRSA. The general nursing units had been adapted to meet the needs of individual service users. There was evidence that bedrooms had been personalised by the residents. The units were clean and well presented. Clinical waste was disposed of in line with infection control regulations. There was some remedial work going on in the corridor area at the time of the inspection, to develop an area dedicated to families and visitors. The housekeeper explained laundry/domestic procedures in line with available staff rotas and discussion took place regarding the cleaning schedules within the whole complex, which was found to be satisfactory. Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,30 EMI units Staffing levels and skill mix were appropriate and adequate on the day of the inspect. General units -Staffing numbers and skill mix was appropriate to the needs of the residents at the time of the inspection. Staff were competent and trained to carry out their jobs. Staffing was appropriate on the residential unit City Gate Lodge. Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 Page 21 EVIDENCE: A check on the staffing rosters evidenced that the staffing levels and skill mix had been maintained as agreed prior to March 31st 2002, by South Staffs Health Authority. On the day of inspection there were suitable numbers of staff on duty to meet the needs of the residents in their care. The shift pattern is 8am – 2.pm, 2pm – 8pm and 8pm – 8.am. There were 108 service users in the home on the day of the inspection (79 nursing) and (29 residential) with 29 vacancies. However, the home use some of their double rooms for single occupancy only. On the early shift of the inspection there were three trained nurses and at present these numbers of trained staff are maintained. Beatrice Court also provided at least two qualified nurses on duty throughout the remaining 24 hour period. The care manager is fully supernumerary and is also a qualified nurse. Catering, domestic and laundry hours are sufficient. There are two administrators who work full time. A maintenance man is also employed in the home. City Gate There appeared to be sufficient staff on the morning shift. Concerns were raised that no member of the care staff at City Gate had a First Aid qualification that was current. The inspector was informed that in the event of an emergency, the staff would contact the main house; where trained nurses were on duty at all times. Care staff working on a residential unit must receive adequate training in this field. There was a need to review the training and development of the staff at City Gate to ensure that the mandatory training requirements were fully met and current. There was recorded evidence of Moving & Handling training completed in 2004. Fire drill training was on going records evidenced that some training had been provided very recently. At the time of the inspection there were sixteen residents present in City Gate Lodge. For this number of residents there were three staff on duty for the morning shift. This reduced to two staff for the afternoon and night shift. There were no staff vacancies. Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 Page 22 The domestic arrangements ensured that there was one member of the housekeeping staff on duty over seven days. The recruitment of new staff was the responsibility of the Care Manager for the whole complex. This standard will be checked on the next inspection. General units At the time of the inspection there were 18 residents accommodated on the ground floor unit and 19 on the second floor all with nursing needs. Through discussions with staff members and examination of the staffing rota, it was identified that the units were staffed as follows:- From 8am-2pm there was a RGN and 3 care staff on each floor and from 2pm-8pm there was 1 RGN between both floors and 3 care staff on each floor. Nightshift was from 8pm8am when there was 1 RGN and 3 care staff between both floors. There was a domestic assistant daily working on each floor. Discussions with various staff members identified that mandatory staff training had taken place on a regular basis, including moving and handling, fire safety and fire drills. NVQ training was on going. Other training had included continence management, medicine administration for carers and COSHH training. Training in infection control was also due to commence in the near future. Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 Page 23 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32,33,36,38 There were no records to evidence that staff meetings are held regularly, although it was understood that they had taken place. The system for consultations with residents and relatives was not fully compliant and views of residents/representatives should be sought and acted upon where appropriate. Standards 31,33 and 36 were inspected on the general units The management of the home was open and inclusive and staff felt supported. Effective quality assurance will need to be developed further and include the views of the residents. The registered manager ensures, so far as is reasonably practicable, the health, safety and welfare of residents and staff. Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 Page 24 EVIDENCE: A Yale type lock on the front door of City Gate Lodge provided security of the home. It was opened from the inside by a coded keypad. The care manager responsible for the day-to-day operations of City Gate had NVQ level III. The inspector was informed by the care manager of City Gate Lodge that there had been no staff meetings for some time. However, the registered care manager disputed this, stating that informal meetings had taken place but no records were available. It is important that any meetings are undertaken on a regular formal basis and are properly recorded and cascaded down to all other members of staff. Staff supervision at City Gate Lodge had continued on a regular two monthly basis. Records evidenced that aspects of supervision were covered. General nursing units The units appeared to be running well at the time of the inspection. Staff stated that they felt very well supported by the management at the home. They stated that the manager was approachable and ran an open door policy. There was evidence that some quality assurance had started. Care plans were in the process of being audited, however, this needs to be developed further to include all other areas of auditing (which is currently ongoing) and quality assurance. A sample of maintenance records were examined. It was identified that fire alarm testing had gone from weekly to monthly testing. Fire alarms must be tested weekly in accordance with fire authority regulations. Hot water temperatures were registering just under the required 43 degrees centigrade and the thermostats will need to be adjusted. Individual risk assessments were not in place for all residents using bedrails. These will need to be developed and regular checks will need to be carried out to ensure that bedrails are safe. It is recommended that the activities co-ordinator receive update training in moving and handling. Accident records had been maintained as required. Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 x x 3 x 3 2 STAFFING Standard No Score 27 3 28 3 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x 2 2 x x 3 x 2 Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 Page 26 YES Are there any outstanding requirements from the last inspection? 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 OP3, OP4 Regulation 17 (1)(a), 14(2) Requirement The assessed needs of service users must be fully established and documented during pre admission and on on admission to the home. This information must be communicated to all nursing and care staff involved in meeting those needs. One care plan seen did not fully include sufficient information on the patients current condition. All plans must include suffient details of a patients current condition and evidence that the identified needs are being met. Robust arrangements must be in place for the safe receipt, administration and storage of all medicines within the home Suitable hand washing faciltities and measures must be in place for the prevention of cross infection in the home. Not all staff had receivied training appropriate to their duties, ie First aid and safe handling of medication. Staff meetings should be held regularly, documented and available for inspection when required. Timescale for action Immediate 2. OP7 15(1) Immediate 3. OP9 13(2) Immediate 4. OP26 13(3) Immediate 5. OP30 18(1)(a)(i ) 21(1)(2) 1 July 2005 6. OP32 1 July 2005 Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 Page 27 7. OP7 15(2)(c ) 8. 9. OP7 OP9 15(1) 13(2) 10. OP33 24(1,2,3) 11. 12. OP38 OP38 23(4) 23(2)(j) 13. OP38 13(4) 14. 15. 16. 17. 18. 19. 20. 21. OP8 13(1)(b) There will need to be evidence contained within individual plans of consultation with residents and/or their representatives General unit. Consistency in format must be achieved with all care plans.(General unit) Temperatures of the drugs fridge must be tested at least weekly and records maintained General unit. Quality assurance needs to be developed within the home and audits must include the views of the residents/representatives. Results of audits must include any actions taken. Fire alarms must be tested weekly and records maintained. Temperature of hot water must be maintained at a safe and comfortable 43 degrees centigrade. Risk assessments must be developed for residents using bedrails and regular safety checks must be carried out on these. The one resident identified must have access to NHS facilities, including laboratory tests. 20 July 2005 20 July 2005 17 May 2005 27 July 2005 22 May 2005 22 May 2005 Immediate Immediate Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 Page 28 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. 3. 4. 5. 6. 7. 8. 9. Refer to Standard OP33 OP15 OP21 OP19 OP12 OP38 OP12 OP 15 OP15 Good Practice Recommendations An annual development plan should be compiled, which includes the aims and outcomes for service users. A more robust system of cleaning the kitchen should be implemented and documented in line with infection control regulations. Bathroom 29 ( City Gate Lodge) would benefit from the bath seat being replaced or refurbished. The arrangements for residents smoking at City Gate Lodge should be reviewed. It is recommended that the activities co-ordinator attend specific training in relation to the delivery of therapeutic activities It is recommended that the activities co-ordinator receive update training in moving and handling. Programme of activies advertised should be followed Current menus should be on display at all times - so residents can exercise a choice. Residents should be encouraged to mobilise and use the dining area at mealtimes (General unit). Beatrice Court and City Gate Lodge Home E51-E09 S22312 Beartice Ct and City Gate V226902 160505 Stage 4 Amended.doc Version 1.30 Page 29 Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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. 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