Inspection on 09/02/09 for Beechill Nursing Home

This inspection was carried out on 9th February 2009.

CSCI found this care home to be providing an Adequate 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.

Other inspections for this house

Beechill Nursing Home 21/05/08

Beechill Nursing Home 09/05/07

Beechill Nursing Home 24/11/06

Similar services:

Chirnside House

Keer Sands Residential Home

Sunny Bank (P.R.S.) Ltd

Ruskin Lodge

Bushell House

Ashwood Court Unit 1

Clover House

Langrigg House

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

CARE HOMES FOR OLDER PEOPLE Beechill Nursing Home 25 Smedley Lane Cheetham Hill Manchester M8 8XG Lead Inspector Steve O`Connor Unannounced Inspection 9th February 2009 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beechill Nursing Home DS0000066845.V374028.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. Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beechill Nursing Home Address 25 Smedley Lane Cheetham Hill Manchester M8 8XG 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) 0161 205 0069 0161 205 0165 beechillcare@yahoo.co.uk Skolak Homes Limited Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (19), Physical disability (12) of places Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 (maximum places: 19) Physical disability – Code PD (maximum places: 12) Mental disorder, excluding learning disability or dementia – Code MD (maximum places: 4) Past or present alcohol dependency – Code A (maximum places 3) Learning disability - Code LD (maximum places: 1) The maximum number of service users who can be accommodated is: 31 Date of last inspection 21st May 2008 Brief Description of the Service: Beechill Nursing Home is owned by Skolak Homes Limited and provides accommodation for a maximum of 31 people. The home is located in the North of the City of Manchester and is situated within easy walking distance of local services and amenities. Limited parking facilities are available to the front and rear of the property. The home is a three storey purpose-built building. Bedroom accommodation is provided on the first 2 floors and the third floor is used as office space. There are 23 single rooms and 4 double rooms. No en-suite facilities are provided but each room has a wash hand basin. There is one lounge, a smoking room, a small quiet room, a hairdressing room and a dining room. The home has a small patio area to the rear of the property. The charges for fees range from £409.00 to £564.00 per week. There are additional charges for hairdressing, private chiropody and other personal items such as cigarettes and alcohol. Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 5 Information about the home and inspection reports can be obtained from the manager. Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. The inspection report is based on information and evidence we (the commission) gathered since the last key inspection in May 2008. Additional information, which has been taken into account, included incidents notified to the commission by the home and information provided by other agencies including the social and health purchasing authorities. Before visiting the home, we asked the manager to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helped us to determine if the management of the home viewed the service they provide the same way that we see the service. Before the visit to the home people and members of staff were sent surveys and were asked to comment on the service and the home. By the time of the visit 4 people and 7 staff had returned completed surveys. This unannounced visit forms part of the overall inspection process and was conducted by 2 inspectors on Monday 9th February 2009. During the visit time was spent talking to people, to the manager and staff on duty. Documents and files relating to people and how the home was run were also seen and a tour of the building was made to assess the environment. The inspection was used to make a judgement on the quality of the service provided by the home and to decide how much work we need to do with them in the future. Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? The previous key inspection report of May 2008 highlighted a number of areas that needed improvement and action taken to make sure that people were safe. Work has been completed to address the areas of concern particularly in the following: • • • Medication that people take ‘as required’ (PRN) now has clear written guidance on how to administer it safely. The management and staff team were aware of their roles in protecting people and in raising concerns with the responsible local authority. The local Environmental Health Officer has been consulted in how to minimise the impact of people smoking cigarettes in the home and how the manager can meet the legal obligations of the ‘no smoking’ legislation. The communal areas were less smokey than the previous visit but we could still see and smell cigarette smoke. The manager was aware of this and was looking into alternative arrangements to reduce the impact further. The staff on duty were able to describe how they supported people and were able to explain to us how they supported people at meal times and in social activities. They were much more positive in their attitude and behaviour towards the people they support. People spoken to during the visit were positive about staff and comments included ‘very good’, ‘the staff are very good and ‘nice’. Changes have been made to the way that people can access their personal monies when they need them. Also additional checks are in place to make sure that the written records are correct. DS0000066845.V374028.R01.S.doc Version 5.2 Page 8 • • Beechill Nursing Home In addition to the above the following areas of the service have also showed some improvement. Comments made by the staff team to us through discussions and surveys showed that they felt that the support they received from management had improved. One member of staff spoken to said that they felt they could go and speak to the manager and express their views and that they were acted on. The manager had been in post since late December 2008. Through talking to him about the work, the environment and the type of service that he wants to provide it was clear that he had a good understanding of the improvements he needed to make to increase the quality of the service that people received. He had developed his own improvement plan, based on the previous key inspection report, and was putting into place new ways of working and new systems of recording to help in the running of the home. New staff had been employed in a management role to monitor and develop, with the nursing and care staff, the quality of the service and the way that care planning, reviews and other key records and practices were being maintained. The manager had started to communicate with people and staff on a more regular basis and this included meetings with people and speaking to them on a one to one basis about their views of the home. As the manager and the new management structure had only been in place for a short time it was too early to establish clearly the evidence to show the more significant changes that the manager was planning. What they could do better: Since the previous key inspection of May 2008 incidents involving the nursing care of a person living at the home raised concerns about the standard of the person’s nursing care and of the care planning process that should document a person’s personal care and healthcare needs fully and in sufficient depth. Examples of the current care plans showed inconsistency in the quality and person focused nature of the care plans. Some examples were very personal and recorded in depth the way that a person wants and needs to be supported to remain healthy. Others were not detailed and had missed out key support plans such as specific pressure sore care. The difference in the quality appeared to match the different nurses who had completed the people’s care plans. To make sure that people receive the support they need to keep the healthy and well, care plans must fully reflect their personal, healthcare, emotional and social needs and support in sufficient detail so that staff meet those needs in the best and safest way that the person wants. Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 9 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. Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 10 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 Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective people’s needs are assessed prior to them being admitted to the home and they are provided with information to help them make that decision. EVIDENCE: Since the last key inspection one person has come to live at the home. Very little information had been provided by the purchasing authority but the owner had commissioned a private nurse to undertake a pre-admission assessment of need that was detailed and comprehensive. At the time of the person’s admission the home did not have a permanent manager in post. Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 12 Other people’s files that were sampled showed that either the manager at the time or a senior nurse had carried out pre-admission assessments of a person’s needs and this was used in conjunction with the purchasing authorities own assessment and care planning documentation, such as Community Care and Care Programme Approach assessments, to make sure that people’s support needs were known and could be met by the staff team. Examples of the pre-admission assessments were viewed in people’s files. Intermediate care was not provided. Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s personal and healthcare needs had not been consistently identified and recorded in sufficient depth and detail so that staff support people in the way that focuses fully on what the person wants/needs . EVIDENCE: The previous inspection report of May 2008 highlighted that the care plans had been written in April 2007 by a senior nurse who had received specific training in the development of care plans. The examples seen at the time were found to be detailed, informative and contained a lot of personal focused information about how the person themselves wanted to be helped and treated. Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 14 Since the last key inspection serious concerns were raised by the purchasing local social services and health authority about the nursing care of a person living at the home. They had identified problems with the standard of the care plans and risk assessments that should describe a person’s nursing, personal care and social needs and support. They also found that nutritional guidance provided by a dietician had not been followed. At the last key inspection the manager had not returned from leave and decided not to return to the home. A manager was appointed in October 2008 but they left within a short space of time. The present manager had started work at the end of December 2008. Effectively, before the current manager started, there had been no permanent manager to maintain the standard of the care plans since the last inspection. Since taking up post in late December the manager had delegated the responsibility of updating and improving the standard of people’s assessment and care planning records to nurses. They were identified as key-workers for several people and took responsibility for making sure that all records were upto-date and reflected people’s current and changing support needs. A new care planning record format had also been introduced. We sampled four care plans and found that the quality and depth of the information recorded differed depending on the nurse who had completed the care plan. An example was seen of a person’s care plan who required nursing care. The plan was detailed and had a depth of personal information about the person, the way they communicated and how to support the person in the way they wanted. The plan was easy to read and follow and showed staff how to support the person in a positive way. Another person’s care plan was positive about how to support a person’s communication to encourage them to speak their mind and express their own views. It clearly set out how staff were to encourage him to be more active and to keep mobile and the daily records and activity records showed that staff were doing this. This compared with other care plans that contained brief and more general information about people’s needs. An example was seen where records referred to a man when it was for a woman and recorded ‘his’ hygiene need and ‘his’ bedding. One plan contained very brief information on how to support a person’s personal hygiene and when describing the person’s communication included the statement that they, ‘only mumbles some words like yes or no’. The care plan did not refer to the speech and language and sign language guidance contained within the person’s file. Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 15 The care plans examined did contain some examples of information about people’s general and specific health and healthcare needs such as diabetes care plans (Diabetes Care Pathway) that required ongoing monitoring of blood sugar levels. Another example showed that a person has been receiving their nutrition through a PEG feed, the manager had requested a speech and language therapy assessment and the person was now eating and drinking thickened fluids and pureed food. A food diary was kept to make sure dietary intake was sufficient. At times the information in the care plans was not focused enough on a key health issue. An example was seen where a person’s risk of getting pressure sores was assessed as very high. There was information spread throughout the plan on pressure sore care but there was no specific care plan in how to minimise the risk and information from previous care plans had not been reflected in the new plan. The manager had implemented a system for assessing the quality of the care plans and for monitoring the process of reviews. This was the responsibility of the deputy manager and they had only just begun this process at the time of the visit. The manager was very aware of the need to improve the quality of the care plans and was making this a priority for action. To make sure that people receive the support they need to keep the healthy and well, care plans must fully reflect their personal, healthcare, emotional and social needs and support in sufficient detail as to allow staff to meet those ways in the way that the person wants. As the care plans fluctuated in quality depending on the nurse completing them it is recommended that all nurses with key-worker responsibility have access to more specific training in developing and writing person focused care plans. Examples were seen in people’s care plans that highlighted to the staff team the importance of maintaining people’s privacy and dignity, especially around the area of personal care. General guidance was provided to staff on how to work with and support people in a dignified way. The medication administration system was assessed and checked and it was found that recording of administering on medication administration records (MAR) was accurate. Examples of staff signatures who administer medication were maintained. Records of medication deliveries and returns were being kept. All thickened fluids were being recorded on a separate record. Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 16 The previous inspection report highlighted the need for medication prescribed ‘as required’ (PRN) to have clear administering guidance. This had been addressed and there was a letter from a hospital consultant advising staff on how to administer PRN medication. Where this medication had not been administered the staff had signed ‘O’ onto the MAR sheets and the reason for not administering this medication was not clearly identified in the space provided on the MAR sheet. It is recommended that when staff used the coding system on the MAR sheet that the reason was clearly recorded in the most appropriate place and format. Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People appeared to enjoy the meals and mealtimes and could see their visitors when they wished. People’s daily lifestyles were generally based on established routines with mostly in-house social and leisure interaction and activities. EVIDENCE: The care plans sampled did contain some information about people’s routines, their likes and dislikes, hobbies and social activities they enjoy. However, as highlighted in the section above, the quality and depth of person focused information about these needs differed between people’s plans and depended on the nurse who completed the plans. An example of one plan noted that a person enjoyed playing snooker and that his favourite football team was Manchester United. In another care plan there was very little information about a person’s social needs. Some of the care plans sampled did have a section describing people’s goals around activities. One example was that the person be encouraged to go for short walks in the community and that they needed supervision to do this. Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 18 Several people were able to look after their own finances and to go into the local community when they wanted to. People were seen using local taxi services to visit shops for personal items. Records were being kept of the activities that people were involved in during the day. As with the previous inspection report, the majority of the activities involved what people did in the home but was more descriptive. For example, a person’s activity record showed they played dominoes, played on the pool table, watched specific television programmes, undertook walking exercises inhouse and local community. Other activities recorded included crafts, drawing and painting, exercise games and several people had a manicure session with staff. Speaking to both care staff on duty, one stated that ‘there was not much going on’ but they both confirmed that after lunch and evening meal they were able to spend more time with people in social activities and simply chatting and being with them rather than constantly having to do jobs such as laundry or cleaning or cooking. The lounge had a pool table, a computer and materials for crafts. There was also a separate room that had been planned to be used as a stimulation room but did not appear to in use at the time of the visit. When in the lounge area people mostly watched the television. However, the picture quality was very poor and so it is recommended that this issue be addressed. It was also found that the television, radio and music centre were all playing at the same time. The manager had started to consult with people about what type of social activities they would enjoy. A meeting in January raised suggestions of going out on trips to local attractions in the summer months. An entertainer had been booked to play at the home in March 2009. It is recommended that people be consulted about the social and leisure activities that they enjoy and want to participate in and this is clearly recorded through their care plan. Visitors to the home were welcome and could visit at any reasonable time and spend time in private or in the communal areas. People had the opportunity to take their meals in the dining room or in their own room if they wished. Lunch was being served during the site visit and people spoken to said that they enjoyed the food and choices were offered if the main meal was not what they wanted. Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 19 The evening meal was prepared and cooked by the cook and left for staff to serve and to clean the kitchen. Snacks and supper would be prepared by the cook and left for staff to serve. The cook described how one person needed a pureed diet and explained how they tried to make the meal look appealing by keeping everything separate. Several people had diabetes and/or had to maintain or lose weight to keep healthy. Low sugar and fat meals were cooked and desserts only used nonsugar alternatives. A recent meeting had raised the issue of what people felt about the food and the feedback was generally positive. The cook stated that they regularly speak to people about the meal choices and what they liked and did not like. Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 20 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 good. This judgement has been made using available evidence including a visit to this service. Staff and management were aware of their roles in protecting people and the necessary procedures were in place to make sure that staff responded appropriately. EVIDENCE: Information provided by the manager in the AQAA self-assessment form stated that no formal complaints had been made since the last inspection. The Complaint Policy and procedures, with time-scales, was available to people in the Service User’s Guide and pinned on the communal notice board. The manager was aware of the issues around adult protection and the local multi-agency procedures had been made available to staff with the relevant contact details for making a Protection of Vulnerable Adults (POVA) referral to the local authority. We talked to three members of staff and they had an understanding of what their role was in reporting to the manager or to local social service any concerns or incidents of adult protection. They were aware of the different forms of abuse and also that they could report their worries to an outside agency if they had worries about the manager or that incidents were not being dealt with. Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 21 The only area where staff needed to be more aware was the actual contact numbers and organisations that they have to or could contact such as the local authority POVA referral phone number. It is recommended that staff were made fully aware of the details of the organisations and agencies that they can or should contact in the event of an incident or allegation of abuse. Since the last inspection there has been one safeguarding investigation by the local authority into an allegation raised by a visiting healthcare professional. The staff at the time of the incident cooperated with the investigation. Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People lived in an environment that was clean and tidy and homely in nature. EVIDENCE: We looked around the building and outside and found that communal areas appeared generally clean and tidy and well maintained. The lift had been refurbished to allow better access for people using wheelchairs. An area had been set up as a sensory room but was not in use at the time of the site visit. A small room within the communal lounge was the designated smoking room with an extractor fan for ventilation. During the visit we could see and smell cigarette smoke in the communal lounge. Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 23 The previous inspection report had highlighted the need for the local environmental health officers (EHO) to be contacted to get advice about how to prevent smoke from drifting into the communal lounge. The manager stated that guidance had been sought and since the last inspection two EHO’s had visited and made recommendations including the improvement of the ventilation fan in the smoking room. The lounge had been divided into two areas using a large sliding door. In one area was seating with the television and music centre and on the other side was more seating with a pool table and computer. The dining room was well maintained and decorated in a homely style. Several people had their own televisions and personal items in their bedrooms to make them more homely. Bathrooms contained both portable and fixed hoists to aid people’s mobility. The previous inspection report highlighted that the emergency call cord in a person’s bedroom was broken and they could not reach it. All emergency cords had been checked and were now positioned so that they could be reached. The manager stated that they were aware that some areas of the home required redecoration and refurbishing and that a refurbishment plan was being prepared to action these areas of improvement. Staff training records sampled showed that they had participated in infection control training. The laundry facilities were suitable for the service and number of people supported. Clinical waste was disposed correctly. Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The number and deployment of staff was sufficient to meet people’s personal and healthcare needs. Staff had received the basic training to support people needs. EVIDENCE: At the time of the visit the staff rota showed that during the day (8:00 am to 8:00 pm) there was always at least one nurse and two care staff on duty. Between 1:00 pm and 4:00 pm two nurses were normally on duty. During the night there was one nurse and one care staff. They supported 13 people, seven with nursing needs and one person who required a minimum of two staff to support them for their mobility and personal care needs. The home employed two people as cook and two domestic workers covering the whole week. Care staff were expected to do most of the laundry tasks during their shift and help to prepare and service food in the evenings. Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 25 The nursing team consisted of four nurses who work nights and two who work the day shifts. We raised the issue of the number of nurses available to cover the day shifts. The manager stated that if required, the night staff could provide cover and that they were also a registered nurse and could work shifts if required. Two members of staff were asked about how they were recruited. Both explained the process and that they had provided identification information to apply for a Criminal Records Bureau (CRB) certificate and two referees. Both staff had recently started work at the home and had done so after a Protection of Vulnerable Adults (POVA) First check and they were still awaiting the CRB certificate. Both staff members files contained references and those from a previous employer had a company stamp to show where it had come from. It is recommended that interview notes be kept for all interviews to show that prospective staff had the knowledge and skills required to meet the job description and specification. A system was in place to check the validity and expiry of registered nurses PIN numbers. The staff members also described the induction they received where they were introduced to people living at the home, to familiarise themselves with the home, the key policies and procedures and the fire evacuation procedures. The manager was using the Skills for Care modules and recording format. A record of team training showed events that staff had participated in and included manual handling, medication, fire safety, first aid, and adult protection had been provided to most of the staff team. The manager had carried out an audit of training needs for nursing and care staff and was in the process of developing more individualised training plans and accessing the resources needed. Five members of care staff had gained the NVQ level 2 and four were completing the NVQ in care. It is recommended that a system be developed to assess the competence of staff in the application of the training and learning they have received in supporting people and meeting their needs. The manager stated that training needs for both care and nursing staff will be identified during supervision and that staff will participate in ongoing refresher training provided through both in-house and local training resources. The issue of providing nurses with the skills to develop more person focused care plans has been raised in the health and Personal care section of the report. Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The current management systems do not fully ensure that people were supported effectively and safely. EVIDENCE: The manager in post at the last key inspection of May 2008 was on leave at the time of the visit. They did not return to work and the Responsible Individual (RI) appointed another manager in October 2008. They left employment with the home a short time later and the current manager started work on the 29th December 2008. In between these times a member of the nursing team had provided management cover. Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 27 The current manager is a qualified registered nurse and has over five years experience working at a supervisory and management level in the nursing and care sector. They were the registered manager of a nursing home for five years in their previous employment and had the required qualifications for that role. The previous inspection report highlighted the need for the home’s manager to apply to become the registered manager. It is strongly recommended that the manager submit an application to us within three months of their appointment. Speaking to the manager they were able to clearly identify the areas and issues affecting people that need to be addressed and improved. They had already attended several meetings with the local authority purchases to discuss concerns that they had and had developed his own improvement plan and actions needed. This included the issues that have been raised in the report in relation to the inconsistency of applying the care planning and review process. As part of this process a deputy/care manager had been appointed with specific responsibilities of auditing and monitoring care planning, reviews and working practices. The care manager had only been in post since January 2009 and was in the process of developing the monitoring systems needed. The manager had also introduced a key-worker system whereby nurses had responsibility for developing and maintaining a named person’s care plan and review documentation. The issue of the inconsistency in the quality and depth and person focus of the care plans sampled has already been raised in the report. The manager stated that they were aware of this inconsistency and were working with the nurses to improve this. Comments from the staff team highlighted that the manager was having a positive affect on how they felt about their work and the home. Comments from staff surveys were positive. One member of staff wrote that, ‘With the new manager starting, he got a lot of experience and aiming to give a best standard of care to uplift the reputation of the home’. The manager had started to develop different ways for people and others involved in their care and support to express their views. Meetings with people were being established to explain changes and to get their views. Staff meetings were being held to explain the aims of the manager and to gather staff views of the changes. This process was just beginning and more meetings were being planned. Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 28 The manager was also starting to use questionnaires to ask relatives and other significant people about their views of the home and the quality of service that people received. He has plans for a more formal quality assurance system where all the information gathered will be used to help improve the quality of the service. The previous inspection report also highlighted concerns that people did not have reasonable access to their personal monies to purchase personal items. The manager stated that the management and nursing staff now had access to funds when required. A number of people looked after their own personal finance and spent their money as they wished. Other did have some restrictions placed upon how much they could be given and this was at the direction of the person’s representative from the local authority. Examples of risk assessments were seen that highlighted the support that people needed and also gave agreement to staff at the home spending money on their behalf for personal items. It is recommended that where any form of restriction was placed on a person’s access to their personal monies or the items they want to buy then this be dome through the agreement with the person and the purchasing authority and/or family. Samples of financial recording sheets were seen that showed that transactions between people and staff in terms of spending and holding money was recorded and invoices were gained where necessary. The manager stated that these records and cash balances were checked on a monthly basis and that records were also past onto the local authority for those people they acted as appointee for. The previous inspection report highlighted that further guidance was needed from the local EHO in relation to preventing cigarette smoke from going into the communal areas. Guidance had been sought and at the visit the door to the smoking room was closed and the ventilation fan was on. However, during the visit their were times when we could see and smell cigarette smoke in the communal lounge due to the location of the smoke room. It is recommended that consideration be given to the placement of the smoke room to minimise the impact of cigarette smoke on people and staff. Health and safety records, policies and procedures were seen and found that all the required servicing of mobility equipment, passenger lift, gas and electricity equipment was up-to-date. The fire log was checked and found that all the required physical checks were being made. Temperature checks and records of water sources and fridge/freezer equipment were being maintained. Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 29 Environmental and working practices and fire risk assessments were in place and being reviewed and updated as needed. Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO 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 OP8 Regulation 15 Requirement To make sure that people receive the support they need to keep the healthy and well, care plans must fully reflect their personal, healthcare, emotional and social needs and support in sufficient detail as to allow staff to meet those ways in the way that the person wants. Timescale for action 03/04/09 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 As the care plans fluctuated in quality depending on the nurse completing them it is recommended that all nurses with key-worker responsibility have access to more specific training in developing and writing person focused care plans. It is recommended that when staff use the coding system on the Medication Administration Record sheet that the reason be clearly recorded in the most appropriate place and format. DS0000066845.V374028.R01.S.doc Version 5.2 Page 32 2 OP9 Beechill Nursing Home 3 OP12 The picture quality of the television in the lounge was very poor and so it is recommended that this issue be addressed. It was also found that the television, radio and a music centre were all playing at the same time It is recommended that people be consulted about the social and leisure activities that they enjoy and want to participate in and this is clearly recorded through their care plan. It is recommended that staff were made fully aware of the details of the organisations and agencies that they can or should contact in the event of an incident or allegation of abuse. It is recommended that interview notes be kept for all interviews to show that prospective staff had the knowledge and skills required to meet the job description and specification. It is recommended that a system be developed to assess the competence of staff in the application of the training and learning they have received in supporting people and meeting their needs. It is strongly recommended that the manager submit an application to become the registered manager to us within three months of their appointment. It is recommended that where any form of restriction was placed on a persons access to their personal monies or the items they want to buy then this be dome through the agreement with the person and the purchasing authority and/or family. It is recommended that consideration be given to the placement of the smoke room to minimise the impact of cigarette smoke on people and staff. 4 OP18 5 OP29 6 OP30 7 8 OP31 OP35 9 OP38 Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection North West Regional Contact Team Unit 1, 3rd Floor 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 Beechill Nursing Home DS0000066845.V374028.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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