Inspection on 19/08/08 for Bentley House Nursing Home

This inspection was carried out on 19th August 2008.

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

Bentley House Nursing Home 08/09/09

Bentley House Nursing Home 12/04/06

Bentley House Nursing Home 12/04/06

Bentley House Nursing Home 07/02/06

Bentley House Nursing Home 12/05/05

Bentley House Nursing Home 03/02/05

Bentley House Nursing Home 16/08/04

Bentley House Nursing Home 01/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

CARE HOMES FOR OLDER PEOPLE Bentley House Nursing Home Twenty One Oaks Bentley Atherstone Warwickshire CV9 2HQ Lead Inspector Michelle McCarthy Key Unannounced Inspection 19th August 2008 8:50 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000004386.V370260.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. DS0000004386.V370260.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bentley House Nursing Home Address Twenty One Oaks Bentley Atherstone Warwickshire CV9 2HQ 01827 711740 01827 712901 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) Dr E Bellamy Mrs Leonore Patricia Park Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (47), Terminally ill (4) of places DS0000004386.V370260.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home may also provide care for the person named in the application dated 14 November 2005. Within the total of 47 beds Bentley House may also care for up to five service users between the ages of 50 to 64 whose nursing needs outweigh age consideration. 12th April 2006 Date of last inspection Brief Description of the Service: Bentley House Nursing Home offers personal and nursing care for up to 47 older people. Service users in this home can be accommodated for long or short term care. Bentley House was originally the Merevale Estate Colliery manager’s house and has been converted for use as a care home. The original country house has been converted to lounge areas and offices on the ground floor with a Day Centre on the first floor. The old stables were converted to kitchen and dining room. A purpose built ‘new wing’ houses residents’ bedrooms, bathrooms and offices for nurses and manager. The home provides accommodation on two floors in 47 single bedrooms. Eight of the single bedrooms offer varied en-suite facilities. All areas of the home are accessible by wheelchairs and there are two passenger lifts for the use of residents. There is ample parking in the home’s car park to the side of the main house. Bentley House is situated in a rural location on the border of Warwickshire and Leicestershire about two miles from Atherstone and offers panoramic views over the countryside. The location of the home does not offer easy access to local shops, local transport services and other community amenities. DS0000004386.V370260.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection visit. This is the most thorough type of inspection when we look at all aspects of the service. We concentrated on how well the service performs against the outcomes for the key national minimum standards and how the users experience the service. Before the inspection, we looked at all the information we have about this service, such as information about: • • • concerns, complaints or allegations incidents previous inspections and reports. We do this to see how well the service has performed in the past and how it has improved. The visit to the home was made on Tuesday 19th August 2008 between 8.50am and 5.30pm. 34 people were living in the home on the day of our visit and two residents were in hospital. It was the assessment of the manager that the majority of people living in the home had medium dependency nursing care needs. We used a range of methods to gather evidence about how well the service meets the needs of people who use it. This included talking to people who use the service and observing their interaction with staff where appropriate. We also looked at the environment and facilities provided and checked records such as care plans, risk assessments, staffing rotas and staff files. The manager completed an Annual Quality Assurance Audit and returned it to us within the timescale required. Three people using the service were identified for case tracking. This is a way of inspecting that helps us to look at services from the point of view some of the people who use them. We track peoples care to see whether the service meets their individual needs. Our assessment of the quality of the service is based on all this information, plus our own observations during our visit. At the end of the visit we discussed our preliminary findings with the manager. DS0000004386.V370260.R01.S.doc Version 5.2 Page 6 The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. What the service does well: What has improved since the last inspection? The presentation of liquidised and soft meals has been reviewed to make the meal more appetising and allow the person to enjoy the taste of each of the foods. The manager has developed a system for the supervision of staff. New boilers have been fitted, carpets have been replaced in the corridors, a new dishwasher has been fitted and decorating of rooms has been on-going as they become vacant. Windows have been replaced at front of the house and the entrance area. DS0000004386.V370260.R01.S.doc Version 5.2 Page 7 What they could do better: 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. DS0000004386.V370260.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection DS0000004386.V370260.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 was assessed. Quality in this outcome area is good. People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care files of three residents admitted were examined to assess the pre admission assessment process. The manager said that it was usual practice for a senior member of the nursing staff to visit people who are considering moving into the home to undertake an assessment of their needs and abilities. Files examined contained a pre admission assessment of each person’s needs and abilities. This means that sufficient information was available so that the DS0000004386.V370260.R01.S.doc Version 5.2 Page 10 home could confirm they could meet each person’s needs and develop care plans. For example, one person was identified as having swallowing problems and needed to have a pureed diet; a care plan was available in the care file and we observed that a pureed diet had been provided. DS0000004386.V370260.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 were assessed. Quality in this outcome area is adequate. People are treated respectfully. Care plans are not consistently developed for identified needs, which puts residents at risk of not having their needs met. The way the service manages medication does not safeguard people from the risk of medication errors. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living in the home looked well cared for. Their hair had been ‘dressed’ or combed and nails were trimmed and clean. People were groomed, well presented and wore clothes that were suited to the time of year. It was evident from our observation that the personal care needs of people living in the home are met. The relative of one resident told us, ‘The care here is better than in hospital. My relative’s pressure sore has healed because of the attention given.’ DS0000004386.V370260.R01.S.doc Version 5.2 Page 12 The care files of three people identified for case tracking were examined. Each person had an individual care file. Care plans were available for some of the identified needs of each person and supplied staff with the information needed to make sure these needs were met safely and appropriately. For example, one person was identified as having swallowing problems and needed to have a pureed diet; a care plan was available in the care file and we observed that a pureed diet had been provided. This means that staff had information to appropriately support this person’s nutritional needs. A care plan was developed and implemented for one resident who developed a pressure sore, recording how the wound should be treated. Wound monitoring records evidenced that instructions were followed and the outcome resulted in wound healing. This means that staff had information to appropriately support this person’s wound care needs. Care plans had not been developed for some of the needs of residents. For example; We observed an oxygen concentrator in the room of one person we case tracked . A member of care staff told us, ‘xxxx usually uses it, but isn’t today.’ The manager told us the person was not always compliant with use of the oxygen prescribed. A care plan was not available describing how the oxygen should be used. The medicine administration record did not record a prescription for oxygen giving information about the frequency or dosage. This means staff do not have written instructions about how to use the oxygen so we cannot be certain it was administered appropriately. The pre admission assessment for one person identified a high risk of developing pressure sores. A care plan was not developed to implement pressure relief. This person subsequently developed a pressure sore after they were admitted to the home. The service uses risk assessment tools to identify whether residents are at risk of developing pressure sores or poor nutrition. When the outcome of a assessment identifies an increased risk, action is not always taken to minimise the risk. For example, the nutritional risk assessment for one person identified a high risk of poor nutrition and a Body Mass Index (BMI) of 15, indicating they were underweight. A care plan was not developed stating what diet would be advisable, records to be kept and the frequency of weighing. Weight monitoring records were not maintained; the person had been weighed on admission to the home 8 weeks ago, but had not been weighed since to monitor whether they had lost, sustained or gained weight. DS0000004386.V370260.R01.S.doc Version 5.2 Page 13 This means staff cannot be certain that this person’s nutritional needs have been met. Each person’s care file contained a record of contact with or visits by Health Care Professionals. These confirmed that people living in the home have access to Health Care professionals such as the GP, dietician, optician and speech and language therapist. Record showed that a person requiring bed rails for their safety had been properly assessed and this told us that staff had given consideration to the best way of maintaining this person’s safety. We examined the systems for the management of medicines in the home. A monitored dosage (‘blister packed’) system is used. Medication is safely stored in locked trolleys, which are kept in a locked clinical room. A medicines fridge is available in each treatment room with daily recordings of the temperature, which were within recommended limits. It is recommended that the room temperature is monitored and recorded so the provider can be sure that medicines are stored below 25°C to maintain their stability. The facility for storing controlled drugs (CD) complies with legislation. The contents of the controlled drug cabinet were audited against the controlled drug register and the quantities were correct. During the audit of controlled drugs we found that a fentanyl 50 microgram patch (a strong painkiller) prescribed for one resident, to be administered at 72 hour intervals, was given 36 hours late on one occasion. This could have resulted in this person suffering increased pain and discomfort. We examined the medicines of three people involved in case tracking and audited one from each of their prescribed medicines by comparing the quantity in stock against the signatures on the medicine administration records (MAR). Anomalies were found in each of the three medicines we audited which means we cannot be certain that medicines are administered as prescribed to individual residents. The MAR sheet for one person recorded that 28 Adcal tablets (calcium and vitamin D tablets) were received into the home and 26 staff signatures on the MAR sheet indicated that 26 tablets were administered. We expected to count 2 tablets left in stock, but we counted 10 tablets. This suggests that tablets were signed for and not administered, or records documenting the number of tablets received into the home were inaccurate. The MAR sheet for another resident recorded that 100 paracetamol tablets were received into the home. There were no signatures on the MAR sheet DS0000004386.V370260.R01.S.doc Version 5.2 Page 14 against this medicine, which indicates that none had been administered. We expected to count 100 tablets in the home but we counted 94. Six tablets could not be accounted for. Accurate records relating to the management of medicines must be maintained so the provider can be certain that medicines are administered as prescribed. A system should be developed and implemented to make sure all medicines received in to the home can be accounted for to enable an accurate audit trail. We observed safe practice in the administration of medicines during a medicine administration ‘round’. For example, the nurse checked the MAR sheet before dispensing medicines from the trolley and administering to each individual in turn. Staff had a sensitive, kind and caring attitude towards the people living in the home. Personal care was provided in private, residents were spoken to respectfully by staff and addressed by their preferred names. DS0000004386.V370260.R01.S.doc Version 5.2 Page 15 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): Standards 12, 13, 14 and 15 were assessed. Quality in this outcome area is adequate. A planned activity programme provides opportunities for meaningful stimulation. Some routines of working practices in the home limit people’s choices in how they spend their time. Residents benefit from a nutritious and varied diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service employs two activity co-ordinators who work a total of 30 hours over five days each week. They do not work on a Sunday or a Tuesday. The daily activities program each week was displayed in several areas of the home, activities each week include a bingo session, a variety of games, shopping trips and mobility, with visiting entertainers, (singers) visiting monthly. We visited on a Tuesday when there is no activity co-ordinator on duty but the hairdresser was visiting and people were enjoying having their ‘hair done’. DS0000004386.V370260.R01.S.doc Version 5.2 Page 16 The relative of a resident contacted us because they were concerned that the working routines of the home meant that residents remained in their rooms until after lunch. On the day of our visit we observed that residents were served breakfast in their rooms and did not use the communal areas until after the midday meal service, remaining in their rooms until then. We observed one resident using the communal lounge before midday, when they were joined by their relatives. We were told an activity co-ordinator supervises people in communal areas when staff are busy attending to personal care needs, however, there is no activity co-ordinator working in the home on a Tuesday or a Sunday. The working routine of the home could limit how people choose to spend their morning. Residents’ case files examined did not record personal preferences such as a preferred time for getting up or going to bed. There were no care plans to indicate whether people are offered a choice of how their day is structured and where they spend their time. The service should ensure that the choice of each individual is recorded as part of their activity programme demonstrating that they are offered a choice about where they spend their day. The home has an open visiting policy. People are encouraged to maintain links with their family and friends. Residents told us that visitors are made welcome and the visitor’s record demonstrated that people could visit when they want to. We observed the lunchtime meal service in the dining room which was served at 1.30 pm. Dining tables were attractively set with white linen tablecloths covered with condiments and floral arrangements. The mealtime was evidently a social occasion giving residents the opportunity to come together and chat over their meal, either with staff or other residents. 17 people attended the dining room. The day’s choice of meal was sausages in gravy or steak pie accompanied by cauliflower cheese, cabbage and mashed swede and potato. cheesecake, strawberry mousse or ice cream was offered for dessert. People are offered the choice of menu on the previous day. The cook told us that alternatives are offered to people who do not have a preference for either of the day’s choices. The meal looked tasty and nutritious. People made positive comments about the food served. One person told us, ‘the food is good. There is always a choice.’ The manager told us the number of staff on duty is ‘staggered’ throughout the day to make sure there were more staff available at times when care needs DS0000004386.V370260.R01.S.doc Version 5.2 Page 17 were greater. There are six care staff on duty during the midday meal service, we observed that there were enough staff to give residents sensitive assistance with their meals. There are usually four care staff on duty during the evening meal service so there are less staff available to offer assistance. We observed staff serving a meal to one resident who required a pureed diet. Each of the foods had been pureed and served individually to make the meal more appetising and allow the person to enjoy the taste of each of the foods. Several requirements were issued during the Environmental Health Officer’s inspection of the kitchen undertaken in April 2008. A further Environmental Health Officer’s inspection in June 2008 confirmed the service had complied with the requirements. DS0000004386.V370260.R01.S.doc Version 5.2 Page 18 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): Standards 16 and 18 were assessed. Quality in this outcome area is good. People living in the home can be confident that their concerns will be listened to and acted upon. There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a formal complaints policy which is accessible to people living in the home and their families. People are encouraged to raise their concerns with the manager or senior staff on duty. Residents told us that they would initially raise concerns with their relatives or representatives who would speak to the manager on their behalf, but they said they felt they could go to the nursing staff and they would be listened to. We have received a number of complaints about services offered by the home since the last inspection. Complaints have been received from family members and professionals. Complaints detail concerns about the standard of personal care received by residents, social isolation, staffing levels and residents waiting for assistance. We referred these to the provider for investigation. DS0000004386.V370260.R01.S.doc Version 5.2 Page 19 A record of complaints and concerns received by the home is maintained along with the action taken by the home regarding each issue raised. Evidence was available that the manager and provider makes a timely and objective response to concerns raised. The home has an adult protection policy to give staff direction in how to respond to suspicion, allegations or incidences of abuse. Training records examined show that staff receive training in recognising signs and symptoms of abuse during their induction. It was evident through discussions with the manager that she is aware of local Social Services and Police procedures and her responsibilities for responding to allegations of abuse. DS0000004386.V370260.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 were assessed. Quality in this outcome area is adequate. People are provided with comfortable surroundings to live in and enjoy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Bentley House is a large converted house with beautiful views over the Warwickshire countryside. 47 single occupancy bedrooms are provided over two floors and are located in one ‘wing’ of the property. A large lounge and conservatory provides comfortable and spacious communal accommodation. A spacious dining room and smaller ‘Quiet Lounge’ are also available for people to use. The public areas in the home are clean, bright and airy. Easy chairs are grouped socially so that residents are encouraged to interact with each other. DS0000004386.V370260.R01.S.doc Version 5.2 Page 21 The home is has a programme to improve the decoration, fixtures and fittings. Information provided in the AQAA told us that, since the last inspection, new boilers have been fitted, carpets have been replaced in the corridors, a new dishwasher has been fitted and decorating of rooms has been on-going as they become vacant. Windows have been replaced at front of the house and the entrance area. We arrived at the home at 8.50am and let ourselves in through the unlocked entrance door. There was no system for us to alert staff that we were present in the home and we were not challenged. We approached a member of he domestic staff to tell them of our presence. The manager told us that it is usual practice to leave the front door unlocked during the day. We recommend that a system is developed to make sure staff know who is entering the home to prevent unwelcome visitors and protect the vulnerable people living there. Several bedrooms, including the people involved in case tracking, were viewed. Rooms were comfortable, well decorated and had good quality furniture and co-ordinating soft furnishings. Eight rooms have ensuite facilities. All the rooms viewed were personalised with people’s own belongings and looked as though it belonged to the person. Equipment is available to assist residents and staff in the delivery of personal care, which includes assisted baths, moving and handling equipment including hoists. Pressure relieving equipment such as cushions and various types of mattress are available for people who have an identified need for them. The home was warm and clean and smelt fresh. Systems are in place for the management of dirty laundry. Protective clothing such as plastic gloves and aprons were available and arrangements are in place for the disposal of waste. DS0000004386.V370260.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 were assessed. Quality in this outcome area is adequate. The high percentage of care staff with a National Vocational Qualification (NVQ) in care means people can be confident that they are being cared for by competent staff. The number of staff on duty is not consistently sufficient to meet the individual lifestyle needs for the people living in this home. Recruitment practices are not sufficiently robust to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care home provides nursing and personal care for a maximum of 47 people, accommodated over two floors. On the day of our inspection 34 people were accommodated in the home and two people were in hospital. It was the assessment of the home manager that the majority of residents had medium dependency nursing care needs. The manager told us that the staffing complement had recently been reviewed and reduced because the home is not fully occupied. The manager told us the number of care staff on duty is staggered throughout the day to make sure there were more staff available at times when care DS0000004386.V370260.R01.S.doc Version 5.2 Page 23 needs were greater, such as getting up in the mornings and going to bed in the evenings. The manager described the current care staff complement as: 7am 1pm 2pm 8pm 9pm – – – – – 1pm 2pm 8pm 9pm 7am 5 6 4 7 3 care care care care care staff staff staff staff staff The number of registered nurses on duty has also recently been reduced because the home is not fully occupied. There is at least one registered nurse on duty at all times. The manager has additional nursing hours available and has distributed these hours across the week at times of peak nursing activity. For example, a second nurse is on duty between 8am and 11am for five days each week and a second nurse is on duty between 8am and 1pm for two days each week. These extra nursing hours are used to support the administration of the morning medicines to residents, which takes from 8.30am until 11am. On the two days each week that a second nurse is available until 1pm, the extra hours are used to support the regular GP visits and medicine ordering or delivery. A member of the nursing staff told us they were ‘stretched’ during evening shifts when the medicine administration could take up to two hours or more and the daily records had to be completed. It is evident from our observations that residents’ basic health and personal care needs are met but social and activities needs are not as there are not consistently enough staff on duty to do this. One member of care staff told us, ‘Two care staff work upstairs and two care staff work downstairs. In the mornings the extra carer staff floats between the two floors. We manage to get everything done’. Residents’ bedrooms are located over two floors and the communal lounges and dining room are in another ‘wing’ of the building. Several residents need the assistance of two carers to meet their needs; for example, the manager told us that 11 people require the use of a hoist to assist them to move. We asked a member of the nursing staff how staff were able to support and monitor people using the various communal areas in the home as well as meeting the needs of people who remained in their rooms. We were told that an activities co-ordinator is available for 6 hours a day on five days of the week and observes residents during participation in group activities in communal areas and seeks assistance from care staff where necessary. Information shared with us by relatives and social care professionals on five occasions since the last inspection raises concerns about the number of staff available to meet the needs of residents with the length of time residents are left waiting for a response as a recurring theme. DS0000004386.V370260.R01.S.doc Version 5.2 Page 24 Evidence in the ‘Daily Life and Social Activities’ section of this report indicates that people’s choice in how they spend their day is limited by some working practices. The manager’s hours are supernumerary and there are sufficient laundry, catering, cleaning, maintenance and administrative staff to ensure that care staff do not spend undue lengths of time undertaking non-caring tasks. The manger has sustained her commitment to staff training evidenced at the last inspection. 16 out of 20 care staff permanently employed in the home have a National Vocational Qualification (NVQ) in Care at level 2 or above which, at 80 , exceeds the National Minimum Standard for 50 of staff to be qualified. This means people can be confident they are being cared for by competent staff. The personnel files of two recently recruited staff were examined. One file contained evidence of satisfactory checks such as Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA) and references. However, the second file evidenced that the staff member had a satisfactory PoVA First check but started working in the home before a satisfactory CRB was obtained. The manager confirmed that the CRB for the staff member had not yet been received by the home. There was no evidence of supervision for this staff member. This practice does not protect people living in the home from the risk of abuse. We discussed this with the manager of the home who was not aware that supervision and mentoring was required for staff with a PoVA First awaiting a CRB. We referred the manager to our website for guidance. Evidence was available that new staff undertake an induction programme and have access to mandatory training in fire safety, abuse awareness and moving and handling. This should mean that staff are updated in safe working practice. DS0000004386.V370260.R01.S.doc Version 5.2 Page 25 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): Standards 31, 33, 35 and 38 were assessed. Quality in this outcome area is adequate. The manager has promoted staff development and training and has developed some systems for monitoring working practices to improve the service people receive. Shortfalls in medicine management and recruitment fail to ensure the safety of people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is qualified or has the necessary experience to run the home. The registered manager has been in post for over a year and has the necessary experience to run the home. She is a registered nurse and has achieved the registered manager’s award (NVQ level 4). DS0000004386.V370260.R01.S.doc Version 5.2 Page 26 The manager returned a completed AQAA within the timescale required. The information gave a reasonable picture of the current situation within the service. The evidence to support the comments made was satisfactory, although there are areas where more supporting evidence would have been useful to illustrate what the service has done in the last year, or how it is planning to improve. The AQAA gave us some limited detail about the areas where they still need to improve. The ways that they are planning to achieve this are briefly explained. Surveys were sent to residents and relatives in April 2008 to seek their opinion on the service they receive in the home. The manager said there was a poor return with only 15 responses received. The results of the survey have not been collated or analysed we cannot be certain whether it was necessary to develop an action plan to implement improvements needed. The manager has developed systems to monitor practice and compliance with the plans, policies and procedures of the home. This includes care plan audits and formal staff supervision. More work is needed in this area; for example, shortfalls in the care plans examined demonstrate that the system for auditing care plans is not effective. It is recommended that the manager develops and implements a system to audit the way the service manages medication. Individual account sheets are maintained where the service holds residents’ personal monies for safekeeping. The account sheets detail all the transactions made but receipts are not available for all the transactions; for example, the purchase of toiletries. It is recommended that receipts are obtained and kept to record each transaction so the service can account for people’s personal monies. The home has effective systems for maintaining equipment and services to the home to promote the safety of people in the home. A sample of service and maintenance records were examined and found to be up to date; for example, fire alarm systems are tested weekly and serviced quarterly, Portable Electrical Appliance testing is ongoing on a ‘rolling programme’ and hoists were serviced in February 2008. Improvements in the management of medicine and robust recruitment procedures are necessary to promote the safety of people using the service. DS0000004386.V370260.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 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 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 2 DS0000004386.V370260.R01.S.doc Version 5.2 Page 28 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 Regulation 12 Requirement Care plans must be available for each of the identified needs of people living in the home and contain details of the actions required to meet each need. This is to make sure people get the care they need to promote their health and well-being. 2. OP8 13 Action must be taken to minimise identified risks to the health or well being of residents. This should include the risk of poor nutrition and the risk of developing pressure sores. This is to make sure the health and well being of people living in the home is maintained. 3. OP9 13(2) Accurate records relating to the 31/10/08 management of medicines must be maintained so the provider can be certain that medicines are administered as prescribed. This will ensure that residents receive their medication as prescribed and it will minimise DS0000004386.V370260.R01.S.doc Version 5.2 Page 29 Timescale for action 31/10/08 31/10/08 mistakes. 4. OP29 19 Staff who are employed with a POVAFirst check must be supervised and mentored until a full satisfactory CRB and POVA check is received. This is to make sure that people living in the home are protected from the risk of abuse. 31/10/08 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 OP9 Good Practice Recommendations It is recommended that the clinical room temperature is monitored and recorded so the provider can be sure that medicines are stored below 25°C to maintain their stability. A system should be developed and implemented to make sure all medicines received in to the home can be accounted for to enable an accurate audit trail. It is recommended that the manager develops and implements a system to audit the way the service manages medication, to include the competency of staff administering medication. The service should be able to demonstrate that it meets the needs of each person in a way that meets their lifestyle preferences. A system should be developed to make sure staff know who is entering the home to prevent unwelcome visitors and protect the vulnerable people living there. The service should keep the number of staff required to DS0000004386.V370260.R01.S.doc Version 5.2 Page 30 2. OP9 3. OP9 4. OP14 5. OP19 6. OP27 meet the needs of the people using the service under review and increase staffing hours where and when required. This should make sure people’s needs are met in a way that reflect their individual lifestyle preferences. 7. OP33 The responses from resident and relatives’ surveys should be collated and analysed to identify any areas that require improvement. Receipts should be obtained and kept to record each transaction so the service can account for people’s personal monies they are holding for safekeeping. 8. OP35 DS0000004386.V370260.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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. 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