Inspection on 26/02/08 for Bluebell Nursing Home

This inspection was carried out on 26th February 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bluebell Nursing Home 25/02/09

Bluebell Nursing Home 06/08/08

Bluebell Nursing Home 10/07/07

Bluebell Nursing Home 30/05/06

Bluebell Nursing Home 03/10/05

Bluebell Nursing Home 06/04/05

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Winton House

Newbeech House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Bluebell Nursing Home 45 - 53 St Ronan`s Road Southsea Hampshire PO4 0PP Lead Inspector Anita Tengnah & Janet Ktomi Unannounced Inspection 09:15 26 February 2008 th 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 Bluebell Nursing Home DS0000062757.V357924.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. Bluebell Nursing Home DS0000062757.V357924.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bluebell Nursing Home Address 45 - 53 St Ronan`s Road Southsea Hampshire PO4 0PP 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) 023 9282 3104 023 9282 6109 suecollins@whnh.com Techscheme Ltd t/a Bluebell Care Home Position Vacant Care Home 51 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0), Old age, not falling within any other of places category (0), Physical disability (0), Physical disability over 65 years of age (0), Terminally ill (0), Terminally ill over 65 years of age (0) Bluebell Nursing Home DS0000062757.V357924.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) 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 (OP) Physical disability over 65 years of age (PD) 2. Dementia (DE) (15) The maximum number of service users to be accommodated is 51. Date of last inspection 10th July 2007 Brief Description of the Service: Bluebell Nursing Home is registered with the Commission for Social care Inspection (CSCI) to provide nursing and personal care to 51 people in the older person category. The home is situated in Southsea and is close to the pier and seafront, a predominant feature of the area, which is well serviced by local bus companies. Local facilities are sparsely situated, although Southeas main shopping centre is a short journey from the home. The nursing home is comprised of five period town houses combined to create a single building, with three separate floors and two mezzanine floors. The home has a small garden to the back with seating provided. The current fee charged is £411-£650 per week. Bluebell Nursing Home DS0000062757.V357924.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience Poor quality outcomes An unannounced visit to the service was undertaken as part of the inspection on the 26h February 2008. Two inspectors carried out this visit. The process included a tour of the service where a number of the bedrooms, communal areas, kitchen, and bathrooms were viewed. As part of case tracking staff and seven service users views were sought and care records were looked at. Information gained from the Annual Quality Assurance Assessment (AQAA) was also used and included in this report, as was information gathered by the commission since the last inspection to contribute in assessing judgements in this report. We also sent out service users surveys to people using the service, their relatives and other professionals who regularly have contacts with the service. We spoke to three visitors and gave feedback to the provider following the visit. The service has been without a registered manager since June 2007. A manager has been in post since August 07 and has not as yet registered with us. The representative of the service was issued with two immediate requirements about things that the Responsible Individual needs to rectify in order to safeguard people’s safety. The Responsible Individual was not present at the time of the inspection. There are a number of requirements that have been raised from this visit and will be reflected in the body of this report. What the service does well: The chefs produce wholesome and well-presented meals that offer choices to people living at the service. There is an ongoing programme of refurbishment in place to provide people with a warm and comfortable environment to live in. The staffing level was adequate to meet the present needs of the residents. Bluebell Nursing Home DS0000062757.V357924.R01.S.doc Version 5.2 Page 6 There is a satisfactory staff recruitment process in place and checks are completed as required prior to employment. What has improved since the last inspection? What they could do better: A statement of purpose must be developed and made available to all prospective service users. All service users must have a pre admission assessment prior to moving into the service so that the home can be sure of meeting their needs. Staff practice must ensure that at all times the privacy and dignity of people receiving care is respected. People must be supported and given autonomy and choices with their activity of daily living. Risk assessments to include dietary needs and prevention of falls must be developed to ensure that people are protected. Medication management at the home needs to be improved in particular with regards to ordering, administration, recording and handling of medicines so that people receive the medication that they are prescribed. A complaint log must be developed and put in place to monitor all complaints received at the service. Environmental risk assessments must be regularly reviewed and updated to include fire management and fire evacuation training for staff. Training in moving and handling must be completed by all staff to minimize risks to the residents prior to providing care. Substances that are hazardous to health must be kept locked for the safety of people using the service. A system must be in place to ensure that staff receive regular supervision as part of their work. Bluebell Nursing Home DS0000062757.V357924.R01.S.doc Version 5.2 Page 7 Quality assurance needs attention to ensure that management tasks such as elements of staff management, the management of health and safety, reporting incidents and providing adequate stimulation for residents are consistently monitored and needs met. 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. Bluebell Nursing Home DS0000062757.V357924.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 Bluebell Nursing Home DS0000062757.V357924.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. 1,3,6 The lack of detailed information such as the statement of purpose does not assist people to make an informed choice about whether they would like to move into the home. The pre admission assessment process was poor and the home did not ensure that the needs of people were assessed prior to providing care. The service does not provide intermediate care. EVIDENCE: Information received as part of regulatory work told us that the home’s statement of purpose was in need of development, as this did not contain up to date information for prospective people using the service. The person in charge at the time of the visit confirmed that this had not been completed and work Bluebell Nursing Home DS0000062757.V357924.R01.S.doc Version 5.2 Page 10 was ongoing. People recently admitted said that they had some information that was given to them verbally. The care records of five people were looked at as part of this visit. Two of the new admissions had a pre- admission assessment completed. The assessment included personal care, moving and handling and one was identified as having numerous falls. A care manager’s assessment was available for one of them that were completed in September 07. However the two other records seen did not contain a pre admission assessment. A relative said that the manager did visit them but there was no evidence that information gathered following the visit had been recorded. The registered person must have system in place to ensure that people’s needs are assessed prior to admission to the service. The lack of assessment did not give staff the information they require to provide care appropriate to people’s needs. One person said that their daughter did visit the home and thought it was “all right”. The acting manager confirmed that the home did not provide intermediate care. Bluebell Nursing Home DS0000062757.V357924.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. 7,8,9,10 There is a lack of clear guidance in care plans and inadequate assessments to promote and protect people’s welfare and safety. The access to external healthcare provision is satisfactory. The medication management is poor and puts people at risk. There is a lack of choice and the privacy and dignity of people using the service is not always protected. EVIDENCE: We looked at five records of people receiving care at the home. Care plans were formulated and there were basic information about the needs of people. The records contained risk assessments for moving and handling, however some of these lacked details to inform practice. The information was not clear Bluebell Nursing Home DS0000062757.V357924.R01.S.doc Version 5.2 Page 12 as it did not tell the staff how the risks were to be managed in practice Records had information about the pressure risks assessments such as Waterlow score. Some of these assessments including Waterlow score were not reviewed regularly to ensure that they identify the current needs of people. There was no record that people had their weight recorded as part of their assessment, as these were not available in any of the care records seen. Obtaining a person’s weight is the baseline in assessing a person’s risk and providing pressure care management. The acting manager reported that staff were aware that people’s weights should be monitored and recorded, particularly those people that are assessed as vulnerable to weight loss. There were no dietary needs risk assessments in place. However a number of people were at risk with swallowing problems. They were receiving thickening agent in their fluids as this suggest that people would be at risk, however the care plans did not contain any assessments for their swallowing reflexes to show how these were assessed and how this was to be managed. There was no information in care plans for staff about the amount of thickening agent needed in their fluids. These concerns were brought to the attention of the acting manager and the director. In other instances we noted that a number of people were having records maintained of their fluids and food intakes. One of the records seen contained detailed information about the amount of fluids and food intakes. This had improved for this person following complaints from their family. The records of other fluids and food intake record charts were poor. One of these showed that only three amounts of fluids had been taken in a twenty-four hour period. Others showed that no records were made in their charts for up to two days. It was also unclear why these food charts were in place as no dietary assessments were available. This was brought to the attention of the acting manager and staff. There was no fall risk assessment undertaken for people identified as having a history of falls. Information received and discussion with staff showed that all the residents were registered with the local GP practice and they were supported in accessing care as needed. Care records contained visits from external healthcare professionals. Equipment was available for the relief and treatment of pressure ulcers. Care records of two people with pressure ulcers showed that wound care plans were in place. There was some evidence of review/evaluation of wounds but again this was not consistent in the two wound care plans seen. As discussed the wound care plans needed further development to include clear wound management plan and evaluation for each individual wound and assessment. Bluebell Nursing Home DS0000062757.V357924.R01.S.doc Version 5.2 Page 13 The acting manager and other staff spoken with confirmed that only registered nurses are responsible for the management of medication at the home. It was noted that oral medication was stored safely and this included controlled medication. Two Registered nurses signed the controlled drug record as required. A sample of Medication Administration Record (MAR) sheets was looked at as part of this visit. These gave us grave concerns and an immediate requirement notice was issued at the time of the visit. Records showed that one person did not receive his morning Insulin on two separate occasions over the weekend. Another person missed one dose of Insulin according to the MAR sheet. A large number of gaps were noted on the MAR sheets that included medications such as heart medication, anti psychotic drugs, blood thinning drugs. Another person had received excess medication according to the prescription on the MAR sheet. The acting manager later informed us that this medication had been increased following a hospital admission. However the prescription and record on the MAR sheet that staff were following had not changed. This still showed that the person was prescribed this medication to be administered five times a day. A further person was given the wrong dosage of a blood thinning medication. The process of checking and ordering medication was failing. A resident complained of being in pain and told us that the home had run out of the prescribed painkiller. The record was checked and it showed that the resident had been without this pain tablet for three days. Staff had recorded that this tablet was out of stock; no remedial action had been taken to resolve this problem and to ensure that this person’s pain care needs are managed effectively. The development of a pain assessment tool should be in place in order to assess and deal with pain effectively. The home has a number of people with dementia and there was no information to show how staff would manage their pain. The management of prescribed ointments and dressings were further abused. We noted that staff had crossed off the names of people for those that creams and dressings, wound- cleansing solutions had been prescribed for and these were used for other people. These were brought to the attention of the acting manager and removed as they pose high cross infection risks and it was not Bluebell Nursing Home DS0000062757.V357924.R01.S.doc Version 5.2 Page 14 evident that they were suitable treatment for any other resident, which presented a risk of harm. We noted notices on some of the bedrooms doors instructing staff to knock and wait until they are asked to enter the people’s bedrooms. Two staff were observed feeding residents their breakfast and they treated them in a respectful manner and had good interaction with them. Comments from surveys we received included that “the staff are friendly, caring and helpful.” People’s privacy and dignity was not always respected. We observed an incident of poor practice on the day of the visit that we brought to the attention of the acting manager and the director. A person was being hoisted in one of the communal areas and their privacy was not being respected. Staff must be instructed to ensure that the privacy and dignity is preserved at all times when they are dealing with people. Notices were seen on the bedrooms doors to instruct staff to knock and wait prior to entering people’s private accommodation. Other issues raised in this report include the lack of screens in shared rooms. The failure to consult people about their choices in their daily lives does not demonstrate practices where people dignity is promoted. A statutory notice will be issued due to the failure of the registered person to ensure that people privacy and dignity is promoted at all times. Bluebell Nursing Home DS0000062757.V357924.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 12,13,14,15 There are some activities available, however these did not meet the needs of all the people. Further development is needed to meeting social, emotional and recreational needs through more individualised assessment and planning. The visiting policy supports people to maintain contacts with their relatives. There are some choices available to people, however this was not consistent and must be further developed to meet people’s needs. The meals at the home were well managed and offered choices that met with their satisfaction. EVIDENCE: We noted that there was an activity programme that was displayed and an external entertainer visited monthly. There was little record in care plans about how individual people are to be supported socially and emotionally on a dayto-day basis. The home has a number of residents with dementia and the care Bluebell Nursing Home DS0000062757.V357924.R01.S.doc Version 5.2 Page 16 records seen did not have an assessment or care plans to show how the needs of people would be met. The recorded activities were television, hairdressing, and musical programme. On the day of the visit the television was on fairly loud in the communal lounge and we observed that people in that area showed no interest in the television. People comments were that “this is always on and one person thought the noise “was a nuisance”. Another person said that they “sometimes” looked at it. As discussed with management there was no staff interaction with people except when tasks were performed. The last inspection report suggested that one area where choices could be improved was in mental stimulation as a number of people sat in the same chair all day in the lounge. We observed that nine people still remained in their chairs all day in the lounge with no stimulation. As part of providing care an assessment must be developed to establish a baseline that reflects the people using the service’s life history, interests, strengths and abilities in order that their needs can be met. In the five care plans seen only two had some social needs recorded such as likes company and staff interaction. People living in the home must be consulted about and have their social interests and recreational preferences recorded, and provided for, having regards for the differing needs of the service user with mental frailty to that of the service users with physical disability. A statutory requirement notice will be issued due to the number of times that this had been identified and the failure of the provider to take action to offer people choices and meet their social and recreational needs. Staff reported that there a vicar visited monthly and pastoral care including one to one support was available. One care plan seen indicated that the resident attended Methodist Church prior to admission. There was no evidence to show that this was still available at the service. The home has an open visiting policy and people spoken with said that they could visit at any time. Comments included that the director and staff are “helpful in every way” and “the owner is always helpful if I wanted to get a message to my father.” The home maintained a record of visitors to the service and this showed that people visited at varying times. The acting manager stated that the office had been moved to the front of house and this would be easier for people if they wanted to meet her. The staff we spoke with said that they offered people choices. Some of the people we spoke to said that they preferred to remain in their rooms and “this was not a problem”. Another person said that they got up late and chose to stay in their room. Others said that they did not have the choice when they got up or when they went to bed. The carers confirmed that the night staff got a number of the residents up and dressed. However the care records did not show how this decision was made. There were no night care plans in any of the Bluebell Nursing Home DS0000062757.V357924.R01.S.doc Version 5.2 Page 17 records seen. People spoken with said that they just waited when the staff are ready to get them up. One person said that they liked to get up early but did not have a choice. There is a planned menu and a copy of the daily menu was displayed in the front hall. The chef said that she went and saw people to discuss the menu with them. We observed that one resident was consulted about the food available for the day. The chef discussed that the menu was rotated on a regular basis. A record of meals provided was maintained on a daily basis. Staff reported that people’s likes and dislikes were sometimes discussed with relatives on admission. As discussed a record of this should be kept in the kitchen to inform practice. The kitchen was well organised, clean and the environmental officer had visited the service since we visited. Comments from people included” The food is very good “, “no problem about choosing what you like” and “there is always plenty”. Staff were available to offer support with meals as required and this was carried out in a respectful manner. A staff member discussed that she had requested a different meal from the set menu for one of the residents after talking to him that morning. A statutory notice will be issued for the failure to provide with suitable recreational and social opportunities to people living at the home, as this had been identified since 2006. Bluebell Nursing Home DS0000062757.V357924.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. 16,18 People say that they would approach the person in charge with any concerns. The management of complaints is poor, with no records of complaints/ investigations and outcome available. Staff knowledge and training in safeguarding was inadequate and did not fully protect people using the service. EVIDENCE: The home has a complaint procedure. All the five people who responded to the survey said they knew how to make a complaint. Some people we spoke to said that they would go to the ‘matron’ if they were unhappy about anything. Staff said that they would go to the person in charge if they had any concerns. The commission had received a recent complaint in January 08 regarding a resident who was admitted to hospital with dehydration and referred this to social services as safeguarding. The outcome of this investigation has not as yet been determined. Another relative had raised her concerns with the acting manager about the lack of fluid that led to her relative suffering from dehydration and was admitted to hospital. The acting manager confirmed that she had been investigating this complaint however she had not recorded this complaint. We asked to look at the complaint log and the director confirmed that this was not Bluebell Nursing Home DS0000062757.V357924.R01.S.doc Version 5.2 Page 19 available. The complaint log was not checked at the last visit. The registered person must ensure that there is a system in place and staff are updated on the procedures in dealing with complaints. This must include a complaint log where records of all complaints received, any investigation and action taken are maintained and they meet the timescale of the complaint procedure. At the last inspection in July 07 we found that staff had some knowledge about safeguarding and training was being developed for staff. We spoke to some of the staff and it was evident that knowledge of what to do with any allegation of abuse was still inadequate. Staff said that they would report to the manager but were unsure about taking it further. As discussed the trained staff who are left in charge of the home must have training and updates on the procedure to report all allegation of abuse to the appropriate authority. We were unable to assess what training had been completed in safeguarding, as the records were not available. The director stated that training in safeguarding was being accessed through an external company for staff. As a result of the serious concerns regarding the care and the safety of the residents identified at the time of the visit, a safeguarding referral was made to Portsmouth Social Services department inn February 08. Bluebell Nursing Home DS0000062757.V357924.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 19,26 The ongoing refurbishment would provide the residents with a comfortable accommodation. The lack of screens in shared rooms does not promote privacy and dignity. The laundry is well managed and the infection control procedures are satisfactory. EVIDENCE: The service has been undergoing a long programme of refurbishment that was still ongoing at the time of this visit. The staff reported that a dining area had been established where some residents were observed having lunch. The acting manager reported that a conservatory/ dining room was being added that would provide the residents with added communal space. The home was Bluebell Nursing Home DS0000062757.V357924.R01.S.doc Version 5.2 Page 21 clean and there was no offensive odour when we looked around the service. Some of the rooms we looked at were personalised and others were not. Comments from people were that the home was always clean and one person said “I like it here and spend my time in my room”. Some of the shared rooms had ceiling track and screens were available. Two of the shared rooms seen did not have any screens in order to protect the privacy and dignity of people. This was brought to the attention of the representative of the responsible person and must be addressed. As discussed risk assessments for the areas at the top of the house with the doors that open directly on the stairs must be put in place to ensure that any identified risks are managed appropriately for the safety of people using the service. There is a laundry where the service users’ personal clothing is washed internally. Staff reported that the beddings and towels are contracted out. The laundry was clean and well equipped with industrial washers and dryers. The washers were fitted with sluicing facilities and infection control information was available. The staff reported that personal clothing was labelled and there was a system in place for return of clothing that worked well. The laundry room was well managed and soiled laundry was managed appropriately. A hand washing facility was in place in the laundry room. Bluebell Nursing Home DS0000062757.V357924.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 27,28,29,30 The staffing was adequate to meet the present needs of people accommodated. The recruitment process ensures that checks are completed prior to employment. The record of training for staff has improved. The lack of training in moving and handling for new staff does not fully protect people accommodated. EVIDENCE: The staff duty record showed that there were 4 registered nurses and 10 carers on the early shift. The afternoon shift had two registered nurses and seven carers. Night duty consisted of 2 registered nurses and 3 carers. Comments received were that there was usually sufficient staff to meet their people’s needs. The director reported that there was a number of extra staff at the home at present due to other development. As discussed the acting manager’s hours were not included on the staff duty roster and this must be addressed. Staff spoken with said that there were two house keeping staff during the week and one at the weekend. Kitchen and laundry cover was also available seven days a week. Bluebell Nursing Home DS0000062757.V357924.R01.S.doc Version 5.2 Page 23 A sample of recruitment records was looked at for three staff recruited since the last inspection and it was found on this occasion that the pre employment checks required had been carried out. Repeated requirements were at the last two visits relating to a development of a structured training matrix, that records training completed, staff training needs and renewal or update dates. At this inspection a sample of training records was viewed. The home has an in house induction programme in place and two staff had started the in house induction, there was no record of induction for one staff member. Information from the AQQA showed that twenty- one staff had achieved National Vocational Qualification (NVQ) 2 or above and nine staff were working to achieve this qualification. This indicates that the home has a high percentage of staff who have achieved this qualification. There was some record of training available that included COSHH, food hygiene, tissue viability/wound care and infection control. The training manager discussed that this training record was a new development and work is ongoing to ensure that it captured all staff training. We noted that new staff had not completed training in moving and handling and pose risk to themselves and people using the service. This was brought to the management’s attention. The director reported that he had the required training in moving and handling to cascade this training to staff and action will be taken. There must be sufficient evidence to demonstrate that all staff are trained in areas including adult protection, induction, moving and handling in order to meet the needs of residents. A statutory requirement notice will be issued due to the number of times that this had been identified and the failure of the provider to take action to ensure that staff members are trained to develop the skills for the safety and meeting the needs of people living at the home. Bluebell Nursing Home DS0000062757.V357924.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the home lacks consistency and would benefit from a structured process that identifies individual role and responsibilities for the service. There is a lack of supervision of staff practices. There is some auditing in place but this requires further development. People are put at risk through inadequate training and some poor practices. EVIDENCE: Bluebell Nursing Home DS0000062757.V357924.R01.S.doc Version 5.2 Page 25 The home has employed a manager who has a number of years experience as a nurse and has completed her registered manager’s award. The director is also involved in the day–to–day management of the service. The manager has been in post since August 07 and has not as yet applied to register with the Commission. The manager has confirmed that an application to register with us will be submitted soon. At the time of the visit the Responsible Individual was not present and there was no registered person to represent the service. There were no records of visits to the home as part as Regulation 26 that the Responsible Individual or their representative must undertake such visits. If these visits had been carried out as part of their responsibilities, these issues should have been identified and acted upon. The failure to have an effective monitoring system in place has meant that poor practices had not been identified to the detriment of people living at the service. During this visit there have been a number of issues identified that related to lack of monitoring of staff practices and auditing of care provided. The manager must be able to demonstrate clear lines of accountability for the care that people are receiving. At the last two previous visits the manager needed to implement a supervision programme in order to achieve and maintain an efficient training matrix. There was evidence that an appraisal system had put in place and some staff had completed this. The supervision programme was being developed and the manager stated that trained staff would be involved in the supervision of the carers. None of the staff has as yet received supervision as part of their practice. This requirement has been partially met. The manager must formulate system for undertaking and recording staff supervision. A statutory requirement notice will be issued due to the number of times that this had been identified and the failure of the provider to take action to ensure that staff members are supervised as part of their practice. The director stated that the home does not hold any money for the people living at the home and that invoices are sent out for services bought. An audit to look at the incidences of falls, complaints and medication management should be put in place in order that these areas could be effectively monitored and action taken to safeguard people. At the previous visit in December 06 a requirement was made about ensuring that substances hazardous to health are stored in a locked environment. At this visit some hazardous substances were found unlocked and posing risk to people. An immediate requirement was issued to ensure that substances that are hazardous to health are maintained safely to protect people using the service. Bluebell Nursing Home DS0000062757.V357924.R01.S.doc Version 5.2 Page 26 The health and safety of people is not fully protected through the lack of training such as fire evacuation and moving and handling training for staff. Records of moving and handling training were inadequate to assess the amount of training that staff had received in health and safety issues. Not all new staff involved in moving and handling could be evidenced as having received the appropriate training by a trained trainer. This was brought to the attention of the director and acting manager due to the risks to people. There are some risks assessments for the building and yet again this is not consistent. The risk assessment for the home must be reviewed and updated to reflect how identified risks including the stairs will be managed. As previously mentioned the lack of complaint management and staff knowledge in reporting allegation of abuse do not protect people. A statutory notice will be issued regarding the concerns raised inn this report relating to the failure to monitor and carry out Regulation 26 visits to ensure that people are safe, and the service provides good outcomes for people living at the home. Bluebell Nursing Home DS0000062757.V357924.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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 1 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 1 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 1 X 1 Bluebell Nursing Home DS0000062757.V357924.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4(1) (2) Requirement The registered person must ensure that a statement of purpose which meets the requirements of the legislation must be available to all current and prospective service users. The registered person must ensure that new service users are admitted only after a suitably trained person has assessed their needs. The registered person has confirmed in writing that according to the assessment the home can meet their needs. The registered person must ensure that as part of care planning, risk assessments for falls are put in place as appropriate in order to protect people using the service. A nutritional screening must be undertaken on admission and people’s weight monitored and appropriate action taken to meet their nutritional needs. The registered person must ensure that staff maintain a DS0000062757.V357924.R01.S.doc Timescale for action 15/04/08 2 OP3 14(1) (a) (d) 15/04/08 3 OP7 13(4) 15 15/04/08 4 OP8 14(1) (a) Schedule 3 (o) 17(1) (a) Schedule 15/04/08 5 OP9 26/02/08 Bluebell Nursing Home Version 5.2 Page 29 3, 13 (2) 6 OP9 13(2) record of all medication kept in the care home and the date on which they are administered to the service user. Immediate requirement notice issued. The registered person must ensure that staff follow procedures for the safe handling, safe administration and disposal of medicines received into the care home. Prescribed medication must only be administered to the named person. 17/03/08 7 OP16 17(2) Schedule 4 (11) 8 OP33 The registered person must 30/03/08 maintain a complaint log where a record of all complaints made by people using the service. The complaint log must show any actions taken by the registered person in respect of any such complaints. Regulation Quality assurance systems must 15/04/08 24 be in place to ensure that systems in the home such as for training, supervision, the management of risks, and reporting incidents are used effectively to ensure that residents’ needs are met consistently. All substances that are hazardous to health must be stored safely and these were not on the day of the visit and put people using the service at risk. Immediate requirement notice issued. 26/02/08 9 OP38 13(4) Bluebell Nursing Home DS0000062757.V357924.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bluebell Nursing Home DS0000062757.V357924.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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