Inspection on 25/06/08 for Breadstone House Care Centre

This inspection was carried out on 25th June 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

Breadstone House Care Centre 28/01/09

Breadstone House Care Centre 29/09/08

Breadstone House Care Centre 22/10/07

Breadstone House Care Centre 30/11/06

Breadstone House Care Centre 16/03/06

Breadstone House Care Centre 22/09/05

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Breadstone House Care Centre Breadstone Nr Berkeley Glos GL13 9HG Lead Inspector Sharon Hayward-Wright Unannounced Inspection 10:45 25th June & 25 & 29th July 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 DS0000063838.V366890.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. DS0000063838.V366890.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Breadstone House Care Centre Address Breadstone Nr Berkeley Glos GL13 9HG 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) 08453 455782 denise.mackereth@blanchworth.net Blanchworth Care Homes Ltd To be appointed Care Home 40 Category(ies) of Dementia - over 65 years of age (40) registration, with number of places DS0000063838.V366890.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd October 2007 Brief Description of the Service: Breadstone House Care Centre is a registered Care Home with Nursing. It is registered to accommodate older people with dementia. The home is situated off the A38 Gloucester to Bristol road and is approximately 20 miles from Gloucester. It is a detached house situated in attractive grounds. The communal areas are situated on the ground floor and include 3 lounges and a dining room. There are 25 single bedrooms (7 with en-suite) and 9 double bedrooms. Current fees are £456.00 to £700.00. Less any contributions from the Funded Nursing Care (FNC). Hairdressing, chiropody, escort and personal toiletries are charged extra. The home makes information about the service, including CSCI reports available to people through a Service User Guide and Statement of Purpose available in the home. DS0000063838.V366890.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. Two Inspectors carried out this inspection over three days in June and July 2008. As part of this key inspection one of our (The Commission for Social Care Inspection) pharmacist inspectors looked at some of the arrangements for the management of medicines on a separate day. The pharmacist looked at some stocks and storage arrangements for medicines, some medication records and the policy and procedures. We spoke to some people living in the home and saw two nurses administer some medicines. We spoke to the deputy manager and two nurses. This medication inspection took place over five hours on a Tuesday morning. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes in to account the views and experiences of people using the service. The Manager was available during the first day of the inspection and the deputy manager was available during the two other days. As were other members of the homes team and a representative from the company that manage the home. A total of 24 standards were inspected. Where possible, people living at the home were spoken with to ascertain their views on the care and services provided and any visitors to the home. Staff were observed interacting with people who use the service. The comments received from speaking to people during the inspection have been used in the report. The staff were spoken with throughout the inspection and were helpful and cooperative. This key inspection was brought forward due to concerns raised in a safe guarding meeting for the protection of vulnerable adults. What the service does well: DS0000063838.V366890.R01.S.doc Version 5.2 Page 6 The kitchen has been awarded 4 stars from local Environmental Health Department. People who use the service are offered choices about their meals and people were seen to be really enjoying the food provided. The home can cater for people who require a therapeutic diet. Medicines were stored safely and those needed by people living in the home were in stock. What has improved since the last inspection? What they could do better: Care plans must be in place for all assessed needs and be up to date with people’s care needs. For people who are admitted to the home for respite care, records must be in place for each admission. Care plans and risk assessments must be completed. People who use the service must receive mouth care from care staff if they are unable to undertake it themselves or care staff must supervise people and maintained records of this. Greater awareness of peoples weight is needed to make sure that the appropriate steps are put into place to monitor this. Any accident or incident both witnessed or un-witnessed involving people who use the service must be audited and investigated. Make sure regular audits of medication are carried out and recorded with actions identified where needed as a result of the audits so that medication arrangements improve. This should help to make sure medication is more DS0000063838.V366890.R01.S.doc Version 5.2 Page 7 consistently managed and deal with some of the issues included in the main report. An activities programme needs to be devised based on the needs, abilities and choices of people who use the service to make sure they receive social interaction. The Registered Person must make sure that all staff have knowledge of abuse and how to report any allegations that are made to them to the correct organisations. The cleanliness of the home needs to improve and also any equipment used by people to include pillows and pillowcases. All staff must be reminded about good infection control procedures to make sure their actions do not place people who use the service at risk. All staff must receive training pertinent to their job roles or any other roles they are asked to undertake to prevent people who use the service from being put at unnecessary risk. A suitably qualified, competent person must be appointed to become the manager of the home and they must apply to us (The Commission) to be considered for registration. A programme of staff supervision must be put in place so that their skills, knowledge and competencies can be monitored to make sure peoples health, welfare and safety are being 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. DS0000063838.V366890.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 DS0000063838.V366890.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): 3&6 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The admission of people to the home does not consider the needs of people in sufficient detail to make sure all their needs can be safely met. EVIDENCE: The pre admission assessment for one person who has been admitted to the home since the last inspection was examined. The manager said this person was an emergency admission. A copy of the care plans completed by a Social Worker was at the home. However the manager had not contacted the family for further information despite them being the main carers. The only record available about this person was a summary of their needs, which was completed on the first day they were admitted to the home. This person was then discharged back to their home but was re-admitted several days later. Again there was no evidence that the manager had contacted the family to obtain further information. DS0000063838.V366890.R01.S.doc Version 5.2 Page 10 Even though the home had obtain information from Adult and Community Care Directorate (CACD) we (The Commission) would have expected to see the manager contact the main carer to obtain further information about this persons care needs. As this person stayed at the home for 2 weeks on their first stay we would have expected to see risk assessments, care plans and some form of ongoing records in place especially due to the complex needs of this person. This is poor practice especially as this is a registered nursing home and all qualified nurses must follow the code of conduct devised by the Nursing Midwifery Council in relation to record keeping. When this person was admitted for the second time it was nearly 2 weeks before risk assessments and care plans were devised. When this was raised with the manager he informed us he had been too busy to write these care plans. Standard 6 is not applicable to the home, as they do not provide intermediate care. DS0000063838.V366890.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples care records are not up to date and therefore do not provide staff with clear instruction on how to meet peoples health and personal care needs. The principles of respect, privacy and dignity are not put into practice by all staff. There are generally adequate and safe arrangements in place for the management of medicines but the inspection highlighted a few weaknesses where these arrangements need to be more consistent so as to always protect people living in the home. EVIDENCE: Care records for 3 people were examined in detail and specific care plans were examined in 2 other people’s care records. The first person we looked at was admitted as an emergency admission and the staff in the home had not devised any care plans or risk assessments on their first 2-week stay at the home. When they were re-admitted to the home several days later records show it took 2 weeks before any care plans were DS0000063838.V366890.R01.S.doc Version 5.2 Page 12 devised and risk assessments completed. Despite this person having a number of care needs. The second person we looked at was chosen at random due to an accident that occurred a few days prior to the inspection. This person’s summary of day and night care and activities of living had not been reviewed since they were devised in October 2006. The vast majority of their care plans had been not reviewed since December 2007. The only care plan that had been reviewed on a monthly basis was the ‘sleeping’ care plan. Two care plans said that hourly checks were needed in the daytime but no records were seen of these checks taking place. In one-care plan it mentioned that staff need to assist this person with all transfers but didn’t say how and if any equipment is needed. A hand written risk assessment for falls had not been reviewed since it was devised in October 2006 despite a number of falls being documented in their care records. Format risk assessments had not been routinely reviewed, for example, for falls it had been reviewed in March 2008 and prior to that July 2007 and the staff had written they were ‘medium’ risk but on checking the score it indicated a high risk. It is a concern that the hand written risk assessment and the format risk assessment had not been reviewed on a more frequent basis as this person had several falls. This persons moving and handling assessment had again been reviewed in February 2008 but prior to that it was October 2007. A reference was made to a wound on the 8th June 2008 but the record did not state where the wound was. A further entry on the 9th June 2008 says that dressing was intact and the bandage was removed and to review on the 13th June 2008. There is no further information about this wound in the care records or if it was even reviewed on this date. This is poor practice. The third person also had a summary of their care needs and their activities of living assessment completed in July 2007. There was no evidence they had been reviewed. This person had care plans in place that had evidence of more frequent reviews compared to other people who use the service. The reviews were not monthly as recommended. A new care plan had been added in June 2008 that related to challenging behaviour and had a review date of 3 months. If this is deemed to be an area of concern then leaving the review for that length of time is poor practice. On checking this person weight they weighed 93kg in August 2007. When they were weighed in October 2007 they weighed 73.5kg. There was no record in their care plan about this excessive weight loss and how they planned to address it. The next documented weight is February 2008 where they had put on 4.5kg. The gaps between weighing this person is unacceptable and could have placed the person at unnecessary risk. This person is now putting on weight. At the last inspection in October 2007 a requirement was issued for care plans to be updated. This requirement related particularly to the care records of one DS0000063838.V366890.R01.S.doc Version 5.2 Page 13 person. On checking their care plans at this inspection the records showed the home had only just started to review them. Again this is poor practice. Another person had one of their care records checked for a challenging behaviour care plan due to an incident. This was in place but the manager said their behaviour was due to pain and now their pain is controlled they no longer display challenging behaviour. However there was no care plan in place for the management of pain. On checking the review dates for all this persons care plans they had an entry for May 2008, but the last entry before that was December 2007. The standard of record keeping in this home is poor and can potentially place people at risk, as care staff do not have up to date information available to them about each person who uses the service. On the second day of the inspection the deputy manager said she had nearly reviewed all the care records, however this was not examined. One visitor was spoken with and they said they are happy with the care their relative receives. During a tour of parts of the home 12 rooms belonging to people who use the service were examined. We looked at nine peoples equipment for mouth care along with their care plan and personal care chart where staff record the care they had given. Eight people were found to have dry toothbrushes. The majority of care plans said that people require help from staff and 2 people did not require assistance. Personal care charts were not always completed, some had not been filled in all week and others had parts filled in. Care staff must ensure that people are receiving mouth care. Incident and accident records were examined from March 2008 up to the inspection date. Eighteen incidents were documented as being un-witnessed, however staff had written ‘this person was hit by a chair’ and ‘ could have been cut by a rough chair’. There was no evidence that the manager had investigated any of these incidents, to ensure the safety of people using the service from sustaining similar incidents. People who use the service do have access to external health professionals. A local GP was visiting the home on the 2nd day of the inspection. The deputy manager was also completing forms to access specialist equipment for people who use the service. Records were seen of a Chiropodist visits. On the first day of the inspection one person was visited in their room and it was found that the pressure-relieving mattress they were on had the cells protruding out of the cover. This could compromise the workings of the mattress and staff would have noticed this when they changed the bedding. This person had only taken a very small amount of fluid and it was late afternoon. On the 2nd day of the inspection the mattress had been repaired and the fluid intake of this person had increased. DS0000063838.V366890.R01.S.doc Version 5.2 Page 14 Since the last inspection we have received an improvement plan from Blanchworth Care, which included telling us the action the home has taken to address medication issues and requirements we made at the last inspection. We found there was an improvement to the way in which medicines were managed but we also highlighted some issues for attention. Registered nurses are responsible for the management and administration of medicines for people living in this home. The company provides additional medication training for these staff. During the inspection we saw two nurses administering some medicines to people living in the home and generally following safe procedures. Since the last inspection arrangements have been made so that the medicine trolley can easily be taken out of the downstairs office. We discussed with the deputy manager about making sure that the medicines are transported around the home in a way that is safe for everyone in the home if people are not close to the medicine trolley when the nurse prepares their medicines. This was because what we had seen for one person could be a possible risk. Nobody living in the home was assessed as able to look after and administer his or her medicines. For each person there was a new company form in place that described their choices and consent about their medication. In discussion, the deputy manager told us there were no equality or diversity issues that would impact on medication. We saw that the choice of gender of carer to provide personal care was included in a care plan together with information about beliefs. We spoke to four people living in the home but they were not able to tell us much about how staff looked after their medicines for them. One person was receiving regular analgesics following an injury after a fall and these were keeping her comfortable. Since the last inspection the way the medicines are supplied has changed. A local pharmacy now provides many medicines each month in special 28-day bubble packs called a monitored dose system (MDS). These help staff to easily see what medicines need administering on a particular day and time and what medicines have been administered. As part of this system the pharmacy each month printed a record of all the medicines the doctor has prescribed with a chart on which staff recorded when they have administered each medicine. We saw that where people had a known allergy to a medicine this was written in a special box on the chart. Rather than leave this box blank we recommend ‘none known’ be recorded so as not to raise a doubt about if someone has forgotten to complete this information. Since the last inspection the times when medicines are administered have been reviewed with the doctor and pharmacist to be spread more equally throughout the day. Staff recorded the medicines received into the home on these charts and there was a separate book to record medicines disposed of via a waste contractor. Complete and accurate records about medication are important so that there is a full account of the medicines that the home is responsible for on behalf of the people living here and people are not at risk from mistakes such as receiving their medicines incorrectly. We made checks on a sample of records for some people and this showed on the whole these were properly completed and DS0000063838.V366890.R01.S.doc Version 5.2 Page 15 contained the required entries. We found for most people where medicines were prescribed to use ‘as required’ new forms were completed and kept with the medicine charts with more information to guide staff on the use of the medication for these people. This had been introduced since the last inspection. This sort of information is important so that people living in the home receive their medicines in a planned and consistent way according to their needs. During the inspection we raised the following issues with the deputy manager for action in order help make sure of the safety of people living in the home and to comply with the Care Home Regulations 2001 – There was one example of an incomplete record, which we brought to the attention of the deputy manager to investigate. There were examples for two people where the actual dose of medicine given had not been noted when a variable dose (5 or 10ml) had been prescribed. We looked in more detail at some medication records for seven people. We found for three people who each had a medicine prescribed to use as required the form giving staff the additional guidance was not in place. The medicines concerned were recently prescribed so it is important to make sure information like this is kept up to date. Audit counts we made on a sample of the medicines in stock agreed with the records except in one case where a course of 14 antibiotic tablets was noted as completed but the records only accounted for 12 tablets. There was another case where two more tablets than the records showed were counted of a medicine for diabetes. In examples such as this it is not clear if staff have failed to make the records accurately or the wrong dose has been given (one tablet instead of two for example). We also found another medicine where 27 more tablets were in stock than the records indicated but the deputy manager was sure in this case a second supply of tablets had been received but not recorded. In one care plan we looked at there was some information about the management of diabetes but it needed more specific information about target and action blood glucose levels to define what ‘high’ and ‘low’ meant for this person. The frequency for testing should be discussed with the doctor or diabetes specialist nurse. The deputy manager could not find the care plan for another person with diabetes so this must be found and checked to contain the relevant information for this person. The lancets staff use to obtain the blood sample must be safe to use in a care home setting and comply with Medical Device Alert MDA/2006/066 issued by MHRA in December 2006. We found a pen device that was not suitable and the deputy manager agreed to discard this. We did see there were some disposable lancing devices that are suitable in a care home and these can be requested on prescription. All the stocks of disposable syringes must be checked as we found examples that were beyond the printed expiry date. DS0000063838.V366890.R01.S.doc Version 5.2 Page 16 The separate room upstairs in which a few opened tubes of creams or ointments were kept (so as to be more readily available for use) was very warm on the day of the inspection so alternative cooler arrangements must be made. Otherwise medicines were stored safely and suitable arrangements for the management of controlled medicines were in place. Since the last inspection the temperature of the main upstairs storage areas and medicine fridge were recorded and in the safe range for keeping medicines. All eye drops in use had a date of opening so that proper stock rotation could be in place. Many other packs of medicines (but not all) also had opening dates recorded to help with proper stock rotation and audit checks. There was a medication policy and procedures available so that all staff were aware of how the company expects medication to be handled in a safe way. We pointed out to the deputy manager and the assistant director of care that the policy needs some amendment to show that Breadstone House now uses a different medication system from the Nomad boxes previously used. We strongly recommend that the nurses see the regular monthly doctors’ prescriptions in the home each month before sending these to the pharmacy for dispensing. This provides an opportunity for the nurses to see the actual doctors’ prescriptions (which are their authority to administer medicines) and to check that these contain the medicines they have ordered. It is also easier to sort out any discrepancies at this stage. We were told that the deputy manager and the assistant director of care make regular checks of medicines but we did not see any written records as evidence of such checks and the issues identified. Regular audit counts such as we carried out during the inspection help to show if medicines are recorded or given correctly. Regular audits of medication are an important part of quality assurance systems to confirm that the medicine policy is put into practice. It is important that where needed, actions to improve practice are identified as a result of the audits. On the 2nd day of the inspection one person was found sitting in a wheelchair outside their room. No staff were present in the corridor and they could not call staff for assistance. The deputy manager asked staff what was happening and they said they were waiting to put them in a chair, however on returning to check on this person we found they were still sat in the wheelchair but had been pushed back into their room. DS0000063838.V366890.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 & 15 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are at times supported to make choices about their daily life. The lack activities and stimulation means that people are not having their recreational and social needs met. EVIDENCE: Since the last inspection the activities coordinator has left the home. The deputy manager said they have now recruited a replacement but are waiting for recruitment checks prior to them starting work at the home. The deputy manager also said they have a volunteer that is due to start soon and they will be helping out with activities. On the first day of the inspection no activities were observed to be taking place and people were just sat around in communal rooms. The television was on in 2 communal rooms on both days of the inspection but most people didn’t appear to be watching it, as they were asleep. One member of qualified staff said that they do have outside entertainers that visit the home weekly and this includes music and movement and also a Church service. Very little interaction was observed between staff and people who use DS0000063838.V366890.R01.S.doc Version 5.2 Page 18 the service, for example, no staff were seen sitting with people and talking to them and this is a concern for people who stay in their rooms as to the level of stimulation they also receive. On the second day of the inspection in the afternoon one member of care staff did undertake a sing along to music and was encouraging people to play instruments and dance. People looked like they were enjoying themselves and staff were encouraged to join in. Visiting to the home is not restricted and two visitors were seen during the inspection. One visitor confirmed that they visit the home at a time convenient for them. Where able the deputy manager said staff offer people choices. One person was seen making a choice about how they wanted to use their plate guard. In relation to meals the deputy manager said that every morning people are asked what they would like for lunch off the menu for that day. A number of rooms belonging to people who use the service were seen during the tour of parts of the home and they had their personal items on display. The cook was on sick leave at the time of the inspection so the home is using agency cooks. An inspection of the kitchen and records did not take place, as there were no issues identified at the last inspection. The home has been awarded 4-stars from Environmental Health Department for their kitchen. A mealtime was observed on one of the days of the inspection and people who use the service were observed to be enjoying the meal. The meal was sampled on this day and it was very tasty. A soft option is available for people who require it and this was all liquidised separately. Staff were seen offering assistance discreetly, however one member of staff was observed standing up feeding a person. This is poor practice. DS0000063838.V366890.R01.S.doc Version 5.2 Page 19 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 & 18 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Procedures are in place to protect people from abuse and harm but these are not being followed and staff are not acting upon allegations of possible abuse. This places people who use the service at risk of harm and abuse. EVIDENCE: The home has received 2 complaints since the last inspection. One was sent by e-mail and copies of all correspondence were in the home. The second complaint was an allegation against a member of staff and this is discussed further below. Due to the medical condition of the people in the home we were not able to ask them whom they would speak to if they had any concerns. A copy of the homes complaint procedure is on the notice board in the main entrance. Since the last inspection 4 people who use the service were found to have unexplained bruising. This was reported to the Adult Protection Unit of Gloucestershire County Council and they informed us (The Commission). As this was an event that affected the well being of people we should have been informed without delay. The Registered Provider completed an investigation. People who use the service who were involved in the incident are not able to communicate how they obtained the bruising. The investigation concluded the DS0000063838.V366890.R01.S.doc Version 5.2 Page 20 bruising was made due to poor moving and handling practices carried out by staff. Following this investigation one person made an allegation that were hit by a member of staff. There was no evidence to demonstrate that this was taken seriously or acted upon by the staff in the home. Records clearly show that the manager was aware of this but did not take any action. This has since been acted upon as part of the adult protection reporting procedures for this County. We found a further complaint that made an allegation that a member of staff had ‘roughed up’ another person using the service. Again this was not reported to us. Brief records were found that mentioned the manager had spoken to the family of this person but no investigation appears to have taken place. This event took place at around the same time as the other allegation. This is unacceptable practice and places people who use the service at risk. Following this a representative from Blanchworth Care said all staff have had a refresher in their abuse training. It is now imperative that all staff undertake the ‘alerters’ guide training provided by the local council to make sure people who use the service are protected. Blanchworth Care has policies and procedure in place in relation to abuse and challenging behaviour and POVA. One senior staff who has left the home has been referred to POVA and the Nursing and Midwifery Council. One member of staff is on suspension pending a disciplinary hearing. DS0000063838.V366890.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24 & 26 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service do not live in a clean, hygienic and pleasant environment, and the actions of the staff can place people who use the service at risk of harm. EVIDENCE: A tour of parts of the environment took place and a number of rooms belonging to people who use the service were seen. A number of areas that need improvement were found and these are listed below. Room 6 – commode lid is damaged and is an infection control risk and must be replaced. Also the armchair this person was sat in was dirty. Their ‘crash’ mat was very soiled on both sides. Both the pillow and pillowcases were also soiled. DS0000063838.V366890.R01.S.doc Version 5.2 Page 22 Room 18 – The commode lid was damaged and is an infection control risk and the sink top was also damaged and needs to be replaced. Toilet 108 – Was being used to store equipment that included hoist, wheelchairs and a mop and bucket. Room 20 – The headboard was loose. The commode had not been emptied and contained a soiled incontinence pad in a bag. This is poor practice. The pillowcases were soiled on this person’s bed. Room 21- a soiled pillowcase was on this person’s bed. Room 22- was odorous and a bowl of what appeared to be urine was left on the floor. This again is poor practice. The taps in this room did not work. A soiled pillowcase was found on this person’s bed. Room 25- the carpet was soiled and again this person had a soiled pillowcase on their bed. Room 9- Commode lid is damaged in places, which means it is an infection control risk. The walls in this room were dirty and cobwebs were found on the ceiling. Room 10- Cobwebs were found in this room and the commode lid was damaged. By rooms 4 & 5 there is a strong odour. The lounge on the left hand side as you walk in the front door has wheelchairs and a hoist stored in the room and one armchair was dirty and needs to be replaced or cleaned. The lounge on the right hand as you walk in the front door also had a heavily stained chair. Room 32 was odorous. Some of the carpets in the main corridors were heavily stained. In one corridor a white bag was found hanging off a handrail and it contained a soiled incontinence pad and pair of gloves. This unacceptable practice as a person who uses the service could have picked this up and it is an infection control risk to anyone in the home. The issues identified above must be addressed, as a matter of urgency and staff must be reminded of the importance of good infection control procedures to prevent people who use the service from being placed at risk. Protective clothing is available for staff to use. DS0000063838.V366890.R01.S.doc Version 5.2 Page 23 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 & 30 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is confident that the number of staff on duty meets the needs of the people who use the service. However some staff are lacking in the appropriate skills and competency, which has placed people who use the service at risk. EVIDENCE: The staffing numbers were discussed with the deputy manager. She is now supernumerary to the staffing numbers to enable her to address the serious issues that have been found at this home. She said they have 1 extra member of staff at the moment, as 1 person who uses the service requires one to one supervision. The deputy manager felt confident that the numbers of care staff on duty were meeting the needs of people in the home. Ancillary staff are available to assist the care staff but concerns were found regarding the cleanliness of the home and this needs to be reviewed. The competency and skills of staff is a concern due to the issues that have been identified in this report. The Registered Provider for the home must look to addressing this as a matter of urgency. The home is now having support from a representative from the company to improve standards at the home. Whilst reading the accident and incident records one incident was noticed where 2 members of staff had written statements. One member of staff following an incident involving a person who uses the service had written ‘that DS0000063838.V366890.R01.S.doc Version 5.2 Page 24 they laughed at them’. This is unacceptable behaviour from staff and there was no evidence the manager had addressed this with them. One visitor spoken with said the staff were very good at looking after their relative. Two members of staff were spoken with and they both said they enjoy working at the home. The home is just under the 50 of care staff trained in NVQ 2 in health and social care but have 2 staff that are qualified nurses from overseas who are working as care assistants. Two new staff have been appointed to work at the home since the last inspection and their recruitment files were examined on the computer system. Both had all the required checks in place. Criminal Records Bureau Disclosures (CRB) are now stored in the home and both members of staff had one in place. One person had a number of gaps in their employment history but it was not clear on the interview records if all the gaps had been explored as it just said unemployed for gaps in employment. To avoid any uncertainty it must be clear that all gaps have been fully explored. Training was discussed with the deputy manager and the representative from Blanchworth Care. Since the concern with the unexplained bruising all staff have received an in house moving and handling update and POVA training. The Care Home support team are going to provide some training for staff and have advised the home to look at some external training to include the ‘alerters’ guide. Dementia training is needed and plans are in place to provide this. The training matrix had a number of gaps and this included infection control training, which is an training area that is needed following the tour of the home. Qualified nurses need training on wound management and tissue viability and risk assessment. Three qualified staff have undertaken training in first aid. The two new members of staff are undertaking their induction training. The provision for this has not altered since the last inspection. Therefore this was not examined, however both had completed the 3-day induction programme with the Blanchworth Care. DS0000063838.V366890.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): 31, 33, 36 & 38 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The poor management and administration of the home has meant that people who use the service have been placed at risk. EVIDENCE: Since the last inspection the Registered Manager has left the home and a new manager has been appointed. However during the first day of the inspection the manager was suspended and later dismissed. The deputy manager is now running the home with support from a Blanchworth Care representative. Due to the serious issues that have been identified Blanchworth Care devised an action plan and a copy given to us. This was prior to the manager being DS0000063838.V366890.R01.S.doc Version 5.2 Page 26 suspended. This inspection had also identified a number of areas that need immediate action to ensure the safety of people who use the service. The only auditing that the manager undertook of the service was for accident and incident records. This was not done sufficiently as none of the unexplained incidents were investigated. Since the manager started at the home we have not received any Regulation 26 reports. This is where the Registered Provider audits the service and could have identified some of the deficits we have found. The deputy manager said she has made some changes to the medications and has put a notice on each pressure-relieving mattress stating the weight of the person and the setting it should be on, which is good practice. Since the Registered Manager left the home there were no records seen to demonstrate staff supervision is taking place. Formal supervision is an opportunity for managers to discuss care practices, competencies and skills with staff and identify training needs. A schedule of supervision must be set up to monitor staff competencies. The deputy manager has also completed individual sessions with one member of staff due to concerns about their practice. A staff meeting has taken place. Since the last inspection a fire risk assessment and an evacuation procedure have been developed. As part of the fire risk assessment Evac chairs have been purchased and the deputy manager said all staff have been trained in their use. She said she has undertaken a fire drill as none had taken place for the last 6 months. DS0000063838.V366890.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 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 X X 2 X 1 X 1 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X X 2 X 3 DS0000063838.V366890.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 OP7 Regulation 15 (2) b Requirement Care plans for residents must be reviewed regularly. This requirement remains outstanding since the last inspection. Care plans must be devised for people who use the service based on their individual assessed needs. This is to ensure their health and well-being are being met. This requirement remains outstanding since the last inspection. The home must ensure that staff are supporting/supervising people to meet their care needs, in particular maintenance of their oral hygiene. The 18 un-witnessed accidents/incidents must be reviewed to make sure the people who use the service are not being put at unnecessary risk. When staff take blood samples for blood glucose monitoring make sure that all lancing devices used comply with the DS0000063838.V366890.R01.S.doc Timescale for action 16/09/08 2. OP7 15(1) 16/09/08 3. OP8 12(1b) 29/07/08 4. OP8 12(1a) 31/08/08 5. OP9 13(3) 31/08/08 Version 5.2 Page 29 6. OP12 16(n) 7. OP18 13(6) 8. 10. OP18 OP19 37 23 11. OP24 16 (2) (c) & (e) 12. OP26 13(3) 13. OP26 16(k) action contained in MDA/2006/066 and are safe to use in care homes. This is to reduce the risk to people living in the home of cross infection linked with the use of the wrong sort of lancing device. To make sure people who use the service are stimulated a programme of activities based on peoples choices, needs and abilities must be put into place. To make sure people who use the service are not put at risk. All staff must receive training in abuse and local reporting procedures. Any event that is listed in this Regulation must be notified to us with immediate effect. The issues identified in the Environment standards must be addressed as a matter of urgency to make sure people who use the service are not put at unnecessary risk. The registered person must ensure that the cleanliness and condition of all pillows, pillowcases and bedclothes in use in the home is reviewed and any remedial action taken. This requirement is outstanding from the last two inspections. Staff in the home must ensure soiled incontinence products are managed in a safe way to ensure that people who use the service are not put at risk of cross infection due to their actions. Odours in the home need to be eliminated to ensure people who use the service live in a pleasing and pleasant environment. This requirement is outstanding from the last inspection. DS0000063838.V366890.R01.S.doc 31/08/08 31/08/08 29/07/08 16/09/08 31/08/08 29/07/08 29/07/08 Version 5.2 Page 30 14. OP30 18 1(ci) 15. OP31 8 16 OP36 18(2a) All staff must receive training pertinent to their roles to make sure people who use the service are not put at unnecessary risk by their actions. A competent, skilled and suitably experienced person must be appointed to manage this home and apply to us to be considered for registration. To make sure that the health, safety and welfare of people who use the service is protected. A system must be devised to make sure all staff are appropriately supervised and that they can meet the needs of people who use the service. 16/09/08 06/11/08 31/08/08 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. 2. 3. Refer to Standard OP7 OP9OP9 OP9OP9 Good Practice Recommendations People’s day and night profiles to be reviewed and updated. Arrange to see and check all prescription forms in the home before they are sent to the pharmacy for dispensing. Carry out and record regular audit checks of medication to demonstrate that safe procedures are in place and people living in the home are receiving their medication correctly and safely. Make sure that actions are developed where needed as a result of the audits so that medication arrangements improve. The staff in the home should consider attending the Protection Of Vulnerable Adults training provided by Gloucestershire County Council. 4. OP18 DS0000063838.V366890.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 DS0000063838.V366890.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!