Inspection on 25/04/08 for Buchanan Court Nursing Home

This inspection was carried out on 25th April 2008.

CSCI found this care home to be providing an Adequate 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

Buchanan Court Nursing Home 01/04/09

Buchanan Court Nursing Home 13/11/07

Buchanan Court Nursing Home 04/06/07

Buchanan Court Nursing Home 12/10/06

Buchanan Court Nursing Home 09/02/06

Buchanan Court Nursing Home 28/06/05

Buchanan Court Nursing Home 18/01/05

Buchanan Court Nursing Home 28/07/04

Buchanan Court Nursing Home 02/02/04

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

CARE HOMES FOR OLDER PEOPLE Buchanan Court Nursing Home Buchanan Court Care Centre Sudbury Hill Harrow Middx HA1 3AR Lead Inspector Mr Ram Sooriah Key Unannounced Inspection 10:30 25 & 28th April 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 Buchanan Court Nursing Home DS0000022918.V363507.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. Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Buchanan Court Nursing Home Address Buchanan Court Care Centre Sudbury Hill Harrow Middx HA1 3AR 020 8423 3311 020 8423 2299 buchanoncourt@schealthcare.co.uk 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) Ashbourne Homes Ltd Vacant Care Home 85 Category(ies) of Old age, not falling within any other category registration, with number (85) of places Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 85 13th November 2007 Date of last inspection Brief Description of the Service: Buchanan Court belongs to Ashbourne Plc, which has been taken over by Southern Cross Healthcare, a national provider of care homes mainly for the elderly. The care home is found in Sudbury Hill and is easily accessible by public transport as the area is well served by buses. The closest underground station is Sudbury Hill, which is about 10 minutes walk away. There is an extensive parking area in the grounds of the home and there are maintained lawn/shrubs areas in the front and at the back of the home. There are some shops and amenities in Sudbury but Harrow on the Hill, where more shopping facilities and amenities are available, is about five minutes drive from the home. Buchanan Court is purpose built and consists of three floors. Accommodation is provided in a mixture of single and double bedrooms with en-suite facilities although most of the double bedrooms tend to be used as single bedrooms. As a result even though the home is registered for 85 elderly residents requiring nursing care, only 60 beds and less are in use. Each floor accommodates an average of 20 residents. The home is run by Melanie Boyd, the manager, and her deputy, Kamala Chohun with support from line management from Southern Cross Healthcare. Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 5 The home charges fees ranging from £578 to £1000 weekly, depending on the needs of the service users and the fees structure of the placing authority, if the resident is publicly funded. On the day of the inspection there were 50 residents in the home. Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This is the first key unannounced inspection for the period 2008-2009. It started on Friday the 25th April from 10:30 to about 18:30 and continued on Monday 28th April from 10:15 to 16:15. During the period 2007-2008 we inspected the home four times to monitor the home’s compliance with the statutory requirements which CSCI imposed on the home. The requirements were imposed after we found evidence of breaches of Care Homes Legislation, which could if not addressed, have detrimental effect on the welfare of residents. The last unannounced inspection of the home was on the 20th February 2008 when we inspected the home to check for compliance with a specific number of requirements which have been repeated a number of times and where we were particularly concerned about the safety of residents. Following this inspection a Statutory Requirement Enforcement Notice dated 12th March 2008 was imposed on the home. This current inspection was instigated to check for compliance with the Statutory Enforcement Notice and to see how well the home meets the Minimum National Minimum Standards. During the inspection we talked to six residents, two visitors to the home and to five members of staff. We toured some of the premises, looked at a sample of records and observed care practices. We also received four comment cards from residents, three from relatives and one from a social care professional. The manager also kindly completed an Annual Quality Assurance Assessment (AQAA), which was forwarded to the commission. This was completed satisfactorily. The AQAA has been used where possible in writing this report. We would like to thank the residents and visitors for talking to us to share their experiences about the service, all people who returned comment cards and the manager and her staff for their cooperation and support during the inspection. What the service does well: Feedback from residents, visitors to the home and from comment cards showed that on the whole people were usually satisfied with the care and support that residents receive from the service. They rate the availability of information to decide about whether they want to move into the home, being kept informed of changes in the condition of residents, approachability of staff and management, and the provision of activities as generally good. Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 7 The home provides information about the service to prospective residents and/or to their friends and relatives to enable them make an informed decision about moving into the home. They are also given a contract/statement of terms and conditions to make them aware of their rights and obligations. To make sure that the home is able to meet the needs of residents who are admitted, the manager or her deputy assess the needs of residents who are referred to the home. The management of the home also recognises the limitations of the home and clarified that the home is not yet ready to accept residents with complex needs. This is positive as the primary emphasis here, is the welfare of residents. The home provides a range of activities to suit the needs of residents and all people, who provided feedback, were pleased with the input from the activities coordinator. A comment card from a resident mentioned, ‘our activities person is so good, she goes out of her way to keep us happy’. Another comment card from a resident said ‘The activities for residents are well planned and enjoyable’ and a relative said that ‘the resources for the provision of activities could be improved. There could be better equipment, TV system, sound system and more DVD’s, CD’s for residents’. The home has a relatively stable and consistent team of staff that ensures continuity of care. One comment card from a resident said “staff is always helpful and cheerful”, another said, ‘there is good interaction between residents and staff’ and a third said, ‘most of the carers are kind with a few exceptions”. There is evidence that staff receive most of the necessary statutory training that is required to make them competent to work in the home. Good records are kept about the training that members of staff attend. Residents, staff and visitors’ safety is taken seriously as all health and safety issues that were inspected, have been attended to and addressed where required. What has improved since the last inspection? The home has met the requirements in the enforcement notice and eleven other requirements that have been previously imposed on the home, particularly with regards to the care of residents, the management of medicines and the physical environment of the home. The standard of the care records has improved. Care plans are more comprehensive and address the needs of residents. There is therefore an assurance that the needs of residents are taken seriously, assessed appropriately and that action would be taken to meet the identified needs. Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 8 Issues about the welfare and healthcare needs of residents are being addressed and the standard of service in this area is improving. It was noted during the last key inspection that residents’ weights were not always monitored at the frequency that has been stated in care plans and were not referred to the GP. This has now been addressed and residents are weighed at the frequency agreed in the care plans and have assessments to monitor their nutritional status. From conversation with members of staff in the home we concluded that they are now more aware about the management of pain. The home has provided a 2-day training session to nursing staff in this area. Residents now have care plans and pain charts in place to address the management of pain. There has been an improvement in the management of medicines in the home. Records about the receipts, administration and return/ destruction of medicines were more comprehensive than during the last inspection. As a result we concluded that the management of medicines usually promotes the safety of people who use the service. Accidents and incidents are appropriately managed, recorded and reported to the manager. There are enquiries by the manager when the cause of injuries, such as bruises and lacerations, is not clear. The reasons are recorded to provide a whole picture about each accident/incident and action that is to be taken to prevent similar accident/incident from happening again. The manager said that she would report any untoward situation to the Commission as required by legislation. There has been a general improvement of the physical environment that the home provides. The call bell system has been replaced, there are more bathing/shower facilities and a number of bedrooms have been redecorated and others are in the process of being redecorated. There has also been a replacement of armchairs and divans beds. Residents were pleased with the standard of accommodation and those who spoke to the inspector thought that their bedrooms and the home had a homely feel and was well maintained. What they could do better: In this report two requirements imposed on the home previously are repeated for a third time and one requirement is repeated for a fourth time. Three other requirements are repeated as they have been partly met. Immediate steps must be taken by the home to ensure that requirements are met within the appropriate timescales, as they are imposed following breaches of legislation. Failure to do so may result in further enforcement action. While the home has taken steps to address the physical needs of residents and to improve care plans in these areas, there are still some aspects of care that must be addressed to ensure that residents receive holistic care. This includes the management of end of life care and the fears and hopes of Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 9 residents/relatives for the future as well as incorporating the cultural, religious and ethnic aspects of the needs of residents in their care plan. Other areas where care plans must be further improved include the manual handling of residents and pressure area care and tissue viability. The care plans and risk assessments on manual handling are not comprehensive and do not address the equipment to use to move residents and the moving of residents when they are confined in bed. As a result residents could be put at risk by staff not using appropriate equipment and the appropriate manual handling technique to move residents. Care plans to promote tissue viability and wound care in cases where residents have pressure ulcers or are at risk of pressure ulcers could be more comprehensive with regards to the repositioning regime and equipment in place to enable a person make a judgement about the suitability of the measures in place to address this area of care. The home accommodates a number of residents who are able to understand and make decisions about their care and therefore they must be consulted and involved in their care as much as possible. Areas where the management of medicines could be further improved include ensuring that when the GP make changes to the instructions in relation to the administration of a medicine, nursing staff must ensure that the changes are acted upon. Should they not do that in a timely manner, then they might be in breech of their professional code of practice and might be putting residents at risk. The recruitment of new staff must be carried out robustly as per the recruitment procedure and legislation to make sure that residents are protected as far as possible. Whilst there were a few members of staff who may not have been recruited by the current manager, the situation with regards to employment checks and other necessary documentation must be regularised. 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. Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1-4 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides all the necessary information that people require for them to decide if they or their relatives/friends want to move into the home. The needs of residents are appropriately assessed before the home decides to accept residents to make sure that the needs of the residents would be met in the home. EVIDENCE: The home has a service users’ guide (SUG) and a statement of purpose (SOP). In the past these documents have been judged to be mostly comprehensive but the SUG had been lacking with regards to information about the fees that are charged by the home and the things that the fees cover. There was a requirement with regards to that. This was not met at the time of the inspection but the manager confirmed after the inspection that she has added this necessary information to the SUG. It was noted that there is also a statement of terms and conditions in the SUG with additional information about fees. Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 12 We checked whether two newly admitted residents had received a SUG. They were both able to converse with us and express their views. They both said that they had not received these documents, but it was later noted that these were in the drawers in the bedrooms of the residents. It is recommended residents are reminded/made aware of the SUG or that these documents are left in a prominent place which can be accessed by the resident if required instead of being placed in the drawer. Two residents who responded to comment cards said that they did not receive information about the home but their relatives did and one said that he did not choose to move into the home but was placed in the home by social services. We checked if residents are given a contract/statement of terms and conditions by randomly choosing two residents, who have been recently admitted to the home. There was evidence that copies of this document were given to each of the resident/relatives and that the home was waiting for these to be signed and returned. Three out of the four residents who responded to comment cards agreed that they have been given a contract/statement of terms and conditions. The preadmission assessments of residents needs were carried out by the manager or her deputy. It was noted that these were on the whole appropriately completed and were available to staff when the new residents were admitted to the home. These documents were used as the basis for determining if the home was able to meet the needs of prospective residents. The manager stated that the home has not accepted residents with complex needs for some time, as in the past there has been some doubts as to whether the home was able to meet the nursing needs of residents with multiple medical conditions. She added that the home has been concentrating in supporting and providing training to staff to improve their clinical skills and confidence and that when she was satisfied that this has happened, the home would then re-start taking residents with complex needs. Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. There has been a marked improvement in the quality and the content of the care records. As a result there is greater confidence that the identified needs of residents would be met. There has been less improvement in involving residents and their relatives/representatives in drawing up and reviewing care plans and risk assessments, and in addressing end of life care and equality and diversity aspects of the care residents. The healthcare needs of residents who are accommodated in the home are on the whole met. Medication management has been improved but further improvement is required to give the assurance that the management of medication is as safe as possible. EVIDENCE: We looked at the whole care plans of six residents and part of the care plans for three more residents. Progress with regards to improving the content and comprehensiveness of the care plans was noted. Residents’ needs were on the whole appropriately assessed and recorded. All areas of the needs’ assessment of residents were more or less completed except for areas addressing the Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 14 cultural, religious and diverse backgrounds of residents and the fears and hopes of residents and/or their relatives for the future. Care plans were in place to address most of residents’ needs and these included details of the action to take to meet the needs of residents. The care plans were reviewed at least monthly and were kept up to date as required. The home accommodates residents from a number of cultural backgrounds. Inspection of the six care plans showed that the care plans did not always make clear the diversity aspect of the care of residents. There was however some evidence that staff understood the needs of residents with this aspect of care and on the whole make attempts to meet these. This was evidenced by staff being able to describe the cultural needs of residents and by us observing the meals that were served to residents from ethnic minorities and the way that staff related to the residents. However one social care professional mentioned that ‘more could be done to address cultural needs of residents, in the diet that is provided. On request this was accommodated’. We therefore concluded that, had these aspects of care been identified as part of a comprehensive assessment of needs, there would not be a need for relatives and social care professionals to request culturally appropriate diets. Care plans also contained a range of risk assessments, which were kept updated at least monthly. It was noted that care plans and risk assessments were not always signed and dated to show that these were agreed with the residents or their relatives/representatives when these were drawn up or reviewed. There was evidence that some relatives were involved in care plans, but the home accommodates a number of residents who are well able to make decisions about their care. Two residents were asked about their care plans and they said that they had not seen these records. From talking to other residents there was little evidence that they were being involved in discussions about their care and in drawing up and reviewing their care plans and risk assessments. One relative said ‘the resident has general difficulty communicating but does understand everything said to him’. Even if residents cannot communicate some are able to understand issues about their care and they should therefore be consulted in their care. The home could also explore providing the care records to residents in a format relevant to the needs of the resident, where possible. All residents have a manual handling risk assessment and care plans were in place to address the needs of residents with regards to manual handling. It was noted that the care plans continue to lack with regards to the equipment to use for manual handling manoeuvres and the action to take to move residents. For example the information about the type of hoists to use and the size of the sling to use was not always clear. There was also a lack of information with regards to how to turn and move residents in bed. Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 15 Feedback from comment cards suggests that the healthcare needs of residents are on the whole being met and that the care service usually support people to live the life that they choose. Three out of four residents commented that they always receive medical support when they need this. We noted during the inspection that residents presented as appropriately dressed and cared for. There was evidence in the care records that residents receive personal hygiene according to their wishes and needs. We also observe during the inspection that residents were being offered personal care according to their plan of care. The home had one resident with pressure ulcers that have now healed. Records showed that the resident was admitted to the home with the pressure ulcers. There was a care plan to manage the pressure ulcers and there was evidence that the home refers residents with wounds and pressure ulcers to the tissue viability nurse specialist. There was however a lacking with regards to residents having appropriate care plans when they have been identified at high risk of developing pressure ulcers. The equipment to use was not always recorded and the amount of time for the resident to sit out and the repositioning regime in place to prevent ulcers from developing was not in place. For example one resident was up for breakfast, went to bed after breakfast and was got up again for lunch. This regime was not documented in the care plan. As a result new members of staff may not follow the regime that was in place to manage the pressure area care because the information about this was not recorded in the care plan. The manager acknowledged that this aspect of the care records and understanding of pressure ulcer management was still lacking in the home and explained that this was one of the reasons why the home has not been accepting residents with complex needs. She added that once the confidence of staff increases residents with more complex needs would be admitted to the home. It has been noted in the past that a number of residents stayed in their beds for no apparent reason. As a result these residents might have been experiencing some degree of social isolation. The home has reviewed this practice and now assesses residents for seating equipment or makes the necessary referrals to make sure that residents have the appropriate seating equipment to enable residents sit in the communal areas or in their bedrooms if they prefer that. The manager stated that the home has purchased three recliner chairs and is in the process of acquiring more recliners. We checked whether residents had their call bells close to them when they were in their rooms to summon staff if they required help. Two residents had a call bell close to them and said that they would use the bell if they needed to. One of the two said that they do not like using the bell as staff are busy. A Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 16 third resident said that she was left in her room and did not have a call bell to call for staff when she wanted to go out of her room. The enforcement notice imposed on the home in March contained a requirement with regards to ensuring that residents’ pain be appropriately managed and that staff received training on pain management. Training records showed that 7 out of 10 nursing staff have received training in the management of pain. A few carers have also received that training. During the inspection we noted that residents had pain charts in place and care plans with regards to managing pain. The pain chart was used daily to assess the level of pain. The above showed that the home has made progress in this area. Staff said that they do take action when a particular resident had pain but the link between the pain chart and the care plan was not always clear. Progress can be made by using the pain chart as a live document when residents have pain and linking the outcome of the pain assessment to a set of action documented in the care plan to address residents pain. If the actions are not successful in managing the pain of residents then the analgesic regime need to be reviewed. Care plans of residents continue to lack with regards to information about their fears and hopes for the future as well as their wishes and instructions with regards to end of life care and death. Out of six care plans one care plan addressed this issue to some extent. Residents who are admitted for the short term do not always know whether they are going to stay in the home or whether they would go back to their own homes and they therefore go through a range of emotions. One resident said that she has lived in her flat for more than 40 years and finds it difficult to give up her flat to stay in the care home. Another said that he/she wanted to go to his/her flat but has been placed in the home by social services. Whilst the home may not find an answer to these issues, it would have been appropriate to acknowledge what residents go through when admitted to a care home and look at the support that could be provided to them. The management of medication was inspected on all the three floors. Marked progress was noted with regards to records keeping and general management of medication in the home, as compared to the findings during the last inspection in February 2008. The amounts of all medicines were appropriately recorded (brought forward or when newly received into the home) to enable a person auditing the medication, easily determine the amounts that should be in place. Medicines were appropriately stored including controlled drugs, and the clinical room were also kept tidy and generally clean. There were records of the temperature of the medicines’ fridges and these were also kept tidy and clean. We were informed that the home carries out in-house twice weekly audits of medication. A sheet was seen where the staff sign to say that they have audited the medication. Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 17 The medicines administration records (MAR) sheets were signed when medicines were administered or a code was used when the medicines were not administered. There were no gaps in the MAR sheets. On one occasion the number of signatures did not match the actual amount of capsules that have been ad ministered. There was an extra signature. This was for an ‘as required’ medicine for pain. Controlled medicines were appropriately recorded and stored in a separate medicine cupboard. There were regular checks to make sure that the amounts tallied. This was good practice. We noted that one resident was recently seen by the GP for a review of his medication and as a result the instructions for administration of one of his medicines were changed. The amount of the tablet to be given was reduced from two to one. However despite the change being made on the MAR sheet, staff continued to administer two tablets instead of one tablet. This was confirmed by checking the amounts of the tablets that have been administered. Therefore despite changes being made to the instructions to administer the medicine this was not implemented. In December 2007 there were two residents whose medication regimes were changed by the GP but which were not implemented by staff. These issues were dealt with within the safeguarding adult procedure of the local Borough. It was also noted that instructions for a number of topical medicines were not clear with regards to location to apply these medicines. This is particularly relevant when there are new staff in the home to administer medicines such as when agency staff is used. Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 18 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): 12-15 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides social and leisure activities to suit the needs of the residents. Meals that are provided take into account the choices and needs of residents and are suitably nutritious and varied. EVIDENCE: Care plans contained a section to record the social and recreational needs of residents. There was also a section for the life history of residents. The section of the care plans to record the social needs of residents, was on the whole completed appropriately, but the section on the life history of residents was not always recorded. We noted that there were care plans in place to address the social and recreational needs of residents, however life histories do help to make care plans more person centred and provide a perspective on the ‘person’ primarily, and then the needs. The home has an activities programme and on the first day of the inspection there was a sherry morning which was well attended. One resident commented that ‘the activities are well planned and enjoyable’. Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 19 Residents said that they enjoyed coming to the activities and are able to choose which activities they would like to take part in. One resident said “I can choose which activities I want to do and I like the exercise session and the sherry mornings” . All residents who responded to comment cards said that they were always satisfied with activities. One relative mentioned that ‘the entertainment organiser appears to be expected to provide services without sufficient equipment’. This is therefore an area that could benefit from a review in terms of resources and equipment. We also noted that some residents were given the opportunity to sit in smaller groups to chat to each other. Others watched television in the communal areas and a few stayed in their room listening to the radio, reading or preferring to be on their own. A number of visitors were observed in the home and they were all greeted appropriately by members of staff. Some visited residents in the communal areas and others were able to see residents in the bedrooms of the residents. Apart from staff offering them drinks, there was also an opportunity for visitors to make their own hot drinks as the manager has provided a facility in the reception area for people to help themselves to hot drinks. The home has a minibus for residents to go out. A number of trips were planned for residents and a few residents said that they have been able to go out to places of interests. A programme for trips that have been planned for the future was available for inspection. We were informed by staff that a few residents are also able to go out with their relatives/friends or on their own if they are able to. Lunch was observed on the first day of the inspection, which was a Friday. Most residents in the home were encouraged to use the dining areas, which were appropriately prepared to provide a welcoming, clean and congenial environment. A few however stayed in their bedrooms because they choose to or for clinical reasons. All residents who spoke to us said that they look forward to the usual fish and chips that are served on the Fridays. We indeed observed residents enjoying their meal on that day. Two residents said in comment cards that they sometimes enjoy their meals, one said usually and one said always. There was evidence that people were asked about their choices for meals and that at times, culturally appropriate food was provided to residents. We also noted that people who did not like a particular food were provided with an alternative. One resident commented that ‘there is lots that I do not like but the chef is good and he always cook me a meal that I enjoy’. Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 20 The home uses the Southern Cross menu system and on the whole the meals that are provided, as per the menu, are judged to be sufficiently nutritious and varied to meet the needs of residents, once these are expressed or identified. Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Complaints are generally dealt with appropriately by the home to get feedback about the quality of the service. The home ensures that people are safeguarded from abuse as far as possible by ensuring that staff have appropriate training and by monitoring the condition of residents. EVIDENCE: The home keeps a complaints’ register and the complaints procedure is available in the service users’ guide and in the foyer of the home. According to the complaints register the home has not had any complaints since the last inspection. There was a case when the relatives of a resident raised some issues about the service. The home dealt with these as concerns and kept appropriate records about this matter. However it was not clear if these were complaints or concerns particularly when there was a relatively serious issue that was raised. There was also no indication whether the person raising the issues was offered the opportunity to use the complaints procedure and the outcome that he/she expected from raising these issues. As complaints can be a subjective matter, it is recommended that when issues are raised by residents or their representatives about the quality of the service that is provided by the home, that the manager/staff confirm with the person raising the issues whether he/she want to complain as per the complaints procedure or raise concerns. Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 22 Comment cards from residents showed that most residents were aware of the person to talk to if they were unhappy about the service that they received. One said that it is normally his/her relative who would speak to management if he/she was unhappy. Comment cards from relatives showed that they were usually or always satisfied with the response from the home when they have raised concerns about the service. The social care professional also said that the concerns that have been raised about the quality of the service have been appropriately addressed by the home. The home has not had any allegations or suspicions of abuse since the last inspection. The manager is now, as are all the staff, aware of the need to report all injuries that are sustained by residents and that causes are identified for these injuries to rule out the possibility of abuse. Accident and incident records showed that all unexplained injuries are investigated as appropriate to rule out abuse. Care plans and risk assessments were also in place in cases where residents sustained bruises easily because of their clinical condition. The training records showed that most staff have had training on the prevention of abuse. This subject is also covered as part of the induction of new staff, as noted in the induction format that is used in the home. Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 23 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, 24,26 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a homely and suitable environment where the needs of residents can be met. EVIDENCE: The grounds in front and on the sides of the home were maintained. The bushes, shrubs and lawns were trimmed and tidy. The car park area was also tidy. The exterior of the building was on the whole in good order. As mentioned in previous inspections reports the home has experienced some subsidence, but a plan has been drawn up by the management of the home to address this issue. The manager stated that the home was on course to meet the plan of action to address the issue of the subsidence. The inside of the home was warm, airy and free from odours. Comments from residents and relatives showed that the home is always fresh and clean. Communal areas were appropriately furnished and decorated. The home has Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 24 replaced a number of armchairs in the communal areas and in the bedrooms, which have in the past been judged not to be appropriate for residents. There was also evidence that the home has acquired a number of recliners for residents who are frail to enable them to sit out either in the communal areas or in their bedrooms It was noted during past inspections that the call bell system was not fit for purpose and needed replacing. This has been addressed and the home now benefits from a modern call bell system, which is fully operational. The home now has a communal bath and a fully wheelchair accessible shower on each floor to improve the provision of bathing facilities. There is also a range of equipment to help residents in the bath. The home benefits from a redecoration plan, which includes the bedrooms of residents. We were able to see that bedrooms were being redecorated during this inspection and during the inspection in February. A few bedrooms, which have recently been redecorated, were seen and we noted that these have been decorated and that curtains have also been changed to make these more homely. The home had a significant number of double bedrooms but now most of the double bedrooms are operated as single bedrooms, which brings the capacity of the home to about 60 residents. There were a few occasions when residents would share bedrooms such as when they are partners or when they have made a wish to share a bedroom. As a result some residents enjoy large bedrooms with a lot space and all residents who provided feedback to us, said that they liked and feel comfortable in their room. The manager stated that a number of divan beds have been replaced particularly for frail residents and for those residents who require pressure relief equipment to prevent pressure ulcers from developing. This was noted in a few of the bedrooms that were sampled. The home does not yet provide locks for the bedrooms of residents. The manager stated that assessments are carried out as to whether residents want locks for their doors and if these are required then the home provides these. The assessments were seen in the care plans of residents. The home was clean and all areas, including linen cupboards were kept tidy. There was evidence of staff having had training in infection control, but according to the training matrix provided to us only 12 out of 39 members of staff have had training on infection control. Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 25 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): 27-30 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides appropriate staffing levels to meet the needs of residents who live in the home. Recruitment procedures have not been robustly applied to make sure that residents are as safe as possible. Training that is provided in the home is suitable to ensure that staff are sufficiently trained to do their job. EVIDENCE: There are three carers and one trained nurse on each of the three floors during the day. At night there are three carers and a trained nurse for the first and second floors and one trained nurse and one carer on the ground floor. These levels are considered appropriate to meet the needs of the residents. The manager clarified that at times agency nurses are used if required to address shortages of staff. We were informed that the home did not have vacancies and was fully staffed to ensure continuity in the provision of services. Feedback in residents’ comment cards showed that staff were always or usually available when residents needed support. One comment card said ‘ I am very satisfied with the help and support that I receive’. Another said that ‘there is shortage of staff and sometimes I have to wait a long time before someone attends, which is very uncomfortable’. Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 26 A relative suggested that the support and care that residents receive is dependent on the staff on duty and that not all staff are able to fully understand the needs of the residents. Another relative said that ‘most of the carers are kind with a few exceptions…and that the nursing staff are kind and very helpful’. The manager stated in the AQAA that, ‘Staff attitude has improved and they are beginning to see the service users as individuals with choices rather than as just a group of people’. She also added that the home has started providing customer service training to staff. As a result there is some assurance that things can only improve with regards to the quality of the support that residents receive from care staff. We looked at the personnel files of four members of staff. The manager stated that she makes sure that all the necessary checks are carried out prior to employing a new member of staff. All the files contained evidence of a CRB check and of the right to work in the UK. It was noted that one member of staff did not have an application form in place and did not have appropriate references. The references were addressed to whom it may concern. A new member of staff did not have the work history completed appropriately and had not signed the declaration with regards to previous criminal convictions as is required since employment in social care is exempt of the Rehabilitation of Offenders Act 1974. While we acknowledge that some members of staff were recruited prior to the manager’s appointment, it is the home responsibility to check the fitness of its employees. The provider must therefore demonstrate that he has carried out all the checks that are required by legislation and good practice, and be satisfied that members of staff who are employed are suitable to work with people who may be vulnerable. We also checked to see whether new employees were offered induction. We noted that a new carer has had an induction and that her induction form had been signed and dated. The Southern Cross induction package is based on the common induction standards as set by Skills for Care, the training organisation for the social care sector. The induction covers key areas such as communication, principles of care, health and safety and abuse. The manager kindly provided a training matrix to the inspector. This showed that most staff were up to date with statutory training including manual handling, fire training, food hygiene and health and safety. The care manager is responsible for the management of training in the home and in ensuring that all staff are up to date with statutory training. It was however noted that out of 39 members of staff 12 have had training in infection control. Training has also been arranged in a number of other areas such as in pain management, customer care, pressure area care, dementia and challenging behaviour. The manager stated in the AQAA that the home has started customer service training for staff. Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 27 The home has 29 care workers on its training records. Out of this number 14 are trained to NVQ level 2 or above. There are 4 more carers who are in the process of training for an NVQ qualification in care. The home therefore does have nearly 50 of its care workers trained to NVQ level 2 or above. In addition there are a number of trained nurses from abroad who work as care assistants. Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager, supported by line management, has been leading her team to ensure compliance with legislation and the national minimum standards to achieve good outcomes for residents. The home has a quality assurance system in place, which helps to a certain extent, in monitoring and maintaining the quality of the service. The personal money of residents is appropriately managed. The valuables/property of residents could be handled in a more robust manner to make sure that these are safe. Health and safety issues and maintenance of equipment in the home are appropriately addressed to ensure the safety of all people who use the premises. EVIDENCE: Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 29 The manager is a trained nurse and has a management qualification. She has now been managing the home for about a year and is not yet registered with the Commission. She stated that she has started the process to become the registered manager of the home. It is a legal obligation for the manager to be registered, to run a care home. Records showed that the manager has arranged a number of meetings with staff. It was however noted that there has not been a general staff meeting and a residents/relatives meeting during the past four months. It is recommended that these meetings be arranged to give people who use the service and staff an opportunity to contribute and share their views about the service. The home uses the Southern Cross quality assurance procedure. The manager carries out monthly audits and the regional manager carries out a validation audit every two months. These were noted to be in place. There has not been feedback from a satisfaction survey for more than a year and the manager stated that she has recently sent questionnaires to residents and/or their relatives/ representatives to get feedback about the quality of the service that the home provides. According to the manager a previous attempt in 2007 to carry out a satisfaction survey had not been successful. She said that she would produce a report summarising the feedback that she would get once the questionnaires that she has recently sent out, are returned to the home. The manager reported in the AQAA that ‘There is always room for improvement with regards to all aspects of our service. As long as we continue to listen to the views of people who use our service and also our visitors our service can only improve.’ The operations manager who was present when we were giving feedback about the inspection to the manager, stated she would continue with monthly visits to the home when she would look at aspects of the service, as is required by legislation. The manager also has a business/ development/action plan that is monitored monthly by the operations manager. A copy was kindly provided by the manager. It was noted that any issues that needs attending to, including business or quality issues are addressed in this plan. We checked the management of the personal money of residents. We were informed that the home is in the process of updating its approach to the management of personal money. Each resident who has money with the home will be allocated a sub-account of the main residents’ account. This will be beneficial as it would be easier to monitor each resident’s account and calculate the interest earned. We checked the accounts of 2 residents chosen at random. We noted that the balances of money for each resident were correct and that receipts were in place for all expenses. Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 30 The home also keeps a record of property and valuables that have been brought into the home by residents or their relatives. Whilst these records were generally well completed, it was noted that these were not signed by the residents or their relatives when the property/valuables sheets were filled, to check that these were correct and to show that they have agreed to the inventory. A sample check on the maintenance and safety certificates showed that these were in place as required. There were gas safety certificates, electrical wiring certificate, portable appliance test certificate and evidence that the water system is maintained to prevent Legionella. The home also had a fire risk assessment, an emergency fire plan and a health and safety risk assessment. Records were kept about in-house checks that were made such as weekly fire detector tests, monthly emergency lights test, fire drills, wheelchair checks and water temperature checks at the outlets to which residents have access to. There was also evidence that issues, which were noted during these checks, were addressed/rectified as required. This is good practice. Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 31 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 3 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 X X 3 Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 32 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(1,2) Requirement Timescale for action 2 OP7 13(5) 3. OP8 12(1) Care plans must be clear about the action to take to meet the 31/07/08 individual needs of residents while taking the cultural and ethnic aspects of the needs of residents (Previous requirement-timescale 31/07/07 and 31/03/08 partly met). 30/06/08 The manual handling care plan and risk assessment of residents must be clear with regard to how to carry out the various manual handling manoeuvres. The type of hoist and the type and size of the sling as well as the number of staff required for the manual handling manoeuvres must be clearly identified. Once a particular plan has been agreed staff must comply with the plan to ensure the safety of residents. (Previous requirementtimescale 31/07/07 and 31/03/08 not met). The items of equipment in place 30/06/08 for the management of pressure ulcers must be recorded and these must be used according to the manufacturer’s instructions. DS0000022918.V363507.R01.S.doc Version 5.2 Page 33 Buchanan Court Nursing Home The care plan of residents regarding tissue viability and prevention of pressure ulcers must address the repositioning regime, the turning of residents and the time for residents to sit out. This is necessary for the home to demonstrate that it offers a high standard of pressure area care to residents. (Repeated requirementtimescale 31/07/07 and 31/03/08 not met). 4 OP9 13(4) Changes, that are made to the 30/06/08 instructions for the administration of medicines by the GP, must be followed by staff administering medicines to make sure that residents are safe. That the instructions for the 30/06/08 administration of creams, ointments and other topical medicines are clarified with regards to the location of the body to apply these medicines. This is necessary to make sure that nurses are applying the medicines at the right location. All residents must be offered a 31/05/08 call bell to make sure that they can call for help, unless risk assessments are in place. A plan to monitor residents must be in place when they are not given their call bells. (Previous requirementtimescale 31/03/08 partly met). The instructions and wishes of residents and of their relatives with regard to end of life care and death must be addressed in the care records while taking into consideration the cultural and the religious backgrounds of DS0000022918.V363507.R01.S.doc 5. OP9 13(4) 6. OP10 12(4) 7 OP11 15(1,2) 31/07/08 Buchanan Court Nursing Home Version 5.2 Page 34 8 OP29 19(1,4) 9 OP31 8 10 OP35 17(2,3) the residents (Previous requirement-timescale 31/12/06, 31/08/07 and 31/03/08 not met). The home must have robust 30/06/08 recruitment procedures and instances when recruitment has not been thoroughly carried out, must be made good, as required to demonstrate that the home complies with the necessary legislation The manager must be registered 31/08/08 as soon as possible to make sure that she is fully assessed regarding this position. As part of the processes to 31/07/08 prevent financial abuse, the registered person must ensure that as far as possible there is an up to date record of residents’ valuables and property, to provide an audit trail. (Previous requirementtimescale 31/03/08 partly met). RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations It is recommended that residents/representatives’ attention be drawn to service users’ guide at the point of admission and that this document be placed in a prominent place in the bedrooms instead of being placed in a drawer, if that is agreeable to the resident. That the pain assessment be linked more closely to the care plans with clear action to take depending on the findings of the pain assessment, that can then be evaluated with regards to the effectiveness of the DS0000022918.V363507.R01.S.doc Version 5.2 Page 35 2 OP8 Buchanan Court Nursing Home 3 OP12 4 OP16 5 OP31 measures in place to relieve the pain of residents. It is recommended that staff not only complete the assessment of the social and recreational needs of residents but also the life history section, to make sure that care plans are truly ‘person-centred’. It is recommended that when issues are raised by residents or their representatives about the quality of the service that is provided by the home, that the manager/staff confirm with the person raising the issues whether these are complaints as per the complaints procedure or just concerns. The manager/member of staff should also offer the person raising the issues the opportunity to use the complaints procedure. To demonstrate that the manager involves and listens to staff and residents/relatives in the management of the home, there must be regular staff meetings as well as residents/relatives meetings. Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Buchanan Court Nursing Home DS0000022918.V363507.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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