Inspection on 04/06/07 for Buchanan Court Nursing Home

This inspection was carried out on 4th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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 25/04/08

Buchanan Court Nursing Home 13/11/07

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 08/07/2008.

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 10:00a 4 and 5th June 2007 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 DS0000022918.V341678.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. DS0000022918.V341678.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 Limited Care Home 85 Category(ies) of Old age, not falling within any other category registration, with number (84), Physical disability (1) of places DS0000022918.V341678.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Temporary variation agreed for individual (BC) who is under the age of 65 years for the duration of her stay. Maximum of 85 persons may be accommodated Temporary variation agreed for individual (CC) who is under the age of 65 years for the duration of his stay. Maximum of 85 persons to be accommodated 12th October 2006 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 70 beds and less are in use. The ground and first floors accommodate 25 residents each and the second floor accommodates 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. The home charges local authorities £549-£784 for service users placed by them and charges self-funding service users £784-£800 depending on the needs of the service users. On the day of the inspection there were 53 residents in the home. DS0000022918.V341678.R01.S.doc Version 5.2 Page 5 DS0000022918.V341678.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This report contains the findings of a key unannounced inspection. This is the first inspection for the period 2007-2008. The inspection started on Monday 4th June from 10:00-18:30 and continued on Tuesday 5th June from 10:00-15:00. During the course of the inspection, I spoke to some residents, visitors to the home, members of staff and the manager. I also toured some of the premises, looked at a sample of records, inspected the medicines management on the 2nd and ground floors and observed mealtimes and care practices. I was also able to check for compliances with past requirements. An improvement plan was provided to the Commission following the last inspection detailing how the requirements, imposed during that inspection, would be met. This report shows that 11 requirements still remain to be fully met. I would like to thank all the residents and visitors who spoke to me and the manager and her staff for their entire cooperation during the course of the inspection. What the service does well: What has improved since the last inspection? Short-term care plans were in place to address short-term needs of residents such as in cases of acute illnesses. DS0000022918.V341678.R01.S.doc Version 5.2 Page 7 There has been an improvement in the management of medicines. A few issues were identified but the overall management of medicines was good. The home now has increased the number of adjustable beds for residents requiring nursing, but there was still progress to be made in this area. There has been a significant improvement with regard to the quality of the environment. There was evidence of ongoing redecoration of the home and of the replacement of some fixtures and fittings. There is alcoholic handrub in place in cases where staff need to decontaminate their hands. The home now has more that 50 of its staff trained to NVQ level 2 or above. The home now has a permanent manager who has experience in running care homes. She has started to address the issues in the home but she would require more consistent support from line manager to achieve the aims and objectives of the home and organisation. Some issues identified during the last inspection with regards to health and safety, have been addressed. What they could do better: The service users’ guide must be updated to reflect changes in the management of the home and to include the range of fees charged by the home. Care plans could be more comprehensive with regards to information about the cultural and ethnic needs of residents. Assessments of needs could also be more comprehensive to include all the needs of residents. Plans of care to meet the needs of residents must be more specific and clearer about the action to take to meet the individual needs of the residents. Care plans and risk assessments must be agreed with residents/representatives when they are first drawn up and must be reviewed with the residents/representatives according to the agreed timescales. Care plans addressing manual handling must be clear about the action to take to manage the various manual handling manoeuvres. The hoist and size of the sling as well as the number of staff required for a particular manoeuvre must be identified. Once the action to carry out a manual handling manoeuvre has been identified staff have a responsibility to comply with this action to ensure the safety of the residents at all times. Prompt action must be taken when pressure ulcers have developed with regards to accurate recording, taking photograph or wound mapping and drawing up of care plans. Equipment in place for the management of pressure DS0000022918.V341678.R01.S.doc Version 5.2 Page 8 area care must be documented as evidence that appropriate pressure relief is being provided. The seating arrangements for residents must be reviewed as part of the falls risk assessment or ability to maintain a safe environment, as the recent fall of a resident demonstrated. She was left seated on the edge of the bed without supervision. Little progress has been achieved in ensuring that care records contain appropriate information about the end of life care of residents and the wishes of residents/representatives and arrangements in place to manage the death of residents. Some areas in the home have been recently redecorated, but other areas could be further improved by making the bedrooms more personalised while taking into account the residents choices. A short-term redecoration plan ending 1st May 2007 was sent to the Commission. The redecoration plan and the plan to replace fixtures and fittings in the home must address the long term redecoration of the home to give some guarantee that input into the home with regards to redecoration will be sustained and ongoing according to the plan. A copy of the review of the bathing facilities in the home has been sent to the Commission and it identifies the conversion of two toilets to a shower room on the first and second floor. The work has not started yet. The recruitment procedures were not always being followed. There were gaps in the employment history of applicants and references received for applicants were not always appropriate. Induction of care staff was not comprehensive and training in clinical areas could have been more comprehensive for care staff to understand the needs of residents brought on by their clinical condition. There has been progress in the provision of supervision to members of staff but this process must now be consolidated. ‘Code 1’ issues identified in the electrical wiring test report must be addressed as soon as possible and the home must have a gas certificate for all equipment which uses gas. Issues identified during health and safety checks, such as water temperature checks and wheelchair checks, must be addressed as soon as possible to ensure the safety of residents. 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. DS0000022918.V341678.R01.S.doc Version 5.2 Page 9 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 DS0000022918.V341678.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive most information about the service prior to moving into the home. Residents’ needs’ are assessed prior to moving into the home. The home can generally meet the needs of residents who are admitted to the home. EVIDENCE: There was a copy of the service users’ guide (SUG) in the bedroom of each resident. It was however an old version which was in place before the current manager of the home. The name of the previous manager was still in the SUG and the information about the fees charged by the home was still not included in the SUG as per Regulation 5(1)(bb) of the Care Homes Regulations 2001. Southern Cross Healthcare has comprehensive contracts/statements of terms and conditions which are given to residents reflecting their particular circumstances with regards to funding. The administrator is normally responsible for providing the contracts/statement of terms and conditions to DS0000022918.V341678.R01.S.doc Version 5.2 Page 11 residents or their representatives. At the time of the inspection she was in the process of drawing out contracts for residents who have recently been admitted to the home. Residents who have been in the home for some time had a contract/statement of terms and conditions in place. The manager stated that her deputy and herself visit all prospective residents to assess their needs prior to admission, including a number of residents who are admitted to the home in ‘step down’ beds. The ‘step down’ beds are for residents who have been discharged from hospital but who are not yet ready to go home and who need a period of convalescence or while work is completed in their house to make the house more suitable for their needs such as by providing and installing adaptations. The preadmission assessments were available for inspection in the care files of residents. I looked at the care records of seven residents and noted that on the whole these were completed appropriately. As a result of the appropriate assessment of the needs of residents, the home was in a position to only admit residents whose needs it can meet. Conversation with members of staff and residents showed that staff working in the home were familiar with the needs of older people and were also aware of the cultural and religious aspects of the care of residents from ethnic minorities. Feedback from residents and visitors showed that staff respected residents from different culture and made attempts to meet their needs taking into consideration equality and diversity issues. Care plans of residents were however lacking with regard to incorporating the religion and culture of residents in planning the care of the resident (See next section). DS0000022918.V341678.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care plans were not comprehensive and specific enough to enable a person reading the care plan provide the required care to the resident. While the healthcare of residents was generally being met in the home, staff were at times not attentive enough to ensure the welfare of the residents. Medicines management in the home was of a good standard to ensure the safety of residents. The care records did not always address the end of life care and the death of residents. There was therefore no guarantee that the needs of the residents would be met when these needs develop. EVIDENCE: The care records were in good order and kept on trolleys which were kept locked in the clinical room when not in use. The care records of seven residents were inspected. The home has introduced the formats of care plans used by Southern Cross Healthcare. The approach to care planning includes the assessment of DS0000022918.V341678.R01.S.doc Version 5.2 Page 13 residents’ needs on admission using the activities of daily living (ADL). Plans of care are then formulated for each ADL, which is then kept updated with regards to the changing needs of residents. I was informed that the ADL list provided by Southern Cross Healthcare is for reference only and is intended to assist when drawing up care plans. It was noted that the care plans did not provide comprehensive information about all the needs of residents, as these did not cover all the ADL’s. Information about aspects of communication such as language spoken, understanding of conversation and willingness to take part in conversation was not always available. It was noted that the likes and dislikes of residents with regards to food, the sexuality issues and information about the sleeping habits of residents was not always available on file. Care plans for manual handling following the manual handling risk assessment did not always address the aid to use. For example it does not specify the hoist to use and the type and size of the sling. In one case the care plan for one resident says ‘needs 1-2 persons’ for a particular manual handling manoeuvre and did not specify exactly how many members of staff were required. Two recent incidents have demonstrated that members of staff do not always follow the guidance as detailed in the care records. In one of the incidents one member of staff was involved in the manual handling of a resident when it should have been two members of staff. In the other incident two members of staff transferred a resident without a hoist as identified in the care plan. This may have resulted in an injury to the resident. The care plan for people with diabetes said that action should be taken when the blood sugar is low or high, but did not clarify what were the values for ‘low’ and ‘high’. A care plan for one resident said ‘to inform the GP when the blood sugar was abnormal’ and did not clarify what abnormal was. It was however noted that the signs of a hypo or hyper glycaemia have been accurately described to ensure that staff were aware of what to observe in these cases. There was evidence of the involvement of some residents in their care records, but two residents who spoke to me, said that they have not seen their care plans. The home also has a shortened version of the care plan for people who are admitted for the short term. There was a section for residents to sign to say that they have agreed to their care plan. Out of three care plans for residents who were in the home for a short stay, two were not signed by the residents or their representatives. Care plans of residents contained little information about the ethnic and cultural backgrounds to enable a person reading the care plan, understand this aspect of care. Most of the time staff have some awareness of how to meet the cultural and religious needs of residents but these were not always recorded to ensure that people reading the care plan would be able to meet the needs of DS0000022918.V341678.R01.S.doc Version 5.2 Page 14 the residents. For example staff found out information about the religion of one resident but did not include the information received in the care plan. Improvement was noted with regards to the formulation of care plans when residents became acutely ill and addressing the monitoring of the residents and the action to take if the problem was not resolved. This is good practice. Records showed that residents were seen by the GP, optician, dentist, chiropodist and other healthcare professionals. The manager said that arrangements are made to ensure that residents are seen by the relevant healthcare professional as required. At the time of the inspection there were 5 residents with pressure ulcers in the home. Conversation with members of staff and records showed that three residents came into the home with pressure ulcers and that two of the residents had developed the pressure ulcers in the home. I looked at the records of one resident who had developed pressure ulcer in the home. Staff first described how they noted a dressing on the pressure ulcer. They did not describe the nature of the sore and how it occurred. It was also not clear who was the person who first noted the sore and put the dressing on the wound. The care plans was written three days after the pressure sore had developed and photos and a body map were completed on that occasion. While pressure ulcers were generally managed appropriately once they had developed, it seems that there are issues with regard to the prevention of pressure ulcers and the recording of information in relation to the ulcers. It was also noted that the equipment in place for the management of pressure ulcers were not always recorded in the care plan and that progress notes were not filled regularly according to the review dates of the sores. In one case the mattress overlay was noted to have been placed below the mattress on the divan bed and hence providing a questionable standard of pressure relief. The care records of a resident, who fell down and sustained a serious injury showed that she was at high risk of falls. She was left sitting on the side of the bed without supervision, which led to her falling. The control measures to reduce the risk of falls and the assessment for maintaining a safe environment did not address seating and were in this case inadequate to prevent the resident falling from a seated position and sustaining a serious injury. A few residents in the home had care plans in place to manage epileptic fits. It was noted that the plans were not individualised to the specific circumstances of the residents and comprehensive with regards to managing a resident when he/she is having a fit. It was not clear from the plan when prescribed medication were to be given, how many times (in cases when the resident is having more than one fit) should these be given and at what point should the GP be informed or the resident be sent to hospital. DS0000022918.V341678.R01.S.doc Version 5.2 Page 15 Medicines management in the home was of a good standard. There were records of medicines which have been received into the home, administered and returned to the chemist when not administered. Appropriate codes were used to record the reasons when residents were not given their medicines. Records with regards to the management of controlled medication was also of a good standard. Staff in the home used appropriate devices for the testing of blood sugar levels, but controlled solutions were not available on one of the floors for the calibration of the glucometers, as confirmed by one of the nurses. There was little information about the end of life care and wishes and instructions of residents with regards to the management of death. There did not seem to have been consultation with residents to deal with this aspect of care. Furthermore the cultural and religious beliefs of residents/representatives did not seem to have been included with regards to this aspect of care. DS0000022918.V341678.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides social and leisure activities for residents to ensure that they lead fulfilling lives as much as possible, but the residents’ profile records/life histories were not always completed comprehensively to ensure that the individual needs of the resident were identified. Appetising and nutritious meals are provided to residents according to their needs, tastes and choices. EVIDENCE: Care plans contain a format for the record of the life history/social profile of residents including an assessment of their social and recreational needs. This information allows a person reading the records have an insight of the ‘person’ in need of care and understand the perspectives of that person and thus promoting person centred care. It was noted that these sections of the care plans were not always completed comprehensively. In some cases the information may not be available but in other cases where it is possible to get this information, then the records must be more comprehensive with regards to this aspect of care. DS0000022918.V341678.R01.S.doc Version 5.2 Page 17 There has been some progress with regards to care plans being in place addressing the recreational and social needs of residents and there were records of activities that residents engaged in. During the course of the inspection, I had the opportunity to observe that residents were engaged in group activities. I also noted that the activities coordinator also attended to residents on a one to one basis. Feedback about the contribution of the activities coordinator was positive. A few residents were seen outside in the garden area enjoying the pleasant weather and the green surroundings. Some were taken by their relatives/visitors for walks in the grounds of the home or around the home. I was informed that residents are encouraged to go out in the local community. The home has a mini bus, which is driven by a member of staff. It was reported to me that there has unfortunately not been a lot of outings this year as there has not been enough staff to escort residents on the trips, particularly residents who are wheelchair users and who require one to one. The representatives from various religions regularly visit the home to provide support with meeting religious needs. Notices were on display with the dates when the visits have been arranged. On the day of the inspection, residents were served chicken chasseur, potatoes and peas for lunch. There was banana mousse for desert. Some Asian and West Indian residents were offered rice and vegetable curry. The chef also catered for individual preferences of residents. All residents spoken to enjoyed their meals and were complimentary of the meals. Residents stated that the chef visits them after meals to get feedback about the meals and the menu or to ask them about meals that they like. This is good practice and the chef is commended for his efforts in meeting the individual needs of residents. There is a dining room on each floor where the meals are served. The dining rooms are prepared appropriately and residents are encouraged to use these areas. Practically all residents were observed in the dining rooms. This is good practice and residents do not only experience a change in environment and mealtimes which are social occasions but the moving from the lounge to the dining area also helps in maintaining/improving the mobility of residents. The residents were also assisted by care staff in a sensitive and appropriate manner. DS0000022918.V341678.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and allegations and suspicions of abuse are taken seriously and are dealt with appropriately by the service. EVIDENCE: The complaints’ register of the service was inspected. There have been four complaints since the last inspection in October 2006. Two were partly substantiated, one was substantiated and one was ongoing. Two were about laundry and standard of cleanliness, one was about equipment and one was about some aspect of the care that was provided to a resident. The records showed that complaints were taken seriously and were appropriately addressed by the organisation. Residents and their representatives are provided information about the complaints procedure in the service users’ guide. A copy of the complaint procedure was also available in the foyer of the home. There have been two allegations in the home which have been referred to the Safeguarding Adult team of the borough. These were reported in an open manner and the home has been cooperating fully with the safeguarding adult investigation. The manager thus demonstrated that issues about safeguarding adults were being appropriately dealt with by the home. DS0000022918.V341678.R01.S.doc Version 5.2 Page 19 I was informed that new members of staff are taught about abuse and safeguarding adults during their induction to the home. Abuse and safeguarding adults is further covered as part of the training and development programme of staff. DS0000022918.V341678.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21,22,24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been some improvement in maintaining the décor of the home and the quality of the environment of the home, but there is more work to be done. EVIDENCE: The outside areas of the home and the parking areas were maintained. The bushes and shrubs in front and around the home were kept trimmed. The lawn was also maintained to a good standard. There were potted flowers in front of the home to provide colour and to make the entrance more inviting. The exterior of the building appears to be in a suitable condition. There were some cracks in a few walls of the home (along the wall of the staircase on the left side of the building and in one bedroom) suggestive of subsidence. It was not clear how the home was dealing with this. The home must provide a report and action plan to address the cracks in the wall/ subsidence, if this is the case. DS0000022918.V341678.R01.S.doc Version 5.2 Page 21 There has been redecoration work in the home since the last inspection. The foyer of the home, all corridors and some of the communal lounges have been redecorated to make the environment more welcoming to residents and visitors to the home. The call bell system was working appropriately at the time of the inspection. Curtains and pelmets were noted in good condition and new curtains have been purchased for some bedrooms to match the décor and to make the bedrooms more ‘homely’. This is acknowledged. The manager provided a redecoration plan to the Commission. It addressed the redecoration of the home until 1st May 07. While a short term plan is good, a comprehensive plan addressing the long term state of decoration of the home and the replacement of fixtures and fittings must be prepared to ensure that improvement in the quality of the environment is being continuously maintained. The requirement imposed on the home during the previous inspection is therefore not fully met. A review of the bathing facilities in the home has been carried out by the estate manager. Opportunities have been identified for the development of additional shower rooms, as identified in the improvement plan of the home. The shower rooms have not yet been completed. The bedrooms in the home are en-suite. Some have a bath, toilet and washbasin and a few have a shower, toilet and washbasin. The baths in the en-suite are not suitable to residents with poor mobility as they are situated against the wall and therefore do not allow access to carers on either side and they do not also accommodate the use of a hoist. There is therefore still one communal bath on each floor. The manager said that there are plans to convert some areas of the home into a bath or shower to increase the bathing/washing facilities in the home. A number of bedrooms of residents have been redecorated, including those where the ceiling in the en-suite was blackish. There were a few bedrooms, which still needed to be redecorated, but the manager stated that these have been identified for redecoration. Some bedrooms were personalised but I noted that quite a number of bedrooms were bare with no or very little items of decoration or personal effects of the residents. The manager said that she was aware of this issue and added that she was in the process of addressing this. There were adjustable beds for some of the residents. I was informed that these are provided for residents with pressure ulcers. I noted that residents with pressure sores and those who were most dependent had adjustable beds in place, but not all residents who require nursing care had an adjustable bed. Some residents were being cared for on pressure relief mattresses and overlays, which did not fit the divan beds properly. The manager stated that she has plans to gradually phase out all the divan beds and replace them with adjustable beds. DS0000022918.V341678.R01.S.doc Version 5.2 Page 22 While most of the armchairs in the lounges have been replaced, some of the arm chairs in the bedrooms of residents still needed to be replaced. It was noted that the cushions on some armchairs in the bedrooms of residents illfitted the frame of the chairs, which may cause the cushion to slide under residents. The home was clean and there were no odours. It was noted that there was a washing bowl and a urine bottle with lime scale on the floor, in the bathroom of the ground floor. Some items of linen were also on the floor in one of the linen rooms. These items must be stored on shelves and not on the floor. Sluice areas were generally tidy and maintained. DS0000022918.V341678.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): 27-30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recruitment procedures were not thoroughly applied to ensure the safety of residents. Staff were up to date with training in statutory areas but the induction training of new members of staff was slightly lacking. As a result even though staffing levels were adequate to meet the needs of residents there was no guarantee that new members of staff would be as competent as possible to care for the residents. EVIDENCE: There has been a reduction in occupancy in the home and as a result staffing has been reduced slightly to reflect the above. At the time of the inspection there were 14 residents on the second floor and there were 1 trained nurse and 3 carers to care for them. There were 19 residents on the ground floor and 18 on the first floor. The staffing on the first floor was 1 trained nurse and 4 carers in the morning and 1 trained nurse and 3 carers in the afternoon. There was 1 trained nurse and 3 carers on the ground floor throughout the day. At night there were 1 trained nurse and 1 carer for the ground floor and 1 trained nurse and three carers for the second and first floors. The manager stated that the staffing level is constantly under review depending on the number and needs of residents in the home. DS0000022918.V341678.R01.S.doc Version 5.2 Page 24 A training programme was available for inspection. It was for a six months period. Analysis of the programme showed that wound care training and promotion of continence have been arranged but apart from that there was not much training in clinical areas. The training grid also showed that most members of staff were up to date with statutory training. As a result it is recommended that more training be provided in clinical areas. Inspection of training records and conversation with the deputy manager, who is responsible for training, showed that the home was not using an induction programme for new care staff based on the common induction standards, as per guidance from Skills for Care, the training organisation for the social care sector. I was informed that the home has more than 50 of its care workers qualified to NVQ level 2 or above. In addition to that there are some care workers who have been trained abroad as trained nurses, but who work in the home as carers. The personnel files of 4 members of staff were inspected. Three of them were newly recruited. The files were well arranged and separated into section which facilitated the inspection of the files. It was noted that one member of staff had one reference and that the three others had character references. They had some professional references but these predated the application for work in the home. One member of staff had a gap in her employment history and another applicant’s work history was not completed to the nearest month. All of the employees have had CRB checks and were issued with contracts. As a result of the above, the requirement imposed during the previous inspection was judged not to have been met. DS0000022918.V341678.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): 31,33,35,36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager runs the home in an open and transparent manner. The quality assurance procedure of the home was not being consistently applied to ensure a quality service. The management of residents’ personal allowances was lacking. A few health and safety issues were identified which could put residents, staff and visitors at risk. EVIDENCE: The manager is not registered yet, but she said that she was in the process of applying to be registered. She is a nurse and she has worked in care homes for a number of years in a senior position. She has also completed the registered manager’s award and was in the process of studying for a higher qualification DS0000022918.V341678.R01.S.doc Version 5.2 Page 26 in management. There was evidence that she has attended other training to keep herself up to date. The manager is well supported in the home by the deputy manager, but line management has not always been consistent to support her in managing the home. She has had changes in line management about four times since she started to manage the home sometime in the beginning of this year. The manager is aware of issues in the home. Since her appointment she has arranged a number of meetings for staff, relatives and their visitors. Comments from all persons spoken to were positive about the way she manages the home. The home uses the quality management system of Southern Cross. This consisted of an annual satisfaction survey and of a system of monthly audits, which is completed by the manager and validated by the regional manager at two monthly intervals. The home has in the past had satisfaction surveys, but there were no reports following the survey to summarise the findings and to give an indication of the outcomes of the surveys. It was noted that the monthly audits by the manager was being completed as per the schedule. There were action plans following the audits when noncompliances were noted. The audits were however not validated regularly as per the audit schedule. There was a validation audit in May 07 and the validation audit prior to that was in September 06. There was therefore some lacking with regards to the audit programme of the home. Regular selfassessments and its validation could help the home identify areas of improvement and address these to ensure a quality service. The personal monies of residents were inspected. The home keeps a record of the amount of money that each resident has. Some residents have only a small amount of money, which is left in the home by relatives to pay for small expenditures. There were a few residents who have their personal allowances paid directly to the home. The money goes to the head office and is then sent back to the home to be allocated to the residents’ accounts. In one case the records of money of a resident showed that three months of personal allowances from last year and beginning of this year were missing from the balance. There was a requirement during the last inspection that the money, which belonged to residents who were no longer in the home, be reimbursed to them or to their estates. On this occasion it was noted that more than 75 residents who were no longer in the home still had money in the home. A discussion with the manager confirmed that she has started to address one to one supervision of staff and that this was not yet taking place every two months or six times a year as a minimum. DS0000022918.V341678.R01.S.doc Version 5.2 Page 27 The home had an up to date Portable Appliances Check, LOLER certificates for the hoists and the lifts and a chlorination certificate for the water system. The electrical wiring certificate following the test in July 06 mentioned that some ‘code 1’ (urgent) work needed to be completed as soon as possible and then the certificate would be valid for five years. These have not yet been completed. There was a gas certificate addressing gas equipment in the kitchen but there were no gas safety certificate for the boilers and the dryers in the laundry. Weekly tests of fire detectors and monthly emergency lights tests were being carried out. According to the records kept in the home the weekly checks on the fire detecting system and fire doors were however not being carried out regularly. Fire drills were completed as appropriate and a fire risk assessment and a fire emergency plan were available for inspection. The home had an up to date health and safety risk assessment. There were tests on wheelchairs and water temperatures. It was however noted that when things were identified which could put residents at risk, these were not always addressed in a timely manner. For example a number of water outlets had high temperature. The readings for subsequent months continue to show a high temperature which showed that the problem was not addressed to ensure a safe temperature of the water. Wheelchairs were identified with faulty brakes and no footrests. The same issues were identified during subsequent months, which again showed that these issues were not addressed. It was noted that that while staff were trained in First Aid, there was no equipment in the home to assist first aid such as mouths pieces or a suction machine. As a result the equipment required for first aid in the home must be reviewed. DS0000022918.V341678.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 3 X x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 2 X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 2 X 2 DS0000022918.V341678.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 5(1)(b) Requirement The service users’ guide must contain information about the range of fees charged by the home in respect to various types of placement and funding. (Previous requirementtimescale 31/12/06 not met). The service users’ guide must also be reviewed and updated with regard to recent changes in the management of the home. The needs’ assessment of residents must be carried out comprehensively (Previous requirement-timescale 31/12/06 not met). Care plans must be clear about the action to take to meet the individual needs of residents while taking the cultural and ethnic aspects of the needs of residents. Residents or their representatives must be involved, whenever possible, in drawing up and in reviewing care plans. DS0000022918.V341678.R01.S.doc Timescale for action 31/08/07 2 OP7 14(1,2) 31/08/07 3 OP7 15(1,2) 31/07/07 Version 5.2 Page 30 4 OP7 12(1) The care plans of residents who have diabetes must be clear about what is ‘low’ and ‘high’ level of blood sugar as this can vary from individual to individual. Residents who have epileptic fits must have clear care plans/protocols in place detailing the action to take when the residents have epileptic fit(s, including clear instructions about the administration of rectal diazepam. 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. The care plan of residents who have been identified at high risk of falls must look at the seating arrangements to prevent falls. Comprehensive records must be put in place without delay when pressure ulcers develop, including information about the ulcer, photograph or wound mapping and daily progress notes. The equipment in place for the management of pressure ulcers must be recorded and these must be used according to the manufacturer’s instructions. Calibration solutions must be available and must be used at the intervals recommended by the manufacturers to calibrate glucometers to ensure that these DS0000022918.V341678.R01.S.doc 31/07/07 5 OP7 12(1) 31/07/07 6 OP7 13(5) 31/07/07 7 OP8 13(4) 31/07/07 8 OP8 17(1)(a) 31/07/07 9 OP9 13(2,4) 31/07/07 Version 5.2 Page 31 always give the right readings about blood sugar levels (Repeated requirementprevious timescale 15/07/06 and 31/12/06 not met) 10 OP11 15 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 the residents (Previous requirement-timescale 31/12/06 not met). That the social and recreational needs of residents are continuously kept under review and updated as and when new information is received and that the registered person develops care plans to address the social and recreational needs of residents based on their individual needs assessments. (Previous RequirementTimescale 30/4/5, 31/07/06 and 31/12/06 partly met during this inspection). The registered person must provide the commission with a comprehensive plan with timescales addressing the redecoration of the bedrooms and of the home, and the replacement of fixtures and fittings. (An immediate requirement was issued on the 12th October 2006 with a timescale of the 23rd October 2006- This was not met at the time. This has now been partly met) The home must provide a report and action plan to address the cracks in the wall/subsidence, if DS0000022918.V341678.R01.S.doc 31/08/07 11 OP12 16(2) (m,n) 31/08/07 12 OP19 23(1)(2) (b) 31/08/07 13 OP19 23(1)(a) 31/08/07 Version 5.2 Page 32 14 15 OP19 OP24 16(2)(c) 23(2)(b) 16 OP26 13(5) 17 OP29 19 this is the case. The provision of armchairs in the home must be suitable for the needs of the residents. The bedrooms of residents must be fit for purpose. They must be decorated to a high standard and must be personalised according to the wishes and choices of the residents (Previous requirement-timescale 31/01/07 partly met). Washing bowls and urine bottles must not be kept on the floor because of the potential for cross infection. Urine bottles must be kept clean and free from lime scale/deposit. The registered person must ensure that all the records as per schedule 2 of the Care Homes regulations 2001 are available for inspection. The work history of all applicants must be fully explored during interviews if gaps are noted in the application forms (Previous requirementtimescale 31/12/06 partly met). 30/09/07 30/09/07 31/07/07 31/08/07 18 OP30 18(1)(c) 19 OP33 24 The common induction standards 31/08/07 as per Skills for Care or a similar induction package must be used for the induction of new members of staff. Consideration must be given to staff having more training in clinical areas. The impact of the quality 31/08/07 management system on the quality of the service must be reviewed to ensure that its use is leading to continuous improvement (Previous requirement-timescale 31/01/07 partly met). The home must reimburse the money of residents who are no DS0000022918.V341678.R01.S.doc 20 OP35 17(2),20 31/08/07 Page 33 Version 5.2 longer in the home as soon as possible (Previous requirement-timescale 31/01/07 partly met). 21 OP36 18(2) The registered person must ensure that all members of staff receive supervision at least every two months or six times every year (Previous requirement-timescale 31/01/07 partly met). That the ‘code 1’ issues identified in the electrical wiring test report be addressed without delay. A gas safety certificate must be available for inspection (Repeated requirementtimescale 30/11/06 partly met). All gas equipment must be certified for safety. That issues identified during checks such as the water temperature checks and wheelchair checks be addressed to ensure that these are not repeated and that residents are not being put at risks. 31/08/07 22 23 OP38 OP38 13(4) 13(4) 31/08/07 31/07/07 24 OP38 13(4) 31/07/07 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 4 Refer to Standard OP7 OP21 OP24 OP31 Good Practice Recommendations All care records should be kept securely as far as possible. That the shower rooms as identified in the improvement plan of the home are provided without delay. The registered person should provide locks for the bedrooms of residents. The responsible individual should promote consistent line DS0000022918.V341678.R01.S.doc Version 5.2 Page 34 management support for the manager of the home to ensure that she is supported as much as possible in meeting the aims and objectives of the home. DS0000022918.V341678.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 DS0000022918.V341678.R01.S.doc Version 5.2 Page 36 - 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!