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Inspection on 01/02/08 for Carr Green Nursing Home

Also see our care home review for Carr Green Nursing Home for more information

This inspection was carried out on 1st February 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Information from surveys told us that people felt they had received enough information about the home and that they can come and look round before making any decisions about whether or not it would be suitable for them. The staff are friendly and make visitors to the home feel welcomed. From talking to staff and observing their approach with people, it was clear they had a good understanding of people treating and respecting them as individuals. Staff respect people`s wishes about when they want to get up, go to bed or where they want to have their meals.People are seen by their General Practitioners, other healthcare professionals such as opticians, allocated social workers, speech therapists, district nurses for people receiving residential care and chiropodists as and when needed. Information from people told us that they enjoyed their meals and the food was good. They said their rooms are kept clean and tidy. Many people have brought in their own furniture, ornaments and pictures to personalise their bedrooms and make them `theirs`.

What has improved since the last inspection?

The redecoration of the communal areas has almost been completed, which makes these areas look fresh and clean.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Carr Green Nursing Home Carr Green Lane Rastrick Brighouse West Yorkshire HD6 3LT Lead Inspector Nadia Jejna Key Unannounced Inspection 10:00 1st February 2008 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 Carr Green Nursing Home DS0000001046.V358412.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. Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carr Green Nursing Home Address Carr Green Lane Rastrick Brighouse West Yorkshire HD6 3LT 01484 710626 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) Flowertouch Limited Mrs Sandra June Speight Care Home 31 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (31), of places Terminally ill over 65 years of age (2) Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Can provide accommodation and care for seven named services users - category DE(E) 13th September 2007 Date of last inspection Brief Description of the Service: Carr Green provides both personal and nursing care for 31 older people in what was once a school. The home is located in Rastrick, close to local amenities. There is a small, safe garden area at the side of the home and car parking is available in the grounds. All of the accommodation is on one level and there is level access to the building. There are single and double bedrooms available. None of the bedrooms have en-suite facilities. Bathrooms and toilets are near to the bedrooms. There is one large lounge and a dining room. The kitchen and laundry are in the basement. The fees range from £395 to £485 per week. There is an extra charge for hairdressing, chiropody and personal newspapers. This information was provided to us in September 2007. Information about services provided is kept in a file in the reception area. A copy of this can be printed from the computer on request. A copy of the last inspection can be provided on request. Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection consists of a review of information received and held by us since the last inspection and the findings made during a visit to the home. The visit was made on 1 February 2008 by two inspectors. Feedback was given to the manager and the deputy manager on 5 February 2008. The purpose of this visit was to make sure that the home was being managed for the benefit and wellbeing of the people using the service and to monitor progress made towards meeting requirements made at the last inspection in September 2007. Following the poor outcomes of the last inspection, the provider was asked to complete and return an improvement plan to us. An outline plan was sent as guidance. At the point of writing this report nothing had been received from the provider. Questionnaires were sent to people living in the home, their relatives and healthcare professionals before the visit took place. These people were selected using information requested from the manager. At the time of writing this report two relatives/visitors, one care manager and one healthcare have returned surveys professional. The information from these is referred to throughout the report. During the visit we talked to people who live there, to visitors who called in during the day and staff on duty. We observed care practice, looked at various records such as staff files, complaints and accidents records and looked round the home. What the service does well: Information from surveys told us that people felt they had received enough information about the home and that they can come and look round before making any decisions about whether or not it would be suitable for them. The staff are friendly and make visitors to the home feel welcomed. From talking to staff and observing their approach with people, it was clear they had a good understanding of people treating and respecting them as individuals. Staff respect people’s wishes about when they want to get up, go to bed or where they want to have their meals. Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 6 People are seen by their General Practitioners, other healthcare professionals such as opticians, allocated social workers, speech therapists, district nurses for people receiving residential care and chiropodists as and when needed. Information from people told us that they enjoyed their meals and the food was good. They said their rooms are kept clean and tidy. Many people have brought in their own furniture, ornaments and pictures to personalise their bedrooms and make them ‘theirs’. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 7 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 Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 8 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, 3 and 4. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s needs are assessed before they move into the home. However, there is a risk that they might not be met because of the poor provision of staff training that does not take people’s specialist healthcare needs into account. EVIDENCE: The provider has not yet produced an information pack or brochure about the home. The manager said that if people want a copy of the Statement of Purpose and Service User Guide one can be printed off from the computer for them to take. A copy of this information is kept in the reception area. The manager said that most people are referred to them via the local authority and copies of their care needs assessments are always requested before any agreements are made about coming to live at the home. The manager or her Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 9 deputy will always visit the individual to assess their needs and make sure they can be met by the services and facilities available. Three of the files we looked at told us people’s needs had been assessed before or on admission to the home. One person told us that their relative had been to look around the home before deciding it was the right place for them. Information from surveys told us that people felt they had received enough information about the home to be able to decide if it would be suitable for them. The home is registered to provide a service to up to thirty-one older people and up to three older people with dementia. From looking at care plans and information given to us by staff it was clear that there were more than three people with dementia living in the home. The manager was advised to look at the individuals needs to identify if their main reason for needing twenty-four hour care was dementia or because of their physical and/or nursing care needs. If people are coming to live at the home because they have dementia the provider should consider making an application for a variation in their registration categories. The information about the home should be altered to show they provide a service to people with dementia and all staff must receive training that helps them to meet their specialist care needs. Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s personal and healthcare needs are being met but the records kept do not fully evidence this and there is a risk that some specialist care needs might be missed. There is risk that individual’s health needs could be compromised because they are not all getting their medications as prescribed by their doctors. EVIDENCE: Care plans are in place for each person who lives in the home. The manager and the deputy said that they are working on the way care plans are written to make them a more useful tool. These are the documents that should tell staff about an individual and their abilities, what their needs are and how to meet them, as well as recording what happens for that person on a day-to-day basis. We looked at four care plans in detail. The level of detail and Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 11 information in the plans varied from being detailed and informative in some areas to being very basic in others. The care plans need more work to make them person centred and individual to the person they are about as well as to provide staff with the all the detailed guidance they need to help them meet people’s needs. The manager must also make sure that where specialist healthcare assessments have been carried out that identify a risk to the individual, a care plan is put in place telling staff what the risk is and what they have to do to reduce it. Examples were given to the manager during feedback at the end of the visit, they included: • The care plan for somebody with a gastric feeding tube did not tell staff how to care for the site where the tube entered the body. This means that staff might not be caring for the site properly and there could be an infection risk. • Staff told us about measures that had been put in place to reduce risk to somebody who was at risk of falling because they got up and walked around at night, but none of this information was in their file. • Risk assessments have been put in place around the use of bedrails. But they did not say why they were being used, who is responsible for checking that they are the correct type for the bed, that they are fitted correctly, in good working order, how often they should be checked and where the results are to be recorded. The assessment seen did not show that the person or their relatives had been consulted about using bedrails. • The care plans for people with dementia did not say how the dementia affected them or how staff could help them. This means that their needs might not be fully identified and there is a risk they will not be met. • The care plan for a person with a urinary catheter did not give all the information needed to make sure correct care was provided. There was no record of it being changed towards the end of 2007 as directed in the plan. This means that the care required might not have been given. • The care plan for somebody who had been admitted from hospital with pressure sores on their heels did not show if the wounds had healed or were still being treated. They were being nursed on a specialist mattress but there was no information about what type or what setting it should be on. This is not best practice and there is a risk it will be put on the wrong setting. • The moving and handling assessment/plan for one person did not have enough detail about what equipment was to be used when transferring the individual -, such as what type of hoist and what type and size of sling with the hoist. This means that staff will not have access to the guidance needed about how to move that person safely. • Nutritional risk assessments are carried out. In one case the person was identified as being at moderate risk of losing weight but this was not mentioned in the care plan around eating and drinking. Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 12 Records looked at showed that people are seen by their General Practitioners, other healthcare professionals such as opticians, allocated social workers, speech therapists, district nurses for people receiving residential care and chiropodists as and when needed. From talking to staff and observing their approach with people, it was clear they had a good understanding of the people living in the home, treating and respecting them as individuals. The manager said that nursing staff look after and deal with medications. Two nurses have completed a medication training course in the last year and she intends that all the nurses will do it. We looked at the policies around dealing with medications. They are not comprehensive and must be revised against the Royal Pharmaceutical Society Guidance ‘Safe handling of medications in social care settings’. We looked at the medication records and storage systems. These showed that people are not being given all of their medications as prescribed. This is not good practice and puts people at risk of not being given their medications as prescribed by their doctors. For example repeat prescriptions are ordered every month, most tablets are dispensed in individual monthly blister packs. Tablets and liquids that cannot be placed in these packs are supplied separately in appropriate containers. The medication storage cabinets showed us that there were very large stocks of boxed and liquid medications for three different people. On checking the amount that would be supplied each month and the dates on the dispensing labels it was clear that they were not being given to the individuals as their doctor had intended. A similar problem was found with specialist eye drops for one person where there were nine bottles of the drops dating as far back as September 2007. Two of the bottles had been opened and used but there was no date of opening meaning they could have been open for more than four weeks and be an infection risk to the person. This is poor practice. The nurse in charge was told to dispose of the opened bottles. The manager was made aware of the concerns and advised to carry out a medication audit and get advice and support from the pharmacy they use. Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The meals are good and the menu is varied. People maintain contact with family and friends. An increase in planned, regular, social, leisure and recreational activities would improve outcomes for people living in the home, working towards meeting their personal preferences and expectations. EVIDENCE: On the day of the visit most people were sitting in the lounge. There was a television playing in one corner but it was a small screen and not easy for people to watch unless they are sitting very close to it. We were told that the provider had said they would buy a larger TV for the lounge and people were looking into this. People were listening to music and three started to sing along to it. We saw staff sitting in the lounge with people before lunch spending time with people. It was clear that there were good relationships and that staff got Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 14 on well with people and treated them as individuals. Staff took time to sit with and talk to quieter people in the room. A member of staff supported one person whilst they showed other people photographs of their newest grandchild. One member of staff chatted to people about plans for their day off, the local area and family history. This was good to see and people clearly enjoyed it. The provider pays for an entertainer to come in to the home once every four to six weeks. People living in the home told us ‘that they are always the same ones’. The provider does not provide any other monies towards social/recreational activities for people living in the home. This issue has been raised in the last two inspection reports and the person responsible for the home was asked if he would refer this back to the company for review. It is clear that nothing has changed since the last inspection in September 2007. The home has an activities organiser who works 2 or 3 days a week between the hours of 1 and 4 pm. They gave us examples of activities they do with people, which included reading books, knitting, some crafts, playing cards and bingo. Some people enjoy a glass of sherry while watching TV in the evening. Staff told us about trips they had planned and organised to places like the Blackpool illuminations and that they plan to visit Mother Shipton’s cave and Eden Camp. There is no budget provided for activities and entertainment and staff do a lot of fundraising to pay for what they do as well as donating items to be used. The staff team are to be commended for the additional work they do raising funds to make sure people living in the home have access to varied social and leisure activities. The manager said that the care plans should contain an outline of each person’s social history. We saw this in two of the files. The third file we looked at told us that the person practised their religion but did not tell us how that care need was being met. People said they could receive visitors at any time. Information from retuned surveys said that: • They felt there could be more hobbies, activities and trips out for people who live in the home. • The staff were very caring, friendly and helpful. Routines are flexible and staff respect people’s wishes about when they want to get up, go to bed or where they want to have their meals. For example one lady arrived later for lunch and this was accommodated without a fuss. She said she had had porridge in her bedroom that morning and had decided to have her lunch later. We saw a package of post left on a table in the reception area. This was for people who could not deal with it themselves and was waiting until their Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 15 relatives came in to collect it. From the post marks some of it had been there some time. We talked to the manager about security and confidentiality and that she should consider some other system of making sure the post got to the people who would be dealing with it. Lunch was a three course meal served in a heated trolley and people had a choice of soup, beef cobbler and mashed potato or sausage roll chips and beans. One person had cheese omelette and chips. The dessert was a choice of mince pie and custard or rice pudding. People were asked at the table what they would like to eat. Only those people who wanted a protective apron on were given one to put on. Some people had soup in cups or lidded beakers; this helped them to eat independently. The atmosphere was friendly with staff laughing and joking with people as they ate. People who needed help were given it discreetly but one staff member was standing up as they helped someone to drink, which is not best practice. Staff asked each other who was “feeding” and one person was described as being “awkward to feed”. Staff should be discouraged from using this kind of terminology as it compromises people’s dignity. After • • • their meal people told us that: “The food was good”, “Very good and they look after us very well here” “Meals are always very nice.” We were told that people have a cooked meal at 5 pm and sandwiches or cake for supper at approximately 8.30 pm. The kitchen was clean, tidy and well organised. The most recent Environmental Health inspection gave them an excellent 5* star rating on the ‘scores on the doors’ system. Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 16 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 adequate. This judgement has been made using available evidence including a visit to this service. People and their relatives were confident that their concerns would be listened to and acted upon. People are safe, but this will be improved when all staff have been given appropriate training around abuse and adult protection and the homes policies and procedures have been revised in line with Government and local authority guidance. EVIDENCE: The complaints procedure is included in the Statement of Purpose and Service User Guide and a copy is displayed in the reception area. It is in small print and not very easy to read. The manager said she would look at changing the way it is presented. When done, a copy should be made available to all people who live in the home and their relatives. Of the three surveys returned by relatives, two said they could not remember how to make a complaint but that if they had raised concerns they had been dealt with appropriately. Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 17 Since the last inspection in September 2007 the home has recorded four complaints. One was a complaint the home made to the hospital about a person being returned to the home while they were still unwell. One was about a hearing aid that had gone missing while the person was in hospital. And another was a care related issue that the manager was able to deal with immediately to the satisfaction of all. Copies of the local authority adult protection procedures are kept in the home along with a copy of the Department of Health guidance ‘No Secrets’. We saw an in house policy around abuse but it was not clear when it had been produced or last reviewed. This was pointed out in the last inspection report. The manager said that training around adult protection has still not been provided to all staff. The provider had been told in the last inspection report that all staff must receive this training by 22nd November 2008. Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 18 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, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a comfortable environment but work needs to continue on improving the décor, lighting and furnishings to improve the overall standard. EVIDENCE: The areas of the home we saw were clean and did not have bad odours. The redecoration of the corridors and reception area, which was being done during the last inspection in September, was almost finished. The same wallpaper has been used throughout and has made the corridors look very ‘hotel like’ and uniform in appearance. This could make it confusing for people with dementia and memory problems to find their way around. There were no pictures on the corridor walls or in the dining room to provide focal or talking points for people. We talked to the manager about looking at ways making the Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 19 environment more ‘homely’ for people and to use things that would be familiar to them, such as historical pictures of the local area and the home, which used to be a school. The carpets in some of the corridors need to be replaced or repaired. There were some areas where carpets are coming apart where they have been joined and other areas where it is frayed and worn. These areas could present a trip hazard to people. The bedrooms are quite large. Many were double rooms that are now being used as singles. We saw that many people had brought in their own furniture, ornaments and pictures to personalise their bedrooms and make them ‘theirs’. One person told us they had brought in a TV, a small fridge and a music system and were very happy with their room. Two of the bathrooms we looked at contained shared toiletries, this is not good practice and presents a risk of cross infection. Some of the waste bins for soiled items did not have lids, some of them had lids that had to be lifted by hand which increases the risk of contamination. The manager has got, but not used, the Department of Health (DoH) ‘Essential steps guide to prevent cross infection’ yet. She was given information about how to get a copy of the DoH book ‘Infection control guidance for care homes’. The mechanical sluice disinfector is out of order and has been for a long time. We were told that staff rinsed and spray disinfected commode pots and urinals after use. There is a lack of storage space for wheelchairs and there were a lot of them in one of the wider corridor areas. These should be reviewed as they could present a hazard to people. The last report highlighted a problem with the lighting in people’s bedrooms and the provider was told to look at the type and suitability of lighting provided. We were told that this has not altered. The central fittings in people’s rooms do not provide much light, which means it could be difficult for people with poor sight to see. The over bed lights can get very hot when used and this could pose a risk to some people who could burn themselves. Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are sufficient staff on duty at all times of the day and night to meet people’s needs. There is a risk that the health, safety and well being of people living in the home and staff will be compromised because the provider does not make sure that suitable training is given to all staff that equips them to do their job safely. EVIDENCE: The report for September 2007 clearly showed that the provider has a poor history of providing staff with the training they need to do their job. Nothing has changed since then. The manager said head office has asked for details of people who need moving and handling training or updates. From records seen some staff have done it but not all who need it. The management team have been very resourceful in finding free training for staff so that they have the basic skills to do their work. Free courses found have included infection control, health and safety, dementia and medication. Despite this there are still large gaps in the training provided to staff and they Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 21 are still are not being properly equipped to maintain the health, safety and well being of people who live in the home or themselves or to meet peoples specialist needs such as diabetes and dementia. Four staff files were looked for people who started work from December 2007 onwards. They showed that two written references were in place as well as a satisfactory POVA (Protection of Vulnerable Adults) first check before people started work. Satisfactory enhanced Criminal Records Bureau checks had been returned for three out of the four. The application forms did not all contain a full employment history; there was no evidence to show that this had been discussed at interview to see if there were any gaps in employment. The file for a registered nurse had a copy of their letter from the Nursing and Midwifery Council but it did not show what their number on the register was and there was no evidence to show that the manager had made her own checks on their registration status. The manager said that she did these by phone calls but had not kept records. None of these staff have completed induction training equivalent to the Skills for Care common induction standards and there were not dates planned for them to do it. The three care staff had not done any moving and handling or health and safety training. Only one has started a basic ‘in house’ induction programme and one has done some fire safety training. The manager told us that eleven of the fourteen staff employed had achieved a qualification in care equivalent to National Vocational Qualification level 2 or higher. When we visited there were twenty-two people living in the home. We were told that there were usually six staff on the morning shift, five on the afternoon/evening shift and three at night. From talking to people who live in the home and staff this is sufficient to meet peoples needs. Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 22 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 and 33. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The provider is not running the home in the best interests of people who live there. Examples of this are given in other sections of this report. The provider needs to invest in the fabric of the home and staff training to improve outcomes for people living in the home. EVIDENCE: The registered manager is an experienced nurse who has worked with older people for a number of years. She has not yet completed her NVQ level 4 in management. She has been trying to get this qualification for three years but Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 23 has had poor support from the two different organisations she has paid to provide this training to her. The company that owns the home does not provide sufficient support to the management team. The registered manager has no control in certain areas, particularly where funding is involved. There is a heavy reliance from the company on ‘staff good will’ to raise money for entertainment and other items that benefit people living in the home. The home has got two computers that have been provided by staff through fundraising. We advised the manager to look at the CSCI website for guidance but were told she could not because they do not have Internet access. The manager works full time hours over four days a week. The provider has allowed her an average of between six and twelve hours a week supernumerary time to deal with the management of the home. She will be on duty as the nurse in charge for a shift and uses the supernumerary hours when another nurse is on duty. The supernumerary time she is ‘allowed’ does not give her enough time to deal with all the management and administrative work she has to do as registered manager, such as: • Staff supervision and appraisals – which are not up to date. • Assessing the needs of people who want to come and live at the home. • Liaising with relatives and healthcare professionals. • Calculating staff hours worked for head office. • Ordering supplies for the home. • Quality control and health and safety audits. • Updating and reviewing policies and procedures. The manager said that both she and the deputy take work home with them to complete outside of their working hours to try and keep up to date. The operations manager visits the home twice weekly and a monthly report is produced. At the last inspection the provider was told to send a copies of these reports to us. To date none have been received but there were three reports in the home and copies were taken. The information from these shows that staff training has not been recognised as a need apart from how many staff have NVQ and how many have completed moving and handling training. All three reports said that staff were spoken to at random and that ‘all staff were positive about the home and felt the standard of care given was good’. It said that people were spoken to but the responses were limited to one word of ‘good’, ‘yes’ or ‘happy with the cleanliness’. Guidance is available on the CSCI website that will help to make these visits and reports a useful tool for assessing the quality of services provided to people. After the last inspection we sent the provider an improvement plan outlining what actions needed to be taken and why that would make outcomes better for people who live in the home. The provider should have completed it, telling us what action was going to be taken and when, to meet the requirements Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 24 made in the report and the improvement plan, returning it to us by 6th February 2008. At the time of writing this report 27th February 2008, it has not been received. A requirement has been made in this report that the provider must return the action plan to us by 30th April 2008. A survey to get the views of people who live in the home, their relatives and other interested parties has not been done. The manager said that they are consulted at ‘residents/relatives’ meetings. The most recent was in January 2008. It showed that people’s views were listened to and acted on where the management team could change things. For example the timing of ‘supper was altered back to an earlier time and coffee added to the hot drinks trolley. Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X 3 2 2 STAFFING Standard No Score 27 3 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X X X X X Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 26 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 OP8 Regulation Requirement Timescale for action 30/03/08 2. OP8 12, 13, 14 The manager must make sure that where risk assessments identify people as being at risk of falling, developing pressure sores or losing weight, advice is sought from appropriate health care professionals and detailed care plans put in place. This will make sure that peoples healthcare needs are identified and met. 30/03/08 13 The manager must make sure that if a safety risk assessment identifies the need to use bed rails that clear and detailed records are kept which include the following information: • Why they were being used. • Who is responsible for checking that they are the correct type for the bed, that they are fitted correctly, in good working order. • How often they should be checked and where the results are to be recorded. • That the person or their relatives had been DS0000001046.V358412.R01.S.doc Version 5.2 Carr Green Nursing Home Page 27 3. OP9 13 (2) consulted about using bedrails. The manager must make sure that steps are taken so that medications are dealt with safely. People must be given their medications as prescribed by their doctors so that their health and general wellbeing is maintained. 30/03/08 4. OP18 13(6) To help with this the policies and procedures around the safe handling of medications must be reviewed and revised against the Royal Pharmaceutical Society Guidance ‘Safe handling of medications in social care settings’. 30/04/08 All staff must have adult protection training so that they all know how to recognise abuse and what action they need to take if it is suspected. This will help to make sure people living in the home are not at risk. Timescale of 22/11/07 given at the last inspection in September 2007 has not been met. The provider must take steps 30/04/08 to: • Replace or repair the damaged/worn carpets in the corridors. • Repair the mechanical sluice disinfector. Provide suitable storage space for wheelchairs and equipment. The new lighting that is being 30/04/08 installed must be checked to make sure that: • It is safe. • It is suitable for people to use. It provides enough light/illumination for older people DS0000001046.V358412.R01.S.doc Version 5.2 Page 28 5. OP19 23 6. OP25 13(4) Carr Green Nursing Home 7. OP30 18(1)(c) and people with poor eyesight. The provider must make sure that staff receive appropriate training that helps them to maintain the health, safety and well being of people living in the home and themselves. This must include training about the specialist needs of people such as dementia and learning disabilities. The provider must make sure that new staff receive induction training that is to Skills for Care common induction standards. The provider must make sure that people who provide training are qualified and competent to do so. All staff should have personal training and development plans that are reviewed at regular intervals. The manager must achieve a management qualification equivalent to NVQ level 4. The provider must produce an action plan showing how requirements will be met within the given timescales and what action will be taken to improve outcomes for people living in the home. 30/04/08 8. 9. OP31 OP33 9 24 31/12/08 30/04/08 Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 29 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. Refer to Standard OP1 OP4 Good Practice Recommendations Information about the home should be available to give to people when they look round the home. The provider should make a decision about what needs will be met by the services and facilities provided by the home. If they want to provide services to people with dementia they must make an application for a major variation to their agreed registration categories. In order to make sure that peoples needs will be met by suitably experienced and qualified staff they must make sure that staff receive appropriate training. Changes should also be made to the environment to make it more enabling for people with memory problems. The manager should make sure that detailed care plans are in place for all of an individuals identified needs so that staff have guidance about what they are and how to meet them. People who live at the home or their representatives must be consulted about their care plans. This will give people the opportunity to comment on the care and support provided. The amount of funding that the provider allows towards the cost of social and leisure activities for people living in the home should be reviewed. This will help the staff to provide a planned programme of activities that is geared towards people’s needs, abilities and expectations. When planning activities people’s religious and cultural needs should be taken into account. The manager should look at the security and confidentiality of post received for people who do not look after their own affairs and consider a system of making sure the post gets to the people who will be dealing with it. The manager should make sure that all people are aware of the complaints procedure and who to speak to if they have a concern. The homes policies and procedures around abuse and adult protection be reviewed and updated in line with DS0000001046.V358412.R01.S.doc Version 5.2 Page 30 3. OP7 4. OP12 5. OP14 6. 7. OP16 OP18 Carr Green Nursing Home 8. OP26 9. OP29 current good practice and legislation. The provider should make sure that a review of infection control polices and procedures is carried out and that action is taken to reduce the risks of cross infection. This should include looking at providing soiled waste bins that foot pedal operated and making sure that communal soaps are not used in communal bathrooms. Steps should be taken to make sure that when new staff are being recruited the application form as request a full employment history from leaving school. This should be used to identify if there have been any gaps in employment and records kept to show that the reasons for them have been discussed. The manager should make sure that records of checks made with the Nursing and Midwifery Council about a nurse’s registration status are kept. The provider should make sure that the manager has enough supernumerary time and support to carry out the management responsibilities involved with running a care home. The provider should carry out a survey in order to get the views of people using the service, their visitors and healthcare professionals who visit the home. 10. OP31 11. OP33 Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North East Region St Nicholas Building St Nicholas Street Newcastle upon Tyne NE1 1NB 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 Carr Green Nursing Home DS0000001046.V358412.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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