Inspection on 15/05/06 for Carr Green Nursing Home

This inspection was carried out on 15th May 2006.

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

Carr Green Nursing Home 20/07/09

Carr Green Nursing Home 26/01/09

Carr Green Nursing Home 01/02/08

Carr Green Nursing Home 13/09/07

Carr Green Nursing Home 08/03/07

Carr Green Nursing Home 06/10/05

Carr Green Nursing Home 07/04/05

Carr Green Nursing Home 17/11/04

Carr Green Nursing Home 19/04/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Carr Green Nursing Home Carr Green Lane Rastrick Brighouse West Yorkshire HD6 3LT Lead Inspector Lynda Jones Unannounced Inspection 15th May 2006 9:15 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.V295856.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.V295856.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.V295856.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) 6th October 2005 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 garden area and car parking is available in the grounds. All of the residents accommodation is on one level. There are single and double bedrooms available. None of the bedrooms have en-suite toilets. There is one large lounge and a dining room. There are four bathrooms and six separate toilets. The kitchen and laundry are in the basement. The fees range from £390 to £495 per week. The manager was unable to provide any documentation to show how the sliding scale of charges is applied. Carr Green Nursing Home DS0000001046.V295856.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is a poor home that has received two additional visits since the last unannounced inspection in October 2005. Two legal notices have been served on the company to try to bring about improvements in standards at the home. One notice that was issued in June 2005 was about staff recruitment. Some improvements were noted but further issues were picked up on this visit. The second, issued in January 2006 was about fire safety in the home. Part of the work that was required has been completed, there is one major area of structural work that is still outstanding, and the company has indicated that this work will be completed by November 2006. This key inspection was carried out by two inspectors over a two day period. Inspectors were at the home for six hours on both days. The inspection was carried out to assess the home against a pre-determined selection of the National Minimum Standards for Older People and to check what progress had been made on meeting the requirements from previous inspection visits. Inspectors talked to ten residents. Some conversations took place in private in residents’ own rooms; other discussions took place with small groups of people in the dining room before lunch, and with people who were seated in the lounge. Care practice was observed throughout the two days. When records were examined, this took place in a central area of the home where residents could speak to inspectors if they wished to do so. Discussions took place with the majority of staff on duty over the two days. This included the management team, domestic and catering staff, maintenance staff and care staff. A full tour of the building was also undertaken. Ten survey forms were left at the home for residents to complete. Six residents completed surveys about the care and support they received at the home; some residents indicated that they had received help from relatives to complete the surveys. The home has received two additional visits since the last inspection to check on compliance on fire safety matters. What the service does well: Carr Green Nursing Home DS0000001046.V295856.R01.S.doc Version 5.2 Page 6 There is a stable staff team at the home, a number of staff have worked together for some time, they say they get on well with residents and with each other. Staff said they enjoy the work they do. Residents said the staff were pleasant and helpful. Residents who completed the questionnaires said the staff listened to what they had to say and there was agreement that the staff were available when needed. Everybody completing the questionnaires was of the opinion that their medical needs were being met at the home. There was general agreement that the home was kept clean by the domestic team. What has improved since the last inspection? What they could do better: The information that is available about the home for prospective residents is poor and needs to be improved; it does not help people to make an informed decision about whether they want to live there. Residents are not particularly empowered. People said they didn’t like to complain, some said they didn’t want staff to get into trouble and didn’t want to upset their family. Staff need to reassure residents and to consult them more often. The record of complaints, how they are investigated and outcomes needs to be improved. Staff need to reflect more on the effect their behaviour has on residents. Some residents had the impression that staff did things in a hurry, one person was “in and out of the bath in four minutes”. One person said some staff have an abrupt manner when asked to do things. One resident said they had “had to learn to have a lot of patience”. Carr Green Nursing Home DS0000001046.V295856.R01.S.doc Version 5.2 Page 7 Opinion about the meals was mixed. Whether people liked the food depended very much on personal taste and what was on the menu. The menu for the day should be on display so that residents know what is on offer, if they do not like what is available an alternative should be offered. The staff should make it their business to find out what people like and dislike so that they can be catered for accordingly. Where individual likes and dislikes are known these should be observed by staff. Residents should be consulted about what is included on the menus. Residents felt that there was a lack of organised activity. One person said, “there’s nothing to do, the TV is on all the time”. For some residents the only change of scene is when they move from the lounge to the dining room at meal times or when they go to the toilet. The care plans need to improve. Detailed care plans need to be written following genuine consultation with residents and their relatives. These should inform staff about the needs of residents and how these are to be met. Staff should know how residents prefer their personal care to be delivered, they should know about meal preferences and about the hobbies and interests of residents. The plans should demonstrate that risks to vulnerable residents have been properly assessed and show what measures have been put in place to protect people. There needs to be improvements in the management of the medication system. The poor decorative standard in the home and lack of suitable toilet and bathing facilities gives the impression that the company that owns the home does not value people. There are not enough baths and toilets for people to use, some people with disabilities cannot have a bath, and some people cannot be properly assisted when they use the toilet. When staff are washing up in the kitchen, there is not enough hot water for people to have a bath. Residents are having to have their baths either in the morning or the evening, not when they want one. The laundry facilities are inadequate for the amount of clothes and bedding that needs to be washed each day. There is only one tumble drier and as the temperature cannot be controlled, it cannot be used to dry clothes. The rotary iron does not work properly. There is still work to be done in the home in order to comply with requirements made by Environmental Services and the Fire Safety Officer. Carr Green Nursing Home DS0000001046.V295856.R01.S.doc Version 5.2 Page 8 There have been concerns about recruitment practice in the past and enforcement action has been taken against the home on this issue. Some improvement was noted in 2005. There are still some areas of the recruitment process that require attention in order to make sure that residents are not put at risk and are supported and cared for by suitable staff. The staff should be offered opportunities for training and development. They do not receive the minimum training entitlement that is set out in the company policy on staff training. Quality assurance and monitoring needs to take place. The home needs to develop ways of asking residents and their families what they think about the way the home is run and about the support they receive. People need to have more of a say about what goes on in the home and be reassured that their opinions matter. 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. Carr Green Nursing Home DS0000001046.V295856.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 Carr Green Nursing Home DS0000001046.V295856.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3, Information about the home that is available for prospective residents is poor & does not help people to decide whether they want to live there. Prospective residents are not always being properly assessed before they move into the home. Without this there is no assurance that their care and support needs can be met. EVIDENCE: There is no up to date information about the facilities at the home for prospective residents. The company has not provided the staff with any information to give out to people when they come to look round. No service user guide is available. The management team have attempted to put together a brochure containing some information about the facilities. They have received no support from the company to do this. The brochure has not been published and the facilities for printing copies at the home are very limited. Carr Green Nursing Home DS0000001046.V295856.R01.S.doc Version 5.2 Page 11 Six residents completed surveys about the care and support they receive at the home. Five people said they had sufficient information about the home before they moved in. As there is very little information for people to take away with them, this may be a reference to the verbal information that staff give when they show prospective residents and their families round the home. The manager said copies of previous inspection reports could be made available on request but there is no information on display to make prospective residents and their families aware of this. It would be useful to display a poster in the home to let people know that the reports are available. New residents are not routinely provided with a statement of terms and conditions when they move into the home. Four out of six people said they had not received a contract or statement of terms of residence when they moved in. Evidence indicates that the needs of prospective residents are not always assessed before people move in to the home. Without this information it is impossible to formulate an individual plan of care and support for the resident concerned and to ensure that all of their needs are met. Care plans relating to four residents were examined. In one case an assessment had been conducted to make sure the home could meet the needs of the resident. Assessments were not on file for the other three people. In two of these cases, copies of assessments that had been carried out by social workers from Calderdale’s Health and Social Care Department were available. There was no assessment in respect of a third resident who had moved into the home in an emergency. This assessment was completed seventeen days after admission. Intermediate care is not provided at Carr Green. Carr Green Nursing Home DS0000001046.V295856.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. The care plans are poor; they do not contain enough information about the care needs and preferences of residents. The documents do not offer any guidance to staff on how day to day care should be delivered, as a result residents needs are not always met. Medication records are not well managed; there are gaps on the records making it difficult to account for stock. EVIDENCE: Five care plans were examined, these related to two new residents and three residents who lived at the home for some time. Some plans contained very brief information, on others large sections of the documentation had not been completed. The plans do not give clear details about the action that staff need to take to ensure that all aspects of health, personal and social care needs are met. The diverse needs of residents is not taken into account at the home. Insufficient consideration is given to providing personal care in a way which best suits each person. The way in which care is delivered depends on the member of staff on duty, how much time they have available and the extent to Carr Green Nursing Home DS0000001046.V295856.R01.S.doc Version 5.2 Page 13 which individual residents can articulate their views and needs. Residents said, “it depends on who is on duty”. Of the plans relating to two new residents, only one contained a life history. Most of the documentation was left blank in respect of one resident who had moved into the home the previous month. No information had been recorded that may have helped this individual settle in the home. There was no record of likes or dislikes, activities/interests or preferred daily routine. None of the assessments relating to assistance from staff with dressing and undressing, oral care, skin care, eye care, behaviour or orientation had been completed. No moving and handling assessment had been completed even though the daily records indicated that a hoist was used to assist with movement. There were no details of weight on admission and no nutritional assessment had been completed. Other parts of the records indicated that good nutrition was important for this individual who had particular dietary needs and who was admitted with a small sore which required attention. There was no plan in place for skin care. Information on the care plan for a second person recently admitted was very basic. No moving and handling assessment had been completed. Daily records indicated that this person had leg ulcers although the plan stated that skin was intact. The care plan stated that a bath was to be offered weekly although there was no record that this had taken place over the previous nine weeks. When asked about this, the resident concerned was unable to recall whether he had had a bath. A plan that was in place for a resident who moved into the home in May 2005 was incomplete. There was no moving and handling plan although the records indicated that this person needed assistance to transfer in and out of bed and to access the toilet and bath. Very little was recorded about the amount of assistance people required with personal hygiene. In the absence of written records, it is likely that this information is passed amongst staff verbally. There was insufficient evidence in the plans examined to show that residents were able to have regular baths at times that suited them. This is made more difficult because there are insufficient bathing facilities in the home and at certain times of the day there is insufficient hot water available (See section on environment). One resident said it had been agreed that he would receive assistance to have a bath each week. This had not been happening regularly. He said he had not had a bath for three weeks, he said he had been unwell one week, on another week there had been insufficient hot water and one week he thought “staff Carr Green Nursing Home DS0000001046.V295856.R01.S.doc Version 5.2 Page 14 forgot” but said he “didn’t like to say anything”. He had a bath on the day of the visit to the home. Six residents returned surveys about the care and support they receive. The consensus of opinion was that the staff were available when they were needed. Of the six people who completed the surveys, most felt that the staff listened to them and acted upon what they said. One person indicated that this was not always the case; comments indicated that some staff were not particularly cooperative and sometimes forgot to do the things they were asked to do. Another comment suggested that some staff could be quite abrupt at times. On a positive note, the management team recognise the shortcomings of the care planning system. They accept that the plans do not contain sufficient detail and that the daily records do not reflect the care that is delivered. From speaking to staff, it was apparent that they knew residents well and had a good understanding of their needs, however this was not reflected in the records. Plans are currently underway to introducing a new care planning format. Inspectors will monitor progress in this area. There needs to be improvements in the management of the medication system. There is no “brought forward” system for medication that is used on a PRN (as required) basis and some medication that was not needed had been re-ordered. An audit of medication revealed that large stocks of Paracetomol were being held in the home unnecessarily. The recording on the MAR sheets (Medication Administration Records) was not satisfactory. Blank spaces were found on the record sheets, therefore in some instances it was not possible to be certain that medication had been administered as prescribed. Some creams/lotions had also not been signed to show that they had been applied. In some instances, where medication had not been given or had been refused by residents, staff had failed to use the appropriate keys on the sheets to define the reasons why. There was some evidence that medication had been given out but not signed for, there was also evidence of medication not being booked in on the MAR sheets. Carr Green Nursing Home DS0000001046.V295856.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Very little stimulating activity is organised, residents are not consulted about things they would like to do and are not encouraged to pursue their hobbies and interests. Residents find themselves “fitting in” with the daily routine of the home. The staff are task focused and time is not set aside for meaningful interactions with residents. Mealtimes are functional and not social occasions, menus are not on display and residents do not know what the meal will be. Insufficient consideration is given to resident’s likes and dislikes. EVIDENCE: There is very little recorded about the life histories of residents. Little is recorded about their hobbies and interests or about the sort of daily routine people enjoy. From speaking to staff it is clear that they know some of this information but the tendency has been to pass this information on verbally amongst the team. From the information recorded, it would not be possible for a new member of staff or a member of staff from an agency, to be able to discover how to support residents’ on a day to day basis, in a way that suits them. Some relatives provided the home with information about residents when they moved in. They have included valuable details about the sort of work people Carr Green Nursing Home DS0000001046.V295856.R01.S.doc Version 5.2 Page 16 have done and about their hobbies and interest. There is no evidence that any of this has been built upon. On one of the care plans examined, it was noted during a review of care that this particular resident “requires more activities to keep him occupied”. There was no evidence to show that this had been actioned. When asked about this during the visit, the resident in question said nothing had changed, he said, “nothing ever happens” The brochure states that each year the home tries to arrange a visit to the illuminations at Blackpool and a fireworks display and Easter party take place at the home. It also states that there are activities available such as board games, jigsaws, puzzle books and a reminiscence hour. The brochure goes on to say “we will be delighted to help you continue with hobbies or interests”. This is not in keeping with the experiences of people who live at the home. In the surveys, people were asked whether there were any activities arranged by the home for people to take part in. Four people replied saying said there were never any activities arranged by the home, two people said there were usually some activities available. Four residents spoken to during the inspection said very little organised activity ever took place. One activity was observed during the two day visit to the home when a member of staff sat with one resident completing a jigsaw. For much of the time people sat in the lounge with the TV on. At some stages during the day whilst the TV was on, the majority of people in the lounge were asleep. In the completed surveys, residents indicated that staff were usually available when needed during the day. From observation, there were prolonged periods where there was very little staff contact with residents who were sat in the lounge, the staff responded if summoned but then they resumed their tasks elsewhere in the home. Some residents choose to spend most of time in their own rooms, the staff respect this and were seen calling on them during the course of the day to offer drinks and ask if people were OK. The record of activities at the home is extremely poor. An “activities file” was examined which contained a record of weekly activities undertaken by each resident since the beginning of March 2006. The record sheets are prefaced with space for the name of each resident and an area to record details of each person’s interests/hobbies and likes/dislikes. Names had been added but none of the other vital information had been recorded. The records are not so much a record of activity but rather a snapshot of what residents are doing at a certain time on a given day. For example, the record for 1/3/06 notes that five people played dominoes, eight people watched TV, three people were sleeping and three people “refused”. It is not clear whether residents were watching Carr Green Nursing Home DS0000001046.V295856.R01.S.doc Version 5.2 Page 17 something in particular on TV by choice, it is also not clear why “sleeping” was recorded as an activity, nor is it clear which activity three people refused to do. On other weeks the record of activities notes the number of people who were either sleeping, sat or resting in their bedrooms or sleeping in the lounge. There is no reference to any resident taking part in an activity of their choice and nothing about whether they enjoyed what they were doing. The performance of the home in this area is particularly disappointing, records indicate that the home is adequately staffed; therefore it should be possible to arrange appropriate activities. From observation, opportunities for meaningful interactions with residents are often missed. For example, during the visit staff were observed sewing name tags on residents’ clothing, they conducted this task in a corridor away from residents. Tasks such as this could be carried out in the lounge in the company of residents. It was noted that once all residents were seated in the dining room, staff congregated and chatted in the corridor whilst waiting for the hot trolley to arrive, leaving no one in the dining room. Residents were not placed at risk but an opportunity to talk was missed. The dining room is faded and dull and in need of redecoration. Most residents require assistance to get to the dining room and the process of seating everyone can take some time. During the visit it was noted that it took 25 minutes from the arrival of the first person in the dining room to serving the first meal. There was no cutlery on the tables; this was distributed when the meal arrived. There were no napkins on the table, most residents were wearing disposable or thick, washable “bibs”. Soup was served in plastic bowls; staff said there were no ceramic bowls available. Some residents chatted as the meal was served and staff asked people what they wanted to eat, overall the process was not particularly dignified. There are no menus on display in the home. No one knew what they were having to eat at the midday meal. When the staff were asked, they also didn’t know what was on the menu for the day. The first indication of what was available came when the covers were taken off the hot trolley in the dining room. This needs to be addressed. Menus should be available for residents to read or the content should be read and explained to residents. The surveys returned by residents indicate that they are generally satisfied with the content of the meals at the home. The comments made by residents during the visit were mixed, whether people liked the meals depended on what was on the menu for the day. Two people said, “you can’t complain”. Carr Green Nursing Home DS0000001046.V295856.R01.S.doc Version 5.2 Page 18 Residents said the breakfasts were good, they said there was plenty of choice available. Residents also confirmed that drinks and snacks are available during the day. One person said he did not like meat or fish. There was evidence that this was recorded in his care plan. However, he is regularly served meat and fish and is not offered an alternative meal. He said he leaves the meat or fish and eats the potatoes and vegetables on his plate. This individual can give a clear account of what he likes and does not like but there is no evidence that he has been asked for his views on the meals he is given. This was discussed with the management team at the end of the visit. Residents confirmed that they are able to have visitors at any time. The visitors book showed that there are frequent visitors to the home. Carr Green Nursing Home DS0000001046.V295856.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Some residents do not feel comfortable about making complaints. There are some shortfalls in the way complaints are recorded and investigated. There is a lack of awareness about adult protection issues and about the need to risk assess situations to make sure that vulnerable residents are safe. EVIDENCE: The complaints procedure is on display in the home. Residents indicated in four of the surveys that were returned, that they knew who they would speak to if they were unhappy about anything in the home. No one gave any indication of who this would be. On previous inspections residents have said they felt they would only complain if something serious occurred. Following the last inspection, staff were asked to try to ensure that residents felt comfortable about raising concerns, however minor, and know that they would be dealt with. Two residents were asked about this during this the visit. They said they didn’t feel comfortable about complaining because they “didn’t want to upset anyone”. One resident qualified this by saying he thought it would upset his family if he said he was unhappy about anything at the home. The staff need to be aware that this is a difficult area for some residents who may need some encouragement to feel more comfortable and confident about expressing their views. Carr Green Nursing Home DS0000001046.V295856.R01.S.doc Version 5.2 Page 20 The record of complaints held in the home was examined. These records need to be improved to include clear details about the complaint; how the complaint was investigated and of any action taken to resolve the complaint. It would be good practice to record whether the complainant was satisfied with the outcome. Staff have received training about protecting vulnerable adults and local procedures are available in the home. It was disappointing to discover that these procedures had not been followed in relation to an incident that had recently occurred in the home. From speaking to members of the management team and from examining available records, it was apparent that the home had failed to conduct a risk assessment on a vulnerable resident in their care and failed to put in place appropriate measures to safeguard this resident. There was some evidence that advice had been sought subsequently from the Adult Protection Coordinator for Calderdale, however details of the incident and advice offered was not recorded in sufficient detail. Carr Green Nursing Home DS0000001046.V295856.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26. There is no ongoing maintenance programme in place. Some fixtures and fittings need replacement and the décor around the home needs attention. There are not enough useable bathrooms for the number of people who live at the home. There are no bathing facilities for some people who need specialist equipment to get in and out of the bath. The toilet facilities do not afford much privacy, the locks on some doors do not work and they are too small to allow staff to assist people comfortably. The home is clean and tidy. EVIDENCE: There is no redecoration and refurbishment programme for the home. The company that owns the home is not investing in improving the decorative standard for residents to make it a nicer place to live. There are a number of areas throughout the home that require attention. Many of the bedrooms are in need of redecoration; staff could not recall any redecoration of rooms ever taking place. The curtains in the bedrooms are dirty and as there are no spare sets the staff cannot take the curtains down to Carr Green Nursing Home DS0000001046.V295856.R01.S.doc Version 5.2 Page 22 get them cleaned. Some of the windows in the bedrooms do not open. Some locks have recently been fitted on bedroom doors; the majority of rooms are still without locks. Not all of the rooms have a lockable drawer within them where residents can keep their valuables. A small group of residents who talked to inspectors said the home could “do with a facelift”. One resident said the home was “basic” The quality of the bed linen is poor, the sheets are thin and several of the pillows are “lumpy”. Many of the towels are frayed. Staff said they have recently been provided with new sheets and towels but these were not yet in use. Some bedrooms do not have bedside lights, some lights were not working, and some had no light shades. Carpets in some of the rooms are stained and need replacing. In some rooms the carpets are “rippled” and need refitting to avoid the risk of residents tripping up. A number of radiator guards need to be painted. Residents, their families and staff have done their best to make the rooms look homely. Prospective residents are informed that they can bring personal possessions with them when they move in and many people have pictures, ornaments and other personal effects in their rooms. There is one bright spacious lounge which most people use throughout the day. Some of the chairs have been arranged in the centre of the room so that residents can be closer to the TV, instead of sitting round the edge of the large room. Residents and staff complained about the poor quality of the picture on the TV in the lounge, due to poor reception. They said they had raised this with the Responsible Individual (who visits the home on behalf of the company) but to their knowledge nothing had been done. The dining room is drab and in need of redecoration, the wallpaper is peeling off in parts. Because of the lack of available power points, the toaster that is used at breakfast time was placed on a pipe cover near the floor. Staff were advised to place the toaster on a table. The hairdressing room is not pleasant. It was once the designated smoking area in the home, it smells of stale smoke and the décor is nicotine stained. The room houses old broken furniture that is not used, it is not conducive to a relaxing hairdressing session. Carr Green Nursing Home DS0000001046.V295856.R01.S.doc Version 5.2 Page 23 Having a bath at the home is not a dignified, pleasant experience for residents. There is only one useable bathroom in the home. Other bathrooms do not have assisted bathing facilities and cannot be used by residents. The useable bathroom contains a Parker bath, as the water pressure to the bath is very low it takes some time for the bath to fill, staff said it takes about 10 minutes. Residents are usually seated in the bath whilst waiting. One resident said, “sometimes the water is hot, sometimes it’s too cold” another resident said “they have you in and out in minutes”. Residents cannot have bath at a time that suits them. Because of the low water pressure and inadequate supply to the bathroom, residents can only have a bath first thing in a morning or in the evenings. Staff said the bath couldn’t be used when staff are washing up in the kitchen because there is not enough hot water. The home is not adequately equipped to meet the needs of residents with disabilities. Because there are not enough suitable, useable bathrooms, three residents living at the home cannot have a bath at present. Because of the nature of their disabilities they need to be hoisted into the bath. There is insufficient room in the only useable bathroom to accommodate a hoist. The manager said the Responsible Individual was aware of this situation, she said there had been some discussion about turning one of the storerooms into a shower room but she had not been told if, or when this would take place. Some of the toilets in the home do not have working locks on the doors. Some do not have mirrors in them. There are dispensers on the walls for toilet tissue but the key to the dispensers is lost and toilet roll is being used instead. The roll sits on top of the dispensers or behind the toilet on the cistern making it difficult for residents to reach. All the toilets were equipped with liquid soap and paper towels. The toilets are too small to comfortably allow staff to assist people who have a disability and use a wheelchair or walking aid. This compromises the privacy and dignity of residents it is also potentially unsafe. There is a good domestic team who work hard to keep the home clean. Five residents who returned surveys said the home was always fresh and clean. One person said the home was usually clean but felt that it depended on which domestic was on duty. Residents who were asked about this during the visit said they were satisfied with the standard of cleanliness. The laundry facilities are located in the basement in Carr Green. The laundry for The Haven the sister home on the same site, is also done at Carr Green. Currently there is only has one tumble drier that is working to dry all of the Carr Green Nursing Home DS0000001046.V295856.R01.S.doc Version 5.2 Page 24 washing for two homes. This cannot be used for clothing as the temperature cannot be regulated and is extremely hot. Clothing is left to dry on washing lines in the basement. The laundry does have a rotary iron, however, the laundry assistant told inspectors that it only works on the ‘silk’ setting and it takes nearly 10 minutes to iron a cotton sheet. The broken laundry baskets that were mentioned in the report following the inspection in October 2005 have still not been replaced. In February 2006 an officer from Environmental Health Services carried out an inspection of the home. The report revealed that a number of improvements were required for the home to comply with The Food Hygiene Regulations. The improvements were underway at the time of this visit; Environmental Services will monitor compliance. Carr Green Nursing Home DS0000001046.V295856.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29.30 The company does not support staff to develop their skills through training. The training that is on offer is limited and staff have to seek their own free training courses. The company does not encourage and support staff to pursue external courses such as NVQ. There are still shortfalls in the recruitment process, prospective staff are not thoroughly checked to make sure they are suitable before they start work in the home. EVIDENCE: There have been concerns about recruitment practices in the past, resulting in a statutory requirement notice being served in May 2005. Subsequent visits to the home confirmed that improvements had been made and the requirements of that notice had been met. Four staff files were examined on this visit, the findings indicate that further improvements in staff recruitment practices need to be made once again. The following observations were made: • The employment histories of prospective staff are not always being requested and are not being routinely checked • References are not always being requested from previous employers • There is evidence that some staff have started work before checks have been carried out by the Criminal Records Bureau Carr Green Nursing Home DS0000001046.V295856.R01.S.doc Version 5.2 Page 26 • • • • • There is no evidence on some files to show that the Protection of Vulnerable Adults register has been checked Interview notes are very brief Where disciplinary action or investigation of actions taken by staff has been necessary, there is no record on the staff file There is no record of staff supervision or appraisal There is no evidence that the PIN numbers of nurses are being checked The company does not fund training for staff. The home’s policy states that the company will provide paid training for all staff and programme of in house training. This is not happening. The nursing staff on duty said they had not received 5 days training per year as described in the policy. There had been some moving and handling training and some fire safety training delivered by a member of the management team. The home’s policy also states half of the care staff will be trained to NVQ level 2. Again this is not happening. There is no evidence that staff are receiving induction and foundation training that meets the National Training Organisations standards. A member of the management team said new staff complete a one day induction session at Learn Direct, then they work one day at the home as a supernumerary member of staff “shadowing” an experienced member of the team. For the first six weeks of employment, new staff are linked with a mentor. A member of the management team said that the mentors are not trained they are there to “keep an eye on new staff”. Carr Green Nursing Home DS0000001046.V295856.R01.S.doc Version 5.2 Page 27 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38. The staff are offered very little in the way of training, development and supervision. There is no quality assurance monitoring in place; the views of residents, relatives and visitors to the home are not sought. The Responsible Individual does not carry out any monitoring of the service provided. There is no evidence of any long term or strategic planning for the home. The home is failing to meet standards in fire safety and environmental health. EVIDENCE: The Registered Manager is an experienced general nurse, who is in the process of completing her NVQ 4 in management. The Responsible Individual and the company that owns the home do not provide sufficient support to the management team. Staff report that they make frequent requests for improvements to the home and the facilities but these are not met. The management team and staff are aware of the shortfalls highlighted in this report. Carr Green Nursing Home DS0000001046.V295856.R01.S.doc Version 5.2 Page 28 It was reported in the last inspection report in October 2005 that the registered manager had developed some quality assurance documents, these have still not been issued to residents or visitors to the home. Residents meetings are not held. Residents’ views are only sought in a very informal way. The staff do not receive any formal supervision. There are no quality assurance systems in place. The Responsible Individual visits the home but is not reporting on these visits every month as required. There was evidence of only six reports having been completed since February 2004. Records of residents’ monies that are being held in the home are kept and receipts for any purchases made on the residents’ behalf are available. One member of staff takes responsibility for this. As mentioned earlier in this report, in February 2006 an officer from Environmental Health Services carried out an inspection of the home. The report revealed that a number of improvements were required for the home to comply with The Food Hygiene Regulations. The improvements were underway at the time of this visit. Environmental Services will monitor compliance with requirements. The last electrical installation inspection was completed in October 2003; there is no evidence that the recommendations made in the report have been completed. Requests made in previous inspection reports for confirmation that this work has been completed have not been met. There was evidence that a gas safety inspection had been carried out and a gas safety certificate was available. Staff said the kitchen oven had been out of commission for one week while parts were awaited. This was not reported to the Commission for Social Care Inspection. A member of the management team has attended a fire safety training course and she has provided the staff with training. Evidence was available to show fire drills were taking place and records were kept of staff taking part. The fire test records must show that the fire alarms are being tested weekly. Discussions are taking place between the Responsible Individual (who acts on behalf of the company) and the Fire Officer regarding outstanding fire safety work that still needs to be completed. Carr Green Nursing Home DS0000001046.V295856.R01.S.doc Version 5.2 Page 29 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 1 1 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 2 1 1 2 2 2 2 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 1 X 1 Carr Green Nursing Home DS0000001046.V295856.R01.S.doc Version 5.2 Page 30 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 Standard OP1 OP2 Regulation Required Action Timescale for action 1 2 5 5 3 OP3 13 4 OP7 15 A service user guide must be made available for all prospective residents Residents must be issued with a contract/terms and conditions of residence document before or on the day of admission. This document must contain all of the information as specified in regulation 5 of the Care Homes Regulations 2001 and Standard 5 of the National Minimum Standards for Older People All prospective residents must be assessed, prior to admission. In the case of an emergency admission this assessment must be completed within the first five days of admission (This requirement was first made on 6.10.05 and has not been met) Care plans must be in place for each resident that detail how that residents needs are to be met. Staff must follow the care plan to DS0000001046.V295856.R01.S.doc 07/08/06 30/06/06 30/06/06 31/08/06 Carr Green Nursing Home Version 5.2 Page 31 5 OP7 13 6 OP7 15 7 OP8 12 8 OP12 16 9 OP16 17 10 OP18 13 ensure that appropriate care and support is delivered. The nursing staff must make sure that care plans are being followed and that the care they are prescribing is being delivered. Risk assessments must detail all of the identified risks for each individual resident, together with details of how the risk is to be minimised (This requirement was first made on 6.10.05 and has not been met) The monthly reviews must identify whether or not the care plan that is in place is meeting the needs of the resident (This requirement was first made on 6.10.05 and has not been met) Staff must ensure that residents personal hygiene needs are met as written in the care plan Residents must be consulted about what activities they would like to participate in. Following this consultation, group and individual activities must be arranged (This requirement was first made on 6.10.05 and has not been met) . Details of any complaints must be documented in the complaints log together with the action taken and outcome of the complaint (This requirement was first made on 6.10.05 and has not been met) Appropriate risk DS0000001046.V295856.R01.S.doc 30/06/06 30/06/06 30/06/06 30/06/06 30/06/06 30/06/06 Page 32 Carr Green Nursing Home Version 5.2 11 OP9 13 12 OP21 23 13 OP21 23 14 OP21 21 15 OP24 16 16 OP24 12 17 OP29 19 assessments must be carried out and adult protection procedures followed to make sure that residents are adequately safeguarded. All medication records must be accurately maintained and signed contemporaneously Arrangements must be made for bathing facilities to be installed, which are capable of meeting the assessed needs of all residents. Toilet facilities at the home must be improved making them fully accessible to residents in wheelchairs and safe for the staff who are assisting them (This requirement was first made on 7.04.05 and has not been met) . Bathrooms and toilets must have suitable locks fitted to ensure residents privacy. (This requirement was first made on 7.4.05 and has not been met) Lockable space must be provided for residents in their bedrooms (This requirement was first made on 7.4.05 and has not been met) Suitable door locks must be fitted on bedroom doors. These must meet the requirements of the fire service This requirement was first made on 7.4.05 and has not been met) Recruitment practices in the home must be improved. References must be taken up from DS0000001046.V295856.R01.S.doc 30/06/06 31/08/06 31/08/06 30/06/06 30/06/06 30/06/06 30/06/06 Carr Green Nursing Home Version 5.2 Page 33 18 OP30 18 19 OP33 26 20 OP38 16 21 OP38 13 22 OP38 23 23 OP38 13 appropriate sources. Employment histories should be explored. Appropriate checks must be carried out on all staff before they start work in the home. Training and development plans must be drawn up for each individual member of staff. The responsible individual for the company must provide a report every month on the conduct of the home. A copy of this report must be available in the home and a copy forwarded to the Commission for Social Care Inspection. The requirements made by the Environmental Health department must be complied with (This requirement was first made on 22.3.06 and has not been met) The responsible individual must confirm that the works identified on the electrical installation inspection report have been carried out (This requirement was first made on 6.10.05 and has not been met). The fire alarms must be tested on a weekly basis and records of these tests maintained. The responsible individual must ensure that the current hot water system at the home is adequate to provide hot water consistently throughout the day and night. Details of DS0000001046.V295856.R01.S.doc 31/08/06 30/06/06 30/06/06 30/06/06 30/06/06 30/06/06 Carr Green Nursing Home Version 5.2 Page 34 24 OP19 23 their findings must be forwarded to the Commission for Social Care Inspection. (This requirement was first made on 6.10.05 has and not been met) All works as identified on the fire schedule dated 25 October 2005 to be completed (This requirement was first made on 7.04.05 and has not been met) 29/09/06 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 OP15 OP25 Good Practice Recommendations The menu for the day should be displayed for residents to see. The radiator guards should be painted. (Previous requirement from inspection that took place on 7 April 2005) The tumble drier and rotary iron should be repaired. New laundry baskets should be supplied . 3 OP38 Carr Green Nursing Home DS0000001046.V295856.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 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.V295856.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. 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