Inspection on 02/11/06 for Catherine House General Nursing Home

This inspection was carried out on 2nd November 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Catherine House General Nursing... 30/07/07

Catherine House General Nursing... 13/12/05

Catherine House General Nursing... 21/06/05

Catherine House General Nursing... 18/01/05

Catherine House General Nursing... 05/05/04

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Fairfields Country Rest Home

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Didsbury Court Rest Home

Belma

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

CARE HOMES FOR OLDER PEOPLE Catherine House General Nursing Home Cork Street Frome Somerset BA11 1BR Lead Inspector Sue Burn Unannounced Inspection 2nd November 2006 09:30 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 Catherine House General Nursing Home DS0000003248.V313939.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. Catherine House General Nursing Home DS0000003248.V313939.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Catherine House General Nursing Home Address Cork Street Frome Somerset BA11 1BR 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) 01373 451455 01373 455177 catherinehouse@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Limited Mrs Ann Rhoda Mary Dawes Care Home 67 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (43) of places Catherine House General Nursing Home DS0000003248.V313939.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. A named RMN shall be employed to manage the dementia care floor. The first floor shall accommodate exclusively people with dementia care needs. The top floor shall provide accommodation for eleven service users with personal care needs, up to five of whom may have nursing needs. No ground floor bedroom shall be used for service users whilst any of them are being used to accommodate nurses working for the company. There will be no less than two trained nurses covering the second and third floors throughout the day and evening shifts and further nurse on the dementia care floor. There will be no less than two trained nurses on the night shifts, one on the dementia care floor and one on floors two/three. 13 December 2005 Date of last inspection Brief Description of the Service: Catherine House is a purpose built care home located in the centre of the town of Frome. The home supports three groups of service users; those needing personal care, general nursing and those with dementia care nursing needs. The first floor provides accommodation for people with dementia care needs and the second for those with general nursing needs. The third floor accommodates some people with general nursing needs and others receiving support with personal care only. All rooms are single occupancy with en-suite facilities. Each floor has its own communal space including sitting rooms, dining and smoking rooms and adapted bathrooms. The dementia care floor has direct access to an outdoor courtyard with seating and raised beds. In addition to this there is a large room on the ground floor, which is used, for social events, meetings and staff training. The reception, kitchen and offices are also found on this floor. The service provides an in-house laundry service. The lower floor of the service is currently used as staff accommodation. Catherine House General Nursing Home DS0000003248.V313939.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the first Key Inspection of the home carried out using the new ‘Inspecting for Better Lives 2’ methodology. 2 inspectors carried out this unannounced inspection over one day. The inspectors inspected ‘key’ standards to determine the quality of the service in the areas covered by this report. The inspectors reviewed comment cards returned to CSCI by families on behalf of service users and professionals who visit the home. A pre-inspection questionnaire was completed by the Registered Manager prior to the inspection. Inspectors viewed the premises, spoke to service users, visitors and staff, examined a range of care and management records and observed the daily life of the home. At the beginning of the inspection it was agreed with the deputy manager that one of the inspectors would spend some time on the dementia care floor carrying out non-participant observation of the staff and service users as they spent their day. This observation is included in the report in general terms but specific feedback was given to two of the nurses working in this area at the end of the morning and afternoon. The nurses spoken to found this feedback useful and discussed ideas about how the information may be used. The friendly, warm atmosphere of the home particularly struck the inspectors. The home has a significant number of overseas staff. Some staff spoken to were aware of the impact cultural differences could have on the service users and were conscious of the need to address any issues as they became apparent. Service users were all treated with respect and dignity and all spoken to made very positive comments about the staff and their care. The Registered Manager, Anne Dawes, was on leave at the time of this inspection. The deputy manager and administrator, who came in to make records available, assisted inspectors. Feedback was given to the deputy manager at the end of the inspection. The inspectors would like to thank the service users and staff for their welcome and assistance during the inspection. The fees for the home range from £410 personal care only to £550 plus any Free Nursing Care Contribution per week. Catherine House General Nursing Home DS0000003248.V313939.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The home has implemented a purchasing programme for adjustable beds as required at the last inspection. An additional 14 profiling beds have been bought and are in use. The detail of the care plans has improved from the briefer plans found at the last inspection. The company have issued contracts to service users as recommended. Catherine House General Nursing Home DS0000003248.V313939.R01.S.doc Version 5.2 Page 7 What they could do better: The home was found to be breaching two conditions of registration. The breach of one of these conditions did impact on the numbers of staff on duty and consequently the amount of time staff could spend with service users socially and the administration of some medicines. The breach of the other condition, the lack of a designated RMN, could potentially impact on the care when specific expertise will be required to lead the team. An Immediate Requirement was issued to require the home to comply with the Conditions of Registration. Cleaning chemicals were found to be stored in 2 sluices, which were not securely locked. It was recommended at the last inspection that these chemicals be stored securely. An Immediate Requirement was made to ensure that all hazardous substances are stored securely in locked areas. Medication management needs to improve in some specific areas. The temperature of one of the medicine rooms and the two drug fridges exceeded the manufacturer’s recommended storage temperatures. An Immediate Requirement was issued to ensure that all medicines are stored correctly. Not all medicines administered to service users receiving nursing care were administered by a nurse and there was no system in place to delegate this task to nominated care staff. This must be addressed. The management of creams, dressings and blood bottle stocks and the administration of ‘as required’ medication all need to be improved to ensure safe practice. Only one of the service users seen had access to a call bell throughout the inspection. An Immediate Requirement was issued to ensure that all had access to a call bell or other suitable arrangements must be made. The provision of social care needs to be further developed to ensure that all service users are offered stimulating activities suited to their needs on a regular basis. The mealtime experience could be improved with the provision of menus and tables laid to suit the needs of the service users. On the dementia care floor real choice should be offered at the time a meal is served for those with memory or comprehension difficulties. The management of odours on the first floor needs addressing to ensure that all areas of the home are clean and fresh. Catherine House General Nursing Home DS0000003248.V313939.R01.S.doc Version 5.2 Page 8 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. Catherine House General Nursing Home DS0000003248.V313939.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 Catherine House General Nursing Home DS0000003248.V313939.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. Standard 6 does not apply. The quality of this outcome group is good. This judgement has been made using available evidence including a visit to this service. Service users and their families are provided with sufficient information to make a choice about moving into the home. Each service user is issued with a contract by the home, as far as possible. All service users are appropriately assessed before moving in to ensure that they home can meet their needs. EVIDENCE: The home has a Statement of Purpose/Service User Guide that provides full information about the services provided at the home. This is made available to all prospective service users and their families. It is also available as an Catherine House General Nursing Home DS0000003248.V313939.R01.S.doc Version 5.2 Page 11 audiocassette. This document also provides clear detail about any charges for additional services. The administrator confirmed that all self-funding service users are issued with a contract with the home. The home endeavours to do this for service users supported by the local authority but some authorities do not provide sufficient or timely information to the home. This is being pursued. Three pre-admission assessments were seen and cover a suitable range of needs to ensure that the home can meet the specific needs of the individual. Catherine House General Nursing Home DS0000003248.V313939.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 quality of this outcome group is adequate. Care plans provide detailed information as to how service user’s physical and behavioural needs are to be met. These are well written and reviewed regularly. Service users would benefit from the development of plans for person-centred social care. Service users can be assured that their healthcare needs will be met through visiting professional input and regular monitoring by staff. The storage of medicines places service users at risk of harm due to the high temperatures in the storage areas. The record keeping is well managed. Some administration practices do not adhere to best practice guidance. Catherine House General Nursing Home DS0000003248.V313939.R01.S.doc Version 5.2 Page 13 EVIDENCE: 8 care plans were examined, sampled from all the floors of the home. All were detailed and clearly written with guidance for staff to follow. Risk assessments and a range of relevant plans were regularly updated and reviewed. Other care records examined included weight turn and blood sugar monitoring and fluid monitoring charts, all of which were well maintained, with evidence of action being taken as required. None of the service users had pressure sores on the day and one person had a small wound. The care plans seen evidenced that body mapping was used where bruising or wounds. This ensures that consistent care and monitoring can be provided. The care plans provided very good information to meet the physical needs of service users. Relatives are involved in planned reviews but there was no evidence of service user involvement in the development of plans. This should be encouraged to ensure that the care provided is in partnership with the service user, wherever possible. Service users, particularly those on the dementia care floor, would benefit from the development of person-centred social care plans. The documentation provides for a social assessment and plan but this is not always used. The plan should be developed based on the person’s social history, preferences and abilities. This is particularly important where service users are less able to communicate their needs and wishes, for example, people with dementia or severe strokes. The development of these plans will also assist the development of activities that are focussed on the identified needs of individuals (see Daily Life and Social Activities). Local GPs and nurses and members of the local community mental health team visit the home. Records seen confirmed their visits and relatives spoken to were satisfied that the doctor was called when needed and they were kept informed. Comment cards were received from 3 visiting professionals. All confirmed their satisfaction with the service provided at the home. One described Catherine House as a ‘very caring home’. The home has a range of pressure relieving and moving and handling equipment that was seen in use and people were supported to change position where necessary. Medication storage and records were inspected. Care staff confirmed that they had received medication training. The home has ‘clinical’ rooms on each of the floors. Receipt and disposal of medicines was satisfactory and all medication was stored securely. Medication administration record (MAR) charts confirmed that medication is given regularly and there were no signature gaps. Serious problems were found with the storage of medicines on two of the floors, where the temperature of the storage was too high. One clinical room exceeded the Catherine House General Nursing Home DS0000003248.V313939.R01.S.doc Version 5.2 Page 14 recommended safe storage of temperature of 25C. Two of the fridges exceeded the safe storage temperature of 2-8C, one of which was used to store insulin. Temperatures had been recorded as high but no action had been taken. On the third floor a number of dressings were found to have exceeded the expiry date and should be disposed of. On the nursing floor a number of out of date vacutainer bottles were found which also need to be disposed of. Creams in use were not dated when opened and it could not be confirmed if they had exceeded the expiry date after opening. An out of date tube of rectal diazepam was in one of the fridges. It would be good practice to review the storage of rectal diazepam in the fridge, as the manufacturer does not require this and it may affect the comfort of administration. A number of medications were prescribed as ‘when required’. Most did not have clear administration instructions as to when the medication should be given and not all had the frequency of administration. This included some sedative and ‘psychotropic’ medication. Action must be taken to ensure that safe practices are implemented to rectify these shortfalls. It was confirmed that a senior carer regularly administers the medication to service users receiving nursing care on the top floor. This is contrary to NMC (Nurses and Midwives Council) and RPSGB (Royal Pharmaceutical Society of Great Britain) guidance and may not be acceptable to the funding authority. Where it has been decided that a care assistant is to administer medication to people receiving nursing care there must be a clear protocol in place. The accountability for the correct administration remains with the registered nurse on duty, who must be satisfied that the task is delegated to a competent person. This should be clearly documented and regularly reviewed. This would include taking observations, such as the pulse before administering digoxin. Catherine House General Nursing Home DS0000003248.V313939.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. The quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to this service. There are good efforts being made to develop the provision of social activity. Not all service users have opportunities to access stimulating activity on a regular basis. The provision of meals in the home is good and offers a choice of menu. The cook is well informed about needs and preferences. Improvements could be made to the ‘mealtime’ experience by enabling people to make choices as determined by their capabilities. Family and friends can be confident that they will be welcomed into the home. Most service users do not have access to a call bell, which may limit their independence and control over summoning staff. Catherine House General Nursing Home DS0000003248.V313939.R01.S.doc Version 5.2 Page 16 EVIDENCE: One inspector observed ‘life in the lounge’ on the dementia care floor. This used a specific recording tool. The detail of the observations was fed back to the nurses on that floor, who were keen to act on the findings. Some of the observation is reported here. Inspectors observed that staff treated service users with kindness and respect. During the late morning hour the 5 people observed slept for the hour with no interaction with staff or service users. Staff were busy with tasks and were in and out of the lounge. Some staff would benefit from further dementia awareness training or feedback from observations as they did not always pause for a response or engage people as they were near them. Both the TV and radio were on which were not conducive to conversation or concentration. During the afternoon the nurse and carers rearranged the seating into groups and organised various board games. This created a different atmosphere with services users participating with staff and each other. The inspector commented on how lovely the lounge felt. Records examined indicated that social opportunities can be ‘patchy’ with 5 out of 6 activity records seen indicating that those people had not participated in any social activity for the last month. The service users on the second floor were visited by the activities organiser who chatted with them, one man went out. Staff spent time with people as they could. On the second floor the 2 staff were busy with care tasks for people receiving nursing care. The service users who were more able were not offered any social activity and one person felt that there was not much to do other than TV. The home has a recently appointed activities organiser who is aware of many of the service users’ backgrounds and interests. He is developing the provision including visiting people in their rooms and takes people into town shopping or for coffee. During the inspection he was seen taking one man out to the town, visiting people in their rooms and socialising in the lounges. Catherine House is a large home with a wide range of social care needs and abilities. It is recommended that the activity provision be reviewed to take account of this and provide opportunities that match the social profiles, which have been compiled. This may be in the form of additional dedicated time, reorganising staff tasks and roles or developing the skills of the care staff to provide for social as well as physical care. Developing social care plans based on the social profiles will support this. Developing activities that reflect best practice in dementia care are dependant on using social profiles to offer what is meaningful to the individual. Catherine House General Nursing Home DS0000003248.V313939.R01.S.doc Version 5.2 Page 17 Family and friends were visiting during the inspection and all felt welcomed at any time and are able to join in such activities as the cheese and wine evening. They were complimentary about the staff and the manager. During the inspection the majority of service users did not have access to a call bell to summon staff. Many rooms had had the call bell lead removed. No call bells were heard ringing throughout the inspection. A number of service users spoken to were able to use a call bell. An Immediate Requirement was issued at the inspection to ensure that all service users are assessed as to their call bell provision. This must ensure that service users have a call bell unless it is assessed as a risk or inappropriate. This must be documented and alternative arrangements made where a call bell is not provided to monitor service user welfare. Lunch was observed and looked appetising and plentiful. Surveys received confirmed that the food was good and service users spoken to enjoyed the food. Relatives spoken to during the inspection confirmed that the food was usually good. All the care records examined had nutritional assessments and appropriate plans to address any identified needs, a number of people had gained weight. The home operates a corporate menu that provides for choice and is nutritionally balanced. All service users make their choice the day before. Most of the service users spoken to did not know what was for lunch and some were unable to respond. It is recommended that menus are made available on the second and third floors as a reminder/prompt to people and enable them to have full information. It is recommended on the dementia care floor that choice is offered at the table in a format to suit the individual as well as displaying a menu. The cook was well informed and the kitchen was well managed and had sufficient food stocks. Catherine House General Nursing Home DS0000003248.V313939.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The quality in this outcome group is excellent. This judgement has been made using available evidence including a visit to this service. Complaints are well managed and acted upon. The home’s systems protect service users from the risk of abuse. EVIDENCE: The home has a corporate complaints procedure. Visitors spoken to were happy to raise concerns with staff and the manager. They felt action was taken with whatever they raised. One professional surveyed commented that they had received a complaint about the home and that this was dealt with effectively. The relatives surveyed all confirmed that they know who to speak to at the home if they were not happy or needed to make a complaint. Staff training about complaints is planned for later in the year. CSCI have not received any complaints about the home since the last inspection. All employees are checked against the Protection of Vulnerable Adults (POVA) list before they start work. Staff spoken to were aware of what action they should take should they suspect any abuse within the home. The training matrix recorded that most of the staff attended POVA training in October 2006. Catherine House General Nursing Home DS0000003248.V313939.R01.S.doc Version 5.2 Page 19 Care plans examined indicated that any behaviours that may challenge staff or place the service users or others at risk were appropriately managed. Catherine House General Nursing Home DS0000003248.V313939.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected 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 The quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to this service. The home provides well maintained, purpose built accommodation, which has a range of accommodation and equipment. Service users all benefit from single rooms that are suitably equipped and personalised. Service users on the dementia care floor would benefit from clearer identification of their bedrooms to provide the opportunity to find their room independently. Staff ensure that their actions minimise the risk of cross infection. Some areas of the home are not fresh and a some of the corridor carpets are stained in parts. Catherine House General Nursing Home DS0000003248.V313939.R01.S.doc Version 5.2 Page 21 EVIDENCE: Inspectors toured the building and visited some of the bedrooms. Each floor has several communal areas and sufficient bathrooms and toilets. Some of the corridor carpets were stained and in need of cleaning or replacement. The first floor did not smell fresh throughout the inspection and action must be taken to address this, this may be through deep cleaning or carpet replacement. The smoking-room carpet on this floor is also in need of replacement as it has a large number of burn marks. All areas of the home seen were clean and tidy. Bedrooms were warm and comfortable with personal possessions in each room seen. There is a purchasing programme for adjustable beds and those people who needed these had been provided with a profiling bed. Communal rooms were homely and comfortable and visitors can visit in bedrooms or in a communal room. There is also a room on the ground floor which is used for functions and training. The dementia care floor had some environmental cues to aid orientation to communal rooms. It would be good practice to extend this to bedrooms to support people to find their own rooms independently and identify with their room. Staff were observed using the hand washing facilities supplied and using aprons for mealtimes. The home has an adequate supply of protective equipment. The home provides dedicated laundry facilities. Catherine House General Nursing Home DS0000003248.V313939.R01.S.doc Version 5.2 Page 22 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): The quality in this outcome group is poor. This judgement has been made using available evidence including a visit to this service. The home does not have sufficient nurses on duty to comply with one condition of registration, which has impacted on social opportunities and medication administration in some areas. The home does not have a designated Registered Mental Nurse (RMN) to lead the team. This is a breach of a condition of registration and may impact on care where specialist knowledge is required. The home protects service users through a thorough recruitment process. Service users benefit from a trained, competent and committed staff team. EVIDENCE: The home was found to be breaching two conditions of registration. The breach of one of these conditions did impact on the numbers of staff on duty and consequently the amount of time staff could spend with service users socially and the administration of some medicines (see Health and Personal Care) on the second and third floors. During the inspection staff, particularly on the third floor, spent most their time supporting people with physical nursing needs and did not have the time to spend social time with the people Catherine House General Nursing Home DS0000003248.V313939.R01.S.doc Version 5.2 Page 23 accommodated on that floor. Rotas examined for the 3 weeks prior to the inspection recorded that the manager works Monday to Friday 8-5pm and it is expected that she provide the RGN ’cover’ where only one RGN is on duty. Catherine House is a large home and it is to be expected that the manager needs to be supernumerary. The rotas also recorded that a significant number of shifts fell short of the required numbers of nursing and/or care staff on the second and third floors. The breach of the other condition, the lack of a designated RMN, could potentially impact on the care when specific expertise will be required to lead the team and the development of appropriate therapeutic activities. The home has recruited an RMN who needs further experience before leading the team. The management should ensure that she is supported with a structured induction and Preceptorship programme, this should include the support of more experienced RMN. Inspectors were informed that the dementia care floor has Registered General Nurses in charge who have dementia care training. An Immediate Requirement was issued requiring the home to comply with the Conditions of Registration. The home provides adequate numbers of domestic, catering and support staff. Nine recruitment records were examined and all contained evidence that thorough pre-employment checks had been carried out. The records were well maintained. The administrator also keeps clear records regarding Criminal Records Bureau (CRB) checks. The home supports staff with a range of training. Staff undertake a corporate induction programme and records were seen on staff files. Staff confirmed that they receive training and a training matrix was provided. This recorded that most staff attend a training session about every 2 months. The home has a significant proportion of overseas staff, who have access to English language and culture training where needed. The manager completed a pre-inspection questionnaire that confirmed that 70 of care staff have a National Vocational Qualification in care, which exceeds that National Minimum Standard. Staff were updated in moving and handling practice in October 2006. Catherine House General Nursing Home DS0000003248.V313939.R01.S.doc Version 5.2 Page 24 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, 32, 35, 37, 38. The quality in this outcome group is good. This judgement has been made using available evidence including a visit to this service. The manager is experienced and competent to run the home. Policies and procedures are wide ranging an updated annually by the company. Effective monitoring systems are in place to ensure the welfare of service users. The management of hazardous chemicals is poor and places service users at potential risk of harm. There are not sufficient staff trained in first aid to provide continuous cover for the service users and staff. Catherine House General Nursing Home DS0000003248.V313939.R01.S.doc Version 5.2 Page 25 EVIDENCE: Staff and visitors spoken to all confirmed that they were able to speak to the manager and she was available within the home. Relatives’ surveys also confirmed this. One commented that they were impressed by the ‘can do’ attitude of the manager. Service users able to comment felt able to approach staff. The manager holds regular staff meetings and an annual social event for relatives. The manager also offers regular booked appointments for relatives and service users to meet with her. An administrator supports the manager. A range of records and audits were examined, including accidents. All records were well kept and organised. The home has a maintenance person who carries our regular equipment checks. The records examined confirmed that all the required maintenance and checks had been carried out and the records were well kept. The fire safety records were examined, including the weekly testing of the fire alarms. 3 checks had been missed since mid-August. It is recommended that the manager ensures that these tests are carried out each week, as in the last report. Cleaning chemicals were found to be stored in 2 sluices, which were not securely locked. Chemicals must be stored securely to protect vulnerable service users. It was recommended at the last inspection that these chemicals be stored securely. An Immediate Requirement was made to ensure that all hazardous substances are stored securely in locked areas. Three staff have a current first aid certificate. This will not be sufficient to provide one trained person per shift. The manager must ensure that training in first aid is provided to comply with the Health and Safety (First Aid) Regulations 1981 and to support any emergency aid that may be needed by service users. Service user records were all stored securely. The administrator confirmed that all personal monies held were stored securely and records were up to date. The manager confirmed in the pre-inspection questionnaire that no monies are managed on behalf of service users. Catherine House General Nursing Home DS0000003248.V313939.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 4 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 4 3 3 3 2 3 3 3 2 STAFFING Standard No Score 27 1 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 X X 3 X 3 1 Catherine House General Nursing Home DS0000003248.V313939.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13(2) Timescale for action The registered person shall make 08/12/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received in the care home. (This is in relation to the following; • The identified clinical room must not exceed 25C; drug fridge temperatures must be maintained between 2-8C. An Immediate Requirement was issued. • Out of date stock must be disposed of correctly. • Clear administration instructions must be available for medication prescribed ‘as required’. • There must be clear protocols in place for the delegation of medication administration by care staff to nursing service users.) The registered person shall 30/11/06 ensure that the home is conducted so as to promote proper provision for the health and welfare for service users. (All service users must have DS0000003248.V313939.R01.S.doc Version 5.2 Page 28 Requirement 2. OP14 12(1)(a) Catherine House General Nursing Home 3. OP26 16(2)(k) 4. OP26 23(2)(d) 5. OP27 18(1)(a) 6. OP38 13(4)(c) access to a call bell. Where this is not provided there must be a documented rationale and alternative arrangements put in place. An Immediate Requirement was issued. ) The registered person shall keep the care home free from offensive odours. (Action must be taken to eradicate the malodour on the first floor.) The registered person shall ensure that all parts of the care home are kept clean and reasonably decorated. (The areas of staining on the carpets must be eradicated and the smoking lounge carpet replaced). The registered person ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. (The home must comply with the condition of registration that requires that there are 2 registered nurses on duty on floors two and three during the day. The home must comply with the condition of registration that requires that there is a designated RMN to lead the dementia care floor. An action plan is required to identify how this will be managed. An Immediate Requirement was issued. ) The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. (All hazardous chemicals must be stored in a locked area. An Immediate Requirement was DS0000003248.V313939.R01.S.doc 31/12/06 31/03/07 30/11/06 30/11/06 Catherine House General Nursing Home Version 5.2 Page 29 7. OP38 13(4) issued. ) The registered person shall make 31/03/07 suitable arrangements for the training of staff in first aid. (Training in first aid must be provided to comply with the Health and Safety (First Aid) Regulations 1981) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP7 OP9 OP12 OP15 Good Practice Recommendations Social care plans should be developed for all service users based on their unique social profile. Creams should be dated when opened to ensure that they are not used beyond the expiry date. The storage of rectal diazepam in the fridge should be reviewed. The activities provision should be reviewed and developed to take account of the wide-ranging needs of the service users in this large home. Menus should be displayed on each floor, either in communal areas or on the table. Choice should be offered at the time of serving the meal for people with memory or comprehension difficulties. Orientation cues should be provided to support service user independence in finding their own bedroom on the dementia care floor. The newly appointed RMN should be supported with a structured induction and Preceptorship programme. This should include the support of a more experienced RMN. The fire alarm system should be tested weekly. (Recommendation repeated from last report.) 5. 6. 7. OP22 OP27 OP38 Catherine House General Nursing Home DS0000003248.V313939.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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. 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