CARE HOMES FOR OLDER PEOPLE
Chorlton Place Nursing Home 290 Wilbraham Road Chorlton Manchester M16 8LT Lead Inspector
Geraldine Blow Unannounced Inspection 15th February 2006 09.00 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 Chorlton Place Nursing Home DS0000021637.V279123.R01.S.doc Version 5.1 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. Chorlton Place Nursing Home DS0000021637.V279123.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Chorlton Place Nursing Home Address 290 Wilbraham Road Chorlton Manchester M16 8LT 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) 0161 882 0102 0161 860 6685 Southern Cross Healthcare Services Limited Veronica Amadi Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Chorlton Place Nursing Home DS0000021637.V279123.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The maximum number of service users requiring nursing care shall be 45. The maximum number of service users requiring personal care only shall be 3. Registration is subject to compliance with the minimum nursing staffing levels indicated in the Notice previously served in accordance with Section 25 (3) of the Registered Homes Act 1984 issued on 3 June 2001. The service should, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 18th August 2005 4. Date of last inspection Brief Description of the Service: Chorlton Place Nursing Home provides accommodation for 48 older people. The home is registered to accommodate 45 older people assessed as requiring nursing care and 3 older people assessed as requiring personal care only. The premises are owned by Nursing Home Properties (NHP) Plc and are leased to Southern Cross Healthcare Limited. The home is located in the Chorlton area of Manchester close to main public transport routes, local shops, public houses and other social and recreational amenities. Parking facilities are available to the front and rear of the property. The home is a three storey purpose-built building set in its own well maintained grounds. Bedroom accommodation for residents is provided on the first 2 floors and the third floor is used as office space, which includes the companys divisional offices. The home offers accommodation in 48 single, en-suite bedrooms. Each floor has 2 lounges, a dining room and 2 small seating areas. Chorlton Place Nursing Home DS0000021637.V279123.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on the 15th February 2006. During the inspection time was spent talking to the acting deputy manager, several of the residents and some members of staff to find out their views of the home. In addition residents files, records and other relevant documentation were examined. Since the last inspection the Pharmacist Inspector has visited the home on several occasions due to concerns regarding medication and a number of requirements have been made. On the day of inspection the Pharmacist Inspector also visited the home to undertake a further specialist pharmacist inspection. A number of serious concerns were identified and a separate letter has been sent to the operations manager of the home. As this inspection only looked at a limited number of standards the report should be read together with the previous and any future reports to gain a full picture of how the home is meeting the needs of the people living there. Since the last inspection the Commission for Social Care Inspection (CSCI) has received 2 allegations of abuse and 1 complaint about the home. The 2 allegations of abuse have been investigated and found not to be upheld and the complaint was upheld in part. What the service does well: What has improved since the last inspection?
Since the last inspection both lounges on the ground and first floor have had new carpets fitted. Chorlton Place Nursing Home DS0000021637.V279123.R01.S.doc Version 5.1 Page 6 What they could do better:
On the day of inspection one of the residents was complaining of pain. When questioned the staff told the inspector that they had run out of his medication and appeared to have made no attempt to obtain them. The staff member could offer no explanation as to why this may have happened and the inspector had to ask the member of staff to obtain the relevant tablets. The systems in place should not allow the situation to arise where residents run out of medication. Following a number of visits by the pharmacy inspector, which included a visit on the day of this inspection, there are issues of serious concern regarding the administration of medication. Some of the issues identified are that medication is not being signed for appropriately, out of date medication had been given to a resident, another resident had run out of medication and medication had been given to a resident on 5 occasions when it should not have been. The above issues are to be addressed in a separate letter directly to the operations manager. A number of shortfalls were identified in the care planning process. Some of these shortfalls include when a resident had been assessed as at risk of developing a pressures sore no pressure relieving equipment was being used, clearly identified problems had not been included in the plan of care, urgent referrals to other health care professions had not been followed up and risk assessments had not been completed for the use of bed rails. There was also no evidence that the plan of care had been drawn up with the involvement of the resident/representative. Due to the above issues it would appear that the health and personal care needs of the residents are not being met. A full audit of all the residents’ plans of care must be undertaken to address the issues. At the last inspection the manager told the inspector that she was in the process of organising adult protection training for new members of staff and a refresher course for existing staff. This had not been done and has been made a requirement from this inspection Two mechanical hoists were found stored in the residents’ bathroom on the ground floor and a further bathroom was found to have a chair stored in there. This is a potential trip hazard and the inspector requested that they be removed immediately and alternative storage space be found. Staff spoken to said that they were not receiving supervision. All staff must be appropriately supervised. It is recommended that staff receive formal supervision 6 times a year. Chorlton Place Nursing Home DS0000021637.V279123.R01.S.doc Version 5.1 Page 7 A record of staff training was held on computerised records and the administrator said that when staff were in need of attending mandatory training she sent them a letter detailing what training was required and the date for that training. However, this system made it very difficult to ascertain what individual training staff had achieved or when training was required. All staff must have an individual training and development plan that is discussed in the supervision sessions. Some concern was raised by the staff spoken to regarding the time of the main meal of the day, which is lunchtime and the fact that the menu has not been reviewed in a long time. It is therefore recommended that the manager undertakes an audit of the residents’ wishes around the meals provided and the meal times. The requirement made at the last inspection that the responsible individual must ensure that the home confirmes in writng to a prospective resident following the pre-admission assessment that the home is able/not able to meet their assessed needs had not been met and has been made again in this report. 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. Chorlton Place Nursing Home DS0000021637.V279123.R01.S.doc Version 5.1 Page 8 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 Chorlton Place Nursing Home DS0000021637.V279123.R01.S.doc Version 5.1 Page 9 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): No judgement was made at this inspection EVIDENCE: At the last inspection a requirement was made that the responsible individual must ensure that the home confirmes in writng to the prospective resident following the pre-admission assessment that the home is able/not able to meet their assessed needs. The deputy manager and the administrator both said that this requirement had not been met. It has been reiterated in this report. Chorlton Place Nursing Home DS0000021637.V279123.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7&8 The health and personal care of the residents were not being met. The shortfalls have the potential to place residents at risk. EVIDENCE: A random selection of care plans was inspected and found to be of an unacceptable standard. A number of serious shortfalls were identified, which are listed below: • • Part of the new client admission checklist had not been completed. The resident had been admitted on 3/2/06 and the pre-printed paperwork clearly documents that this must completed 24 hours after admission. A referral to the Tissue Viability (TV) Nurse was seen, however it did not contain a date or a signature of the person completing it. The referral stated “Urgent, 1-3 days”. A further referral to the TV Nurse for the same resident was seen and it was dated 6/2/06 but did not contain any further details as to the reason for the referral. The acting deputy manager said that they were both the same referral. There was no evidence that the TV nurse had visited the resident. Urgent referrals must be followed up in a timely manner.
DS0000021637.V279123.R01.S.doc Version 5.1 Page 11 Chorlton Place Nursing Home • • • • • • • • • • A resident’s recorded waterlow score was 24 “high risk” and the dependency assessment also scored “at risk”. There was no evidence that any pressure relieving equipment was in place to minimise the risk. The acting deputy manager confirmed that no equipment was being used and could offer no explanation. One resident had a pressure ulcer but there was no plan of care or any entries in the daily record of any dressings, yet the acting deputy said the ulcer was being regularly re-dressed. Several residents had bed rails in place but a risk assessment not been completed and consent for their use had not been obtained. The nutritional risk assessment of one resident stated “recent weight loss”. However, evidence was seen that the resident had acutely gained weight. One resident required the use of a Zimmer frame to mobilise and the assistance of one nurse. This had not been incorporated into the care plan. A nutritional risk assessment score was 15 for one resident. The preprinted documentation stated that a score above 8 must have a care plan. No evidence could be found of a care plan. One resident was on a pureed diet. There was no care plan for this identified need. One resident was doubly incontinent yet a continence assessment had not been completed. There was no evidence that the plan of care had been drawn up with any consultation with the resident or their representative. As identified at the last inspection food charts contained statements like “lunch eaten” and did not include any details of the actual food eaten. The requirement made at the last inspection that the recording of food must be in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory in relation to nutrition has been reiterated in this report. Due to the above issues a full audit of all care plans must be undertaken to ensure that every resident has a detailed plan of care which has been generated from a comprehensive assessment and sets out in detail the action which needs to be taken by care staff to ensue that all aspects of health, personal and social care needs of the resident are met. The plan of care must be drawn up with consultation with the resident or their representative. The plan must be made available to residents and kept under constant review. As already identified in this report the pharmacist inspector has made several additional visits to the home to inspect the medication procedures. A number of serious concerns have been identified which will be addressed directly to the responsible individual. The remaining standards had been assessed during the previous inspection. Chorlton Place Nursing Home DS0000021637.V279123.R01.S.doc Version 5.1 Page 12 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): No judgements were made at this inspection. EVIDENCE: The key standards were assessed during the previous inspection. However a member of staff said that the menus had not been changed or reviewed in a long time. Two members of staff told the inspector that because the main meal of the day was at lunchtime residents often complained that they were hungry in the evening. It is recommended that the manager conduct an audit of residents’ wishes around the meals provided and the meal times. Chorlton Place Nursing Home DS0000021637.V279123.R01.S.doc Version 5.1 Page 13 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): 18 Staff have not received up to date training in the Protection of Vulnerable Adults. The lack of training does not ensure that the people living in the home are protected from abuse EVIDENCE: The home had corporate policies relevant to vulnerable adult protection including whistle blowing; the home subscribed to the Manchester MultiAgency Protection of Vulnerable Adults policy, procedures and protocols. The homes’ own policies were in line with the multi-agency policy and the Department of Health (DOH) guidance, “No Secrets.” At the last inspection the manager said that she was in the process of organising training for new members of staff and a refresher course for existing staff. This has not been implemented. Evidence was seen of adult protection traing in 2004. All staff spoken to either said that they had not received any training or that it was about 2 years ago. In order to protect the people living in the home this must be organised as a matter of some urgency. Chorlton Place Nursing Home DS0000021637.V279123.R01.S.doc Version 5.1 Page 14 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): No judgements were made at this inspection. EVIDENCE: The key standards were assessed during the previous inspection. However, during a tour of the home it was noticed that 2 mechanical hoists were being stored in the bathroom numbered 36 and a ‘bucket chair’ was being stored in bathroom 22. These are a potential trip hazard for residents and alternative storage space must be found. Chorlton Place Nursing Home DS0000021637.V279123.R01.S.doc Version 5.1 Page 15 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 & 30 Sufficient staff are employed in the home to meet the needs of the people who live there. EVIDENCE: A member of staff expressed concern to the inspector that the home did not employ enough staff to meet the needs of the residents. However, on examination of the duty rota it was found that the home were meeting the staffing requirement issued by the previous registering authority. The home has a structured Induction process. The Induction is currently based on the TOPPS guidance. However, the organisation that set the standards of training for all social care services and workers recently introduced new guidance on what an induction programme for new staff should include. These new standards will be compulsory in September 2006. The organisation is aware of this new development and the Quality Department is currently reviewing the Induction programme to make sure that it meets the new standards. There was evidence of staff training on a computerised database. However, as already detailed in this report, each member of staff should have an individual training and development programme The remaining core standards were assessed during the previous inspection.
Chorlton Place Nursing Home DS0000021637.V279123.R01.S.doc Version 5.1 Page 16 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): 33, 35, 36 & 38 The home has the systems and practices to monitor and develop the service based on people’s views. Systems and procedures were in place, which safeguards and protects residents’ financial interests and the home was seen to promote the health, safety and welfare of the residents and staff. EVIDENCE: Evidence was seen of a quality monitoring system to seek feedback from the relatives of the residents who use the service. The administrator is responsible for sending out customer comment cards on a monthly basis to a cross section of relatives and the cards are also on display in the reception area for feedback to be given by any visitor to the home. It has been recommended that the comment cards are also sent to all visiting professionals. The completed cards are sent directly to the company’s head office. Copies are then sent to the
Chorlton Place Nursing Home DS0000021637.V279123.R01.S.doc Version 5.1 Page 17 home manager along with comments from head office. The administrator said that she was unaware of any action plan being developed as a result of the feedback received. Evidence was seen that the systems in place did safe guard resident’s financial interests. Southern Cross Healthcare Ltd had a national agreement with CSCI’s Provider Relationship Manager (PRM) regarding residents’ finances. Policies and procedures reflecting this agreement were in the development stage. Secure facilities were provided for money and valuables held on behalf of residents and receipts were given if possessions were handed over for safekeeping. All of the staff spoken to said that they were not receiving any kind of supervision. All staff should received formal supervision 6 times a year. Evidence was provided that the manager ensures the health, safety and welfare of the residents and staff are protected at all times. Chorlton Place Nursing Home DS0000021637.V279123.R01.S.doc Version 5.1 Page 18 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 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 X X 2 X X X X X STAFFING Standard No Score 27 3 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 2 X 3 Chorlton Place Nursing Home DS0000021637.V279123.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement 2. OP7 13 & 15 The Responsible Individual must ensure that the home confirms in writing to the prospective resident following the preadmission assessment that the home is able/not able to meet their assessed needs. (The previous timescale of 17/11/05 had not been met). 31/03/06 1. A full audit of all care plans must be undertaken within the timeframe set. 2. Each resident must have an individual plan of care that sets out in detail the action which needs to be taken by care staff to ensure that all aspects of health, personal and social care needs of the residents are met. 3 .The plan of care, where possible, must be drawn up with the involvement of the resident in a style accessible to the resident. Once agreed it must be signed for by the resident where applicable and/or a representative. 4. The use of restraints such as bed rails must be thoroughly risk Timescale for action 08/03/06 Chorlton Place Nursing Home DS0000021637.V279123.R01.S.doc Version 5.1 Page 20 3. OP9 13 assessed and consent for their use obtained. The Registered Person must make arrangements for the recording, handling, safekeeping and safe administration of medicines which are detailed below: • • All medication records must be accurate The ordering for medication must be reviewed so that safe levels of medication are in stock. The review must be completed by 23/1/06 All medication must be administered as prescribed. All medication administered must be ‘in date’. Nurses must undertake basic medication training and training on record keeping for medication by 27/2/06. Evidence that this has been arranged must be provided to CSCI within the timescale. 27/02/06 • • • An action plan must be submitted to CSCI detailing how the above requirements have been actioned within the timescales set. 4. OP8 12, 17 Sch 3 & 4 1. The record of food provided to a resident must be in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory in relation to nutrition. (The previous time scale of 22/9/05 had not been met).
Chorlton Place Nursing Home DS0000021637.V279123.R01.S.doc Version 5.1 Page 21 08/03/06 2. Evidence must be provided of the treatment of pressure sores i.e. pressure relieving equipment and evidence of pressure relief. 4. A record of pressure sores/ulcers must be kept along with details of their treatment. 5. In order to promote and make proper provision for the health and welfare of residents, referrals must be followed up in a timely manner to access specialist advice. 6. Referrals to other health care professional such as the Tissue Viability Nurse must be singed and dated. All staff must receive training on the actions to be taken in the event of an allegation of abuse. To avoid any unnecessary risk to the health or safety of residents the manager must ensure that the hoists and the ‘bucket chair’ are not stored in residents bathrooms The home must undertake an audit of all the staff training and develop individual staff training plans that set out what training staff have undertaken, what training was required and when refresher training was needed. The manager must develop an action plan for the home based on the feedback from the comment cards sent out. The responsible individual must ensure that staff are appropriately supervised. 5. OP18 13 01/04/06 6. OP21 13 15/02/06 7. OP30 18 30/04/06 8. OP33 24 08/05/06 9. OP36 18 30/03/06 Chorlton Place Nursing Home DS0000021637.V279123.R01.S.doc Version 5.1 Page 22 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 OP12 OP33 OP36 Good Practice Recommendations It is recommended that the daily report sheet contain more detail to accurately reflect the care provided over a 24 hour period. It is recommended that the manager undertakes an audit of residents’ wishes around the meals provided and the meal times. It is recommended that the comment cards are sent to visiting professionals and not just relatives in order to obtain their opinion of the service being delivered. It is recommended that staff receive formal supervision 6 times a year. Supervision should cover: • All aspects of practise • Philosophy of care in the home • Career developments needs Chorlton Place Nursing Home DS0000021637.V279123.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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