Random inspection report
Care homes for older people
Name: Address: Church View Nursing Home Church View Nursing Home Rainer Close Stratton St Margaret Swindon Wiltshire SN3 4YA zero star poor service 16/10/2008 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Janice Patrick1 Date: 1 5 0 4 2 0 0 9 Information about the care home
Name of care home: Address: Church View Nursing Home Church View Nursing Home Rainer Close Stratton St Margaret Swindon Wiltshire SN3 4YA 01793820761 01793820180 churchview@hallmarkhealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Hallmark Healthcare (Swindon) Ltd care home 43 Number of places (if applicable): Under 65 Over 65 43 0 3 old age, not falling within any other category physical disability terminally ill Conditions of registration: 0 3 3 No more than 3 service users with a terminal illness may be accommodated at any one time The staffing levels set out in the Notice of Decision dated 1 December 2003 must be met at all times Date of last inspection Brief description of the care home Church View is a purpose built care home providing nursing care and accommodation for up to forty-three residents. The home is part of the Hallmark Healthcare Group.
Care Homes for Older People Page 2 of 10 1 6 1 0 2 0 0 8 Brief description of the care home The registered manager post is currently vacant. The home is located within a residential development in Stratton St Margaret, situated on the outskirts of Swindon, and is within walking distance of a local shop. Accommodation comprises of twenty-nine single rooms and seven double rooms, located over two floors with all having en suite facilities. Residents also have access to a lounge and dining area on each floor and a ground floor conservatory, which leads out to an enclosed garden and patio area. As the home provides nursing care, registered nurses are on duty at all times and are supported by care assistants. Domestic, laundry, catering, maintenance and administration staff are also available. Current fees range from 469.44 pounds to 690 pounds. Information about the Funded Nursing Care Contribution (FNC) is provided by the company. Care Homes for Older People Page 3 of 10 What we found:
One inspector carried out this inspection in order to follow up an Immediate Requirement made at the main Key Inspection on 1st April 2009. This was an urgent requirement for the Registered Providers to staff the home appropriately in number and skill so that peoples basic needs could be adequately met. We also wanted to revisit specific areas of concern that were raised at the Key Inspection to ensure people were safe. We found during this inspection that the numbers of staff had been increased by one carer on each floor throughout the day time shifts. The Deputy Manager had also been allocated full time supernumerary hours (hours in addition to those allocated to the qualified nurses and carers and purely for management and supervisory puposes). These could be used across the home but she was predominantly focusing on the first floor where most of the shortfalls had been identified. We were informed by the acting manager that qualified nurses had been given supervision sessions regarding their leadership skills, which include effective organisation of daily routines and the monitoring of peoples overall care. The acting manager also said communication between staff was improving and that she was making daily visits to each care floor to monitor things for herself. We observed that most people were up and dressed, on the first floor, by 11.30 am. Those that were not had been given help to wash and had either chosen to stay in bed or were in bed because of health reasons. This is different to what we saw during the Key Inspection when some people had to receive this initial care after lunch. We observed lunch time starting at 12.25 pm with plenty of staff around to offer assisstance to those that required it. We can also confirm that we observed people being helped to have a drink at various times throughout this inspection which, was an improvement from the Key Inspection observations. Although there was evidence to suggest peoples needs were being met more effectively we will continue to monitor staffing levels at future visits to the home. The Immediate Requirement issued on the 1st April 2009 to increase staffing levels has been complied with. During the Key Inspection we were concerned that one person in particular had not been having a shower or bath. During this visit records told us that this person had received a shower twice since our last visit. We also saw from another persons records that they continued to be monitored by a visiting health care practitioner regarding a pressure sore. The difference seen on this inspection was that the home staff had also decided to keep this person in bed for the majority of the time to aid healing of the pressure sore. We were able to see from a previous picture of the wound that this was obviously helping. We were concerned that this person may develop constriction of the limbs but we were informed that they were getting up for short periods each day day. This person was also on a pressure relief mattress and was having their position altered. The use of bed rails on this persons bed had been reviewed and the persons safety at
Care Homes for Older People Page 4 of 10 night was being managed in a different way. We were told that assessments on the safe use of bed rails had been carried out on all people in the home and only eight still had these in place. The ones still in place had completed risk assessments and were the type that are integral to the profiling bed being used. We saw that all bed rail bumpers that had been considered unsafe had been discarded and new ones were on order. The home had also ordered two special mattresses that are designed to help people from rolling out of the bed because the edges curl upwards. We observed staff working in a calmer and more organised manner. One carer said it is calmer and not so manic. Another carer hoped the increased numbers of staff would last and explained that they had been passing on their concerns about the lack of staff for sometime now. We revisited the weight records of twelve people and saw that new scales had been delivered to the home and some weights had been redone to obtain an accurate reading (suspected problems with previous scales not giving correct readings). Some people still needed to be weighed at this point but, out of the twelve inspected nine had gained weight in either April or March and four had lost weight. Only one had lost a significant amount since their last recorded weight in February. Four people had been identified as requiring additional calories which were also being given mid morning in this inspection. This group included the person who had lost a significant amount of weight. This tells us that the staff are addressing the needs of people who are nutritionally at risk, although some thought may need to be given to how and when these extra calories are given as one person did not want their lunch and staff thought this maybe because they were full from their milky hot chocolate and mini choclate bar at 11am. We did not observe people being specifically helped to the toilet from the lounge area however, one person who did attract the staff attention for this reason, by banging their bedside table in their bedroom, was helped immediately to use the toilet facilities. We questioned where the persons call bell was and it was found to be alongside their bed nowhere near where they were seated. We brought this to the attention of the person in charge. There had been concern from visiting health care practitioners that the home often smelt of urine when they visited. We did not experience this on the 1st or 2nd April or during this inspection however, we did learn during this visit that the carpet cleaner being used on the day of this inspection was hired. We asked why and were told that the homes own one often broke down and that a new one was on order. We were informed that plans to refurbish the home are still in progress and that work on the patio doors, leading into the garden from the downstairs lounge, was due to start as soon as possible so that those in wheelchairs could have easy access to the garden. What the care home does well: What they could do better:
Care Homes for Older People Page 5 of 10 Arrangements at lunchtime still require consideration and review as people who had been taken to the dining table were still waiting for their meal for over an hour. Some people did not get their puddings until 1.45pm and staff are still in the situation of having to wait for more meals to be delivered to the floor before they can move on to assissting the next person. One member of staff confirmed that they could be waiting for up to twenty minutes. We were told that a hot trolley was being purchased in order to resolve this problem. Despite the increased monitoring and organisation of care work, one person ended up having two washes during this inspection, so we were concerned as to how successful this actually was in practice. The acting manager also thought the night nurse was helping the morning nurse by giving out some of the early morning medications where in fact this had not taken place at all according to one of the Registered Nurses. This Registered Nurse on the first floor had actually worked out a system with the Registered Nurse on the ground floor which saved her having to break off from the morning medication round to phone the GP surgery. Any visits by the GP to the home have to be requested before a certain time, so as the medication round is shorter on the ground floor this nurse had agreed to make requests on behalf of the first floor as well as her own. Therefore we felt that some aspects of communication were still a problem but in other areas staff are using their initiative to try and improve the working routine. We inspected peoples fluid intake charts and there had been some confusion in the recording of these again. A chart for one person implied that they had not received much fluid at all over a three day period. It was agreed that because this person liked to go downstairs to sit and it was probable that the fluid intake chart was staying upstairs and not being completed. This confirms that at times there is still disorganisation in the system, poor communication and poor record keeping. Senior staff had put an explanation of what each receptacle used in the home held, in milliliters in the front of the fluid chart folder so that staff had a guide as to what to write down once people had consumed their drink. Requirements have not been made as a result of this inspection however, the requirements made as a result of the Key Inspection commenced on 1st and 2nd of April 2009 still remain outstanding. As previously explained in this report the Immedaite Requirement issued on the 1st April 2009 has been complied with. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 8 12 People living in the home are 02/04/2009 potentially at risk and their health, safety and wellbeing is compromised. This is due to high levels of individual health and social care needs. The inadequate levels of staff in place means that the peoples needs are not met effectively. Provision must be made to adjust the levels of care staff throughout the home between 8AM-8PM, effective from 8AM on 02/04/09 By increasing the staffing levels people living in the home should be able to receive the care delivered to them as prescribed in their individual care plans in an effective save way. 2 9 13 Review all medicine records 08/07/2009 for people living in the home to make sure that for all medicines prescribed with a direction when required there is clear and detailed written guidance available to staff on how to reach decisions to administer. Also include how staff are to reach the decision to administer the medicine or a
Page 7 of 10 Care Homes for Older People Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action particular dose in accordance with the provisions of the Mental Capacity Act 2005. This particularly relates to some care plans not including all medicines prescribed when required or some not including enough information to guide staff. This will help to make sure that there is some consistency for people in the home to receive medication when necessary and in line with planned actions. 3 9 13 When medicines are 08/07/2009 administered to people living in the home you must keep complete and accurate records about the medication. This particularly refers to always recording the actual dose given where a variable dose is prescribed and to keeping records about all medicines received into the home when people are first admitted. This is to make sure that all medicines are accounted for and that people living in the home receive the correct levels of medication and are not at risk of mistakes with medication because of poor recording arrangements. Care Homes for Older People Page 8 of 10 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 9 of 10 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 10 of 10 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
