Inspection on 15/10/08 for Church View Nursing Home

This inspection was carried out on 15th October 2008.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Church View Nursing Home 29/09/09

Church View Nursing Home 15/04/09

Church View Nursing Home 01/04/09

Church View Nursing Home 15/08/07

Church View Nursing Home 14/06/06

Church View Nursing Home 30/01/06

Church View Nursing Home 01/11/05

Church View Nursing Home 09/02/05

Church View Nursing Home 06/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key 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     The quality rating for this care home is:   zero star poor service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sharon Hayward-Wright     Date: 1 6 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Church View Nursing Home Rainer Close Church View Nursing Home 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): Hallmark Healthcare (Swindon) Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : 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 Additional conditions: 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. The registered manager post is currently vacant. The home is located within a Care Homes for Older People Page 4 of 37 Brief description of the care home residential development in Stratton St Margaret, situated on the outskirts of Swindon, and is within walking distance of a local shop. Accommodation comprises of twentynine 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 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection took place over two days in October 2008. As part of this inspection a Pharmacist from our organisation (The Commission) also visited to review the homes medication systems. Prior to this visit we sent the home a number of surveys for people who use the service to complete. We received seven back and comments from these have been included in the report. We also spoke to people who use the service, any visitors to the home and staff during the inspection and their comments have also been used in this report. We looked at care records, medication systems, activities, staff records, complaints, quality assurance systems the home has in place and records relating to maintenance Care Homes for Older People Page 6 of 37 and ongoing checks on equipment used in the home. What the care home does well: What has improved since the last inspection? What they could do better: A more consistent approach is needed to care planning, and recording of information into care plans. One care plan examined was personalised but the other two were not. There was also conflicting information found in some peoples care plans. Specific care plans must be in place for people who are receiving end of life care. Improvements with the medication system is needed to make sure people are not put at unnecessary risk. The staff in the home must respect peoples dignity and choices and act upon peoples requests. The home must manage complaints according to its policy and make sure the appropriate actions are taken and recorded. Staff need to access training in relation to the local reporting procedures in case an allegation of abuse is received. Parts of the environment need to be redecorated due to damage and the decor looking tired. Care Homes for Older People Page 8 of 37 The home has reviewed its staffing since the last inspection but concerns were still raised that at times there is not enough staff on duty to always meet peoples needs. The home must undertake all the required recruitment checks prior to a member of staff starting work at the home and make sure the appropriate risk assessments are completed where required. The home needs to appoint a suitably qualified and competent person to manage the home and apply to us to be considered for registration. A system must be put into place to make sure staff are appropriately supervised. An evacuation procedure must be devised as a matter of urgency to make sure people who use the service are not put at unnecessary risk. 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 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 37 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has systems in place to make sure people who may use the service receive an assessment of their needs and assurance from the home that these can be met. Evidence: The systems the home has in place for managing the Funded Nursing Care Contribution (FNC) were examined. Information about how the home manages this contribution is included in the service agreement. A copy of a letter that was sent to people last year was seen as it provided information about the changes to the amount people receive for the FNC. The home is due to send a letter out this year regarding the changes in the FNC amount. A pre admission assessment of a person who was recently admitted to the home was examined. The home had already contacted us (The Commission) to discuss this person due to their health needs. An assessment of their needs was in place and this Care Homes for Older People Page 11 of 37 Evidence: included their past medical history and medication. This was completed prior to their admission and an external health professional had also completed an assessment of which the home had a copy. The person completing the assessment from the home had not signed or dated the assessment form and consideration should be given to make sure all staff sign and date any entries in peoples care records. A copy of the letter the home sends to people confirming their needs can be met was seen. Church View Nursing Home does not provide intermediate care. Care Homes for Older People Page 12 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is mostly based on their needs, however peoples care records do not reflect this or always provide staff with current information. The actions of some staff do not respect peoples privacy and dignity. There are some safe arrangements in place for the management of medicines but the inspection highlighted particular weaknesses where improvements in these arrangements are needed so as to always protect people living in the home from unnecessary risks with medication. Evidence: Three people were chosen at random to have their care examined in detail. This includes reviewing care records, speaking to the person where able and observing staff interactions and speaking to staff. One person was new to the home and the other two people had been living at the home for a number of years. All three people had an ongoing assessment of need that had evidence of ongoing reviews. However one persons contained differing information to what was written in their care plans and Care Homes for Older People Page 13 of 37 Evidence: this will need to be amended. There were some inconsistencies between the three care plans for example one person had an activities report and a menu preference questionnaire but the other two people did not. All three people had care plans in place for their identified needs but these did not always contain detailed information about peoples individual needs. This means staff do not have the correct information available for them to meet the assessed needs of people who use the service. For example one persons care plan for personal care does not include how many staff are needed and what they have to do to meet this persons needs and if they have any personal presences. One person did have very detailed individual care plans in place that listed their personal choices. Written in some care plans were actions that could not be measured for example one person had written in their care plan for pressure area adequate nutrition and hydration, there was no other instructions for staff to follow and this cannot be measured. In another persons care plan it was written that they need a good dietary intake and 2 litres of fluid a day, however this person also had a care plan for poor dietary and fluid input, therefore these care plans contradict each other. More examples where statements had been written in care plans that require more detail include, assess pressure areas and bath as per schedule. The second comment does not allow the person any choice and indicates that the person is bathed to suit the service and not the person. Consideration must be given for staff not to use the word regularly as it is not descriptive enough and staff must be given clear instructions. In one care plans staff had used medical symbols and not plain English which could mean that not all staff will know what it means. This is poor practice. All care plans had evidence that they were reviewed mostly monthly and any changes were documented in the evaluation sheet, however consideration should be given to writing any changes directly into the care plan to make sure staff have access to the most up to date information in one place about how to meet peoples needs. One person has communication difficulties as they speak another language. The staff had included the family in their care and had listed some phrases for staff to use to help which is good practice. Copies of these are displayed in this persons room. One person is receiving end of life care. No specific care plan was in for place palliative care but some information had been obtained from the family and some information had been included in some of their other care plans. The staff must devise a specific care plan on how they plan to meet this persons needs and choices in relation to their end of life care. Several members of staff were asked about the care they provide to these three people and all staff demonstrated a good understanding of each persons needs. On the first day of the inspection it was noticed that the people sat in the upstairs lounge did not always have their legs supported. This was reported to the qualified nurse on duty as it could place people at risk of pressure sores and foot drop. This was rectified immediately once it was pointed out to the staff. Risk assessments were in place for moving and handling, falls, pressure sores and Care Homes for Older People Page 14 of 37 Evidence: nutrition and there was evidence of reviews but these were not always consistent for example one person who was assessed as being nutritionally at risk had not had their nutritional risk assessment reviewed since January 2008 and one person who has a risk assessment for bed rails had not had this reviewed for 9 months until it was reviewed in August 2008. People who were identified nutritionally at risk had evidence that they were being weighed on a frequent basis, some people were weighed weekly whereas other people were weighed monthly. Records were seen of external professionals input into peoples care and these include their GPs, Chiropodists, Dentist and Opticians. Two people who had their care examined in detail had input from a Tissue Viability Nurse (TVN) for their wound management. Wound documentation was in place for people who had wounds or pressure sores. Arrangements were also underway for people to have a hearing test in October. We received seven surveys from people who use the service and in them we asked people if they felt they receive the care and support they need. Three people said always and four people said usually. One person had written Always met with kindness. As part of this key inspection one of our (The Commission for Social Care Inspection) pharmacist inspectors looked at some of the arrangements for the management of medicines. The pharmacist looked at some stocks and storage arrangements for medicines, some medication records and procedures. We saw a nurse administer some medicines and spoke to one person living in the home about his or her medication. We talked with the acting manager and two registered nurses. Registered nurses were responsible for the management of medication on behalf of people living in this home. At the time of the inspection nobody was assessed as able to self-administer medication. We saw one of the nurses administering some medicines during the morning and at lunchtime when most people were sitting at the table in the dining room. We were concerned that the times when medicines were administered did not always leave a sufficient interval between doses. One person was given some paracetamol only two and a half hours after a previous dose when a minimum four hour interval is necessary. Staff could consider administering some medicines such as painkillers earlier in the morning so that there is a more even spread of doses throughout the day and people living in the home experience a better effect from the medicines. We also noted that a nurse did not always make an immediate record of medicines administered as when we arrived the charts for a number of people were signed together. We also saw that some medication was carried to bedrooms just in a medicine pot without the medicine chart and labelled containers immediately to hand to check. These are both considered poor practices that can lead to mistakes. We discussed with the acting manager about finding out each persons choice about where they wanted their medicines and if it respected their dignity and privacy for certain medicines to be administered in public in the dining room at a meal time. For example the nurse gave one person an inhaler to use at the lunch table; this person was not Care Homes for Older People Page 15 of 37 Evidence: eating at the time but was waiting for sweet having finished the first course. In discussion, the deputy manager said staff had not identified any diversity or equality issues relating to medication. We spoke to one person living in the home and their relative who was visiting. This person said they was happy living here, were well looked after and can ask for pain relief when it is needed. For each person living in the home there were arrangements for recording medication received, administered and leaving the home or disposed of (as no longer needed). Complete and accurate records about medication are important so that there is a full account of the medicines the home is responsible for on behalf of the people living there and so that people are not at risk from mistakes, such as receiving their medicines incorrectly. We looked at a sample of records and these generally appeared to be in order but we identified some matters where more attention and action was needed. Some medicine charts must be kept up to date as they listed medicines that presumably were no longer in use as there were no records of doses administered. In a few cases the allergy section on the medicine chart was not completed and when a variable dose was prescribed (one or two tablets for example) the actual dose the nurses gave was not always noted. Some medicines for two people were marked on the records as not being in stock. Failure to administer medicines as prescribed could be a risk to the health of the people concerned. The nurse was making arrangements with the doctor to urgently obtain another prescription in one case. Some medicines were prescribed to use only when required. The nurses we spoke to had a good knowledge of people living in the home and was able to explain about when some of these medicines were used. We found there was very little if any information on the medicine records or in the care plans to give clear written direction to all nurses about how these medicines were intended to be used to meet identified needs in a consistent way and in accordance with the provisions of the Mental Capacity Act 2005 - (for example for pain relief, night sedation or laxatives). We looked at some care plans where people had particular health needs and treatment with medicines. We found that although these were identified in the plans more specific information was needed so that all staff would have written direction about meeting these peoples needs in a consistent and planned way. Safe storage arrangements were generally provided for medicines but storage arrangements for controlled medicines were not large enough so that not all medicines in this class were stored in accordance with The Misuse of Drugs (Safe Custody) Regulations 1973. This is necessary to make sure such medicines are stored safely and legally. We strongly recommend improved storage and recording arrangements for a particular liquid medicine we found in the medicine trolley on the first floor. In the medicine fridge we saw a small specimen bottle with a sample taken from a person living in the home and one of the medicine cupboards was also used to store other valuables such as rings. Both of these examples are poor practices. We found some medicines and dressings that were beyond their expiry date. Two of six eye drop bottles did not have a date of opening so that it was not possible to know when to Care Homes for Older People Page 16 of 37 Evidence: discard after four weeks in use to prevent risks from microbial contamination. All medicine storage areas therefore need to be carefully checked on a regular basis to make sure that stock is rotated properly. Writing opening dates on all medicine containers and recording quantities of medicines carried forward at the end of each month are useful ways to audit medicine use and help with stock control. The lancing device the nurses used to obtain capillary blood samples (to measure blood glucose levels) on a number of people living in the home was not in accordance with Medical Device Alert MDA/2006/066 dated 6th December 2006. This can put people living in the home at a known risk of transmission of blood borne infection. Staff are also at risk from needlestick injury and cross contamination. The correct lancets are available on NHS prescription. There was a new medication policy and procedures available so that all staff were aware of how the company expected medication to be handled in a safe way. The medicine procedures that were available on the medicine trolleys must be discarded, as they were obsolete and replaced by the new care practices and procedures. There was a basic monthly medication audit sheet that the previous manager had completed. Checks like this are good practice but do need improving to be effective in identifying issues such as were highlighted as a result of our inspection. Staff were observed speaking to people in a respectful manner. However concerns about peoples privacy and dignity were identified during the inspection. On the first day of the inspection the hairdresser was cutting and setting peoples hair in the dining room whilst other people were eating and undertaking activities. This is poor practice. Whilst observing a mealtime one person asked a member of staff to take them to the toilet, the staff member said they had to wait. This person then continued to mention to the person next to the that they were desperate for the toilet. The two staff members continued to give out meals and then give this person their lunch despite them asking for the toilet. We had to intervene at this point and report this to the nurse in charge. This is bad practice as the staff had the opportunity to ask the cook to stop serving meals, as they were using a heated trolley, whilst they took this person to the toilet. This action by the staff could have resulted in this person being incontinent through no fault of their own. Care Homes for Older People Page 17 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their lives, however the actions of some staff mean these are not always respected. Recreational activities are provided to help meet peoples interests and social needs. Evidence: In the last few months the home has appointed an activities coordinator to plan activities for people who use the service. These include group activities, one to one and outings. The home has had themed weeks for example when the Olympics took place and for Harvest Festival. Outside entertainers that visit the home, normally on a monthly basis, include impressionist and musicians. The hairdresser visits weekly. At the time of the inspection the home was providing for peoples spiritual needs with a monthly church services and one person who was a practicing Catholic was having visits from a Priest. People spoken with said they could make a choice about whether they took part in activities and several people said they prefer to make their own. One person said they enjoy the bingo sessions. In the surveys we received from people who use the service; we asked are there activities arranged by the home that you can take part in. Three people said always, two people said usually and two people said sometimes. Comments we also received were, Wish there were more activities and Care Homes for Older People Page 18 of 37 Evidence: that we could be taken out more, and what happened to minibus for outings which has been talked about, Activities are arranged and the variety is good but sometimes my relative is too tired to take part, but they do like to watch though and enjoys what she can. It was observed during the inspection that the Television programmes that were on in the upstairs communal room were not appropriate for the people sat in there as they were childrens programmes. Staff need to be mindful of what programmes are on the television. No restrictions are placed on visiting and a number of visitors were seen during the inspection. Several were spoken with and all said they are made to feel welcome when they visit and they can come at a time convenient for them. One person said their family takes them out on a frequent basis and they also go to visit a relative at another care home. During a tour of parts of the home a number of rooms belonging to people were viewed. People are able to have their personal belongings on display and some items of furniture. People who were spoken with said they are able to make choices about their daily lives and people were asked in the surveys we sent; do the staff listen and act on what you say. Six people said yes and one person said usually. An incident that was mentioned in the previous outcome group where staff did not act upon the request of a person is a concern and actions need to put in place by the home to prevent this from happening again. The homes cook was spoken with and she has been working at the home for a number of years. The cook devises the menus and she is aware of the likes and dislikes of people who use the service. Each day people are asked what they would like from the menu and therapeutic diets are catered for. On one of the days of the inspection for the lunchtime meal people had two choices and alternative was provided for one person who is a vegetarian. Staff were observed assisting people in a discreet manner and were always sat down when helping people with feeding. People are also offered drinks with their meal. The feedback received during the inspection in relation to food was good. In the surveys we sent out people were asked do you like the meals at the home. Five people responded to this question, one person said always, two people said usually and two people said sometimes. Comments received were food isnt very varied, meat frequently over cooked, lots of pastry and stodge not much in the way of nutritious filling and not much fresh fruit. Records were seen of health and safety checks undertaken in relation to food and the kitchen. Food records are in place but they are not documenting the evening meals. Care Homes for Older People Page 19 of 37 Care Homes for Older People Page 20 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their views using the homes complaints procedure. However the home is not acting upon these to make sure people are safeguarded. Evidence: The homes complaint records were examined and since the last inspection 16 complaints were recorded. In some of these the home has not met the required 28 days timescale for a response, some did not have full records of the outcome of the complaint or any action that might have been taken. Several complaints were regarding possible thefts of peoples belongings. No evidence could be found of the Police being contacted and in one complaint the home reimbursed the person for the missing items; whilst it is recognised that the home was thinking of the person they should have contacted the Police prior to this gesture being made. From the evidence seen the home is not responding to complaints in a robust way and the standard of record keeping is very poor and the home is not safeguarding people. In the surveys we sent to people we asked them do you know who to speak to if you are unhappy, six people responded to the question; four people said always one person said usually and one person said never. We also asked them do you know how to make a complaint. Six people responded, five people said yes and one person said no. One person commented I would tell my next of kin who deals with the situation. Care Homes for Older People Page 21 of 37 Evidence: The systems the home has in place to help safeguard people who use the service were examined. In every persons room a booklet is provided by the local Council which informs them about the safeguarding procedures for that area. The acting manager said that as part of of the induction programme for new staff they receive in-house training about abuse. The home was not able to find evidence that all staff have received training in the local reporting procedures for allegations of possible or actual abuse. Two qualified nurses were asked about the local reporting procedures and both did not know what to do, however they both said they would report it to the acting manager. This needs to be rectified urgently to make sure people who use the service are safeguarded. The home does have policies and procedures in place for staff to follow in relation to safe guarding of people and these include abuse, whistle blowing and aggression towards staff. However it would appear that some staff are not following these procedures following an incident with a member of staff and some relatives. Care Homes for Older People Page 22 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service live in a comfortable and, on the whole, clean environment. Evidence: Church View Nursing Home is set in a residential area. It has two floors and a shaft lift and stairs provide access to the upper floor. Outside to the rear of the property is a garden area and car parking is at the front of the home. A tour of parts of the environment took place and a number of rooms belonging to people were seen. The decor of the home is looking tired in places and there is damage to the majority of doors and frames. A Representative from the company said they are aware that the home needs redecorating and they are looking into this. People who are assessed as requiring a height adjustable bed all had electric beds in place. Lockable facilities have now been provided for people in their rooms. Storage of hoists appears to be an issue as they are stored in corridors which makes the home look cluttered. Hairdressing was taking place in a communal room where people were eating and others were taking part in activities, this is not good practice and the home must look at alternative arrangements. No concerns were found with the cleanliness of the home at this inspection and no odours were present. In the surveys we sent to people we asked them is the home always clean and fresh. Of the seven surveys we received six people answered this question. Two people said always and four people said usually. Care Homes for Older People Page 23 of 37 Evidence: Comments included sometimes bits are left on my relatives floor but the communal rooms are always clean and fresh and the garden neat and En-suite bathrooms could be kept cleaner. It was noticed that during the tour of parts of the home that the domestic staff were leaving their cleaning trolleys unattended and they contained cleaning materials. This could potentially place people at risk and staff must not leave these unattended. The laundry area was not seen at this inspection but staff said they have a procedure to follow in relation to the management of soiled linen. Staff were seen to be wearing protective clothing when required. Care Homes for Older People Page 24 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home have access to training but this is not always up to date and sufficient numbers of staff are not always available to meet the needs of people who use the service. Evidence: Since the last inspection the acting manager said that they have reviewed the staffing levels and duty rotas to help to make sure extra staff are on duty at mealtimes. The acting manager is extra to the staffing numbers. Ancillary staff are available to support the care staff. People who use the service that were spoken with said the staff were very good and one relative also said the same. In the surveys we sent to people we asked are the staff available when you need them, all seven people answered this question. One person said always and six people said usually. Comments include sometimes staff are slow to answer the bell in my room and sometimes they are busy with another resident. Five members of staff were spoken with during the inspection and all said they enjoy working at the home. Two of these were new members of staff who said they are well supported by the existing staff. Some members of staff said there are times when they are short staffed and we have received a number of notifications were the home informs us when they work under their allocated staffing levels. The acting manager informed us that the home has appointed several new members of staff and this will improve the situation. Care Homes for Older People Page 25 of 37 Evidence: The acting manager said that 10 of the care staff have NVQ 2 or above in health and social care and this equates to 61 which means the home exceeds the recommended 50 of care staff trained or undertaking NVQ 2 or above. The acting manager said that the ancillary staff are also undertaking qualifications in NVQ. Three personnel files of staff that had commenced working at the home since the last inspection were examined for the required recruitment checks. All had the required checks in place except for a full employment history where any gaps must be fully investigated. On checking the Criminal Records Bureau Disclosures for all staff it was noticed that 3 staff had conviction/cautions but no evidence could be found of a risk assessment to make sure people who use the service would not be put at unnecessary risk. One recorded offence was very serious and the home should have acted upon the information received. Induction training is provided in house via e-learning and the acting manager said it is based on the Skills for Care Common Induction Standards. Each new member of staff has 5 days supernumerary where they shadow other staff. A certificate is issued on completion and one was seen. The home did not have any recorded evidence that new staff are allocated a mentor where they would work with this member of staff where possible and they can monitor the progress of the new member of staff. This must be addressed. The acting manager said the home has a training matrix in place that allows her to see when staff are due an update or further training. A number of gaps were seen where staff are due an update and this includes moving and handling due to some issues identified with staff practice. Some health and safety training is also required and this includes first aid training. Some staff have undertaken training in dementia care which is good practice and the home should consider providing this for all care staff. Staff spoken with confirmed that they have access to training. Care Homes for Older People Page 26 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Without a competent and appropriately qualified person to manage the home this has meant that at times it is not run in the best interests of people who use the service. Evidence: The home has not had a Registered Manager in post for a number of years. The last manager did start our registration process but decided to leave the home and withdrew their application. At the time of the inspection interviews were in process to appoint another manager. As the home does not have an appointed person to oversee the management and administration it has led to issues not being identified and acted upon. Once a new manager is in post they must apply to us to be considered for registration. The quality assurance systems the home has in place were examined. Regulation 26 visits are taking place but they are not looking at complaints and if this had happened the issues identified at this inspection could have been found. Copies of these reports Care Homes for Older People Page 27 of 37 Evidence: must now be sent to us at our Bristol office address. The last audit of the home took place by the last home manager in September 2008 and it covered a number of areas for example looking at monitoring peoples weights and accidents, this is good practice. The acting manager is also investigating two issues that she has identified and these relate to care issues, again this is good practice. External professionals have been involved in one investigation. Meetings for people who use the service have taken place and the last one was in August this year. Staff meetings also take place. The administrator for the home said that the views of people are obtained by the company that owns the home as surveys are sent out to them, however no report was found in the home that detailed responses. Surveys are available in the main entrance for people and visitors to the home. The home has safe systems in place for the management of peoples monies. The system the home has in place for staff supervision was examined. The acting manager was due to undertake supervision with the qualified nurses on the first day of the inspection. A list is in place for when each member of staff is due a supervision session. A number of staff files were randomly selected to follow up on how many sessions staff were receiving. From checking five staff files the home does not have a consistent system in place and they are not meeting the recommended six times per year for care staff. This should be addressed. Maintenance records and ongoing checks of equipment were seen. The home has a fire risk assessment in place but not an evacuation procedure and this must be addressed as a matter of urgency. Checking of fire equipment was up to date and there was evidence of training in fire safety. A health and safety policy was in place and there was a meeting for staff held in September 2008 relating to health and safety. Care Homes for Older People Page 28 of 37 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 14 12 (2) The registered person is 16/08/2007 required to ensure that, as far as practicable, service users are enabled to make decisions with respect to the care they receive. The registered person is required to appoint a manager and apply for their registration with the Commission. 01/12/2007 2 31 8 (1,a,b) Care Homes for Older People Page 29 of 37 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, Care Homes 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 1 7 14 The assessments of peoples 22/01/2009 needs must be kept under review and updated with any changes. This will help to make sure that the care that is planned for people is based on their current needs. 2 7 15 People who use the service must have care plans in place that reflect their individual needs and kept under review and updated with any changes. This will help to make sure that staff have access to up to date information about peoples assessed needs. 31/01/2009 3 8 15 People who use the service that have risk assessments in place must have them kept under review and updated with any changes. 31/01/2009 Care Homes for Older People Page 30 of 37 This will help to make sure that staff have access to up to date information about peoples assessed needs. 4 9 13 Provide sufficient storage arrangements for all controlled drugs in accordance with the Misuse of Drugs (Safe Custody) Regulations 1973. This is to make sure all these medicines are stored securely and in accordance with the law. 5 9 13 When staff take blood samples for blood glucose monitoring make sure that all lancing devices used comply with the action contained in MDA/2006/066 and are safe to use in care homes. This is to protect people living in the home and staff from known risks of cross-infection linked with the use of the wrong sort of lancing device. 6 9 13 When medication is prescribed for use when required or with a variable dose or when people are receiving more complex treatment with medication make sure there are always clear written directions to staff about the use of the medicines and how to make decisions about 09/01/2009 09/01/2009 31/01/2009 Care Homes for Older People Page 31 of 37 administration for each person and medicine and in accordance with the provisions of the Mental Capacity Act 2005. This will help to make sure there is some consistency for people to receive the correct levels of medication in accordance with their needs and planned actions. 7 9 13 Improve the arrangements 09/01/2009 for the safe administration of medicines so that staff follow safe procedures and doses are administered within an acceptable period of the stated dose time and there are suitable and safe intervals between doses throughout the day. (This relates particularly to the timing of some of the 8am medicines and staff carrying single doses of medicines around the home in medicine cups.) This is to help make sure that people living in the home receive the correct levels of medication at suitable time intervals for effective treatment and are not at risk because of wrong dose intervals. 8 9 13 Take action to make sure that there is a safe system 09/01/2009 Care Homes for Older People Page 32 of 37 in place to monitor that medicine stock levels are sufficient and and that medicines are suitable to use particularly with regard to expiry dates. This is to help protect people from either not having their medication available or only having an unsuitable supply of their medicine. 9 10 12 The actions of staff must not 09/01/2009 affect peoples health, welfare and dignity. This will help to make sure that people who use the service are not put at risk by the actions of staff. 10 14 12 People who use the service must have their decisions and choices respected and acted upon by the staff. This will help to make sure that the service respects peoples choices in relation to their health and welfare. 11 16 22 The homes complaint 09/01/2009 procedures must be followed to make sure the views of people are listened to and acted upon appropriately. To make sure people feel confident that their views will be listened to and acted upon. 05/01/2009 Care Homes for Older People Page 33 of 37 12 18 13 The staff in the home must 09/01/2009 be made aware of the local reporting procedures in case an allegation of abuse is made. This will help to safeguard people who use the service. 13 26 13 The staff in the home must make sure that cleaning materials are not left unattended. This is to prevent people who use the service from possible risk of harm. 09/01/2009 14 29 19 The home must make sure that all the required recruitment checks are undertaken prior to the new member of staff starting work at the home. This will help to safeguard people who use the service. 23/01/2009 15 30 19 The home must appoint a mentor for each new member of staff that is appropriately skilled to undertake this task. This will help to make sure that new staff are inducted into the home in a safe manner to reduce any risks to people who use the service. 23/01/2009 16 31 8 The home must appoint a suitably qualified and competent person to manage the home and they must apply to us to be considered for registration. 20/02/2009 Care Homes for Older People Page 34 of 37 This will help to make sure the home is run in the best interests of people who use the service. 17 36 18 A system must be put into place to make sure staff are appropriately supervised. This will help to make sure staff can meet the needs of people who use the service. 23/01/2009 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 1 2 3 7 Staff that undertake assessments should sign and date the form. Staff should not use the word regularly in care plans as it is not descriptive enough and staff need to be provided with specific instructions. Review medication administration records to make sure that the known allergy section on each chart is completed. Care plans must reflect what choices people who live in the home were given and have made about how their medicines are administered and their consent to the way in which staff administer their medicines. (This particularly relates to the administration of some medicines during meals times and in a public area.) Store and keep records for the particular liquid medication identified at the inspection as for a full controlled drug. The home should record the evening meal that is provided for people. The home should make sure that all the gaps found on the training matrix are filled and that staff receive training so they can undertake their job roles competently. The home should devise their evacuation procedure without delay to make sure people who use the service are not put Page 35 of 37 3 9 4 9 5 9 6 7 15 30 8 38 Care Homes for Older People at risk. Care Homes for Older People Page 36 of 37 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk 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) Commission for Social Care Inspection (CSCI). 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