Inspection on 15/07/08 for Church View (Nursing Home) Limited

This inspection was carried out on 15th July 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Church View (Nursing Home)... 19/08/09

Church View (Nursing Home)... 06/01/09

Church View (Nursing Home)... 18/07/07

Church View (Nursing Home)... 31/05/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Church View (Nursing Home) Limited Princess Street Accrington Lancashire BB5 1SP Lead Inspector Jane Craig Unannounced Inspection 15th July 2008 09:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Church View (Nursing Home) Limited Address Princess Street Accrington Lancashire BB5 1SP 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) 01254 386658 Church View (Nursing Home) Limited Manager post vacant Care Home 40 Category(ies) of Dementia (18), Old age, not falling within any registration, with number other category (22) of places Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing: Code N, to people of either gender, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category: Code OP (maximum number of places: 22). Dementia - Code DE (maximum number of places 18) The maximum number of people who can be accommodated is: 40. Date of last inspection 18th July 2007 Brief Description of the Service: Church View Nursing Home was purpose built in 1990. The home is registered to provide 24 hour nursing and personal care for up to 40 residents, some of whom may have dementia. Accommodation is provided on 2 levels. The first floor comprising only four rooms and a lounge. A stair lift provides access to the first floor. All other accommodation and facilities are on the ground floor. The floor has been split to provide a dementia care unit, which is separated from the other part of the home by a door with a coded lock. Each unit has its own lounge and dining area. There are gardens and a car park for visitors and staff. The home is situated in a quiet residential area in Accrington close to local amenities. The current fees are available on request from the home manager. Additional charges are payable for hairdressing, newspapers and transport for hospital visits. A copy of the statement of purpose and service user guide is available to prospective service users on request. Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. A key unannounced inspection, which included a visit to the home, was conducted at Church View Nursing Home on the 15th July 2008. There had been one additional visit since the last key inspection. This was carried out on 14th February 2008 and was to follow up concerns that had been raised about the standard of care of a person living at the home. The findings of that inspection are available on request. At the time of this visit there were 25 people living at the home. The inspector met with a few and asked about their views and experiences of living at Church View. Some of their comments are included in this report. Three people living at the home were case tracked. This meant that the inspector looked at their care plans and other records and talked to staff about their care needs. As part of the key inspection a number of surveys were sent out to people living and working at Church View. Six people using the service and two members of staff returned them. One relative also completed a survey. During the visit discussions were held with the acting manager, the regional manager, members of the staff team and a visitor. The inspector looked round the home and viewed a number of documents and records. This report also includes information from the Annual Quality Assurance Assessment (AQAA), which is a self-assessment that the manager has to fill in and send to the Commission every year. What the service does well: People who completed surveys all said that they received the care and medical attention they needed. At the time of the inspection one person said that he liked the home because they look after him very well and give him his medicines. A relative who completed a survey wrote, “I have always found the nurses and carers very helpful while my mother has been ill and confined to bed.” During the course of the inspection staff were heard to address people with respect. A member of staff said she felt strongly about promoting people’s Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 6 privacy and dignity and said, “You have to think how you or your family would want to be treated.” Everyone who was asked said they liked the meals. One person said that she only liked very plain food and the cook tried very hard to accommodate her. Everyone who completed a survey indicated that they always or usually liked the meals. There was open visiting at the home which meant that people could see their visitors at times that were convenient to everyone. One person said that the staff had always been very good to her whenever she visited the home. People using the service were given a copy of the complaints procedure and everyone who returned surveys said they knew who to speak to if they were unhappy about their care. People who returned surveys said the home was always clean and fresh. People were encouraged to personalise their bedrooms with small items of furniture, ornaments and pictures. Everyone who was asked said they liked their bedrooms. Over half of the care staff held an NVQ level 2, which is a nationally recognised qualification in care. What has improved since the last inspection? There was a new brochure, which told people who were thinking of moving into the home what facilities they could expect. It also explained some important procedures such as how to make a complaint. The manager assessed anyone thinking of moving into the home. Following the assessment she wrote to tell them whether or not their needs could be met at Church View. This meant that people could be confident that they would receive the right care. New staff had induction training when they started work in the home. This helped to make sure that they had the basic knowledge and skills to understand and meet the needs of the people living at the home. The ways of assessing and monitoring the quality of the service had improved since the last inspection. People living at the home, and their relatives, had been asked to complete surveys giving their opinion of the service and how it could be improved. The manager also held meetings where residents and staff could air their views. The systems for looking after people’s money had improved. There were clearer records to show when residents gave money for safekeeping and when it was returned to them. Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 7 What they could do better: Everyone should receive a copy of their terms and conditions of residency at the time they move into the home. This is so that there is no potential for misunderstandings about what services and facilities should be provided. Care plans must clearly identify the needs of people who have dementia and provide sufficient directions for staff to meet those needs. All care plans must be updated as and when the person’s needs change so that staff have up to date and accurate directions about the care to be provided. In order to protect the health and safety of people living in the home, risks to their health must be assessed and plans to minimise the risks must be put into place. This also includes risks associated with using chairs that restrict people’s mobility. Some medication practices were unsafe and could place people at risk. The manager and registered nurses, who are responsible for managing medication, must make improvements in the way medicines were recorded and administered. In order to promote dignity and self-esteem and to reduce the risk of cross infection, everyone should have toiletries that are kept for their own use. To make sure that all parts of the home remain safe and reasonably decorated, there should be a programme of routine maintenance and a plan for future redecoration and renewal of furnishings. A number of people living and working in the home, and two visitors, said that there were not always enough staff on duty. The manager should review the staffing levels in the home and make sure that there are always enough staff to meet the individual needs of the people using the service. All staff who work with people with dementia should have relevant training to ensure that they have suitable skills to meet the specialist needs of this group of people. The records of training should be brought up to date and staff should have sufficient training in health and safety topics. In order to safeguard people using the service the manager must make sure that new staff have all the required pre-employment checks before they start work in the home. In order to protect people living and working in the home, all staff must have fire safety training. Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People had sufficient information to enable them to make a decision about moving in but the lack of contracts meant their rights may not be understood. EVIDENCE: The combined statement of purpose and service user’s guide was available on request. The document needed some minor updates and further information to reflect the type of service provided. People thinking about moving into the home were given a brochure. This had recently been updated and provided comprehensive information about what people could expect from the service and the day-to-day routines in the home. Four out of six people who returned surveys stated that they received enough information about the home to help them make a decision about moving in. Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 11 A number of people had not been given a contract or terms and conditions of residency. This could lead to misunderstandings about people’s rights and the provider’s responsibilities. People were generally referred to Church View after they had been assessed by health or social care professionals. Copies of those assessments were on files. The manager of the home had also assessed the most recent resident to make sure that facilities and staff team at Church View could meet her needs. Although most of the essential information about the person’s health and personal care needs was recorded, the assessment was not complete. As recommended following the last inspection, the manager wrote to prospective residents confirming whether or not their needs could be met at Church View. Standard 6 was not applicable. Intermediate care was not provided at Church View. Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all of the care plans provided staff with the information they needed to satisfactorily meet residents’ personal and health care needs. Some medication practices were unsafe and could place people at risk. EVIDENCE: Care records for three people were inspected as part of the case tracking process and others were looked at to check specific issues. All three people had general assessments of daily living activities on their files. Some had been updated but others had not. This resulted in a lack of clarity about the person’s current needs. For example, one person’s assessment indicated that he was fully self-caring but all other records showed he was dependent on staff to meet most of his needs. Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 13 Most care plans to support people to maintain their personal hygiene were person centred and contained sufficient detail to ensure that staff provided the correct support. Other care plans were not so specific and included vague directions for staff, for example, to provide, ‘regular checks’ or ‘offer extra fluids’. Vague instructions may result in misunderstandings and inconsistencies in care. Although there were a few good, personalised, interventions to assist staff to communicate with people with dementia, these were not consistent. In general, staff did not have sufficient instructions to support people with individual needs associated with memory loss, disorientation and difficult to manage behaviour. For example, the care plan for one person indicated that they had increased aggression, repetitive behaviour and were wandersome but there was a lack of direction for staff to provide care with regard to these behaviours. Care plans were reviewed every month. The review notes had generally improved since the last inspection and gave a summary of progress and care provided in the previous month. Any changes in the person’s health or care needs were usually recorded in the reviews. However, care plans were not always updated to include this information. For example, one person had a plan for an eye infection. The review notes, written several months ago, indicated that there was no longer any infection present but the plan had not been altered. This meant that new or temporary staff would not be sure what care to give. Another person had been referred to their GP and dietician because of steady weight loss. Their care plan had not been changed to incorporate advice from either of these professionals. This could result in information being ‘lost’ or new directions for care not being incorporated into day-to-day practice. Some people had a signed document on their files indicating that they agreed with their care plans. Other plans showed no evidence of consultation with the person, their family or advocate. All the care files seen included health care risk assessments. Plans to minimise the level of risk were not always in place. For example, one person was assessed as very high risk of developing pressure sores. There was nothing on the appropriate care plan about positional changes to minimise the risk, although the progress notes occasionally mentioned that positional changes had been carried out. Another person’s plan indicted that they may be at risk of being undernourished because they had poor concentration and were not able to stay at the table to finish their meal. A member of staff talked about what they had put into place to avoid the person becoming malnourished but it had not been written in the care plan, which meant that it might not become part of everyday practice. Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 14 As required following the additional inspection, wound care plans and assessments were in place and were being followed. There was evidence on all files seen that people had access to GPs, District Nurses and other health professionals as needed. Everyone who returned a survey indicated that they received the care and medical support they needed. During the inspection people said that they were well looked after and one person who had recently returned from hospital said they were glad to be back. One person on the dementia care unit sat for the whole day in a special chair that restricted her movement. Her care plan indicated that this was because she was safer there and did not try to get up. There was no assessment to show that the chair was the most appropriate solution to minimise the risk of falls. In addition there was no assessment to show that risks associated with restricted movement had been assessed. Another person was restrained by a lap strap in a wheelchair for the duration of the inspection. There was nothing in their plan of care to indicate why they could not sit in an armchair. Registered nurses managed all medication. Some medicines were ordered directly by the chemist, which meant that staff were not able to carry out checks and identify any errors before the medication was dispensed. One person administered some of their own medicines. There was no risk assessment in place to support this. Records of medicines received into the home were not complete. There were no records of stock carried forward from the previous month and no dates of opening on packets. This meant that there was not a complete audit trail. There was a new system for recording medicines leaving the home and, as recommended at the additional inspection, all medicines were disposed of appropriately. There were several handwritten entries on Medicine Administration Record (MAR) charts that were not signed and witnessed. This increases the risk of transcribing errors. Most people had clear written criteria to alert staff when to give medicines that were prescribed ‘when required’. This helped to prevent under or over medicating. Variable doses were not always recorded, which meant that staff could not audit the effectiveness of a particular dose. It was noted that medication was left for a resident to take unsupervised. This was in a dining room where there were people who would not be aware of the potential danger of taking someone else’s medication. The dining room was un-staffed for periods of time. Discussions took place with the manager to ensure that this unsafe practice ceased. Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 15 One person was prescribed a regular dose of medication but twice in the month had only received half of the dose. There was no written explanation for this. There were some gaps on MAR charts, again without explanation, which may indicate that medication had not been given as prescribed. One person was prescribed a controlled drug every 72 hours. Records showed that one dose was administered two days late, but there was no explanation for this. The resident declined the next dose but there was no indication that it was offered again within the 72 hour cycle. This meant that the person might not have received adequate pain control. All other controlled drugs were administered as prescribed, and recorded and stored according to the policy. Medicines were stored safely. Staff monitored the temperatures of storage areas and ensured they remained at the recommended level. There was a new cupboard for storing controlled drugs. Several care plans mentioned promoting privacy and dignity and helping people to maintain their independence. Staff received training on core values during their NVQ training. Staff talked about respecting people’s privacy by knocking on doors and promoting dignity by giving choice and control. One member of staff said that this was an area she felt strongly about and said, “You have to think how you or your family would wish to be treated.” During the course of the inspection staff were heard speaking to people politely and with respect. Despite a previous recommendation, unnamed toiletries were still in bathrooms, which could indicate that they are being used communally. This does not promote people’s individuality or their dignity. Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not everyone using the service had sufficient choice and control over their lives or had their social and recreational needs met. EVIDENCE: There was an activity co-ordinator four days a week. Records showed there were activities on those days, usually games and quizzes and crafts. The groups were often attended by the same people. There were some trips out and on the day of the visit a number of people went out for lunch, which they said they enjoyed. On the day of the inspection two people said there was enough going on for them because they were able to entertain themselves. Others said that they just watched television. People who returned surveys had mixed views about the amount of suitable activities. The annual quality assurance assessment (AQAA) showed that the manager plans to involve people more in choosing activities and plans to improve the variety of activities over the next year. Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 17 Two people who were case tracked had care plans because they were at risk of social isolation. Whilst the plans gave information about what the people liked to do, there were no directions for staff to spend set time with them or how to assist them to meet their need for social contact. There were a few records to show that the activity co-ordinator did one to one activities with people who stayed in their rooms but these were not recent. Information about the open visiting arrangements was included in the home’s brochure. One regular visitor said that the staff were always very good to her. There was some contact with visitors from the local community, for example church visitors. Most people had some information in their care plan about their preferred daily routines and staff said they tried to accommodate them. Some of the comments from residents confirmed this. One person said, “we can get up and go to bed when we want, there are no restrictions that I am aware of.” Other routines such as mealtimes and personal care routines were not as flexible. One member of staff said that one of their aims was to maintain people’s independence and they did that by “giving and respecting choices.” However, People who were unable to communicate their preferences had little information on their plans to assist staff to help them to make choices. For example, nutritional plans encouraged staff to offer food that people liked but did not specify what this was. Everyone who returned surveys indicated that they liked the meals most of the time. On the day of the inspection people commented that the meals were, “alright”, or “good.” One person said, “I enjoy the meals very much.” The daily menu was displayed. There was an alternative to the main meal, which was decided on the day. The records of meals showed that people received a varied and balanced diet, although the cook discussed difficulties in ensuring that people had the recommended five portions of fruit and vegetables a day. There was fresh fruit available but seldom requested. All vegetables were frozen, which, the cook said, restricted their use in soups and other dishes. Special diets were catered for. At least one person had a pureed diet. Although the components of the meal were blended separately, they were served in the same dish, which looked unappetising. Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service were protected by the complaints and safeguarding procedures followed by staff. EVIDENCE: A clear complaints procedure was on display in the home. A summary was also included in the information brochure. Everyone who returned surveys indicated that they knew how to make a complaint. Staff indicated they knew what to do if a resident or relative expressed concerns about care. There had been one complaint about care practices since the previous inspection. This had prompted an additional inspection. The manager had carried out an investigation and sent a response to the complainant but the complaint had not been finalised at the time of the inspection. There was a copy of the new safeguarding procedure for Lancashire and staff had access to a procedure specific to the home. This gave them information about how to recognise and report abuse. A new training pack, which included a written assessment, was to be distributed to all staff and the manager planned to follow this up during supervision. Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 19 Most staff had received formal training in safeguarding during their NVQ training. The regional manager also planned to undertake a ‘training the trainer’ course so that she could provide regular updates to staff. Staff spoken with during the inspection were aware of the indicators of abuse and knew how to report inside and outside the home. The manager was aware of her responsibilities and had used the local authority procedure appropriately. Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean and well maintained and provided people with a safe and comfortable place to live. EVIDENCE: Since the last inspection an area of the home had been designated as a separate dementia care unit. The unit had its own lounge and dining area and was separated from the general unit by a key pad lock. The home was generally well maintained. During a tour of the building a few areas that were in need of attention were identified and discussed with the manager. Records showed minor faults were reported and rectified by the maintenance staff. Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 21 Despite a previous recommendation there was no programme for routine maintenance or for renewal and redecoration. The manager said that bedrooms were decorated when needed and whenever they became vacant. One resident said that she had moved from her original room to allow it to be redecorated and had not wanted to go back. The communal areas of the home had satisfactory décor and serviceable furnishings. There were some homely touches, for example, staff had created a comfortable seating area in the corridor alcove in the dementia area. Most bedrooms were personalised with small pieces of furniture, pictures and ornaments. Everyone who was asked said they liked their bedrooms. One person said she had a nice view and the room was light and bright. As previously recommended the overgrown gardens had been cut back. The rear garden was a large lawned area and, at the time of the visit, bare of flowers and colour. There were a few chairs but no designated seating area. Although the garden was secure people were not able to go out unescorted because the ramp was slippery and the handrails were rusted up. There was also an unused clinical waste bin in the garden, which looked unsightly. The AQAA indicated that the manager was looking at improving the gardens so that people would have a comfortable and safe place to sit outside. At the time of the visit all areas of the home were clean and free from odour. People who returned surveys indicated that it was always like that. Very few staff had received infection control training. Although there was an infection control procedure, the systems set up in the home for managing the spread of infection had not been assessed using the department of health guidance. The manager had plans to do this. The laundry was adequately equipped for the size of the home and there were sufficient hours allocated to laundry staff. There were no complaints from people using the service about the laundry service. Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People using the service were not protected by the recruitment practices and there were not always sufficient staff, with appropriate training, to meet their needs. EVIDENCE: People using the service had mixed views about the staffing levels in the home. Those who returned surveys indicated that staff were usually available when needed. However, at the time of the visit almost everyone who was asked said that there were not always enough staff on duty. One person said, “Staff are sometimes pushed to the limit,” another person said that staff were too busy to stay and have a chat. One person said that staff always attended when he used the buzzer but he sometimes had to wait. Some of the staff also said there were not always enough of them on duty and two relatives commented that staffing levels should be improved. On the day of the visit it was observed that there were frequent periods of time when there were no staff in the lounge area of the dementia unit, which meant that people were not being supervised at all times even if their care plan stated they should be. The files of two new staff were seen. Both evidenced a lack of a thorough recruitment process. Both employees had started working at the home at least Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 23 two months before their CRB disclosure was returned. This meant that the manager could not be sure that the applicants did not have a criminal record that precluded them from working with people who may be vulnerable. There was no evidence of a POVA first check for either member of staff although the manager said this may be held at the company head office. One member of staff only had one reference. The other had two references but one had been returned the day after she started work. One person had not given a complete employment history. The manager said this had been explored at interview but there were no records of this. The regional manager advised that in the future the requested pre-employment checks would be returned to the home instead of the company head office, which should help the manager to improve the recruitment. The manager had a system in place to check that nurses who applied for jobs were currently registered with the Nursing and Midwifery Council. The home did not employ any registered nurses with a mental health qualification, although the manager said they were trying to recruit. The manager stated that some staff had attended a one-day dementia awareness session and some others had completed a longer course. Although the training records were not up to date it was clear that not everyone, including nurses, who worked on the dementia care unit had attended either of these courses. Training in safe working practice topics was not up to date. Some staff had done a moving and handling course very recently but most had not had training for over a year. According to the AQAA only a small percentage of care staff, who were responsible for handling and serving food, had done basic food hygiene training. Although there was always a registered nurse on duty there was no evidence that any of them had recent first aid refresher training to ensure that they were aware of the most up to date techniques to use in an emergency situation. There were occasional courses in other topics, for example, some staff had attended a wound care course and there had been recent training in difficult to manage behaviours. The manager had recently joined the Lancashire Workforce Development Programme which she said would help in the future to access funding and suitable courses for the staff team. The regional manager was also introducing training packs in various topics that would be distributed to staff. The AQAA showed that 50 of care staff were qualified to NVQ level 2 or above. As recommended following the last inspection, the company had introduced an induction training programme. There was an initial introduction to the home and the residents. Staff then went on to complete a workbook covering basic care skills. It was not clear whether the programme covered all of the topics in the Skills for Care common induction standards and whether staff would be able to use the workbook when they went on to do NVQ training. The manager said she would look into this. Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 24 Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The new manager was working to improve the organisation and management of the home for the benefit of the people living and working there. EVIDENCE: A new manager was appointed six months ago. The manager, a registered nurse, has had some experience working in a senior clinical role. At the time of the visit she was working towards the Registered Manager’s Award. The manager said she was in the process of completing her application for registration with the Commission. Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 26 Since her appointment, the manager has had few supernumerary hours and for much of the time has been working as the nurse in charge of shift. This lack of management time could be seen as one of the reasons why some of the shortfalls in care, as identified in this report, have gone unrecognised and why the manager has not had time to put systems and planned improvements into place. The recent appointment of a regional manager who is based in the home should provide the manager with day to day support and the planned recruitment of more registered nurses should assist in freeing up management time. The manager had introduced a programme of regular staff supervision and appraisal. Since a recommendation at the last inspection more systems to monitor the quality of the service had been put into place. The home held the Investors in People Award. A recent survey had been carried out with residents and relatives. The results of the survey had not been collated at the time of the visit but most of the responses seen were quite positive. The regional manager had introduced audits of medication and care plans but these were not fully operational at the time of the visit. Occasional staff meetings were held. The minutes showed that staff were able to make suggestions for the development of the service. Any money held on behalf of people using the service was kept in a secure place. There were records of money received and given back or spent on behalf of the resident. Receipts were obtained if money was spent outside the home but not if a resident purchased something from the home’s ‘tuck shop’. The administrator said she would put this into place. The majority of people using the service had relatives or appointees to help them manage their finances. The company acted as appointee for two people. Their records were being transferred from a previous home and were not available at the time of the visit. The fire procedure was on display in the entrance of the home. Maintenance and servicing of the fire systems and equipment was up to date. Fire safety training was overdue. Records showed that some staff had last had training in June 2007 and others in November 2006. The fire alarm was tested every week. The manager used the tests as practice drills but there were no records to show, which staff had attended, or notes about the outcome of the drills. To comply with recommendations made by the fire officer, automatic door closures, linked to the fire alarm system, were being installed at the time of the inspection. A number of people used bedside rails. There was a risk assessment on all the care records seen to ensure that this was the most appropriate method to prevent the person falling out of bed. However, the assessment did not look at the safety of the rails themselves or their compatibility with the bed and Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 27 mattress. There were no records to show that regular maintenance checks were carried out to ensure the bedrails remained safe. There were spray bottles of cleaning fluid in the bathroom and the sluice room on the dementia care unit. The contents had been decanted from the original container and did not provide the name or any information about the product. This meant that staff would not know what the first aid treatment was, for example, should someone ingest the fluid. The AQAA showed that maintenance of installations and appliances was up to date. Certificates were seen to evidence maintenance of electrical installations and gas appliances in the home. Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 28 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 2 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 4 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 15(1) Requirement Care plans must clearly identify the needs of people with dementia and provide sufficient directions for staff to meet those needs. Care plans must be amended as and when the person’s needs change so that staff have up to date and accurate directions about the care to be provided. In order to protect the health and safety of people living in the home, strategies to reduce the assessed risk to people’s health must be included in their care plan. Timescale for action 30/09/08 2. OP7 15(2) 30/09/08 3. OP8 13(4)(c) 30/09/08 4. OP8 13(4) People must not be restrained in 31/07/08 chairs unless their assessment clearly indicates that this is the most appropriate way of temporarily controlling the risk of falls. People must be given their medication as directed by the prescriber. Any changes or DS0000066412.V367822.R01.S.doc 5. OP9 13(2) 31/07/08 Church View (Nursing Home) Limited Version 5.2 Page 30 omissions should be clearly recorded along with the reasons why. 6. OP9 13(2) In order to protect the health and safety of people using the service and to provide a thorough audit trail, accurate records must be kept of medicines received into the home. In order to protect people using the service staff and show that staff are suitable to be employed all staff must have a POVA first or CRB disclosure before they start work at the home. All other required documents must be obtained and kept on file. (Previous timescale of 20/07/07 not met) 31/07/08 7. OP29 19 31/08/08 8. OP38 13(4)(c) Bedside rails must not be used 31/08/08 unless there has been a thorough assessment to show that the rails are safe to use with the bed and mattress. All staff must receive sufficient fire safety training and practice drills to ensure that they are completely clear about their role in the event of a fire. 30/09/08 9. OP38 23(4)(d)( e) 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. Refer to Standard OP2 Good Practice Recommendations All residents should receive a copy of their terms and DS0000066412.V367822.R01.S.doc Version 5.2 Page 31 Church View (Nursing Home) Limited conditions of residency at the time they move into the home so that there is no potential for misunderstandings to occur about what will be provided. 2. 3. 4. 5. OP7 OP7 OP9 OP9 Care plans should provide sufficient directions for staff to ensure that care can be carried out in a consistent way. Everyone using the service, or their relatives, should have opportunities to be involved in care planning and reviews. Anyone administering their own medication should have an assessment to ensure that they are safe to do so. Handwritten entries on Medication Administration Record charts should be signed and witnessed to reduce the risk of transcribing errors. Each resident should have their own toiletries. These should not be left in bathrooms to prevent them being used communally. Each item in a pureed diet should be served separately so that the meal looks attractive and appetising. A programme of routine maintenance and redecoration should be produced. The manager should review staffing levels in the home and ensure that there are always sufficient staff to meet the planned needs of people using the service. Nursing and care staff working in the dementia care unit should complete relevant training so that they have the knowledge and skills to understand and meet the individual needs of this group of people. The training records for the home should be brought up to date and any shortfalls in training in safe working practices should be addressed. Potentially hazardous substances should be stored in the original containers that include first aid instructions and they should be stored safely. 6. OP10 7. 8. 9. OP15 OP19 OP27 10. OP30 11. OP30 12. OP38 Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: 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 © 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 Church View (Nursing Home) Limited DS0000066412.V367822.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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