CARE HOMES FOR OLDER PEOPLE
Church View (Nursing Home) Limited Princess Street Accrington Lancashire BB5 1SP Lead Inspector
Mrs Susan Hargreaves Unannounced Inspection 10:00 31st May 2006 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.V289123.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Church View (Nursing Home) Limited DS0000066412.V289123.R01.S.doc Version 5.1 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) 01286 872038 Church View (Nursing Home) Limited Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (26), Physical disability (1), Physical disability of places over 65 years of age (24) Church View (Nursing Home) Limited DS0000066412.V289123.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 40 service users to include: Up to 24 service users in the category PD(E) requiring nursing care. One (1) named service user in the category PD requiring nursing care. 2. Up to 26 service users in the category of OP requiring nursing care. The care home should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 10 January 2006 Date of last inspection 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. Accommodation is provided on 2 levels. The first floor comprising only four rooms and a lounge. All other accommodation and facilities are on the ground floor. This includes 2 lounges and a spacious dining room. All bedrooms are single occupancy with en-suite facilities. A stair lift provides access to the first floor. The gardens are well kept and easily accessible to all residents. There is 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 charged at Church View Nursing Home are £315-514.50 per week. Additional charges are payable for hairdressing, newspapers and hospital visits £7 per hour plus taxi. 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.V289123.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days. No additional visits have been made since the last unannounced inspection. At the time of this inspection 35 residents were living at the home. A tour of the premises took place and staff files and care records were inspected. Members of staff on duty, residents and visitors were spoken to. Discussions also took place with the administrator, nursing staff and the registered person regarding issues raised during the inspection. What the service does well: What has improved since the last inspection?
The management of medication has improved since the last inspection. Detailed records are kept of the disposal of all unwanted medication. Four members of staff are working towards NVQ qualifications in care. When these have been achieved more than 50 of care staff will have an NVQ level 2 or 3 in care. This will ensure that the standard of care is maintained and improved. Church View (Nursing Home) Limited DS0000066412.V289123.R01.S.doc Version 5.1 Page 6 What they could do better: 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. Church View (Nursing Home) Limited DS0000066412.V289123.R01.S.doc Version 5.1 Page 7 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.V289123.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admission procedures were thorough. A pre-admission assessment was completed for each resident prior to admission. EVIDENCE: Prospective residents were visited and assessed by a senior member of staff from the home prior to admission. The individual records of four residents were inspected. These contained a detailed pre-admission assessment. This assessment provided important information for the care plan. Prospective residents received confirmation in writing that their needs could met at the home. Information about the admission procedure was included in the statement of purpose and service user guide. However, the statement of purpose and service user guide was included in the same document. The administrator was advised to separate these documents and review them to ensure they contained all the required information. Standard 6 is not applicable to this service. Church View (Nursing Home) Limited DS0000066412.V289123.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care was given in a manner, which promoted the privacy and dignity of all residents. A care plan was not in place for each resident. Care plans did not contain detailed information relating to all aspects of care. This meant there was the potential for some care needs not to be fully met. Medication was managed efficiently promoting good health. EVIDENCE: The individual care plans of five residents were inspected. Four of these plans identified the personal care needs of each resident and explained how these needs were met. However, falls risk assessments had not been carried out for any of these residents. Nutritional assessments did not clearly state the level of risk. It was difficult to understand from the pressure sore risk assessments how the overall risk had been determined. Where a risk of developing pressure sores had been identified a care plan giving information about the action being taken to address the risk was not in place. One care plan provided insufficient information about the care and condition of a pressure sore. This care plan had not been reviewed since January. Another care plan lacked information about the care and condition of a wound.
Church View (Nursing Home) Limited DS0000066412.V289123.R01.S.doc Version 5.1 Page 10 Moving and handling assessments were unclear because of the number of alterations written on them. Not all care plans were reviewed monthly and they were not up dated when the needs of the resident changed. Residents or their relatives had signed their care plans to indicate their involvement with care planning. A written report about the care given to individual residents was completed during each shift. A care plan and appropriate risk assessments were not in place for a recently admitted resident. Residents were registered with a GP and had access to other healthcare professionals. At the time of the inspection none of the residents were self-medicating. Registered nurses were responsible for administering all medication. Records of the receipt, administration and the disposal of unwanted medication were seen. However, hand written instructions on the medicines administration records were not signed or witnessed. Medication was stored in a locked trolley and cupboards inside a locked utility room. The temperature of this room was checked and recorded daily. Controlled drugs were stored correctly and a stock check was satisfactory. Personal care was carried out in private. Members of staff were observed attending to residents in caring and professional manner. One member of staff explained in detail how she promoted dignity for the residents. One resident said, “The staff are lovely.” A visitor said, “The staff are helpful and patient.” Church View (Nursing Home) Limited DS0000066412.V289123.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Leisure activities were not routinely organised. Visitors were welcomed into the home at anytime. The daily routine was flexible in order to meet the needs and preferences of residents. Meals were wholesome and appetising. EVIDENCE: Resident’s interests and hobbies were recorded in their individual care plans. Residents were encouraged to pursue chosen religion. Leisure activities were not routinely organised by members of staff at the home. A resident played videos or DVDs in one of the lounges everyday. An exercise session took place every three weeks. An outside entertainer visited the home monthly, clothes parties were held twice a year and special occasions and birthdays were celebrated. Visitors were welcomed into the home at anytime and offered refreshments. Discussion with members of staff and residents confirmed that the daily routine was flexible. One resident said, “It’s up to me what time I get up.” Residents had personalised their rooms with ornaments, photographs etc. The meal served at lunchtime on the first day of the inspection looked appetising and wholesome. The mealtime was unhurried allowing residents time to chat and enjoy their meal. Members of staff were observed assisting
Church View (Nursing Home) Limited DS0000066412.V289123.R01.S.doc Version 5.1 Page 12 residents in a sensitive manner. The meals were varied and offered choice. All the residents asked said the meals were good. Church View (Nursing Home) Limited DS0000066412.V289123.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Detailed records of the action taken to resolve a complaint were not available. Members of staff had a clear understanding of adult protection issues. EVIDENCE: A copy of the complaints procedure was included in the statement of purpose and service user guide. One visitor said she knew how to make a complaint should it be necessary. Records were seen of one complaint made to the home in March. However, it was unclear from these records how this complaint had been resolved. Policies and procedures relating to the protection of vulnerable adults were available. This issue was discussed with two members of staff. They were aware of the procedure and said they would report any concerns immediately. However, a whistle blowing policy was not available. Church View (Nursing Home) Limited DS0000066412.V289123.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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, comfortable and well maintained. Laundry facilities were appropriate for the size of the home. EVIDENCE: At the time of the inspection the home was clean, tidy and free from offensive odour. One relative stated on a comment card that they were impressed with cleanliness of the home. This provided a safe and comfortable environment for the residents. The administrator explained that to improve the environment bedrooms were decorated when they became vacant. However, a planned programme of maintenance and redecoration and of the home was not available. The gardens were well kept and accessible to all residents. Laundry facilities were appropriate for the size of the home. An infection control policy was available. Church View (Nursing Home) Limited DS0000066412.V289123.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels were appropriate to meet the assessed needs of the residents. Recruitment procedures were not thorough potentially putting residents at risk. Induction training needed further development to ensure consistency in the delivery of care. EVIDENCE: Examination of the duty rota confirmed that a sufficient number of staff were on duty for all shifts to meet the assessed needs of the residents. The files of four recently appointed members of staff were inspected. These files indicated that not all the required pre-employment checks to ensure protection of the residents had been completed prior to appointment. One member of staff had started working at the home before two written references had been received. CRB/POVA checks had not been obtained for the other three. Moreover one recently appointed care assistant was unable to speak English sufficiently well to talk about induction training. It was evident from discussion with members of staff and the administrator that training opportunities were available. This included first aid, moving and handling, basic food hygiene and fire safety. Five members of staff had an NVQ level 2 in care and four had NVQ level 3. A further four members of staff were working towards NVQ level 2. Induction training for new employees took place but this did not meet the ‘Skills for Care’ standard.
Church View (Nursing Home) Limited DS0000066412.V289123.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. An effective quality monitoring system has not been developed. Formal supervision for all care staff was not taking place regularly. Appropriate procedures were in place to safeguard the health, safety and welfare of residents. EVIDENCE: The company are in the process of recruiting a manager for the home. Until this process is complete the deputy manager has responsibility for the day-today running of the home. Senior managers within the company support her in this role. The home had achieved the nationally accredited Investors in People award. Resident’s and their relatives were encouraged to give feedback about the care provided at the home at anytime. However, a formal system for obtaining the views of residents and their relatives was not in place. An annual development
Church View (Nursing Home) Limited DS0000066412.V289123.R01.S.doc Version 5.1 Page 17 plan to help monitor the quality of the service and improve outcomes for residents was not available. Transactions involving resident’s money were seen to be well maintained and up to date. Discussion with two members of staff confirmed that appraisals were taking place annually. However, one of these staff had not received any formal supervision in the last six months. Policies and procedures relating to safe working practices were available. A member of staff qualified to administer first aid was on duty for all shifts. Fire alarms were tested weekly and emergency lighting monthly. Fire drills took place monthly. A fire risk assessment was in place. Records of the routine servicing of equipment were seen. Testing of small electrical appliances had taken place in April and an electrical installation certificate dated 27/11/04 was available. However, a gas safety certificate had not been obtained. Records maintained by the cook included fridge, freezer and food temperatures. Safety notices were displayed in the home. Church View (Nursing Home) Limited DS0000066412.V289123.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Church View (Nursing Home) Limited DS0000066412.V289123.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 1 OP7 15(1) Unless it is impracticable to carry 01/06/06 out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. All residents must have a care plan in place from the day of admission. 2 OP7 13(4)(b) The registered person shall 30/06/06 (c) ensure that - (b) any activities in which service users participate are so far as reasonably practicable free from avoidable risks and (c) unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. A falls risk assessment must be completed for each resident. Timescale of 24/02/06 not met. 3 OP7 15(2)(b) The registered oerson shall (b) 30/06/06 (c)(d) keep the service user’s plan under review; (c) where appropriate and , unless it is impracticable to carry out such consultation with the service user or a representative of his,
Church View (Nursing Home) Limited DS0000066412.V289123.R01.S.doc Version 5.1 Page 20 4. OP8 12(1)(a) (b) 5. OP8 17(1)(a) Sch 3(k) 6 OP8 17(1)(a) Sch 3(n) revise the service user’s plan and (d) notify the service user of any such revision. All care plans must be reviewed monthly and up dated when the needs of the resident change. Timescale of 28/10/05 and 24/02/06 not met The registered person shall 30/06/06 ensure that the care home is conducted so as - (a) to promote and make proper provision for the health and welfare of service users; (b) to make proper provision for the care and, where appropriate, treatment, education and supervision of service users. Nutritional and pressure sore risk assessments must clearly identify the level of risk. When a risk assessment states that a resident is at risk of developing pressure sores a care plan must be in place to address this risk. Timescale of 24/02/06 not met The registered person shall - (a) 09/06/06 maintain in respect of each service user a record which includes the information, documents and other records specified in schedule 3 relating to the service user; (k) a record of any nursing provided to the service user, including a record of his condition and any treatment or surgical intervention. Detailed records relating to the care and condition of all wounds must be kept. Timescale of 10/01/06 not met The registered person shall - (a) 09/06/06 maintain in respect of each service user a record which includes the information, documents and other records specified in schedule 3 relating
DS0000066412.V289123.R01.S.doc Version 5.1 Page 21 Church View (Nursing Home) Limited 7 OP12 16(2)(n) 8 OP16 22(3) 9 OP29 19(1)(b) Schedule 2 10 OP29 19(5)(b) to the service user; (n) a record of the incidence of pressure sores and the treatment provided to the service user. These records must be kept up to date. The registered person shall having regard to the size of the care home and the number and needs of service users – (n) consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of the service users activities in relation to recreation, fitness and training. The registered person shall ensure that any complaint made under the complaints procedure is fully investigated. Records of how a complaint is resolved must be kept. The registered person shall not employ a person to work at the care home unless (b) he has obtained in respect of that person the information and documents specified in (i) paragraphs 1 to 7 of schedule 2 A satisfactory POVA/CRB check must be obtained before a person starts work. A person is not fit to work at a care home unless – (b) he has the qualifications suitable to the work he is to perform, and the skills and experience necessary for such work. All members of staff must be able to communicate effectively in English. The registered person shall, having regard to the size of the care home, the statement of
DS0000066412.V289123.R01.S.doc 28/07/06 01/06/06 01/06/06 01/06/06 11 OP30 18(1)(c) (i) 28/07/06 Church View (Nursing Home) Limited Version 5.1 Page 22 11 OP31 8(1)(a) 12 OP33 24(1)(2)( 3) 13 OP36 18(2) 14 OP38 13(4)(a) purpose and the number and needs of service users – (c) ensure that the persons employed by the registered person to work at the care home receive (i) training appropriate to the work they are to perform. Induction training for new employees must meet ‘Skills for Care’ specification. The registered provider shall appoint an individual to manage the care home where (a) there is no registered manager in respect of the care home. Completed application for registered manager must be received by CSCI by the date given. (1) The registered person shall establish and maintain a system for (a) reviewing at appropriate intervals, and (b) improving at the care home, including the quality of nursing where nursing is provided at the care home. (2) The registered person shall supply to the Commission a report in respect of any review conducted by him for the purpose of paragraph (1), and make a copy of the report available to service users. (3) the system referred to in paragraph (1) shall provide consultation with service users and their representatives. Timescale of 31/03/06 not met. The registered person shall ensure that persons working at the care home are appropriately supervised. All care staff must have formal supervision six times a year. The registered person shall ensure that (a) all parts of the home to which service users have access are so far as
DS0000066412.V289123.R01.S.doc 21/07/06 28/07/06 28/07/06 28/07/06 Church View (Nursing Home) Limited Version 5.1 Page 23 reasonably practicable free from hazards to their safety. An gas safety certificate must be obtained. Timescale of 24/02/06 not met. 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 OP1 Good Practice Recommendations The statement of purpose and service user guide should be two separate documents. These documents should be reviewed to ensure they contain all the required information. Moving and handling assessments should be clearly written. All handwritten instructions on the medicines administration records should be signed and witnessed. A whistle blowing policy should be developed. A programme of routine maintenance and redecoration should be produced. Induction training should meet the ‘Skills for Care’ standards. An annual development plan should be developed. 2 3 4 5 6 7 OP7 OP9 OP18 OP19 OP30 OP33 Church View (Nursing Home) Limited DS0000066412.V289123.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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