Inspection on 12/02/08 for Colbury House Nursing & Residential Home

This inspection was carried out on 12th February 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Colbury House Nursing &... 11/07/06

Colbury House Nursing &... 21/10/05

Colbury House Nursing &... 24/05/05

Colbury House Nursing &... 15/12/04

Colbury House Nursing &... 13/05/04

Colbury House Nursing &... 04/02/04

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Winton House

Newbeech House

Treloar College

Rush Court

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Colbury House Nursing & Residential Home Hill Street Totton Southampton Hampshire SO40 2RX Lead Inspector Janet Ktomi / Carole Payne Unannounced Inspection 08:15 13 February 2008 th 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 Colbury House Nursing & Residential Home DS0000011420.V356734.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. Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Colbury House Nursing & Residential Home Address Hill Street Totton Southampton Hampshire SO40 2RX 023 8086 9876 023 8086 7119 margaret@colbury.com 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) Mr Jeffrey Collins Mrs Margaret Josephine Collins Care Home 51 Category(ies) of Dementia - over 65 years of age (17), Old age, registration, with number not falling within any other category (51), of places Physical disability (6), Physical disability over 65 years of age (39) Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 6 beds may be used at any time for service users in the category of PD between the ages of 50-65 11th July 2006 Date of last inspection Brief Description of the Service: Colbury House Nursing and Residential Home is situated on the outskirts of Totton, in a quiet lane, surrounded by pleasant countryside and close to the New Forest. There are close links to the M27 motorway and the nearby amenities of Totton and Southampton. The home provides accommodation for up to fifty-one people over the age of sixty-five. Up to seventeen of these places are available for people with dementia and thirty-nine for people with a physical disability. Up to six places can be used for people with a physical disability aged between fifty and sixty five years of age. Accommodation is arranged on two levels accessible via a passenger lift. The home has a pleasant lounge with views over the home’s gardens, a lounge/dining room with views of the courtyard garden and main garden and there is a separate dining room. The home has an annex, the coach house, providing single bedrooms. Residents that live in the Coach House can use the lounge and dining area in the main building if they wish to although the coach house has its own lounge/dining room. The home is owned by Mr and Mrs Collins. Mrs Collins takes an active part in the day to day running of the service. At the time of the key inspection the home did not have a registered manager. Fees at the home range from £335.23 per week for persons needing personal care and up to £850 per week for those needing nursing care. Fees are dependant on assessed level of need. Colbury House Nursing & Residential Home DS0000011420.V356734.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. This report contains information gained prior to and during an unannounced visit to the home undertaken on the 13th February 2008. All core standards and a number of additional standards were assessed. The visit to the home was undertaken by two inspectors and lasted approximately eleven hours commencing at 08.15 am and being completed at 7.30 pm following feedback to the provider and senior staff. The inspectors were able to spend time with the provider, staff on duty and were provided with free access to all areas of the home, documentation requested, visitors and people who live at the home. Prior to the visit the provider completed an annual quality assurance questionnaire (AQAA), information from which is included in this report. One inspector met with a health professional visiting the home. Comment cards were sent to the home for distribution to people who live at the home and their relatives/visitors. Six comment cards were received from people who live at the home and three relative responses were received. Two staff members also completed comment cards. Information was also gained from the link inspector, the home’s file containing notifications of incidents in the home and minutes of safeguarding adults meetings held by the local social services department. During the visit to the home the inspectors were able to meet with and talk to many of the people who live at the home and four visitors. What the service does well: The home has a comprehensive pre-admission procedure. This ensures that only people whose needs can be met are admitted to the home. The home has successfully managed the individual needs of people whose needs may have presented challenges in other services. Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 6 The home provides a range of activities including outings, providing people who live at the service with a variety of social opportunities. The home employs appropriate numbers of nursing, care and ancillary staff. Staff receive some training and good recruitment procedures are in place. What has improved since the last inspection? What they could do better: Eleven requirements are made following this inspection. Further information and specific details as to how the home has failed to meet the required standard are contained within the relevant sections of the report. The provider must ensure that people with wounds have a wound management plan and records can demonstrate that care has been provided. The home must ensure that all medication administration records are fully completed with no gaps, so that it is clear when medicine has been administered to people living in the home, or the reason for omission. When medication has not been administered this must be recorded clearly showing the reason it has been omitted. The home must ensure that medication stored in the fridge is stored at the correct temperature monitoring with a maximum/minimum thermometer. Controlled medication storage capacity must be increased and no medication where the label is damaged should be administered. Medication must clearly state who it belongs too. The home must ensure that when nurses have hand written medication administration sheets that abbreviations are not used to indicate the frequency or route of administration and that two qualified nurses have signed the medication sheet. The provider must ensure that people’s wishes are known and respected such as with foods they don’t like not being put on dinner plates. The home is recommended to complete life history information for all people. Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 7 The provider must ensure that people’s dignity is promoted, additional tables in the lounge are required so that people can place hot drinks on them and have access to cold drinks at all times. People must have access to call bells at all times and these must be responded to appropriately. The provider must ensure that a minimum of fifty percent of care staff have an NVQ level 2 in care and that all staff undertake mandatory training in safeguarding adults, manual handling, infection control, health and safety and fire awareness. The home must have a registered manager. The provider must ensure that all valuables held on behalf of people living at the home are stored securely. The provider must ensure that all areas of the home and garden are safe and that people are not placed at risk such as from the loose tiles on the garage beside the patio area. All substances hazardous to health must be stored securely. 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. Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All people are assessed prior to moving into the home to determine that their individual needs can be fully met. Standard 6 is not applicable, as the home does not provide intermediate care. EVIDENCE: One inspector viewed the pre-admission assessments for two people admitted to the home in recent weeks and discussed the admission process with the representatives of one person also recently admitted to the home. The home’s admission process was also discussed with the home’s provider. Within the home’s AQAA the provider states that the home does well with preadmission assessments and assessments of needs and that they could do better by producing a new brochure about the home and plan to do this over the next year. The provider also states in the AQAA that the home’s contract Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 10 has been reviewed by a solicitor for accuracy. A copy of the homes contract was seen within the information pack in each bedroom and five of the six comment cards from people who live at the home confirmed they had received a contract. The provider stated that before anyone is admitted to the home a preadmission assessment is completed by herself or a senior member of nursing staff. The pre-admission assessments seen contained thorough details of past medical history and described health care needs and dependency levels. The detailed assessments covered aspects of the person’s physical, social and emotional needs. Also available, and seen were discharge and transfer notes from the hospital. A relative visiting the home confirmed that the provider had visited her relative in hospital and undertaken an assessment prior to offering a place at the home. Nursing and care staff stated that they have sufficient information about new people to meet their needs. One person had been re-admitted to the home following a period in hospital. The provider stated, and records confirmed, that she had visited the person six times whilst she had been in hospital and had initially refused to accept the person back to the home until she had arranged a suitable bed to meet the person’s needs. The home does not provide intermediate care. Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 11 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, 10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People may not always receive the health and personal care they require and this affects the protection of their dignity. Medication records are not fully maintained and the home requires improved storage capacity for controlled medication, in order to ensure that people benefit from safe medication procedures. EVIDENCE: During the unannounced visit to the home one inspector viewed care plans, risk assessments and records relating to accidents, visits from medical staff and daily records. These are all held on computer and were viewed with the provider. The home has recently appointed a qualified nurse, who the provider stated is to be the home’s new manager. The new manager had been at the home for just over a week but was unaware that all relevant records were held on the computer and initially directed the inspectors to paper files in a filing cabinet when care plans were requested, as did a Registered nurse working in Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 12 the home. These records did not reflect current care needs. Other records relating to care being provided on a daily basis (food/fluids and care) were seen within people’s bedrooms. Within the AQAA the provider identified that the home does well to provide comprehensive care plans and that they could do better by ‘getting more client and relative involvement’, and that they have improved over the past year with the introduction of nutritional screening. Care plans viewed on the computer contained information to ensure that all aspects of health, personal and social care needs could be individually met. Plans are now reviewed on a monthly basis however there was evidence that these had not been reviewed monthly until December 2007. With care plans being held only on computers these are not easily accessible to care staff and may result in new or agency staff not being fully aware of people’s needs. Comment cards were received from two care staff who identified that some staff are ‘not that confident on the computer’. However care staff did feel that they had sufficient information of the needs of people they care for. During the inspection visit the provider showed the inspectors shorter versions of care plans, which contain relevant information for carers as to how people’s care should be provided. The provider stated these would be printed off the computer and copies placed discreetly within peoples bedrooms. A requirement is therefore not made as the provider has taken appropriate steps to ensure that care staff have information about people’s care needs. There was discussion with the provider as to how people are included in the formation of their care plans and how the home can demonstrate that people have been involved in and agreed to their care plans and reviews of plans. The provider stated that she is to introduce a form which people or their relatives can sign to confirm they have agreed their care plans and if they wish to be involved in monthly reviews. Care plans contained risk assessments in relation to nutrition, manual handling, individual risks, mental health needs and use of bedrails. The home has recently purchased a set of sit on scales and records of monthly weights were seen in care plans with action taken when weight loss is identified. The home was seen to have consulted external occupational therapists regarding the moving and handling needs of one person. Care plans also contained detailed records of consultation and visits by GP’s to people who live at the home. The provider and a senior nurse have attended a wound management course and described how, as a result of the course they have altered the type of dressing used for one person. Although generally care plans contained all the information some were seen to not have wound management plans which clearly describe the wound and what action the home are taking in respect of Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 13 the wound. The provider must ensure that all people receiving care related to wound management have a wound management care plan. The home has responded to issues raised following a safeguarding investigation undertaken by Hampshire Social Services. Discussions with nurses and staff, and comment cards received, showed that staff felt that they had sufficient time to meet peoples’ needs and that peoples’ needs were being met. Discussions with relatives who were visiting on the day of the inspection also stated that they were happy with the care their relative was receiving at the home. Comment cards from the people who live at the home stated that they always or usually received the care and support (including medical care) they need. During the inspection visit one person who lives at the home was observed who had rung the call bell as he required assistance to the toilet, he stated he had been waiting half an hour and had moved himself to the door of his room. A carer came and turned off the call bell, outside his bedroom, and said he would return in about five minutes. The carer did not ask the person what he wanted and the person was now stuck in the doorway of his bedroom unable to return to his room to ring the bell again. The person stated to inspectors that this often happens. A qualified nurse walking past provided the necessary assistance. The provider said that the carer had probably gone to get a hoist. However, he did not explain what he was doing and the resident was distressed. This occurred during the shift change time after lunch. Shift times for nursing and care staff are 8am to 2pm, 2pm to 8pm and at night 8pm to 8am. There is therefore no overlap for handover. Another person also raised concerns about the length of time it took for call bells to be answered and delays in waiting for care. Daily records within care plans were comprehensive and detailed the care that had been provided to people. Within some peoples’ bedrooms were daily records of care provided and food and fluid received. Discussions with people during the inspectors visit indicated that they felt their health and care needs were fully met and that staff always treated them with dignity and respect. Observations of staff interactions and all comment cards received confirmed that people are treated with respect. Comment cards received from people confirmed that staff listen and act on what they say. The home provides both single and twin bedrooms. Twin rooms were seen to contain screens to promote privacy during personal care tasks. The inspectors were concerned that information about one person’s care needs had been placed on the door into his room. This could be read by any visitors passing his room. This was discussed with the provider who agreed to remove the notice. The provider also agreed to place some form of curtain or screening over a bathroom window, which although slightly opaque, could still provide a view of people receiving personal care. The inspectors visited some people in their bedrooms, not all could reach their call bells and would have been unable to Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 14 summon assistance if required. As previously mentioned peoples dignity may be compromised by delays in the answering of call bells and in not receiving the care they receive. Comments received from people who live at the home prior to the inspectors visit and raised in the safeguarding investigation said that there were delays in people receiving their medication. The home always has two qualified nurses on duty at all times who each take responsibility for half of the home. Several medication trolleys were seen around the home. During the inspection visit medication appeared to be administered on time and the qualified nurses stated they had time to complete this task in a timely manner. No body at the home was self administering their medication. The inspectors viewed medication administration records (MARs) left on top of these trolleys throughout the day. These would have been accessible to visitors or people living at the home. Many of the medication records were incomplete with gaps where it was not possible to identify if medication had been administered or not. Some gaps had been identified by the provider who had highlighted the gap and she stated that she addresses all gaps with the nurses responsible. There were also gaps in the recording of medication received into the home and information about allergies had not been completed on medication records although this information was recorded elsewhere within the Medication folder. Some people’s medication had been handwritten onto the MAR sheets and these had not been double signed and in one case not signed at all. It was also noted that there was use of abbreviations such as ‘/1and o.d. Medication records were not, therefore, clear, ensuring that people received their medicine safely. The inspectors viewed the storage arrangements for controlled medication and the specific records relating to this. The home is correctly storing controlled medication, however the controlled drugs cupboard is too small for the quantity of controlled medication held. Some controlled medication is supplied in liquid form and the labels on these had become damaged during use and one was virtually illegible. The provider must ensure that the controlled medications storage cupboard is big enough to accommodate all controlled medications held in the home. Any medications whose label is damaged must be replaced. The home has the necessary procedures and equipment for the destruction of unused medication. The home has a suitable fridge for keeping medication cool however this did not have a maximum/minimum thermometer and some medication in the fridge did not need to be kept in the fridge. The provider must provide a maximum/minimum thermometer for the medication fridge. The inspectors also noted that some medication that had been commenced in use had not been dated when opened. Insulin administration pens were not labelled as to whose they were. Also noted within the nurse’s office were a quantity of Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 15 syringes and winged infusion sets (for use with syringe drivers) that were out of date. These were removed during the inspectors visit. The records for a person receiving terminal care had not been completed and stated that care had been provided at 9am. The time was 3pm. This was shown to a qualified nurse on duty who stated that care had been provided but not recorded by the morning nurse. The nurse then signed the record in retrospect. Later in the afternoon this person who was being cared for in bed was cold, appeared to be in some distress and the catheter bag was unable to drain as it was laid in the bed under the persons leg. Once drawn to the attention of the provider action was taken to address the issues raised. However the trained nurse in charge of this area of the home had failed to recognise the person’s needs. It was also noted that the person was in pain, as she was tensing her body and was clearly in discomfort. Again, the provider responded expediently to this issue. The provider has confirmed that relevant training is in place and will be continue to be accessed in relation to palliative care. Colbury House Nursing & Residential Home DS0000011420.V356734.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, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home tries to be flexible and attempts to provide a service that is as individual as possible however this is not always achieved. Family and friends are able to visit. The food in the home is of satisfactory quality. EVIDENCE: The routines for daily living and activities made available are flexible however four people stated that they would prefer to get up at times other than those they usually got up at. People and relatives confirmed to the inspector that they are able to choose where in the home they spend their day, many were seen to spend time in the home’s lounge with others remaining in their bedrooms. People confirmed to the inspector that they are given choice over their meals with options being chosen on a daily basis. Bedrooms seen contained personal items brought into the home. Care plans and assessments include some Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 17 information about leisure activities, catering and religious needs but did not have specific information about people’s life histories. The administrator explained that there was a church service in the home on a regular basis, and that this was usually well attended. An activities list was noted on display in the hall. This listed activities planned by care staff and external groups. Interact, an external organisation visit the home once a week and undertakes a range of music or craft activities. The home also organises monthly minibus trips out to places selected by the people who live at the home. There was no activity listed on the monthly plan for the day of the inspection visit. The home has craft equipment and on the day of the inspectors visit a painting activity occurred during the afternoon. The home has very pleasant and extensive gardens surrounding the home. The home has a calendar board in the main lounge, on the day of the inspection visit the board stated that it was Friday 8th February when in fact it was Wednesday 13th February. The homes main lounge had two televisions sets, each showing a different channel. One with the volume turned down very low the other quite high. The inspectors were able to meet some visitors with comment cards from other relatives stating that they are able to visit at any time and kept informed about issues affecting their relative. The home does not have a private room for visitors, people were observed visiting in the main lounge, however the dining room could be available for private visits outside meals times if required. The home has a good-sized main dining room where many people had their meals. There is also a lounge/dining room in the new extension where four people were seen to have their meal. People’s views on their meals varied. Within comment cards people stated that the food is always/usually good and choice provided. One added ‘ meals are good most of the time, but they are the same and not enough variety’ another saying ‘staff seem to go out of their way to offer alternatives’. One inspector was present for the main lunchtime meal. People stated they had been asked what they wanted, however all seemed to have the same meal. One person the inspector spoke with stated she did not like peas, however, these were on her plate when this was given to her. The person left the peas and therefore only had fish, mashed potato and carrots. Care staff stated that they had enough time to support people who required assistance with their meals and this was observed. The inspector observed people being given morning and afternoon hot drinks, biscuits and cake. The home stated in the AQAA that they are now providing food outside meal times, people the inspector spoke with could not confirm this and stated that other than meal times they were not offered anything other than drinks and biscuits. Two comment cards received and conversations with people indicated Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 18 that people keep their own supplies of fresh fruit and biscuits in their bedrooms. One saying ‘I keep my own food as I need a little and often, I can’t manage large amounts’. The need for special diets or supplements is recorded pre-admission and a person was observed being given a supplement drink. The home has a good-sized, well-equipped kitchen, with a cook and kitchen assistant available throughout the day. The provider informed the inspectors that the home has recently changed the menus following discussions with people who live at the home and is trying to provide more fresh fruit and vegetables. On the day of the inspection visit the inspectors noted that the potatoes and frozen peas had been cooked by 9.30 am. This was discussed with the provider who was unaware of this practice. Some areas of the kitchen are in need of a thorough cleaning and this was pointed out to the provider, who undertook to attend to this straightaway. Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure, which has been used, however people may not always complain. People stated they feel safe in the home however not all staff have undertaken safeguarding adults training. The home demonstrates an appropriate response to safeguarding the welfare of people who live at the home. The homes safeguarding adult’s policy must reflect the Hampshire adult protection policy and procedure. EVIDENCE: Within the homes AQAA complaints and protection section there was no reference to complaints and limited information about the protection of vulnerable people. Elsewhere in the AQAA the home identified that the home had received eleven complaints in the year prior to the inspection, none of which had been upheld. In the previous year one person had contacted the Commission with a complaint about the service this was returned to the provider for investigation however the person remained unhappy with the outcome of the homes investigation. In comment cards four of the five people stated that they knew how to make a complaint and knew who to speak with if they had a complaint. The inspectors spoke with people at the home, some stated that they were aware of who to complaint to; one person stated that they would not complain and another Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 20 person stated that they had not complained when she discussed an issue regarding the home. A copy of the homes complaints procedure is provided with other information to staff during induction. Staff spoken with stated that they would refer any complaints to the qualified nurse on duty or to the provider. Relatives the inspector spoke with could not recall having been given specific information about how to complain however they stated that they would talk to the provider. During the inspection some relatives approached the provider and raise an issue, which the provider dealt with immediately. Following the inspection the provider confirmed that all relatives have a copy of the complaints procedure attached to the contract. One inspector viewed the complaints log with the provider and discussed the way the home manages complaints. Full records are kept of complaints and action taken to investigate them. There was evidence in one care plan as to how staff should respond to complaints from one person in relation to a specific issue. Following complaints by people who live at the home the person in charge took action to dismiss a nurse. Seeking guidance regarding determining if POVA, NMC referrals are appropriate was discussed at the time of the inspection. Some care staff have undertaken safeguarding adults training others have not. Information about the homes Abuse Policy is provided to staff within induction paperwork. Care staff on duty were aware of what was unacceptable and would be considered abuse. All stated that they would report any concerns to the nurse in charge or the provider. The home has responded expediently to issues raised in a recent safeguarding referral to Hampshire Social services in order to ensure the protection of people living at the home. As identified in this report some concerns in respect of dignity and care were identified during the inspectors’ visit. Procedures in respect of recruitment and people’s personal money are appropriate to ensure people are protected in these areas although valuables held on behalf of people were not stored appropriately. Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. People live in a generally clean, mainly safe home that meets their individual and collective needs. EVIDENCE: One of the inspectors had previously visited the home so was aware of the layout. The provider showed the inspectors the new extension and then the inspectors were able to view the home unaccompanied. Both inspectors viewed all communal areas, bathrooms, WC’s, many bedrooms and the kitchen and laundry rooms. One inspector viewed the outside of the home and the coach house. The home is situated in a quiet area outside Totton. The home comprises of a large older building with a new extension and a separate smaller building, Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 22 known as the coach house. The home can accommodate up to fifty-one people the majority in single bedrooms with seven twin rooms. All bedrooms have washbasins and many including all those in the new extension have en-suite facilities. The home has a large lounge, separate dining room and a lounge/dining room in the new extension. The inspectors noted, and staff and people living at the home agreed, that there are insufficient chair side (occasional) tables available in the lounge. People were noted to be holding cups of hot drinks unable to place them on a table, with one person dropping hers onto her lap, the fluid spilling out onto clothing. Chairs within the dining room were noted to be dirty and some in need or repair/replacement. The coach house has a small lounge/dining room with people living there being able to use the communal rooms within the main building. Sufficient toilet and bathroom facilities are provided in both houses. The home has extensive gardens, including a new courtyard style garden, and paved patio area, which some people were seen to be enjoying during the inspection visit. Many rooms and the lounges provide good views of the gardens and surrounding countryside. The provider provided limited information about the home’s environment in the AQQA. The AQQA stated that they could do better to provide more grab rails in the downstairs corridors, which the inspectors noted contained, only grab rails on one side, which may make it difficult for a person to get around the home with a limb weakness on the side of the rail. As the home has identified this as an issue a requirement is not made and will be assessed again at the next inspection. The provider informed the inspector about further plans to improve the homes environment, which she stated are currently awaiting planning permission. Generally the home was clean and free from offensive odours on the day of the inspection visit. People living at the home and relatives stated this was always the case, however the inspectors noted some WC’s in need of attention at the start of the inspection. The home employs specific domestic staff, with two being available on four days per week and one available on the other three days per week. The home has a laundry containing appropriate washing and drying machines. The home employs a laundry person. The laundry was noted not to have handwashing facilities. The inspectors also noted that the laundry is not locked and laundry detergents were readily accessible. Issues around the storage of substances hazardous to health are further discussed in the management section of the report. The flooring in the laundry was in a poor condition, with a carpet in the centre, which is not an easily cleanable wash down surface for such a working area. This was drawn to the attention of the provider, who agreed that an easily cleanable surface replacement would be considered. This will be reviewed at the next inspection. Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 23 Generally the home’s environment was safe however the inspectors were concerned about the garage and clearly loose/slipped tiles on its roof. The garage is used to store some food and care products. Health and safety issues around the garage are further discussed within the management section of the report. Care staff stated that they had sufficient supplies of disposable gloves and aprons with stocks being available around the home. Many, but not all staff have undertaken infection control training. Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 24 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 adequate. This judgement has been made using available evidence including a visit to this service. The home employs appropriate numbers of nursing, care and ancillary staff that ensure that peoples needs are generally met. Staff receive an induction training although not all staff have undertake all mandatory training. Good recruitment procedures are in place. EVIDENCE: The inspectors viewed staff duty rotas, recruitment records, spoke with people who live at the home and staff on duty. Comment cards were received from two staff members. Training records were viewed with the homes administrator providing additional information about training and staff qualifications. As with other sections the homes AQQA provided little information about staffing and staff training. Some supplemental information was provided with the AQQA. The provider stated in the AQAA that the service could do better by providing more staff meetings, that they had improved by ‘NVQ’s achieved, R/N training achieved’ and future plans were identified as ‘more training for junior staff’. Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 25 Comment cards and discussions with people who live at the home and their visitors reflected that people were generally happy with the staff employed at the home, although as previously identified some people raised concerns about the length of time it took for call bells to be answered. The inspectors observed positive interactions between staff and people who live at the home, however they also observed instances when people were ignored (as described with the call bell). Staff on duty stated that they felt they had sufficient time to meet people’s needs. Duty rotas and staff on duty indicated that the home provides sufficient qualified nurses, care staff and ancillary staff. At the time of the inspection the home had Forty people living there although it has the capacity to accommodate fifty-one people. The provider stated that the current staffing levels are to meet the needs of fifty-one people. The home accommodates people with both residential, low care needs and nursing, high care needs. The home will need to monitor staffing levels depending on dependency of people living at the home. Duty rotas and staff stated that people work shifts that start at 8 am to 2pm, 2pm to 8pm and 8pm to 8am. There is no handover period and it was not clear how information is passed from one shift to the next without the expectation that staff will stay following the end of their shift or start work early. Discussions with staff indicated that they were aware of what their roles are and what is expected of them. Staff explained how work is organised with a qualified nurse and number of care staff being allocated to each floor of the home. People living at the home said that staff know what they are doing and did not express any concerns re staff other than some delays in answering call bells. The section stating the number of care staff with an NVQ of at least level 2 was not completed on the AQQA however this information was provided with supplemental information included with the AQQA and confirmed by the administrator during the inspection visit. This stated that in December 2007 the home employed twenty-three care staff of which six had at least NVQ level 2. This equates to approximately twenty-seven percent of care staff having an NVQ. During the inspection visit the administrator informed the inspector that a further three staff were doing their NVQ. Discussions with care staff confirmed that some were doing their NVQ and that others would like to do this qualification when places and funding are available. The administrator described how the provider would pay for half of the NVQ course fees for those staff who are not entitled to government funding for NVQ training. A member of care staff confirmed that the provider had stated she would pay half the NVQ fees when the person commenced the course. One member of care staff stated that she was not entitled to government funded NVQ training, and whilst she would like to do this training she did not have the necessary money to pay her share of the fees ‘up front’ and therefore was unable to do her NVQ. Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 26 Care staff confirmed that they had received appropriate induction and further training, those having been employed longer having undertaken all mandatory and some additional training. Discussions with staff indicated that they felt they had the necessary skills to meet people’s needs. However records and discussions with some staff who had been employed for three months indicated that they had not completed all essential training. One person who had commenced employment in November 2007 had undertaken infection control, MRSA, manual handling and fire training. They had not undertaken safeguarding adults training or health and safety training. Other new care staff who had commenced work at the home shortly after the training had been provided in November had not undertaken fire awareness or manual handling training. Qualified nursing staff stated that they had enough opportunities to attend training and meet their training requirements as detailed by the nurse’s regulator body the NMC. Qualified nurses stated that they had attended wound management training and as a result had changed the type of dressings used for one person. Staff informed the inspector that they were due to attend training in the mental capacity act and implications this may have for the people they care for. One inspector viewed recruitment records and spoke with newly recruited staff on duty. Recruitment procedures and records seen should ensure that unsuitable people are not employed at the home. It is recommended that the home keep a written record of interviews for its own protection. The home does use some agency staff however nursing and care staff stated that they generally cover shortfalls resulting for sickness or holiday themselves by doing extra shifts. Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 27 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, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not have a registered manager. The home undertakes quality assurance however the AQAA was poorly completed and failed to provide the necessary information about the service. The home does not store people’s valuables appropriately in all cases and some records are not stored confidentially or fully completed. The home has failed to take all the necessary action to keep people safe. EVIDENCE: The home has been without a registered manager since September 2007 when the provider contacted the commission to inform that the registered manager was no longer working at the home. Since this time a manager was appointed Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 28 who left in December 2007 without commencing the registration process. In December 2007 the provider informed the commission that she would be applying for registration. On the day of the inspection visit in mid February 2008 the provider had not commenced the registration procedure and informed the inspectors that a newly appointed qualified nurse would now be applying for registration. The provider possesses a nursing qualification and is fully involved in the day-to-day running of the service at present. During this period without a registered manager the home has been investigated by Hampshire social services under safeguarding adults procedures due to concerns about a number of areas of care and practises at the home. The provider informed social services in one meeting that she had not been fully aware of the situation at the home and this had resulted in the issues identified by social services occurring. The provider was present throughout the inspection visit. One inspector discussed quality assurance procedures with the provider and viewed records relating to quality assurance. The home undertakes three monthly resident questionnaires as a result of which the menu has recently been reviewed to try and provide more variety at tea-time and incorporate more fruit into peoples diets. The inspectors were shown the revised menu plans. The provider stated that she undertakes an audit of complaints and accidents and intends to use the Nursing Homes Association format for quality assurance. As with other sections the homes AQAA in relation to the management and administration outcome group lacked insight and contained very little information. Overall the AQAA did not provide the information required and this was discussed with the provider during the inspection visit. The homes AQAA did not stated when equipment had been serviced. One inspector therefore checked this with the provider and this indicated that all equipment had been serviced and maintained appropriately. The AQAA also did not state when policies and procedures had been reviewed. The questions relating to the views of people and to equality and diversity were incomplete. The homes AQAA did not give a reliable picture of the service. Some sections had one or two word responses, which did not adequately respond to the area of practice. The home does not become directly involved in people’s money. All additional financial costs incurred are billed directly to the representative who is responsible for that person’s money if it is not managed by the person himself or herself. Facilities were seen in people’s bedrooms, which could be locked for secure storage. People stated that they managed their own money and confirmed to the inspector that they had somewhere secure where they could keep money or valuables. One inspector did however see an envelope in the office pined to a notice board which stated that inside was a ring belonging to a named person who lives at the home. There was also a broach on the Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 29 window ledge in the laundry. The provider has confirmed that action is taken to ensure that people’s valuables are stored securely. Throughout the inspection visit a range of records were viewed. As detailed in the relevant sections of this report there were poor record keeping noted in relation to the medication administration records and in records relating to care provided to people. Other records were seen to be appropriately maintained and stored such that people’s confidentiality could not be compromised. During the inspection visit it was noted that a garage close to the house and patio area had a number of tiles that had slipped and some were seen lying on the patio around the base of the garage. During the inspection visit people and staff were observed in this area and one person was seen sitting on a patio chair immediately under the loose tiles. This was pointed out to a member of nursing staff who took action to move the person. The provider stated that she was aware of the garage roof but had not taken any action to rectify the situation as the garage would be demolished as part of future plans for the development of the home. The area had not been blocked off, or made safe in any way to prevent people, visitors or staff being in danger. The provider stated she would make this area safe and provided photographic evidence of the action taken the day following the inspection. Whilst touring the home the inspectors noted various substances hazardous to health that had not been stored securely, these being noted in bathrooms, laundry and cupboards. The storage of substances hazardous to health was also seen to be insecure. The door to the storage cupboard was held shut by a high bolt but not lockable. The provider stated that no people living at the home would be able to open the cupboard however the inspectors noted a number of people walking around the home who would be able to reach the bolt and open the cupboard gaining access to all substances within. This cupboard was unbolted when the inspectors passed the cupboard, when they were looking around the environment. Other issues which may present a risk to people living at the home have been raised within the relevant sections of this report including the need to ensure the kitchen is thoroughly cleaned and toiletries, combs and hairbrushes and bar soap should not be stored in bathrooms as if used by more than one person could present an infection control risk. Lower work surfaces in the kitchen were dusty and a knife holder was dirty. Not all staff have undertaken all mandatory training including infection control, manual handling and safeguarding adults. Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 2 1 Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO 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 OP8 Regulation 12(1) Requirement The provider must ensure that people receive the care they require at all times and that records can demonstrate that care has been provided. The provider must ensure that all call bells are within reach and that they are answered within a reasonable timescale so that peoples needs met. The provider must ensure that all Medication administration records are fully completed stating when medication has been administered and giving clear reason why it has been omitted. When medication administration records are hand written two members of nursing staff must sign to confirm the name of the medication, date commenced and amount to be administered. Abbreviations must not be used on Medication Administration records to indicate the frequency with which a medication is to be administered. Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 32 Timescale for action 15/03/08 2. OP10 12 (1) 15/03/08 3. OP9 13 (2) 15/03/08 4. OP18 13(6) 5. OP19 23 (2) 6. OP26 23 (2)(d) 7. OP30 18 8. 9. OP31 OP38 8 13 (4) The provider must ensure that the homes safeguarding adults policy and procedure reflects the local (Hampshire) safeguarding adults procedures. The provider must ensure that sufficient tables are available in the lounge and that dining room chairs are repaired/replaced and kept clean. The provider must ensure that all areas of the home are kept clean and that hand washing facilities are provided in the laundry room. The provider must ensure that all staff undertake mandatory training to include manual handling, infection control, safeguarding adults, health and safety and fire awareness. The provider must ensure that the home has a registered manager. The provider must ensure that people are not placed at risk. The proprietor must ensure that the home and gardens are well maintained such that people are not at risk such as identified from the garage roof tiles. All substances hazardous to health must be stored securely. 01/04/08 01/06/08 01/04/08 01/09/08 01/06/08 15/03/08 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 OP12 Good Practice Recommendations The home should complete life histories for all people and incorporate this information into care planning. DS0000011420.V356734.R01.S.doc Version 5.2 Page 33 Colbury House Nursing & Residential Home 2. OP28 The provider should provide a maximum/minimum thermometer for the medication fridge. Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Colbury House Nursing & Residential Home DS0000011420.V356734.R01.S.doc Version 5.2 Page 35 - 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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