Inspection on 14/12/06 for Collingwood Court Nursing Home

This inspection was carried out on 14th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Collingwood Court Nursing Home 19/11/08

Collingwood Court Nursing Home 12/09/07

Collingwood Court Nursing Home 27/02/06

Collingwood Court Nursing Home 16/06/05

Collingwood Court Nursing Home 06/01/05

Collingwood Court Nursing Home 03/08/04

Collingwood Court Nursing Home 12/02/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Townley Road, 2-3

Orchard House Nursing Home

St Josephs Rest Home

Foxley Lane (121a)

Tudor Lodge

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

CARE HOMES FOR OLDER PEOPLE Collingwood Court Nursing Home Collingwood Court Rear Of 1-95 Nelson`s Row Clapham London SW4 7JR Lead Inspector Sonia McKay Unannounced Inspection 14th December 2006 10:00 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 Collingwood Court Nursing Home DS0000007015.V324253.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. Collingwood Court Nursing Home DS0000007015.V324253.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Collingwood Court Nursing Home Address Collingwood Court Rear Of 1-95 Nelson`s Row Clapham London SW4 7JR 020 7627 1400 020 7720 1998 askent@bupa.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) ANS Homes Limited Care Home 80 Category(ies) of Dementia (52), Mental disorder, excluding registration, with number learning disability or dementia (52), Old age, of places not falling within any other category (28), Physical disability over 65 years of age (28) Collingwood Court Nursing Home DS0000007015.V324253.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 28 elderly women aged 60 years and above 52 persons aged 55 years and above suffering from organic mental health disorders The 3 current physically disabled patients aged below 65 years To include one person aged between 50 years and 55 years, to be accommodated on either Hazel Unit or Rose Suite 28th July 2006 Date of last inspection Brief Description of the Service: Collingwood Court is a care home owned and managed by a care provider called ANS, which became a subsidiary of BUPA in August 2005. The home provides nursing care for up to 80 service users in a purpose built two-storey unit. It is set in its own grounds on a quiet street. The location is convenient for public transport and the local shopping area of Clapham. It has a back garden and limited parking facilities are available at the front. The home has three separate units, two of which are on the ground floor. The third unit is located on the first floor. Two of the units provide nursing care for people with mental health problems or dementia. The third unit is for frail older people and people with a physical disability who require nursing care. Each unit has a lounge and dining room. The main kitchen and laundry facilities are located in the basement. A hairdressing room and an activities resource room are available on the first floor. A passenger lift is provided for access to the first floor and the basement, and the home is accessible to those in wheelchairs. Collingwood Court Nursing Home DS0000007015.V324253.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection team spent a full day in the home, during this key inspection. Our visit was unannounced. We spoke with service users, visitors and staff members. We toured the premises, observed care practices, and examined documentation. We would like to thank the service users who contributed to the inspection, and the general manager and members of staff on duty who assisted with our visit to this service. What the service does well: What has improved since the last inspection? There have been some improvements to the environment since the previous inspection. In particular, Rose unit has been refurbished. This has included new flooring, curtains, pictures and redecoration, both in communal areas and also in individual service users’ bedrooms. The home has drawn up an action plan to address requirements set at previous inspections, and some of these requirements have been met. Collingwood Court Nursing Home DS0000007015.V324253.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Collingwood Court Nursing Home DS0000007015.V324253.R01.S.doc Version 5.2 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 Collingwood Court Nursing Home DS0000007015.V324253.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 (6 does not apply to this home) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s service user guide needs revision. Service users’ needs are assessed before they move into the home but not all service users receive a contract detailing the terms and conditions between themselves and the home. EVIDENCE: On Hazel unit, an inspector noted that some information about what the service users could expect from the home was kept in service users’ bedrooms. This was in written format and provided information on a number of areas that were relevant to the care provided. However, much of the information required to be provided in the service users guide was missing, including information on the environment, staffing, qualifications, contract and what to do if the service user wished to raise a concern or complaint. It did however contain a copy of the last inspection report. Collingwood Court Nursing Home DS0000007015.V324253.R01.S.doc Version 5.2 Page 9 The files of two recently admitted service users on Hazel unit were viewed to determine the information gathered by the home before the service users’ admission. Both contained at least one professional assessment and the preadmission assessment completed by the home. An adult mental health assessment had been completed for one service user who had been admitted with a number of mental health issues, and this was supported by an occupational therapist’s report and consultant psychiatrist information. The pre-admission assessments were completed to a basic level, although more detailed information was provided in the professionals’ assessment. The inspector noted that where the diagnosis was a mental health disorder this had been written but limited other information had been recorded. Neither of these files on Hazel unit contained any terms and conditions of residency or contract. The home’s general manager stated that this was because the service users are funded by the local authority but that where service users are privately funded they are given a contract. However, neither contained this document and even where the service users are funded by another agency this contract would be between the local authority and the home. Service users must also receive a contract detailing the terms and conditions between themselves and the home. Service users should also have this information, including fee levels, before they are admitted to ensure there is openness and clarity. A recently admitted service user on Diana unit had received an assessment of needs from the head of nursing before moving into the home. The service user’s condition restricted communication but it was evident the assessment and care plans drawn from it had also involved the service user’s family. The placing authority’s care management assessment was also on file. The service user’s file did not contain a contract or any terms and conditions of residency. The general manager was not able to locate the contract, explaining that there was no financial administrator in post yet. On Rose unit, three service user plans were selected for inspection. Some of the service users had been in the home for a number of years. An inspector was unable to locate the assessment details for these service users and assumed these had been archived. The inspectors observed that service users with dementia and service users with mental health problems were being cared for within the same environments. They raised this as a discussion point with the general manager and were pleased to hear that this arrangement was presently under review. The manager appeared to be taking a proactive approach to the issue, and was well aware that creating separate dementia and mental health units might improve the home’s ability to meet the needs of its different service user groups. For example, it is recognised there is limited orientation signage in the home to assist service users with dementia. However, installing these aids Collingwood Court Nursing Home DS0000007015.V324253.R01.S.doc Version 5.2 Page 10 would probably not help the service users with mental health problems, who may even resent them being put in place. Collingwood Court Nursing Home DS0000007015.V324253.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, 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans have been reviewed but improvements are still needed to their content. Service users have access to health care services. Medication administration is generally satisfactory, though there are some issues for the home to address. EVIDENCE: In response to a previous requirement about care plans being reviewed and updated, the home provided an action plan to the CSCI that stated all care plans are being reviewed and are subject to systematic audit to ensure they reflect service users’ changing needs. The care plan for a service user being nursed in bed on Rose unit was selected for inspection. The service user had a grade 4 pressure sore. The care plan had been drawn up using the activities of daily living format and reviews were in place. There was a photograph of the sore, which had been dated. Weekly pressure sore evaluations were in place. The tissue viability nurse was in the Collingwood Court Nursing Home DS0000007015.V324253.R01.S.doc Version 5.2 Page 12 home reviewing this service user’s pressure sore. She gave positive comments to an inspector about the staff and the fact that they refer to her any wounds that need more professional guidance. Another care plan problem for this service user was stated as “coughing and pyrexia”. However, the outcome was stated as “(name) cooperates when checking his BP, pulse and temperature promote privacy and dignity”. The outcome should have been relevant to the actual problem. This was also true of other care plans. Another care plan seen on Rose unit was that of a service user with bipolar affective disorder. The format was similar. The nutrition risk assessment was without a score as there were no weight records, just a statement that the service user could not be weighed. This situation had gone on for some time. In such cases, staff should use professional judgment as to the level of risk and act accordingly. A third care plan viewed on Rose unit had a problem stated as “confused and senile dementia”, with an outcome of promoting privacy and dignity as well as happiness and security. Care plans need to identify the behaviours associated with condition and tailor a care plan to address that problem. Within the same care plan, physical and mental health issues were included as one, under one heading. The service user’s partial blindness was not stated within a separate care plan. All of the identified issues needed specific actions taken and should be individually identified. The format of the care plans was such that, if fully completed, the plan would give a comprehensive picture of the service user. Examples were seen on Rose unit of information being given in plans, such as a service user being nursed on the floor, and reference to aggression in another. Such significant issues should have individual care plans and risk assessments in place to address them, but this was not always the case. An inspector viewed a care plan of a service user on the Hazel unit. The care plan contained details of the service user’s physical health and personal care needs, and the areas in the care plan had been evaluated recently. However, there was no information or needs identified in respect of the individuals’ mental health needs, despite this being the main diagnosis. There must be information on these needs together with the interventions used by the home to address them and a crisis plan where there may be relapse, including signs and symptoms and triggers. The care plan did not identify any dietary needs and was not very specific in the actions to be taken. For example, the mobility care plan covered toileting and personal care but gave little information about how many staff were needed and how they would achieve this. There was no information about the leg tear the service user had received and how this was being treated. In the two files viewed on Hazel unit, assessments had been completed in relation to falls, pressure care, continence and moving and handling. However, Collingwood Court Nursing Home DS0000007015.V324253.R01.S.doc Version 5.2 Page 13 these were not always fully completed and. in respect of the moving and handling, there were no interventions detailed despite the service user requiring mobility aids and possible staff assistance at times. There was no nutritional assessment completed. Both service users’ files contained a record of the observations on admission including the service users’ weights. Staff also monitor service users’ weights monthly and record this in a separate book. However, this information should be available in the service users’ files. The file of a service user who has bedrails had no supporting documentation to show the decision making process for the use of bedrails, including the risks for and against their use. Service users have access to medical support as they require. Three service users on Diana unit said they saw the doctor if they needed. The unit maintains a ‘doctor’s book’, to assist communication with the visiting GP for the home. A local authority care review team were on Diana unit to review the care of a service user they had placed in the home. The team told an inspector that their client had improved since moving into the home, in particular, they had noticed she was more independent now than when she had been in hospital before moving to the home. A care manager said staff in the home tried hard to meet service users’ needs and that the services provided were generally “adequate”. Team members said an on-going problem with the home was odour (see comment in ‘Environment’ section). A brief audit of the medication procedures took place on Hazel unit and included observations of administration at lunchtime and viewing of the records. The lunchtime medication practice was good, with the nurse administering the medication to service users in a safe manner. She also showed good practice by ensuring when she spoke to them and wanted to give their medications she spoke at eye level rather than standing over them. She was pleasant in her approach. Medication is dispensed by the pharmacy in blister packs supported by printed medication administration records (MAR). When audited, the medication records were found to be in reasonably good order with limited gaps on administration. Photographs were in place on a separate sheet at the front of the record. Service users’ details including allergies where known and if unknown were recorded on this sheet. However, this information was not always transferred to the medication record. Many service users were in receipt of a number of prescribed medications, which required a MAR. However, the records were not always clear about the number received by the service user. For example a service user’s record showed 1 of 2. However, there was also another record for the same person saying 1 of 1. This may lead to confusion and staff possibly omitting medication where they believe they have administered all the medications prescribed on the record. Most of the medication had been recorded into the home as received with amounts, dates and signatures. There were some medications where the Collingwood Court Nursing Home DS0000007015.V324253.R01.S.doc Version 5.2 Page 14 amounts had not been recorded, particularly liquids. Where the staff had hand transcribed medications there was not always evidence of two staff signatures. One medication record and the corresponding label for insulin had been changed by the nurse as she stated there was an error. However, staff must not alter or amend labels of prescribed medication but must request another label from the person prescribing or dispensing the medication. An inspector also noted that sodium valporate for one service user was still in the blister pack for one administration period on a particular day, although the MAR had been signed as given. Controlled drugs on Hazel unit were stored and recorded appropriately. However, oromorph was to be given ‘as required’. There must be clear guidelines as to when staff are to administer this drug. It is suggested that for ease of auditing the home orders a specific aid for measuring liquids when they wish to be accurate in determining how much is remaining in a container. Drugs were stored appropriately in the fridge and, where they had a limited shelf life, the date of opening had been recorded. The temperature of the fridge had also been recorded daily. The storage of medicines on Diana unit was satisfactory. Although the clinical room does not have natural ventilation, it has an air conditioning unit and the temperature of the room is recorded regularly. At the time of inspection, it was within safe limits for medicine storage at 18 degrees. Internal and external medications were separately stored. Medicines requiring refrigeration were also being stored appropriately. The medication of a recently deceased service user was being retained on the unit for seven days before disposal. Three service users on Diana unit were receiving controlled drugs (CD). The storage and recording of two service users’ CD’s were inspected and were satisfactory. The qualified nurses in this home administer depot injections. The community psychiatric nurses attending the service users usually give these injections, although qualified general/adult nurses can administer them. Inspectors were concerned that the home’s nurses who administer these injections did not have enough knowledge about the medication’s side effects, uses or contraindications. The previous requirement under NMS 30 is relevant to this matter. In response to a previous requirement about the care of dying service users, the home has provided the CSCI with an action plan that confirmed the home is working in partnership with the local PCT’s palliative care team to ensure that service users receiving palliative care are comfortable, with any pain being controlled effectively. The action plan states that dying wishes are recorded in service users’ plans and implemented at death, with the involvement of the multi-disciplinary team. A service user receiving palliative care on Diana unit told the inspector he was being made comfortable by the nurses and carers, “they look after me well”. He was being seen regularly by the home’s GP. Collingwood Court Nursing Home DS0000007015.V324253.R01.S.doc Version 5.2 Page 15 Collingwood Court Nursing Home DS0000007015.V324253.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 coordination of planned activities for service users needs improvement. Service users receive a balanced diet and have choices of meals but more feeding aids, such as plate guards, are needed to help some service users maintain their independence. EVIDENCE: In response to a previous requirement about activities, the home provided the commission with an action plan and a copy of its activities programme for week beginning 09/10/06. The action plan stated that two full-time activities coordinators were in post and that carers are also involved in daily activities with service users. However, at this inspection visit, the inspectors were told that the activities coordinator was on long-term leave and there had not been anyone in post to replace her. The general manager said that a new coordinator had been recruited but a POVA/CRB check was awaited before she could start work. In the meantime, the coordination of activities was seen as being the carers’ responsibility. Collingwood Court Nursing Home DS0000007015.V324253.R01.S.doc Version 5.2 Page 17 It was not evident that the previous requirement had been fully met. Staff on Rose unit led some activities. One staff member walked around the room clapping to service users whilst singing ‘A White Christmas’. This did not seem appropriate as many service users were sleepy and this did not promote any interaction with service users. One senior carer offered a quiz for the service users, several of whom chose to take part. The only activities seen to be offered to service users on Diana unit were either recorded music being played or television. An inspector spent two hours observing service users in the lounge on Hazel unit. At various times, staff were involved in some activity with service users such as exercising with a balloon. However, the activity finished abruptly and then started again just as quickly. The observation focussed on the five service users with dementia. Throughout this time two of the service users were either asleep or dozing. There was very little interaction between the staff and these two service users, although observation later showed them to benefit from staff talking to them. It was also evident that staff were more communicative and interactive with service users who were able to initiate conversations. Staff need to be more proactive in their interaction with and stimulation of service users. The lunchtime period was observed on Rose unit. A choice of lunch was available, served with two types of juice. The home had responded to the previous requirement that whenever possible service users have the opportunity to exercise their choice in relation to meals. The mix of service users with varying mental and physical heath needs was very apparent. Those service users who were frail and elderly were in the dining room with one man who was shouting and abusive, another who was taking his clothes off while his trousers were already falling down, whilst yet another man repeatedly got up and in a hurried manner left the dining room. Staff were present and intervened in these situations, however the dining experience was not a relaxed affair. This was also evident during the afternoon period following lunch. On Hazel unit, an inspector observed the lunchtime routine. This was a fairly relaxed environment. Tables were laid with tablecloths and decorated with a vase of flowers. The service users were offered either of two meals, which they chose at that time. They were also offered choices of vegetables. Those requiring assistance had the support of staff who demonstrated good practice. For example, service users were fed appropriately at a pace that suited them and during this time staff were seated and chatted to the service users often making eye contact. Staff offered drinks and ensured that service users ate their meals. A previous requirement to ensure that adequate fluids are always available was being met. One service user spoke to the inspector saying, “this is really good”. However, there was a lack of condiments on the table and a lack of aids such as plate guards. There was also a lack of plate guards on Diana unit, which was causing difficulty for several service users. The general Collingwood Court Nursing Home DS0000007015.V324253.R01.S.doc Version 5.2 Page 18 manager was visiting the unit during lunch and when an inspector drew her attention to this need she agreed to ensure appropriate feeding aids were obtained. Collingwood Court Nursing Home DS0000007015.V324253.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, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home operates an appropriate complaints procedure. Staff have access to abuse training and the home follows its adult protection procedures. EVIDENCE: The home has a complaints procedure, which is followed to ensure complaints are investigated and that complainants receive responses within appropriate timescales. Staff receive training about adult protection and the home has appropriate procedures in place. Nurses and carers who met with an inspector showed satisfactory understanding about adult protection, regarding what to look for and what action to take. A domestic spoken with had limited knowledge about abuse, including the need to report such matters. The CSCI was informed in July 2006 of an adult protection issue relating to a service user resident in the home. The placing authority’s care management had raised concerns and initiated a POVA investigation. The home’s acting manager at that time also took appropriate action. In response to a previous requirement about the use of restraining lap belts, the home has provided the commission with written confirmation that service Collingwood Court Nursing Home DS0000007015.V324253.R01.S.doc Version 5.2 Page 20 users using such belts do so with the consent and agreement of all concerned (family, GP, social services, key workers). Collingwood Court Nursing Home DS0000007015.V324253.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, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The provider has begun to refurbish the home, concentrating initially on one of the units. The rest of the home still requires refurbishment. Staff try to keep the home free from odours but this remains a problem. Staff need to improve their understanding of specific infections that can be prevalent in care homes. EVIDENCE: In response to a previous requirement under four national minimum standards for improving its environment, the commission has been provided with a brief action plan that states the home is having on-going refurbishment and that this work is being carried out in line with the budget for the current year. The previous requirement remains outstanding as a programme of maintenance and renewal for the fabric and decoration of the building has not yet been provided to the CSCI. The action plan provided does not give sufficient detail in this respect, though did state that priority was being placed on repairs to the Collingwood Court Nursing Home DS0000007015.V324253.R01.S.doc Version 5.2 Page 22 Rose unit. It was evident during this visit that Rose unit had undergone a complete refurbishment since the previous inspection. This included new flooring, curtains, pictures and redecoration, in communal areas as well as individual bedrooms. However, there was evidence of wear and tear, for example, bedroom 76 had cigarette burns to the laminate flooring and in bedroom 59 the wardrobe door was missing. A light cover was missing in one of the bathrooms. Bathroom 3 had no shower curtain in place. The home has a maintenance technician who can carry out repairs reported by staff. In its action plan for the commission, the home confirmed it had addressed a previous requirement for a suitably qualified person to assess the premises and facilities. The plan states that rehabilitation specialists carried out an occupational report earlier this year. Christmas decorations were evident in the main lounge area on Rose unit. There was only a limited selection of decorations elsewhere on this unit. The dining room was prepared for meals with tablecloths, napkins and cutlery although condiments, adapted cutlery and plate guards were absent. In one bedroom the pressure relief mattress was signalling a fault. A staff member attempted to rectify this but the fault continued. It had been referred for repair. The service user was in bed beside the window but at right angles to the TV, which was on. It would be very uncomfortable to watch TV in such as position. The radio was broken. Staff should endeavour to give those service users nursed in bed as much comfort, stimulation and access to facilities as is possible. The bedroom lay out should be reviewed. Hazel unit appeared in need of a complete refurbishment. The corridors had torn wallpaper and the ceiling opposite bedroom 3 was stained and the tiles sagging. The inspector was advised this was due to an earlier leak. The lounge area was also suffering wear and tear with torn wallpaper and marked /chipped paintwork. A few bedrooms were inspected and found to be of a variable standard. Some items of furniture were in need of repair, for example, in bedroom 24 the drawer front was missing. In bedroom 5 there was a strong malodour. Bedroom 25 had a number of items stacked in the corner including a portable fan and a bedspread. The shower area was cold because the window was open, and this was also the case in many individual bedrooms. The windows were open to air the bedrooms, however the windows remained open until the afternoon and it was chilly in these areas. One bathroom in this corridor was out of order whilst another toilet had a very loose fitting handle. The maintenance person was in the process of addressing repairs in this area. On Diana unit, a bathroom had various pieces of equipment in it and could not have been used without clearing the room first. Staff said they were not using this bathroom much but mostly using it to store hoists. The equipment seen included a mattress and two hoists. The toilet seat was broken and the ventilation unit had been switched off. The bathroom next to the nurses’ station was said to be in regular use but had two hoists stored in it. The room Collingwood Court Nursing Home DS0000007015.V324253.R01.S.doc Version 5.2 Page 23 did not give the impression of being a pleasant place in which to bathe. There was also a linen trolley, items of clothing, a urine bottle and various toiletries. The area behind the bath was not clean and had exposed pipes, loose bath trim and broken flooring. There were many scuff marks along the skirting. The ventilation unit had also been switched off in this bathroom. The bathroom opposite room 54 contained a hoist and wheelchair that staff said was not normally kept there. The toilet seat needed replacement. With regard to a previous requirement to keep the home free from offensive odours, the home’s action plan confirms staff try to do this. A local authority care review team were on Diana unit to review the care of a service user they had placed in the home. The team told an inspector that an on-going problem with the home was odour and that this “puts a lot of families off”. Odour was evident in the lounge on Diana unit during the inspection visit. In response to a previous requirement to ensure that staff are trained in infection control, the home provided written confirmation that all staff were undertaking such training. Comments about staff training, including in infection control, are made below (‘Staffing’ section). It was noted that all staff on Rose unit who an inspector spoke with had poor understanding of the term ‘clostridium difficile’ and the management of this infection. Collingwood Court Nursing Home DS0000007015.V324253.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, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels and mix have been reviewed. Recruitment of new staff has begun, with some new staff members to come into post shortly. Recruitment procedures have improved but there are specific issues to be addressed. Staff are supported to undertake training that is relevant to their work in the home but certain training needs remain, for example, mental health care and aspects of infection control. EVIDENCE: An inspector met with four staff on Rose unit including nurses, care staff and a domestic. The inspector focused on discussion of training appropriate to the work that they undertook as well as ongoing support and supervision they receive. One qualified staff member was quite difficult to understand hence it was hard to determine her level of knowledge. She related appropriate information on MRSA and infection control measures, but a poor understanding of clostridium difficile and how to manage this infection. She had a limited understanding of mental health issues and management but had a reasonable knowledge of her key service users. She was unable to confirm if formal supervision was taking place. Collingwood Court Nursing Home DS0000007015.V324253.R01.S.doc Version 5.2 Page 25 The second qualified staff member had recently come into post. He confirmed he had completed an induction programme, covering statutory topics and those related to the home itself. He also had a limited knowledge of mental health issues and their management, although confirmed he had received training on dementia. He was aware of the adult protection procedures and the reporting of suspected abuse. The previous requirement for staff to have training suitable to the work they do remains outstanding. Some improvement has been made in this respect, for example, it is noted that the home’s action plan confirms dementia training has been cascaded to all staff. However, there is more to do, for example, the need for qualified nurses in the home to raise their understanding of depot medications given by injections (see comment above in ‘Health and Personal Care’ section) and for all staff to gain understanding of mental health issues (see comment below in this section). The two care staff interviewed on Rose unit included one experienced senior carer and one newly appointed carer. The senior carer had completed her NVQ3 and was knowledgeable on most areas asked about, including abuse, aggressive behaviour and dementia. The second carer interviewed had been in post for a short time and confirmed he had completed an induction programme. He demonstrated a basic knowledge of infection control and MRSA procedures, but a poor understanding of clostridium difficile infection. He had little knowledge about dementia or mental health. A domestic who met with an inspector had been in post for some years. The focus of discussion was around infection control and COSHH. She presented with only a limited knowledge on these topics. She stated she had received training on fire prevention, manual handling and abuse. Her knowledge on abuse was very limited and she was not aware about the need to report such matters. An inspector spoke with two members of staff on Hazel unit; one qualified nurse and a senior carer. Both stated that since BUPA had taken over the home there had been improvements in the training provided, particularly in paying staff to attend. Core training had been received including moving and handling and, for some staff, first aid, infection control and food hygiene. A workbook relating to the care of people with dementia is also supplied to staff, which they are expected to work through. However, there was a gap in the knowledge of staff about the mental health needs of clients, apart from those with dementia. This raises concern, as most service users admitted to this unit are those with a mental health problem. An important issue for the home as a whole was that the training provided does not adequately reflect the numbers of service users with mental health problems. There is a clear need for all staff to receive specific training in this area and this has been made a requirement. Also, it would be good practice to Collingwood Court Nursing Home DS0000007015.V324253.R01.S.doc Version 5.2 Page 26 ensure that all the training provided for individual staff members is scheduled clearly in the staff files. Some personnel files sampled indicated that staff were trained in moving and handling and COSHH procedures, but there is a need to schedule all training taken by staff to ensure a consistent approach. The commission has received a written response from the home to the previous requirement to ensure there are always suitable levels of staffing and skill mix. The response confirmed that the home was recruiting for more permanent staff and also bank staff to cover vacant shifts. On the day of the inspection, there were two qualified staff on Rose unit, with care and ancillary staff in support. Inspectors were told that a new RMN had been recruited to ‘float’ between Rose and Hazel units, and would be taking up post shortly. On Diana unit, there were twenty-five service users in residence. There were two qualified nurses were working a ‘long day’ (12 hour shift). They were supported by five carers also working a 12 hour shift and one carer working an early shift. One of the carers was working 1:1 with a service user, an arrangement for which additional funding was being received. Two housekeepers were on duty. Rotas showed that some staff members were working long hours. For example, nursing staff on Diana unit had worked up to 60 hours (5 long days) each week during the period 1-14 December. Staff confirmed the information shown on the rotas and said that they had been covering vacant shifts. Another nurse would be on the Diana unit rota from 15 December, which would ease this situation. Staff members said that short-term absences, such as someone being off-sick for a shift, were covered by permanent or bank staff. On one occasion, a nurse had needed to work a night shift after a long day, as the night nurse had not arrived. The nurse said she had been allowed to rest during the night shift and had been given additional time off afterwards. The general manager assured the inspectors that staff working 60 hours each week was a “one-off” situation and not a regular occurrence. It was understood staff members’ working hours are monitored to ensure they do not become overtired and thus risk compromising standards of care delivery. It seemed there was misunderstanding about the use of agency staff to cover vacant shifts. For example, the rota showed that on the 6 December the Diana unit had been one carer short. Two staff members and a service user said if there was no-one available to cover a shift, that shift remains short-staffed, as agency staff were not used. The general manager advised the inspectors that this was not correct, as agency staff could be used if necessary. Twenty-three service users were in residence on Hazel unit. During this inspection the staffing on the unit consisted of two qualified nurses and five care staff, including a senior care assistant. A further two staff were supporting Collingwood Court Nursing Home DS0000007015.V324253.R01.S.doc Version 5.2 Page 27 service users with one to one care. At night, there is one nurse and four care assistants. Staff spoken to felt that the increase in the staffing level had improved care and benefited the service users. Nine staff members’ personnel files were inspected. Efforts had clearly been made to ensure that current CRB checks existed for the nursing and care staff employed at the home. In general, staff files indicated that procedures were in place for the employment and vetting of staff in compliance with regulations. However, there should be evidence of verification of references to establish that the authors were authentic, especially as the stamp of the organisation was not evident in a number of cases, and the reason for applicants leaving their last employment must be confirmed wherever practicable. The home’s action plan for the previous requirement about recruitment records confirms that a recruitment audit has been completed and that the home is complying with standards. However, the requirement remains outstanding until the findings of the audit are supplied to the CSCI. Collingwood Court Nursing Home DS0000007015.V324253.R01.S.doc Version 5.2 Page 28 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, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered manager post is vacant thus, at present, service users cannot be assured that the home is being run by a person whose fitness has been assessed with regard to relevant legislation. The home safeguards service users’ financial interests, and promotes the health and safety of its service users, staff and visitors. EVIDENCE: The provider has ensured there are management arrangements in place but, at the time of this inspection, the home did not have a manager whose fitness had been assessed by the commission with regard to the Care Standards Act. It was understood from the general manager that the head of nursing is applying to the commission to be the registered manager of the home. The head of nursing was away on leave at the time of the inspection visit. Collingwood Court Nursing Home DS0000007015.V324253.R01.S.doc Version 5.2 Page 29 The home did not provide the pre-inspection information requested by the commission. This includes names and contact details of service users’ next of kin and care managers. This lack of full information has limited the commission’s ability to invite those parties to contribute to the inspection. The responsible persons are reminded that it will soon become a legal requirement for registered providers of adult services to produce a quality assurance assessment each year. Until this is implemented, the commission is asking providers to complete the pre-inspection questionnaire. Evidence was seen of the way in which service users’ personal allowances were managed. Income and expenditure for individual service users is recorded on computer. Receipt numbers confirming money paid out on the behalf of residents was cross–referenced and found to be accurate with actual receipts. Cash purchases are funded from the home’s float and then reimbursed from the service users’ individual personal accounts. Health and safety aspects are given close attention by the maintenance technician, who was available to show that maintenance was currently certified by outside contractors for the gas fired hot water and heating equipment, electrical ‘hard wiring’, lift maintenance, emergency lighting and Legionella testing, baths and hoists. Portable appliance testing was overdue but was to be carried out ‘in-house’ once labels were received. Fire alarm testing is recorded weekly with fire drills monthly (staff only) together with monthly checks on fire doors, fire fighting equipment, emergency equipment. Fire panels are located on each wing. A response to the previous requirement to ensure that fire doors are not wedged open has been included in the home’s action plan supplied to the commission. It states that all staff are aware of fire regulations and monitoring takes place to ensure fire doors are not wedged open. The plan also states that if a service user insists a fire door needs to be left open, a chair can be used to prop it open “as advised by Lambeth Fire Services on their inspection”. During the visit, an inspector noted a fire door by room 31 on Diana unit had a large gap when closed, with a strong airflow through the gap. This was drawn to the attention of the shift leader and was also discussed with the home’s maintenance technician. The technician reassured the inspector that the matter was already in hand and showed documentation confirming that all fire doors in the home were about to be checked and adjusted/repaired as needed. Thus, a requirement has not been made on this occasion. The home’s action plan for the commission confirmed that staff had addressed a previous requirement to supervise/monitor service users when smoking, in accordance with their individual risk assessments. Collingwood Court Nursing Home DS0000007015.V324253.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 2 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 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 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Collingwood Court Nursing Home DS0000007015.V324253.R01.S.doc Version 5.2 Page 31 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 OP12 Regulation 12(3)16(2 )(m) (n) Requirement The registered person must ensure that service users are given opportunities for stimulation through leisure and recreational activities both inside and outside of the home; particular consideration must be given to activities for people with dementia and other cognitive impairments and those with physical disabilities. Previous requirement. Timescale for action 31/01/07 2 OP19 OP20 OP21 OP24 23 The registered person must 31/01/07 ensure that a programme of maintenance and renewal for the fabric and decoration of the building is produced and provided to the CSCI. The programme must include: Improved lighting Redecoration of walls Repair of damaged garden path Replacement of damaged interior bedroom doors Replacement carpeting Replacement all broken toilet seats Suitable window coverings in bedrooms that have none DS0000007015.V324253.R01.S.doc Version 5.2 Page 32 Collingwood Court Nursing Home Redecoration of damaged/ peeling paintwork in some ensuite bathrooms Previous requirement. 3 OP26 16 The registered person must ensure the home is kept free from offensive odours. Previous requirement. The registered person must complete a full audit of the recruitment records for all staff employed. The findings of this audit must be supplied to the CSCI. Previous requirement. The registered person must ensure the home’s service user guide includes all the required information. The registered person must ensure that all service users receive a contract between themselves and the home, detailing the applicable terms and conditions. The registered person must ensure that all needs identified through assessment have individual care plans and risk assessments in place to address them. The registered person must ensure there is specific guidance for staff administering any controlled drug prescribed to be given ‘as required’. The registered person must ensure staff do not alter or amend labels of prescribed medication but request another label from the person prescribing DS0000007015.V324253.R01.S.doc 31/01/07 4 OP29 19Sch 2 31/01/07 5 OP1 5 31/03/07 6 OP2 5 31/03/07 7 OP7 15 31/01/07 8 OP9 13 31/01/07 9 OP9 13 31/01/07 Collingwood Court Nursing Home Version 5.2 Page 33 or dispensing the medication. 10 OP18 13(7) The registered person must ensure it is always evident that the use of restraining lap belts has been reviewed in a multidisciplinary forum that includes relatives/ representatives or advocates. The registered person must always obtain, wherever practicable, written verification of the reason an applicant previously working with vulnerable adults ceased to work in that position. The registered person must ensure staff receive training appropriate to the work they are to perform, specifically, to raise their understanding of service users’ particular physical and/or mental conditions and of managing infections such as clostridium difficile. 31/01/07 11 OP29 19 (Schedule 2) 31/01/07 12 OP30 18 28/02/07 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 OP7 Good Practice Recommendations The registered person should ensure that the outcomes stated in care plans are always relevant to the assessed need/problem. The registered person should obtain a specific aid for measuring controlled drugs in liquid form, to ensure accuracy in determining how much is remaining in a DS0000007015.V324253.R01.S.doc Version 5.2 Page 34 2 OP9 Collingwood Court Nursing Home container. 3 OP9 The registered person should ensure that when a staff member hand-transcribes a medication record there is always evidence that another staff member has checked it. The registered person should ensure that appropriate feeding aids, such as plate guards, are made available to those service users who may benefit from their use. The registered person should ensure it is evident that written references without company stamps have been followed up to verify their authenticity. The registered person should ensure that all the training provided for individual staff members is evidenced clearly in the staff files. 4 OP15 5 OP29 6 OP30 Collingwood Court Nursing Home DS0000007015.V324253.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Collingwood Court Nursing Home DS0000007015.V324253.R01.S.doc Version 5.2 Page 36 - 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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