CARE HOMES FOR OLDER PEOPLE
Conifers Nursing Home 158 Manchester Road Chorlton Manchester M16 0DS Lead Inspector
Geraldine Blow Unannounced Inspection 14th March 2006 09:30 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 Conifers Nursing Home DS0000021639.V279126.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Conifers Nursing Home DS0000021639.V279126.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Conifers Nursing Home Address 158 Manchester Road Chorlton Manchester M16 0DS 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) 0161 881 2514 0161 862 9635 Dr VK Trehan Mrs S Trehan Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Conifers Nursing Home DS0000021639.V279126.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The numbers of those requiring nursing care at any one time shall not exceed 23 patients of either sex aged 60 years or over A maximum of 2 persons per day are provided with nursing day care in the home. Registration is subject to compliance with the minimum nursing staffing levels indicated in the Notice which was previously served in accordance with Section 25 (3) of the Registered Homes Act 1984 dated 4 April 2001. 12th September 2005 Date of last inspection Brief Description of the Service: Conifers Nursing Home is registered to provide accommodation and nursing care for up to 23 older persons. It is part of a family run business, which includes one other nursing home and a residential home. The registered provider is Dr. V Trehan. The home is situated on a busy main road in the Chorlton area of Manchester. It is close to local facilities, bus routes and the city centre. Accommodation is provided on two floors, served by a passenger lift and the home is accessible to service users who use a wheelchair. Bedroom accommodation is on the ground and first floor. There were 7 single bedrooms, 2 of which offer en-suite facilities and 8 double bedrooms. All rooms offer the facility of a wash hand basin. There were 2 lounges and one lounge/ dining area. There is a paved patio to the rear of the home, that is accessible to service users via patio doors and a ramp. The proprietor has purchased further land to the rear of the property and has plans to landscape the area. There is a small designated smoking area on the ground floor. Conifers Nursing Home DS0000021639.V279126.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on the 14th March 2006. During the inspection time was spent talking to the home’s consultant, the senior nurse and several of the residents to find out their views of the home. In addition residents files, records and other relevant documentation were examined. The home had provided the CSCI with an action plan setting out how they were going to carry out the requirements and recommendations made in the previous inspection report. During the inspection it was found that the majority of the requirements had been actioned and now met the National Minimum Standards. There were still some outstanding issues and these were discussed with the home and will be reiterated in this report. It is of concern that the home has been unable to appoint a manager. A requirement was made at the last inspection, in September 2005 and a separate letter was sent to the provider in December 2005. This issue will be addressed directly with the registered provider. Since the last inspection the CSCI has not received any complaints or concerns regarding the home. As this was the second unannounced inspection within the last 12 months only the core standards not covered from the first inspection were assessed. Therefore, this report must be read in conjunction with any previous reports to gain a full picture of home What the service does well:
The home has an open visitors policy where people can visit residents at any reasonable time. Residents can see visitors in privacy of their own room or in any communal areas. No restrictions are placed on visitors unless requested by the resident or otherwise agreed through the care management and risk assessment process. However, visitors are requested not to sit in the dining room during meal times in order to preserve the dignity of those residents who experience some difficulty with eating or may require some assistance. The home acknowledged that supporting residents to exercise control and choice over their daily lives can sometimes be difficult but is very important. This aspect of care is covered during the induction process. Residents are encouraged to bring in personal possessions with them on admission to the home and some evidence of this was seen. Conifers Nursing Home DS0000021639.V279126.R01.S.doc Version 5.1 Page 6 The home has a quality auditing system in place, which is based on seeking the views of the people living at the home, their representatives and the visiting professionals to the home. From the systems in place it appeared that the financial interests of residents are safeguarded. What has improved since the last inspection?
Since the last inspection it has been decided that when a bedroom becomes vacant the room will be re-decorated and a check of the furniture will be undertaken to ensure it meets the required standard. The home has ordered new carpets and curtains for the main lounge and it is to be redecorated. In an attempt to make meal times more enjoyable for residents the home has bought new cutlery, crockery, water jugs and glasses and new table clothes have been ordered. The tables are now set an hour before the meal. This makes the dining room more attractive and appealing to residents. The home has had positive comments from the residents. The requirements made at the last inspection to ensure the dignity of residents who require help with feeding that staff should not stand up while assisting residents to eat their meal had been met. A number of residents require pureed meals. The home have ordered dividing plates, from India, so that the meal can be served in separate helpings in order to improve the presentation of the meal and the variety of tastes and textures available. The home’s consultant has put a bid to Age Concern for TSI funding for a part time activity co-ordinator. One of the care staff has shown an interest in taking on the role of activity co-ordinator and since the last inspection a number of activities have taken place. Residents have been consulted on an individual basis with regard to their hobbies and interests. However, this had not been documented, as required at the last inspection. The pre-admission assessment of prospective residents care needs now includes a section on hobbies and interests. The home was in the process of organising a celebration for the Queen’s birthday on 21st April 2006. At the last inspection a number of requirements were made in relation to the inappropriate storage of equipment and the repair of some bedroom furniture. These requirements had been met. It is commendable that the home had recently achieved The Investors in People Award. This award is based around valuing staff and actively encouraging training and development. Conifers Nursing Home DS0000021639.V279126.R01.S.doc Version 5.1 Page 7 At the last inspection requirements were made in relation to the care planning process. In an attempt to address the issues it is commendable that the staff have received training and a review of all care plans is being undertaken. Since the last inspection the home now sends a letter to relatives/representatives inviting them to be involved in the drawing up or reviewing the care plan. 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. Conifers Nursing Home DS0000021639.V279126.R01.S.doc Version 5.1 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 Conifers Nursing Home DS0000021639.V279126.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No judgements were made at this inspection EVIDENCE: The home did not provide an intermediate care service. The other core standard was assessed during the previous inspection. Conifers Nursing Home DS0000021639.V279126.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7&8 Each resident had an individual plan of care. However, some areas of the documentation required improvements to ensure that all residents’ health, personal and social care needs are fully met. These shortfalls have the potential to place residents at risk. EVIDENCE: A random sample of care files were inspected. As already stated in this report improvements were seen, however a number of shortfalls were identified in the files which are detailed below: • A number of the care plans contained vague statements e.g. “assist to eat and drink” and “ensure he drinks more fluids”. • One documented problem was “at risk of choking”. No risk assessment had been completed. • One plan of care was found to be very misleading. The senior nurse told the inspector that the resident was on a pureed diet yet the care plan stated “encourage self-help e.g. with finger foods”. The same resident was on normal fluids yet this had not been incorporated into the care plan.
Conifers Nursing Home DS0000021639.V279126.R01.S.doc Version 5.1 Page 11 • • • • The standard of recording in the daily progress sheets was variable and did not always refer to the residents’ assessed needs or evidence of the actual care delivered. One entry in the daily log evidenced that the resident was “having wheezy respiration”, the GP had seen the resident and written him up for Ventolin. This had not been incorporated into the plan of care. The risk assessments were vague and lacked detail. They did not appropriately identify any potentional risks or the action to be taken to minimise the risk. For example, one risk assessment stated risk “cot side injury” and the documented action was “see care plan”. Evidence was seen of involvement of the Tissue Viability Nurse and her report was available for inspection. However, the home had not developed a wound care plan according to her advise and there were no instructions on the frequency of the dressing changes. The requirement made at the previous inspection that the temperature of the drug fridge must be with in normal temperature range had been met. However, the requirement that all prescribed medication must be signed for had not been met. A number of tablets from the previous day 10pm drug round had been given but had not been signed for. It was of further concern that one of the tablets was a controlled drug, Temazepam, for KC. This was discussed with the senior nurse and the consultant at the time of the inspection. The home was not recoding medication that was to be sent for destruction. In order to provide a complete audit trail the records must be complete and accurate. This is in order for the home to demonstrate that all medication is both accounted for and administered as prescribed. The requirement made at the previous inspection to ensure the residents dignity is protected staff must not stand up while assisting residents to eat had been met. The other core standard was assessed during the previous inspection Conifers Nursing Home DS0000021639.V279126.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 & 14 The home supports residents to maintain contact with family and friends and encourages residents to make their own choices. EVIDENCE: The previous inspection report required the home to provide evidence that the residents’ are consulted regarding the planning of activities, outings and entertainment. This requirement had not been met and has been reiterated in this report. The recommendation that the home employ the services of an activity co-ordinator had not been actioned. However as already mentioned in this report a carer has expressed an interest and the home has made a bid to Age Concern for TSI funding. The home has an open visitors policy where people can visit residents at any reasonable time. Residents can see visitors in the privacy of their own room or in any communal areas. No restrictions are placed on visitors unless requested by the resident or otherwise agreed through the care management and risk assessment process. However, visitors are requested not to sit in the dining room during meal times in order to preserve the dignity of those residents who experience some difficulty with eating or may require some assistance. The home acknowledged that supporting residents to exercise control and choice over their daily lives can sometimes be difficult but is very important.
Conifers Nursing Home DS0000021639.V279126.R01.S.doc Version 5.1 Page 13 This aspect of care is covered during the induction process. Advocacy contact details are included in the Service User’s Guide, which has been given to every resident. Residents are encouraged to bring in personal possessions with them on admission to the home and some evidence of this was seen. The requirement made at the previous inspection that the cooker and grill must be deep cleaned had been met. The home’s consultant told the inspector that liquidised meals are now served in separate portions in order to meet the previous requirement that the meals must be presented in a manner, which is attractive, and appealing in terms of texture, flavour and appearance. However, it was acknowledged that although the food is blended separately and served in separate portions once on the plate it still tends to blend into each other. As already referenced in this report the home has plates with divided sections so that the puréed food can be served in separate compartments. The other core standard was assessed during the previous inspection Conifers Nursing Home DS0000021639.V279126.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No judgements were made at this inspection. EVIDENCE: All the core standards were assessed during the previous inspection. Conifers Nursing Home DS0000021639.V279126.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No judgements were made at this inspection EVIDENCE: Requirements were made at the previous inspection due to inappropriate storage of equipment. The requirement had been met. The broken and missing drawer handles had been replaced and the free standing wardrobes that were required to be risk assessed, the homes consultant told the inspector had been replaced with new ones. The homes consultant told the inspector that each resident had now been provided with a lockable storage space for medication, money or valuables. A requirement was made at the previous inspection that a risk assessment must be completed to ascertain the urgency of the need for an adjustable height bed. A risk assessment had been completed but as identified already within this report the risk assessments were vague and lacked detail. These risk assessments must be reviewed.
Conifers Nursing Home DS0000021639.V279126.R01.S.doc Version 5.1 Page 16 All the core standards were assessed at the previous inspection. Conifers Nursing Home DS0000021639.V279126.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No judgements were made at this inspection EVIDENCE: All the core standards were assessed at the previous inspection. Conifers Nursing Home DS0000021639.V279126.R01.S.doc Version 5.1 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 The home did not have an appointed manager. A quality assurance system has been developed to seek residents’ views and the systems for managing residents’ money are clear and transparent and the home ensures the health, safety and welfare of the residents and staff are protected EVIDENCE: The previous registered manager left the home in September 2003. The post was advertised on several occasions. A manager was appointed to the home and this office received an application for registration on the 15th November 2004. The Commission for Social Care Inspection (CSCI) interviewed the manager on the 19th April and 15th July 2005. Unfortunately she did not successfully complete the interviews and left the interviewers with concerns about her lack of understanding and knowledge of the legislative framework,
Conifers Nursing Home DS0000021639.V279126.R01.S.doc Version 5.1 Page 19 which underpins work with older people. During the unannounced inspection on 12th September 2005 it was identified that the home had not appointed a manager and a requirement was made. The requirement was not met and a letter was sent to the provider dated 7th December 2005. The letter detailed that CSCI felt it would be appropriate to give a 3 month time limit from receipt of the letter for the home to put forward the name of a person to be registered as permanent manager. During this inspection the home’s consultant told the inspector that the vacancy had been advertised on 3 occasions with no response. A separate letter will be sent directly to the registered provider. Evidence was seen that a quality audit system was in place. Quality audit questionnaires had been sent out in November 2004 to residents and their representative and a resident and relative meeting was held to seek their views of the service provided. On reviewing the results of the questionnaire an action pan was developed and implemented. The home’s consultant said it was his intention to repeat the process in the next 3 months. In addition to sending the questionnaire to residents and relatives it would also be sent to visiting professionals. Evidence was seen of regular staff and residents/relatives meetings. The home has a policy and procedures file that is available to all staff. The file is reviewed on an annual basis or more frequent if needed. Polices and procedures are now due for reviewing. The home is only responsible for the personal allowance of 1 resident. However, there is evidence that the home keeps ‘pocket money’ for residents that is given to them by the resident’s representatives. The home has a running balance, written transactions are maintained and receipts are kept for all purchases. Evidence was seen that the home ensures the health, safety and welfare of the residents and staff are protected at all times. Conifers Nursing Home DS0000021639.V279126.R01.S.doc Version 5.1 Page 20 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 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 3 x 3 x x 3 Conifers Nursing Home DS0000021639.V279126.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation Requirement Timescale for action 30/04/06 15, 13, 17 1. Each resident must have a Schedule plan of care which sets out in 3 detail the action which needs to be taken by care staff to ensure all aspects of care are met. (Previous timescale of 30/4/05 & 31/10/06 had not been met.) 2. The plan of care must include detailed risk assessments. 2. OP8 17 Schedule 3 3. OP9 13 3. The daily log sheet must include an accurate record of all nursing care provided. Where approprriate a wound 11/04/06 care plan must be implemented based on the advicse of the Tissue Viabality Nurse and include the frequency of dressing changes. In order to provide a complete 14/03/06 audit trail the medication records must be complete and accurate. This is in order for the home to demonstrate that all medication is both accounted for and administered as prescribed: 1. All prescribed medication Conifers Nursing Home DS0000021639.V279126.R01.S.doc Version 5.1 Page 22 must be signed for to facilitate audits and to ensure that the records are clear and accurate. (Previous timescale of 31/10/05 ahd not been met). 2. A record must be kept of medication to be disposed. Evidence must be provided that residents are consulted regarding the planning of activities, outings and entertainment. 4. OP12 16 31/03/06 5. OP24 13 & 16 6. OP31 8&9 (Previous timescale of 31/10/05 had not been met). The risk assessments to asertain 30/03/06 the urgency of the need for an adjustable bed must be reviewd and contian sufficient detail to identify any possible risk and the action taken to minimise that risk. As detailed in the letter dated 10/03/06 7/12/05, the regstered provider must forward an application to CSCI for a manager who complies with the criteria established within the Care Standards Act 2000 and the Care Homes Regulations 2001. to be regstered. (The previous timescale had not been met) Conifers Nursing Home DS0000021639.V279126.R01.S.doc Version 5.1 Page 23 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 It is recommended that the home employ the services of an activity co-ordinator. Conifers Nursing Home DS0000021639.V279126.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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