Inspection on 03/07/08 for Conifers Nursing Home

This inspection was carried out on 3rd July 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

Conifers Nursing Home 14/11/07

Conifers Nursing Home 13/06/06

Conifers Nursing Home 14/03/06

Conifers Nursing Home 12/09/05

Conifers Nursing Home 14/02/05

Conifers Nursing Home 28/06/04

Conifers Nursing Home 26/01/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Conifers Nursing Home 158 Manchester Road Chorlton Manchester M16 0DZ Lead Inspector Val Bell and Steve O’Connor Unannounced Inspection 3rd July 2008 07:00 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 Conifers Nursing Home DS0000021639.V366466.R02.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. Conifers Nursing Home DS0000021639.V366466.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Conifers Nursing Home Address 158 Manchester Road Chorlton Manchester M16 0DZ 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 V.K. Trehan Mrs S Trehan Sarojanamma Adala Care Home 21 Category(ies) of Dementia (5), Old age, not falling within any registration, with number other category (21) of places Conifers Nursing Home DS0000021639.V366466.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing: Code N, to service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category: Code OP Dementia - Code DE (maximum number of places 5) The maximum number of service users who can be accommodated is: 21. 14th November 2007 Date of last inspection Brief Description of the Service: Conifers Nursing Home is registered to provide accommodation and nursing care for up to 21 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 residents who use a wheelchair. Bedroom accommodation is on the ground and first floor. There are 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 are 2 lounges and one lounge/ dining area. The paved patio to the side and the rear of the home, is accessible to residents 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. Until the area has been landscaped residents are not using the rear patio. The charges for fees range from £350.51 to £399.10 per week. Information about the home can be gained through contacting the registered provider, Dr V Trehan or the registered manager Mrs Sarojanamma Adala. The CSCI inspection report is available at the home and through the CSCI web site. Conifers Nursing Home DS0000021639.V366466.R02.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 was a key inspection, which included a site visit to the home by two inspectors. The visit was unannounced which means the manager was not informed beforehand that we were coming to inspect. During the visit we spent time talking to people living in the home, four members of staff on duty, the registered manager and the home’s management consultant who provides advice regarding care and management issues. An Annual Quality Assurance Assessment (AQAA), which is a selfassessment document, had not been issued prior to this visit as the key inspection had been brought forward from its planned date. Relevant documents, systems and procedures were assessed and a tour of the home was undertaken. What the service does well: We looked at four care records and found that the people had received thorough assessments prior to their admission. Careful assessment of any risks involved in providing care and support had also been carried out. This ensured that the service was able to meet the particular personal and healthcare needs of each person before they were admitted. The information from the assessments had been recorded in detail and had been kept under regular review. We observed that people living in the home were treated with respect and had their dignity maintained. Staff took time to explain the tasks that they needed to undertake in providing care and this was reassuring for the residents. One resident said, ‘I get on well with staff. They look after me well.’ Residents told us that they are able to receive visitors at all reasonable times and they have access to the full range of health and social care services. By examining records, policies and procedures we were satisfied that good systems were in place to protect people from harm, such as safeguarding people from abuse and fire safety. Conifers Nursing Home DS0000021639.V366466.R02.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: We found several shortfalls and areas for improvement during our visit. Requirements and good practice recommendations were made as follows. The management and staff team must involve people who use the service in their care planning and to consult with them more about their right to make choices that affect their daily lives, such as the food and activities provided and people’s wishes in relation to their religious, cultural and social needs. For people that lack capacity to make their own decisions, assessments must be undertaken to provide evidence that decisions taken on their behalf are done in their best interests. The information gathered in this way must be consistently written down. Similarly, staff must take care to recognise when other healthcare professionals need to be consulted for advice on issues such as continued weight loss and communication needs. This will improve personal and healthcare outcomes for people living in the home. The home support people to take the right medication and an important aspect of any medication administration system is that unused medication is accounted for and disposed of correctly. During the inspection we found discarded medication in a plastic bag by the waste bin. The home have a clear procedure for the disposal of medication but they could give no explanation as to why these procedures had not been followed in this case. The home must make sure that all unused medication is accounted for and disposed of correctly. People need to be able to have a nutritionally healthy diet to help maintain their wellbeing and have access to any special or specific diet based on their health needs and/or cultural needs. The staff who help develop the appropriate menus, prepare and cook people’s meals need to have the knowledge and Conifers Nursing Home DS0000021639.V366466.R02.S.doc Version 5.2 Page 7 understanding to achieve this. The member of staff responsible for providing nutritious meals that people want and enjoy must have access to the training and development to gain those skills. We also found several shortfalls and risks in the environment and use of equipment that could potentially cause harm to people living and working in the home. This included possible risks of tripping and falling people may face from accessing and using the garden area. The use of bedrails needs to be reviewed to see if this is the safest way to protect people. We have asked the registered provider to write to us and confirm when these issues will be addressed and shortfalls will be brought up to standard. Several people living at the home need some support in managing their personal monies. The management and staff team help people by looking after some of their monies and shopping for personal items. It is important that the management act to make sure that clear and accurate records are maintained of all transactions and that there is a regular monitoring system in place to make sure that records are being maintained accurately. Another area that the management team need to improve is in the way that they monitor the quality of people’s experiences, the services provided and the systems that are in place to operate the home. There was a system of assessing quality but this had not been used in the past 12 months and there was little evidence of how the management team were consulting and seeking the views of people about the home. 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. Conifers Nursing Home DS0000021639.V366466.R02.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 Conifers Nursing Home DS0000021639.V366466.R02.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): 1, 2, 3 and 6 Quality in this outcome area is good. People’s needs had been assessed prior to coming to live at the home. Information about the home and services had been provided to each person. The information about the services provided should be reviewed to make sure that it is accurate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the information provided to people admitted to the home to see if this was accurate and up to date. The information was provided in the form of a Statement of Purpose and Service User Guide. It was encouraging to find that copies of the Service User Guide were held in each bedroom. The two documents contained comprehensive information and guidance for people considering using this service. The Guide did refer to some aspects of the service and the home that was slightly inconsistent with what was found during the site visit. The building was Conifers Nursing Home DS0000021639.V366466.R02.S.doc Version 5.2 Page 10 accessible to wheelchair users but the person would require assistance to enter and leave the building. The guide referred to the provision of dementia care therapies and to residents’ meetings but little evidence was found to back this information. The issues raised will be addressed throughout the report. However, it is recommended that the Service User Guide be reviewed to make sure that the information provided to people is clear and accurate. Samples of contracts between the home and people were seen and they contained a range of information about the terms and conditions of the service. It is recommended that the contract terms and conditions be reviewed to make sure that they meet with the Care Homes Regulations 2001. We looked at the care records belonging to four people for evidence that their needs had been appropriately assessed prior to admission. Comprehensive assessments of need had been undertaken with these four people and these had been reviewed and updated at regular intervals. The home did not offer an intermediate care service. Conifers Nursing Home DS0000021639.V366466.R02.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 and 10 Quality in this outcome area is adequate. People’s identified needs and support were not fully reflected through their care plans. People’s access to specialist treatment and healthcare provision was not always based on their identified needs. Systems were in place to make sure that people received the medication they needed. The disposal of medication was not totally safe and needed to improve. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at care plans belonging to four people in order to assess how their needs were being met. Care plans provided evidence of treatment and access to primary healthcare services, such as dentistry, chiropody, opticians, dieticians and tissue viability services. Risks relating to the provision of care had been assessed and outcomes of clinical interventions had been recorded. These documents had been reviewed regularly. There was no written evidence Conifers Nursing Home DS0000021639.V366466.R02.S.doc Version 5.2 Page 12 that people using the service had been involved in drawing up their care plans as none had been signed by the individuals or their representatives. Nutritional screening had been undertaken and weight loss and gain was being recorded every month. One of the care plans recorded that the person had lost 10 kilograms in the eight months since admission. The manager said that this was due to fluid loss resulting from oedema, which had been present on admission. However, this person’s records showed that weight continued to be lost on a monthly basis. The last review on 16/06/08 stated ‘nutritional needs met. No problems.’ There was no written evidence to demonstrate that a referral had been made to investigate this. The care plan of one person who had a dementia assessment stated that they were, ‘Unable to communicate.’ This was understood to mean that the person did not communicate verbally. There was no evidence that this person had been referred to a speech and language therapist for assessment and guidance on the methods of communication that may be appropriate to him. This was discussed with the registered manager and management consultant during the visit. The home’s Statement of Purpose detailed the creative activities provided by the home for people suffering from dementia. One of the care records contained a dementia care assessment stating that the person needed creative therapies to be provided as a form of stimulation. This had not been written into the dementia care plan and there was no evidence that this was being provided. People’s assessed and identified needs and support must be reflected through the care planning system to make sure that those needs are being fully met. We looked at medication records for the four people and these appeared to be accurate and up to date. A nurse administering medication took time to ask people if they were ready for their medication and respected their responses. Medication administered during breakfast time was carried out in an unobtrusive and respectful manner. Several plastic bags intended for the disposal of soiled waste, were found near the waste disposal bins at the side of the home. They contained mainly empty packaging and empty medicine containers. However, we also found a quantity of discarded medication. The manager could provide no explanation for this and consequently could not accurately account for medication held in the home. The manager said that she would investigate this. However, at the time of writing this report, no explanation had been provided to the commission. Medication held in the home must be disposed of safely and fully accounted for. Conifers Nursing Home DS0000021639.V366466.R02.S.doc Version 5.2 Page 13 We observed interactions between staff and people living in the home throughout the inspection. Staff treated people with dignity and respect and provided their personal care in private. One person said, ‘I get on well with staff, they look after me well.’ Conifers Nursing Home DS0000021639.V366466.R02.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. The social and cultural needs of people using this service are not consistently being met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The four care plans we looked at contained little evidence that people were offered choice in relation to leisure, social activities, cultural interests, food and religious observance. Care plans did record individuals’ preferences in relation to getting up and going to bed and those people who were up by 07:00 said this was in accordance with their choice. Notice boards did not contain any evidence of forthcoming activities or social events and people spoken to during the inspection did not appear to know what was to be provided. There was some photographic evidence displayed of social occasions being previously held in the home. The activity provided on the afternoon of the inspection was colouring books and crayons. The materials for this had been stored in a resident’s wardrobe. An alternative storage arrangement should be found in order to maintain individuals’ right to privacy. Conifers Nursing Home DS0000021639.V366466.R02.S.doc Version 5.2 Page 15 People spoken to throughout the visit confirmed that they could receive visitors at all reasonable times. People wanting privacy could receive visitors in their bedrooms. The home had developed few links with the local community and there was no evidence that trips out or community-based activities were provided for people living in the home. Furthermore, there was no evidence that people had access to advocacy services. A person’s care plan identified that they ‘appreciated’ contact with their church but there was no evidence that this was being supported or that their wishes had changed. People must be offered choice in relation to leisure, social activities, cultural interests, food and religious observance. This must be recorded in their care plans. The home provides a 6-week menu and this is held in the kitchen. It is recommended that these menus are made available to people using the service and their representatives. This could be achieved by posting the menus on notice boards. On the day of the visit the menu for the lunchtime meal had been written on a blackboard in the dining area. The cook told us that she, ‘Talks to people regularly about what they want on the menu.’ Several soft diets and a vegetarian diet were provided. When asked about the vegetarian diet the cook said she adds fish to vegetables in the blender. No records were held of the special diets provided to service users. The cook had received no formal training in catering and did not possess a current food-handling certificate. One person using the service said ‘ the meals are bland and mostly from packets like fish in a bag. The rice pudding was not home cooked but from a tin.’ Catering staff must have the relevant skills and knowledge to meet the cultural and dietary preferences of people living in the home. We looked at food stocks. These were mainly comprised of supermarket value brands, such as economy mince, burgers and tinned food. There was no evidence of fresh vegetables, although the cook said she had used some the day before. She added that she preferred to use frozen vegetables because they took less time to prepare and were easier to cook. It is recommended that consultation takes place with people accommodated and their representatives to establish if the food provided meets their cultural and dietary preferences. Conifers Nursing Home DS0000021639.V366466.R02.S.doc Version 5.2 Page 16 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, 17 and 18 Quality in this outcome area is good. The home has policies and procedures in place to deal with concerns and complaints and to safeguard people from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The system used for recording complaints detailed the last entry on 25/08/06. However, from conversations with visiting local authority care managers and reviewing officers it was clear that several concerns had been raised in relation to formal reviews of the care provided. They confirmed that action had been taken to address the concerns raised. It is recommended that such concerns be recorded as part of the home’s complaints and quality assurance system. This data will enable the continual monitoring and improvement of outcomes for people using the service. There was evidence that the home’s management consultant had undertaken research into the implications of the Mental Capacity Act introduced in 2007, although training still needed to be rolled out to the staff team. In one of the care plans a nursing review undertaken in 2006 stated that the person was ‘unable to make choices.’ This legislation requires that capacity assessments be carried out with individuals that lack capacity to ensure that decisions taken on their behalf are in their best interests. Conifers Nursing Home DS0000021639.V366466.R02.S.doc Version 5.2 Page 17 Suitable policies and procedures were in place for the safeguarding of adults from abuse and staff had received in-house training in this area. The correct procedures had been followed in reporting a safeguarding issue that was brought to the attention of the manager in February 2008. One of the nurses on duty had received safeguarding training the day before our visit. She was unsure of her authority to suspend a member of staff who might be suspected of abuse during a shift when she was the person-incharge. It is recommended that this be reinforced with nursing staff. Conifers Nursing Home DS0000021639.V366466.R02.S.doc Version 5.2 Page 18 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, 20, 22, 24 and 26 Quality in this outcome area is adequate. Improvements to health and safety and the quality of the homes environment are needed to ensure that people living in the home are provided with a pleasant, comfortable and safe place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We undertook a tour of the premises to assess the quality of the facilities provided. Suitable provision had been made to meet the assisted bathing and toiletting needs of the people accommodated. Screens had been provided in double bedooms to preserve the privacy and dignity of people sharing rooms. Lighting, heating and ventilation was appropriate to the needs of the people accommodated and furnishing of communal rooms was domestic in character. Conifers Nursing Home DS0000021639.V366466.R02.S.doc Version 5.2 Page 19 People with high mobility needs and/or wheelchair users would require assistance to enter and exit the building despite the Service User Guide stating that the building was ‘wheelchair accessible’. There are two patio doors in the lounge area and both had a large lip that a person in a wheelchair would not be able to negotiate on their own. One of the doors had a large piece of furniture in front of it and could not be used at all. There were paved areas to the side and rear of the house and garden furniture was provided on the patio area. This area contained several raised paving stones that could cause a tripping hazard. Washing lines were hung at neck height across the patio area and this presented a further health and safety risk to people living and working in the home. It was explained that the washing lines were a temporary measure as the tumble drier had broken down. The washing lines were removed during our visit. The external ramp to a fire door had a handrail to the side, but not at the top. This must be risk assessed to ensure that the risk of falls from the top of the ramp is minimised. There was a large grassed area to the rear with a gazebo and table and chairs provided. The lawned area was very uneven and there were no paths to the seating area. This potentially presented further health and safety risks Over to the left of the grassed area was a large pile of broken furniture, wheelchairs and garden waste. A member of staff was seen transferring a number of broken wheelchairs from inside the building to the waste pile. The management consultant said that a contractor had been instructed to remove the rubbish. We noted that fire doors on the ground and first floors had been fitted with bolts to lock them in place. The bolt on the ground-floor fire door was difficult to open. When unlocked the door did not sit snug into its frame and was damaged with a hole in the middle of the panel. We were concerned that this would impede the timely evacuation of the home in the event of a fire. The management consultant told us that the fire officer had not previously raised this as an issue. The registered person must consult the local fire officer for advice on the use of bolts on exit fire doors to ensure that people living and working in the home are safe. Several bathrooms and toilets had either no suitable handwash or paper towels available. Personal protective equipment (PPE) such as aprons and gloves, were being stored in these areas, whereas current advice from the Primary Care Trust is that PPE should be stored outside toilets and bathrooms to minimise the risk of cross infection. The policy and procedures for the control of infection should be reviewed to ensure that the health and safety of Conifers Nursing Home DS0000021639.V366466.R02.S.doc Version 5.2 Page 20 people living and working in the home is protected. An old wardrobe stored in one of the bathrooms contained staff clothes and other personal items, despite staff lockers being provided for this purpose. One of the toilets was in need of redecoration, while another toilet needed its flooring replacing. Two sluice rooms and a toilet could not be used due to being used for storage Five bedrooms were noted to contain old, worn and damaged furniture that should be replaced. A list of jobs and refurbishment that were needed around the building and garden had been developed. Some of the work included a new cupboard for storing hazardous substances, decoration of bedrooms and bathrooms, repair of the patio doors and carpets to be replaced. These were jobs that were planned to be completed by a builder in the near future. The management consultant could not give a date to the work comencing. The registered person should provide an action plan that details the work to be undertaken and the timescales for achieving this. This should also include the improvements needed to the environment that have been identified in this report. Conifers Nursing Home DS0000021639.V366466.R02.S.doc Version 5.2 Page 21 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 good. Staff employed by the home, receive induction and in-house training to equip them with the skills and knowledge necessary to meet the assessed needs of the people accommodated. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the day there appeared to be sufficient nurses and care workers to support people’s needs and to spend time talking and socialising with them. Catering and domestic staff were also on duty. We did have some concern that there was one nurse and one carer on duty the night before as one carer had called in sick and a replacement could not be found from the staff team. It is recommended that shortfalls in the staff rota are covered by agency staff to minimise the risk of people’s needs not being met in a timely manner. A member of staff described the training events that they had attended and provided by the home’s management consultant. This included the Induction to the service, Adult Protection, First Aid, Basic Food Hygiene, Moving and Handling, Continence Care, Dementia Care and Risk Assessments. Examples of training certificates were also sampled in other staff files. Conifers Nursing Home DS0000021639.V366466.R02.S.doc Version 5.2 Page 22 Personnel files contained copies of pre-employment checks undertaken such as application forms, references and Criminal Record Bureau certificates. Conifers Nursing Home DS0000021639.V366466.R02.S.doc Version 5.2 Page 23 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, 36, 37 and 38 Quality in this outcome area is adequate. The lack of effective management systems, staff supervision, health and safety concerns and continuous selfmonitoring means that the service has failed to provide evidence of the home being managed in residents’ best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the last inspection in November 2006 a requirement was made for the registered manager to notify the Commission of any incident that affects the welfare and safety of people living in the home. Since that time the Commission had been notified of several incidents. However there were further occasions when this was not done within the required timescales. This related to two instances of unexplained fractures. Conifers Nursing Home DS0000021639.V366466.R02.S.doc Version 5.2 Page 24 There is a formal quality assurance tool but it was last used in June 2006. The Service User’s Guide did state that regular residents meetings were held. However, the last record of any meeting was from December 2007.The management consultant said that surveys had not been undertaken since because they thought that the commission’s self-assessment documentation and surveys would suffice. In light of the shortfalls identified in this report there needs to be continuous self-monitoring through internal audits and the involvement of people using the service and their representatives. This will capture the data required to measure the success in providing positive outcomes for people using the service. None of the staff employed in the home act as appointee for the people accommodated. Appointeeship is managed by relatives or the local authority. However, support with personal allowances is provided to several people. We looked at one of the records to assess how this was being managed. Staff had not signed for all money deposited by relatives and had not consistently provided receipts. Similarly, staff had not signed for money taken out to make purchases for the resident, although receipts for purchases were obtained. The manager said that balances were checked once a month, although there were no written records as evidence of this. The finance policy and procedures should be reviewed and updated to make sure that staff evidence and record all financial transactions and that there is an auditing/monitoring system in place. The finance policy and procedures should be reviewed and updated to make sure that staff evidence and record all financial transactions and that there is an auditing/monitoring system in place. The six personnel files examined did not provide evidence that staff had received any formal supervision since 2007, despite the minutes of a general meeting in December 2007, stating that supervision was to be provided. The records that we examined during the inspection visit were generally found to be accurate and up to date. We looked at how health and safety, including safe working practices were being managed in the home. An up to date fire safety risk assessment was in place and this included the evacuation needs of people living in the home. The outcome of the most recent fire service inspection of the home in January 2007 was satisfactory. All the periodic fire safety checks were up to date and staff working in the home had been trained in fire safety procedures. The servicing and maintenance of the home’s equipment, apart from the testing of portable electric appliances, was current. Conifers Nursing Home DS0000021639.V366466.R02.S.doc Version 5.2 Page 25 The issue regarding the use of bolts on fire doors has been raised in the Environment section of the report and a requirement to consult with the Fire Authority has been made. We were contacted in June by a local authority care manager and funded nursing care nurse who both expressed concern over the number of bed rails used with people living in the home, particularly in relation to their use with people who were ambulant. One of these residents had sustained an unexplained fracture to her wrist and the continuing care nurse had queried if this might have been related to the use of rails on her bed. At the time of our visit it was noted that nine people had rails fitted to their beds. It is required that a review into the use of bedrails is undertaken to ensure that they are appropriate and that the nine people concerned are safe from harm. Safe working practice assessments were last undertaken in April 2004. These should be reviewed to ensure that they reflect current good practice in health and safety management. Conifers Nursing Home DS0000021639.V366466.R02.S.doc Version 5.2 Page 26 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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 X 2 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 2 2 2 Conifers Nursing Home DS0000021639.V366466.R02.S.doc Version 5.2 Page 27 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 OP7 Regulation 15 (1) Requirement Timescale for action 08/09/08 2 OP8 13(1)(b) People’s assessed and identified needs and support must be reflected through the care planning system to make sure that those needs are being fully met. Timely referrals must be made to 08/09/08 healthcare professionals to investigate continued weight loss and for advice in relation to people with specialist communication needs. Medication held in the home must be disposed of safely and fully accounted for. People must be offered choice in relation to leisure, social activities, cultural interests, food and religious observance. This must be recorded in their care plans. Catering staff must have the relevant skills and knowledge to meet the cultural and dietary preferences of people living in the home. DS0000021639.V366466.R02.S.doc 3 OP9 13(2) 08/09/08 4 OP14 12 08/09/08 5. OP15 18 (1)(c)(i) 08/09/08 Conifers Nursing Home Version 5.2 Page 28 6. OP17 17(1) Capacity assessments must be undertaken for people who are unable to make decisions about the care and support they need. Action must be taken to ensure that people have safe access and use of the garden area and to prevent the risk of falls from the external ramp to the fire door. The registered person must consult the local fire officer for advice on the use of bolts on exit fire doors to ensure that people living and working in the home are safe. The registered person must provide evidence of continuous self-monitoring through internal audits and the involvement of people using the service and their representatives. A review into the use of bedrails must be undertaken to ensure that their use is appropriate in keeping people safe from harm. 08/09/08 7 OP19 13 (4) 08/09/08 8 OP19 13(4) 08/09/08 9 OP33 24 08/09/08 10 OP38 13(4)(c) 08/09/08 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 OP1 Good Practice Recommendations It is recommended that the Service User Guide be reviewed to make sure that the information provided to people is clear and accurate. It is recommended that evidence should be provided that people using the service and/or their carers have been involved in drawing up their care plans. DS0000021639.V366466.R02.S.doc Version 5.2 Page 29 2 OP7 Conifers Nursing Home 3. OP15 The current menus should be made available to residents and their representatives and they should be consulted with to determine if their dietary and cultural needs are being met. All concerns and complaints should be recorded as part of the home’s complaints and quality assurance system. This data will enable the continual monitoring and improvement of outcomes for people using the service. The registered person should submit an action plan detailing the timescales for environmental improvements identified in this report. The policy and procedures for the control of infection should be reviewed to ensure that the health and safety of people living and working in the home is protected. It is recommended that shortfalls in the staff rota are covered by agency staff to minimise the risk of people’s needs not being met in a timely manner. The finance policy and procedures should be reviewed and updated to make sure that staff evidence and record all financial transactions and that an auditing/monitoring system must be in place. To help monitor staff performance and give them support regular supervision should be provided. Safe working practices should be reviewed to ensure that they reflect current good practice in health and safety management. 4. OP16 5. OP19 6. OP26 7. OP27 8. OP35 9. OP36 10. OP38 Conifers Nursing Home DS0000021639.V366466.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Conifers Nursing Home DS0000021639.V366466.R02.S.doc Version 5.2 Page 31 - 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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