Inspection on 25/10/06 for Copper Hill Nursing Home

This inspection was carried out on 25th October 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

Copper Hill Nursing Home 18/09/07

Copper Hill Nursing Home 30/11/05

Copper Hill Nursing Home 03/08/05

Copper Hill Nursing Home 01/03/05

Copper Hill Nursing Home 22/07/04

Copper Hill Nursing Home 28/01/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Copper Hill Nursing Home Church Street Leeds Yorkshire LS10 2AY Lead Inspector Sean Cassidy Key Unannounced Inspection 25th October 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 DS0000001333.V299276.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. DS0000001333.V299276.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Copper Hill Nursing Home Address Church Street Leeds Yorkshire LS10 2AY 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) 0113 2771042 0113 2719324 www.bupa.com BUPA Care Homes (CFHCare) Limited Mr Charles David Hitch Care Home 180 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (30), Old age, not falling within any other category (150), Physical disability (8), Terminally ill over 65 years of age (10) DS0000001333.V299276.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That no person under the age of 65 with a physical disability be placed on the dementia unit. 30th November 2005 Date of last inspection Brief Description of the Service: Copper Hill is owned by BUPA Care Homes and is located in the Hunslet area of Leeds. It is designed to care for residents with Dementia, Mental Disorder, Physical Disability and also terminally ill. The Home is comprised of six bungalows providing care for a total of 180 residents. There are attractive garden areas with outdoor seating near to each bungalow and ample car parking space giving easy access to all parts of the home. Each bungalow contains its own lounge facilities and kitchenette. The bedrooms are fully furnished, with en-suite facilities. Service users are encouraged to bring personal effects such as ornaments, pictures and small items of furniture. Facilities nearby include supermarkets, a church, post office, banks and a variety of shops. There is a good bus service into the city centre of Leeds. The fees for a room at this home range from £395- £595 per week. Copies of the previous inspection reports can be found at the reception area of the home. DS0000001333.V299276.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. In April 2006 the Commission for Social Care Inspection (CSCI) made some changes to the way in which care services are inspected. Care services are now judged against outcome groups. The inspection report is divided into separate sections for each outcome group for example Choice of Home. An overall judgement is made for each outcome group based on the findings of the inspection. The judgements reflect how well the service delivers outcomes to the people using the service. The judgements categories are “excellent”, “good”, “adequate” and “poor”. The judgements are recorded within the main body of this report. More detailed information about these changes is available on our website – www.csci.org.uk This was an unannounced inspection; it took place over two days. The inspection was carried out between 9.30am and 17.30pm on 25/10/06 and between 09:30am and 15:00 pm on the 26/10/06. Three inspectors were involved with the key site visit. The last inspection of this home took place in November 2005 and a number of concerns were identified, some of which were outstanding from previous inspections. During the inspection all the key standards, and others, were assessed. These are identified in the main body of the report. The inspectors looked in detail at the care of nine residents living in the home. The home has six units, each of which has thirty residents living in them. Three units were inspected and three residents from each unit were case tracked. We looked at care records; spoke to the residents and some of the visitors about their care needs and to the staff about how they deliver care. We inspected the environment in which these residents receive care and observed care practices. We also spoke to other residents and some of their visitors in the home, carried out a tour of the building and looked at other records including maintenance records, staff files and training records. A pre-inspection survey was completed by the home before the visit; the information provided was used during the inspection. Detailed feedback was given to the registered manager at the end of the visit. DS0000001333.V299276.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: More information must be provided to the residents and their families so that they are able to make an informed choice about moving into the home. The information should be more accessible and should contain the terms and conditions of their stay. The assessment process must be reviewed to ensure the experience of residents and their families is a positive one. Although this home has been assessed as adequate the inspectors had several concerns about care planning and meeting the health care needs of the resident group. These concerns were given to the manager during feedback DS0000001333.V299276.R01.S.doc Version 5.2 Page 7 and assurances were given that they would be looked into as a matter of priority. A full re evaluation of the care plans and risk assessments for residents is needed. All care plans reviewed showed needs that were identified in the assessment had not been provided for in the care plan and risk assessment documentation. This practice is poor and places residents at risk of not having their care needs met. The home’s policies and procedures in these areas are not being adhered to. These documents must also show that the resident or their representative has been involved with the process. A review of the systems used by staff to administer, store and dispose of medication must be reviewed to make sure they are safe. More resources are needed to ensure residents are kept active and that they are provided with various forms of stimulating interactions. Particular attention needs to be paid to those residents that spend all their time in their rooms and also those residents with dementia. Staff must be provided with training in adult protection to bolster their existing knowledge. The home should work closely with residents and their families to make the environment more personalised and homely. This was particularly relevant to resident rooms. The staffing levels and the staff roles need to be reviewed to ensure they are correct. Evidence showed that staff were attempting to meet the residents’ physical needs, but not their other holistic needs. The home must ensure that the recruitment policy is being followed. Gaps in this process were identified and this placed residents at risk. The staff-training programme must be reviewed to ensure staff have the necessary training and knowledge to be able to meet the care needs of the resident group. Particular attention must be paid to dementia. A large proportion of the resident group have this condition, but the evidence showed that there was an overall lack of awareness in the staff group as to how the residents’ needs were to be appropriately met. Improved management systems and processes must be introduced to improve care provision and also health and safety within the home. Please contact the provider for advice of actions taken in response to this DS0000001333.V299276.R01.S.doc Version 5.2 Page 8 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. DS0000001333.V299276.R01.S.doc Version 5.2 Page 9 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 DS0000001333.V299276.R01.S.doc Version 5.2 Page 10 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 and 3 Quality in this outcome area is adequate. This judgement has been made following a site visit and by checking records. The home could enable residents and their representatives to make a more informed choice about moving into the home if the required information was included in the Statement of Purpose. Residents and relatives do receive a financial contract from the home. However, they are not fully informed of their rights and responsibilities, as they do not receive a copy of the home’s terms and conditions. The admissions process needs to be a positive experience for all residents. EVIDENCE: The home has developed a Statement of Purpose and Service User Guide, which is made available to residents and their representatives during their stay. Some relatives spoken to said this documentation was ‘discovered by accident,’ as opposed to being given to them on admission. DS0000001333.V299276.R01.S.doc Version 5.2 Page 11 The Statement of Purpose does not contain the required information needed to ensure the prospective resident and their representatives have been enabled to make an informed choice. The manager gave assurances that this would be rectified. The contracts for three residents were looked at. These documents show the amounts of money that will be paid by the local authority and what monies the resident must pay. Residents or their representatives are not provided with a copy of the home’s terms and conditions. Three relatives spoken to were not aware of what the terms and conditions of their relatives stay was. They expressed an interest in this information so that they could be more aware of what their responsibilities were, and also those of the provider. The manager agreed that this was needed to ensure all parties were kept fully informed. Generally, the standard of the pre assessment of residents prior to moving into the home was good. Also, residents who transfer from one unit to another within the home are assessed prior to the new move taking place. This is good practice. However, the experience of one resident and his family was poor and they felt quite aggrieved by the whole pre assessment process. This particular resident presented with some care needs that placed him and others at risk. Unfortunately, the assessment carried out by the home was poor; there was no evidence of who was involved in the assessment or who supplied the information. More importantly, there was no evidence of this individual’s strengths and abilities, such as what he could do for himself, or of the impact that other individuals in the environment would have on him. An assessment was also completed on the same day but the information from this was vague and not completed properly. The family were very upset with the whole admission process. The staff on duty were not aware of what this person’s needs were and one staff member said, ‘You don’t know what their needs are when they are new.’ This is poor practice and places the resident at risk of not having his or her needs met and causes distress to family and others. The manager was made aware of this resident and gave assurances that the matter would be investigated as a matter of priority. DS0000001333.V299276.R01.S.doc Version 5.2 Page 12 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 poor. This judgement has been made following a site visit and by checking records. Evidence is needed to show residents and their representatives are involved with care that is prescribed. Because care records are poor, there is no assurrance that all of the resident’s needs will be met. Residents and/or their relatives have been involved in the development of the care plan. Not all medication practices adopted by the home help to ensure residents are properly protected. Staff are attentive and polite. They respect the privacy and dignity of the residents. EVIDENCE: Care plans are evaluated on a monthly basis and formal reviews, which involve the resident’s family, take place every six months. One relative said she had DS0000001333.V299276.R01.S.doc Version 5.2 Page 13 been involved in the development of care plans for her mother, however other relatives said that they were not. Three out of the six units were inspected and each inspector inspected the care plans for three residents. Each resident has a care file that should identify assessed areas of need. It should also provide appropriate directions for staff to assist them to meet those care needs. Much of the care documentation inspected showed the home does not make sure a care plan is in place for each assessed resident need. The following are some examples: • • • • A resident assessed as being epileptic had no risk assessment or care plan in place. Two residents identified as being aggressive and violent at times did not have a risk assessment or care plan in place. Two residents with Grade 3-4 pressure sore had no wound care plans in place and no pressure area care plan. One resident assessed as being aggressive and having inappropriate sexual behaviour, had no risk assessments or care plans in place to assist staff. A resident had been admitted on the 26/8/06 but did not have any care plans written until 10/9/06. • The inspectors saw little evidence to show that the home actively involves the residents or their representatives in agreeing/consenting to the initial care plans that are written. The home involved other health professionals such as tissue viability nurses, chiropodists, opticians and dieticians in the care of residents when they identified the need. This is good practice. Some care plans did not contain the detail needed to ensure residents’ needs were met. This was particularly relevant to the areas of continence, pressure area care, personal hygiene and nutrition. Care staff said that they had very little input, if any, with resident care plans. One unit manager confirmed that the staff mainly relied on verbal information regarding resident toileting regimes and that these were not written down. For example, in the care plans when it stated, “Offer regular toileting”, “ Offer toilet when needed,” This was unspecific. Staff do not always follow the instructions in care plans. A resident whose care plan said she needed a weekly bath had not had one for three weeks. Staff said there were systems in place to make sure residents’ needs were met, however, this seemed to have been overlooked. Some of the care staff said DS0000001333.V299276.R01.S.doc Version 5.2 Page 14 they do not have time to read the residents’ care plans but are informed of care needs by the nursing staff. Some writing in the care plans was difficult to decipher which could lead to care needs being overlooked. This is poor practice. Nutritional risk assessments were not carried out for all residents and those written were not all reviewed monthly. One resident with two grade three pressure sores did not have a record of when staff had been relieving pressure for that individual or a nutritional risk assessment or nutritional care plan. The home’s weighing scales were inaccurate and must be repaired. Another set of scales used in a unit had not been working for three months. Photographs had been taken of a resident’s pressure sore without gaining written consent from the resident.This is poor practice. The home is registered for thirty people with a primary need of dementia. However, many other residents living in the different units also have specialist dementia needs and this was confirmed through the documentation and also speaking with the staff. Good practice in dementia care recommends that care planning should be ‘Person Centred’ to ensure a full holistic picture is in place so that the person’s needs are met. The care plans inspected were not person centred and mainly concentrated on the physical needs of the residents. However, it should be pointed out that the manager on the dementia unit did provide some care plans for other residents that showed elements of a person centred care approach. The home has good policies and procedures in place for dealing with medication. They include a policy for self-administration of medication and homely remedies. The policy includes information on how and when to use homely remedies safely. In one unit, homely remedies administered were recorded properly in the homely remedy administration book, but the unit had failed to obtain GPs permission to use them. This is not the procedure identified in the home’s policy. There were several handwritten entries on MARs (Medication Administration Records) that were not signed by the person making the entry and were not checked and countersigned by a second person. There were also several MARs that had pharmacy labels attached, instead of printed instructions or handwritten entries. The guidelines from the Royal Pharmaceutical Society state that this practice increases the risk of errors. This is poor practice. One inspector observed some poor medication administration practice during the course of the inspection. The period of time taken to administer medication is very long and the gap between medication rounds is very short. This places possible risks to residents and must be reviewed as a matter of priority. These issues were highlighted with the unit managers and also the registered manager. DS0000001333.V299276.R01.S.doc Version 5.2 Page 15 The medication charts for those residents case tracked were examined and a number of unexplained signature omissions in the MAR were identified. A controlled drug was listed in the controlled medication book but had not been transferred to the resident’s MAR sheet. The medication returned to the pharmacist is not countersigned by the pharmacist who collects it, leaving the system open to potential abuse. DS0000001333.V299276.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 and 15 Quality in this outcome area is adequate. This judgement has been made following a site visit and by checking records. Residents and staff said that the home could do more to ensure the residents’ social cultural and recreational interests could be met. The home actively promotes resident contact with family and friends whenever possible. The majority of people spoken to said that the food provided in the home was good. Some expressed disappointment EVIDENCE: The overall provision of activity provided to residents in the home is insufficient. An activity co-ordinator visits for three sessions per week. Activities such as bingo and arts and crafts are on offer. Outings to local shops or places of interest are occasionally arranged. There are two activity coordinators employed by the home. A conversation held with one identified that there are time restrictions to the role and they are unable to provide for everyone’s needs. The inspector was told that activities DS0000001333.V299276.R01.S.doc Version 5.2 Page 17 are mostly spent with the client group that are more able. The activity coordinator confirmed that she did not have any dementia training in her role but thought that this would be of great benefit to the residents if she was more aware of their needs and capabilities and how to engage them. The evidence seen suggests that the activities coordinators are solely responsible for this role in each unit. This was also confirmed through conversations with residents and staff. This is not satisfactory and more work is needed in this area so that resident needs are properly met. Throughout the day, residents were seen to spend time watching TV or listening to the radio. However, some residents could not see the TV properly due to the positioning of their chairs and the radio station, which was playing most of the time. The music did not seem appropriate to the age of the residents in the room. Staff said they did not have time to sit and just chat with residents. Some of the more dependant residents or those who were in their own rooms were quite isolated, socially. One resident who was in her room said “the majority of the staff are really good if they have time to have a good conversation with you.” A number of residents are nursed in their rooms and no records were seen to show exactly what interaction they had with others over the course of each day. Visitors were made welcome, and a private room is available for people to use. Relatives are encouraged to visit the home. One relative said “We are made to feel really welcome and can make drinks for ourselves.” One resident’s family visited him in the main lounge area, and whilst they were talking another resident tried to remove the chairs that they were sitting on. They were at a loss about how to react or what to do. Staff carried on working and it was the manager who eventually intervened. Whilst the flexible approach to care is to be applauded, some attention should be given to the effect that this has on people visiting the unit. A Church of England vicar visits the home and Nuns visit for the needs of Catholic residents. Muslim residents’ needs are catered for. Hallal meat and food products are provided and religious practices are observed. Staff have also made efforts to use a resident’s own language, this is good practice. Menus were varied and nutritionally balanced. Most residents and their families said they were very satisfied with the food and choices available. One resident said, “The food’s great and there’s plenty of it.” The chef meets with residents on a monthly basis to ask if they are happy with the food. The main meal of the day is served at lunchtime. An alternative can always be provided. The lunchtime meal was smoked haddock in parsley sauce with peas and mashed potatoes followed by chocolate cake. Sandwiches were the alternative choice. DS0000001333.V299276.R01.S.doc Version 5.2 Page 18 Residents were observed to eat their meals in a calm and relaxed environment. Those residents needing assistance with their food were assisted in a dignified manner. Residents were supported with courtesy and dignity during their meal. However, all residents were given a bib to protect their clothing during eating when a napkin may have been sufficient and given them a bit more independence. Menus were available for residents throughout the various dining areas. Menus appeared varied and nutritionally balanced. There was a good deal of choice and flexibility around meal times, food and drink. The specialist dementia unit gave service users the opportunity to eat at different times throughout the day, and snack foods were available all the time. There was a good selection of buffet food available and staff asked the chef to prepare another choice of meal for a person who had refused what was on offer. This practice was not observed in the other two units but they would possibly benefit from this good practice being introduced. Varying degrees of feedback were obtained from residents/relatives regarding the food. The overall comments were positive but there were some negative comments that suggest not everyone is content. The following are some examples of comments that were given regarding the food, “The food is of a good quality.” “ Mum seems to love the food. There is always plenty.” “We have to come in every day with food because it is not nice and mum doesn’t like it.” These comments were presented to the manager for further investigation. The manager confirmed that food audits are regularly taken and the cooks attempt to gather the food likes and dislikes of the residents regularly. The inspectors observed the cooks gathering this information during the inspection. DS0000001333.V299276.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made following a site visit and by checking records. Complaints are recorded and dealt with through the right channels. Relatives and residents said they were confident their complaints would be dealt with correctly. The care staff showed a good awareness of adult protection issues. Ensuring all carers receive the training in adult protection would further protect residents. EVIDENCE: Feedback obtained from residents and relatives showed there is a good awareness of the complaints procedure within the home. Those that have used it said they were satisfied with the outcomes that they were provided with. Those spoken to were confident that their complaints would be properly dealt with and also felt at ease with highlighting them. The complaints record was examined and the outcomes viewed. A recent complaint highlighted a number of poor care practices within the home. The home had responded to this complaint and had been open and transparent in its response. An apology was given to the complainant and they were assured that the home would attempt to make sure the situation was not repeated. It was recommended that the manager follow the complaints policy and record outcomes of complaints and the date when the investigation was completed. DS0000001333.V299276.R01.S.doc Version 5.2 Page 20 The records showed that the home is proactive in referring issues to Adult Protection when they are highlighted. There is an ongoing adult protection investigation that the police have been involved with. This is coming close to completion. Staff showed they had a good awareness of adult protection issues. The training for staff in this area needs further action, as there were a number of gaps where staff had not received it. DS0000001333.V299276.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made following a site visit and by checking records. The environment of the home was assessed as clean and tidy. The maintenance programme, which is ongoing, would benefit from more specialist dementia care input. EVIDENCE: The dementia unit is following some principles of good practice in dementia care with the use of colour. All toilet doors are painted yellow, and are well signed. Corridors are full of reminiscence photographs, pictures and other memorabilia and there are boxes outside some rooms with items that are relevant to the individual resident. Bedroom doors are numbered, and have either a photograph of the person or an item that they can relate to. Some bedrooms are personalised with ornaments, pictures, and one person had brought her own sideboard in with her. There is a quiet room for visitors to DS0000001333.V299276.R01.S.doc Version 5.2 Page 22 use and a room with some soothing sensory equipment. Other units within the home would benefit from this good dementia practice highlighted in the dementia unit. One other unit inspected had noticeable evidence of excessive wear and tear. Skirting boards and doors were scraped badly and carpets were stained in a number of areas. The manager stated this unit was soon to be refurbished as part of the ongoing refurbishment plan for the home. Some bedrooms were dark and dingy and it was difficult to see, when only the central ceiling light was used. One unit manager had said that a number of relatives had already complained about the poor lighting. No records were found to show the complaints were correctly recorded. All rooms within the home have been redecorated in the same style and using the same furnishings. Some rooms were tastefully decorated by the resident, but overall, there was a lack of individuality. All rooms had vinyl floor covering and metalframed beds, unless a special bed was used for pressure relief. In some rooms the metal frames were clearly visible because there were no valances or bedspreads in use. The manager said that residents and their families could have carpets in their room if they request. This should be clearly highlighted in the Statement of Purpose and Service user Guide. In some lounges there is a large TV and there is a small smoking lounge with a TV. The seating arrangement in the lounges could be set out better to make sure residents can see the TV from whichever chair they sit in. The taps in bedrooms and communal bathrooms have a push down lever mechanism with the water only flowing whilst the lever is pressed down. This means that washing both hands together is very difficult as the water does not flow long enough for hands to be washed properly, thereby creating a potential cross infection risk. In one unit the vinyl flooring in some bedrooms was ‘sticky’, and some bedrooms had tyre marks on the floor from wheelchairs. The dining room flooring was badly marked with footmarks, trolley and wheelchair marks. This made this part of the unit unsightly. The home was experiencing problems with a particular carpet, but this was being dealt with. The majority of the feedback regarding the cleanliness of the home was positive and the overall assessment of the cleanliness of the home was good. However, some negative comments were made regarding cleanliness. One said that when their relative arrived to move into their room was dirty. One person said that the tables, comfortable chairs and wheel chairs could do with a good cleaning. These comments were passed on to the manager at feedback. DS0000001333.V299276.R01.S.doc Version 5.2 Page 23 There is a large laundry in the home that caters for all the units. The laundry has a facility to ensure soiled clothing is washed at appropriate temperatures. Sluicing facilities are sited in each unit. Infection control is well managed. Staff were seen to wear protective clothing when assisting residents to the toilet or bathroom, although some staff failed to remove their protective clothing immediately after leaving the toilet area. Correct procedures are followed when dealing with clinical waste. All staff asked were able to describe the infection control measures that the home has in place. DS0000001333.V299276.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made following a site visit and by checking records. Staffing levels implemented do not meet the holistic needs of the resident group. Residents are not fully protected by the recruitment procedures used by the home. Residents would benefit from a more focussed training package centred on their care needs. EVIDENCE: The home has six units that all have their individual staffing rotas. The unit managers are in regular contact with the registered manager to deal with any staffing issues that may affect resident care. The home has an internal bank system to fill staffing shortages and other local agencies supply workers when needed. The inspectors observed the staff working in three of the units. Although the staff were observed to be very pleasant and courteous to the resident group, they appeared to be very busy carrying out physical tasks and appeared to have little time, if any, with one to one or group activity with the residents. DS0000001333.V299276.R01.S.doc Version 5.2 Page 25 All staff spoken to said they do not feel rushed in their work but wish they had more time to spend chatting to residents or doing some sort of activity with them. One staff member said, “It’s a very busy, heavy unit, we don’t get out much with residents.” Another said, “We don’t have time to read the care plans, we get to know the routines and then just get on with the job.” Residents said they thought there were enough staff around if there was noone off sick or on holiday. Most interaction through the day was when staff were attending to some physical care need of the residents. One resident said, “Staff are always rushed off their feet but they always come if you press the buzzer.” Another said, “You only have to ask and they come, they are always helpful and friendly.” Staff are aware of residents’ needs despite some gaps in training. They are made aware of needs through their own observation and instruction from the nursing staff. Some staff have done some specialist training around the needs of people with dementia and their nutritional needs. Most staff said they wanted to do further training in dementia awareness. Some staff’s statutory training such as moving and handling was overdue. Staff spoke highly of their induction and statutory training they had completed. The induction pack is well structured and based around the Skills for Care induction standards. The home have recently employed an individual to review and implement a training programme for the staff group. It is hoped that that this well help to improve the training provided to staff. The home is committed to ensuring at least 50 of the care staff are trained to NVQ Level 2 or above. This target is very nearly achieved. However, the training records of four carers were looked at. These records show that the home has a tendency to concentrate on the mandatory training needs of the staff group. Staff said that they are provided little training in the areas of resident need, such as, pressure area care, diabetes, epilepsy, communication and nutrition. The home has provided dementia training to some carers but more needs to be done to ensure they are aware of the dementia needs of residents. Three carers working in the specialist dementia unit had no training in this area. The absence of training provided in these areas means that residents may not receive an appropriate care package. The recruitment files of those carers that have recently started provided evidence to show that not all the required checks were carried out prior to the carer starting work in the home. Appropriate references and a correct police check had not been obtained. The home had not followed the recruitment procedure developed by BUPA. DS0000001333.V299276.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38 Quality in this outcome area is adequate. This judgement has been made following a site visit and by checking records. The home has a good management structure in place. However, systems for monitoring and improving care practice and Health and Safety are in need of review. EVIDENCE: The manager has been in post for nearly two years and has the qualifications needed to manage a care home. He is an experienced manager and has managed a number of different services within the organisation. Like all BUPA homes, the resident group is surveyed for its views regarding the services that are offered. The large majority of the resident group at this home DS0000001333.V299276.R01.S.doc Version 5.2 Page 27 are unable to give their opinion due to the nature of their condition so there is a strong probability that their views will not be heard. It was recommended that the home seek other ways of ensuring as many people as possible are enabled to air their views. This includes consulting with relatives and advocates where necessary. The results of these surveys must be published and made available to all. Regulation 26 visits are made and the results of these are sent to theCSCI to view. The manager said that there is regular auditing of care plans used in the home. It was recommended that this process be reviewed as there are a number of issues highlighted in this report that require improvement in care planning. Care records are not stored safely, therefore confidential information about residents is accessible to people who should not have access to this information. A robust policy is in place that deals with resident monies. A sample of the records kept in relation resident finances were examined and were found to be in good order. Discussions were held with the manager in relation to health and safety in the home. There is a robust set of policies in place to deal with health and safety issues. All equipment apart from wheelchairs and pressure relieving equipment are regularly checked for safe use. Hot water temperatures are checked and altered to ensure resident safety. Two domestic staff spoken to were unable to identify what the COSSH instructions were for the cleaning fluids they were using and were not aware of the COSSH training file. It was confirmed that they both were unable to read English and therefore would not understand the information. This places them and others at risk of harm. There are identified trainers in place to provide training in the areas of Moving and Handling and Fire Training. The records showed, and the manager confirmed, there are gaps in this training. Assurances were given that these gaps would be rectified as soon as possible. Environmental health officers have recently carried out an inspection at the home. This inspection highlighted a number of poor practices in food handling and storage. A Hygiene Improvement Notice was issued under the Food Hygiene Regulations 2006 and the home was given a timescale to ensure all the elements within the notice have been met. DS0000001333.V299276.R01.S.doc Version 5.2 Page 28 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 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 x x x x x x 3 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x 2 2 DS0000001333.V299276.R01.S.doc Version 5.2 Page 29 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 OP1 Regulation 4, Schedule 1 5 14 Requirement The registered person must ensure the Statement Of Purpose contains all the necessary information. All residents should be provided with a copy of the home’s terms and conditions. The home must ensure that all new residents are admitted only after a full assessment is carried out and they are assured the resident’s needs will be met. All residents must have care plans in place for any identified need. These must include all the necessary detail and show evidence that the resident or their representative has been involved with the process. The registered person must ensure the identified health care needs of the residents are properly planned for and met. The care plans developed must have a more Person Centred approach. Timescale for action 31/12/06 2. 3. OP2 OP3 31/12/06 30/11/06 4. OP7 15 30/11/06 5. OP8 15 31/01/07 DS0000001333.V299276.R01.S.doc Version 5.2 Page 30 Particular attention must be given to the areas of: • Nutrition • Pressure Area Care • Continence Care • Personal Hygiene The registered person must 30/11/06 ensure equipment used to weigh residents is in good working order. The registered person must 30/11/06 ensure medication is administered, stored and disposed of safely in line with the Royal Pharmaceutical Guidelines. The registered person must ensure staff are aware of the home’s medication policies and that they are adhered to correctly. All residents must be enabled to take part in social and leisure activities that meet their needs and expectations. This must be clearly documented with a care plan provided. (The previous timescale of 20/02/06 was not met) The complaints record must show evidence that an outcome has been obtained within the 28 day timescale. To ensure residents are appropriately protected from abuse, all staff must have Adult Protection training (Previous timescale of 20/11/05 was not met). 6. OP8 15 7. OP9 13 8 OP12 16 31/01/07 9 OP16 22 30/11/06 10 OP18 13 31/03/07 DS0000001333.V299276.R01.S.doc Version 5.2 Page 31 11 OP19 13 and 23 Those areas of the home in need of refurbishment should have clear timescales identified. Residents and their representatives must be informed of the planned work. Some water taps in the home create the opportunity for potential cross infection and must be replaced. (Previous timescale of 20/11/05 was not met). Carpets and floor coverings must be reviewed to ensure they meet the satisfaction of the resident group. Resident representatives should be consulted if the resident is unable to air their view. 31/03/07 12 OP27 18 13 OP28 18 The registered manager must 31/01/07 review the staffing levels to ensure there are enough staff on duty to meet the care needs of the resident group. The registered person must 31/03/07 ensure at least 50 of the carers are trained to NVQ Level 2 standard. The registered person must ensure that staff receive training in areas of resident care need. The registered person must follow the home recruitment procedure and obtain all the necessary information on an employee prior to commencing work in the home. The registered person must ensure all carers are correctly trained in the areas of Moving and Handling and Fire Training. The registered person must make sure that any employees DS0000001333.V299276.R01.S.doc Version 5.2 Page 32 14 OP29 19, Schedule 2 30/11/06 15 OP38 23 31/01/07 23 16 OP38 23 17 OP38 23 18 OP37 17 using harmful substances are appropriately trained and informed of how to protect themselves and others. The registered person must 11/12/06 ensure that all notices from other Inspectorates are complied with. (This relates to the Environmental Health Notice) The registered person must 31/01/07 ensure that equipment used for monitoring residents’ weights are in good working order. The registered person must 31/12/06 ensure that the personal information of residents is properly protected in line with the Data Protection Act. 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 home inform residents and their representatives about being able to have carpets in their rooms if they wish. This information should be included in the Statement of Purpose and the Service user Guide. The manager should review the use of bibs for residents when meals are served. Not all residents may need one of these and a napkin may be more suitable. The registered person should work closely with the residents and their families to make their bedrooms appear more attractive, comfortable and homely. It is recommended that the seating arrangements in lounges are altered to ensure televisions are able to be viewed by all. It is recommended that alternative ways of seeking the views of all residents are developed. 2 OP15 3 OP19 4 OP33 DS0000001333.V299276.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 DS0000001333.V299276.R01.S.doc Version 5.2 Page 34 - 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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