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Inspection on 05/08/06 for County Homes Nursing Home

Also see our care home review for County Homes Nursing Home for more information

This inspection was carried out on 5th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

NHS and other health professionals are actively involved in the care of service users as needed. The relatives spoken to told the inspector that the staff are kind and caring, and it was observed that the staff respect the privacy and dignity of all residents. An increasing range of activities is offered by the designated activities co-ordinator who works for 40 hours per week; with both individual and some group activities, including outings, being available. Ongoing training and development was seen for most staff.

What has improved since the last inspection?

Evidence of family involvement in resident`s care files, and the environmentally themed areas on each unit.

What the care home could do better:

The cleanliness of the environment of Chester Unit has deteriorated considerably since the previous inspection, which is very disappointing as this unit was the most improved last year. A number of requirements have been issued regarding how this regulatory breach must be rectified.

CARE HOMES FOR OLDER PEOPLE County Homes Nursing Home 40 New Hey Road Woodchurch Birkenhead Wirral CH49 5LE Lead Inspector Julie King Unannounced Inspection 09:30 4 & 11 August 2006 th th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address County Homes Nursing Home DS0000020949.V298269.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. County Homes Nursing Home DS0000020949.V298269.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service County Homes Nursing Home Address 40 New Hey Road Woodchurch Birkenhead Wirral CH49 5LE 0151 604 0022 0151 604 0066 county.homes@ashbourne.co.ujk 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) Modelfuture Limited, Paula McCabe Care Home 90 Category(ies) of Dementia - over 65 years of age (88), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (2) County Homes Nursing Home DS0000020949.V298269.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Five named adults under 65 years of age within the maximum number of 90 Two named adults in the category MD(E) within the maximum number of 90 31st January 2006 Date of last inspection Brief Description of the Service: The Home is a purpose built two-storey building. The Home is registered to provide ninety beds for the care of older people with dementia. The Home is divided into three separate units, which are named after northern cities, Chester, York and Lancaster. A First level registered nurse is in charge of each unit, day and night. All three units have access to a secure garden area. The home is situated on the Woodchurch estate close to all amenities such as shops, libraries. The M53 motorway is close to the home, which affords motorway access to Liverpool and the North Wales coast. There are six double bedrooms and eighty-four single bedrooms that have a shared en-suite toilet. There is a service lift on each unit to access the first floor. Fees range from local social service rates to privately arranged costs as agreed individually. County Homes Nursing Home DS0000020949.V298269.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This statutory inspection (site visit) took place over two days, during which time residents, day and night staff, management, and some relatives were spoken to. Most areas of the environment were examined, particularly Chester Unit, which was the focus for the environmental inspection. Staff personnel files, safety records and resident’s care documentation were examined; and found to be maintained in accordance with current good practice guidelines and requirements. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. County Homes Nursing Home DS0000020949.V298269.R01.S.doc Version 5.2 Page 6 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 County Homes Nursing Home DS0000020949.V298269.R01.S.doc Version 5.2 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents assessed needs are being met, and the home is able to provide assurances to residents and their representatives that assessments will be a continuous process throughout the resident’s stay. EVIDENCE: Pre admission assessments provide a holistic assessment of actual and potential needs of each prospective resident; thus allowing a comprehensive care plan to be developed. These assessments care completed by either the registered manager or deputy manager, and include demographic details of the prospective service user – next of kin, past history both medical and psychological / mental health; a specific mental health assessment and involvement of representatives as needed. Multidisciplinary healthcare team (MDT) input is evident in resident’s care files, and include reference to NHS outpatient’s appointments, opticians, dentistry, and tissue viability nurse specialist (TVNS) input at the home when needed. County Homes Nursing Home DS0000020949.V298269.R01.S.doc Version 5.2 Page 8 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a care planning system in place for all residents. This provides staff with the information they need to meet the resident’s needs. Medication management was compliant with current good practice requirements and guidelines, thus helping to ensure the safety of residents. EVIDENCE: Recently admitted residents, and those requiring a high amount of care were case-tracked (followed from pre-admission into the home in all aspects to date), and spoken to in order to establish a holistic view of what that resident’s lifestyle is like at County Homes. The resident’s relatives said that they had had the opportunity to meet someone from the care home “for a chat” prior to admission; and that they felt involved with the daily care of their relative. The care plans are loosely based on the Roper, Logan and Tierney model of nursing care; and evidence input from the resident, their representative and the multidisciplinary healthcare team as needed. County Homes Nursing Home DS0000020949.V298269.R01.S.doc Version 5.2 Page 9 Monthly reviews and evaluations were evident on most care plans seen, and the plans were based on needs identified on the pre-admission assessments. Multidisciplinary healthcare team (MDT) input was evident in all necessary care plans. Some of the care plans required updating with what was actually being recorded on the daily report records – this was discussed with the unit managers who assured the inspector that this would be done. Medications were examined as part of this site visit, and it was evident that the medication management was satisfactory on all units. Residents spoken to said, “[the] staff are lovely”. Staff appear to have a good rapport with residents and their relatives, and were observed sitting talking to them during the afternoon. County Homes Nursing Home DS0000020949.V298269.R01.S.doc Version 5.2 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Links with the local community are good, and support and enrich the resident’s lives. EVIDENCE: Residents at the time of their admission are asked about their lifestyle preferences. Each resident, with help from a family member, is encouraged to complete a “Getting to know you” questionnaire, which is a “Work life History” of the resident, and includes past significant events such as schooling, work, hobbies, as well as food likes and dislikes etc. This information is used to plan organised activities for the resident. The home has employed an activities co-ordinator full time, who also has an input in arranging meetings and training courses with other activities coordinators in the company. The home has a large activities room, plus a “Bar” which residents and staff can celebrate birthdays and other events. County Homes Nursing Home DS0000020949.V298269.R01.S.doc Version 5.2 Page 11 Every day eight-service users from the different units are escorted to the bar where they have lunch, served by the coordinator. This small group gives the residents an opportunity to get to know each other, socialise and have lunch in quiet surroundings. This is good practice; it is therapeutic and will benefit the residents. The activities co-ordinator escorts one or two residents out to the local supermarket for personal shopping as and when required. Visitors are allowed in the home at any reasonable time of day and residents may entertain their visitors either in the communal lounges, their own bedroom or the court yard (weather permitting). County Homes Nursing Home DS0000020949.V298269.R01.S.doc Version 5.2 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A complaint and adult protection policy and procedure was in place that helps ensure the safety and welfare of residents. EVIDENCE: County Homes has an efficient complaint and adult protection policy and procedure in place to help ensure the safety and welfare of service users that they, their relatives and staff can access when necessary. This procedure includes information on ‘whistle-blowing’, in accordance with the Department of Health ‘No Secrets’ guidelines. Most of the staff have, or are in process of completing training in adult protection, with the remaining having training planned for the near future. However all staff do receive basic training in the protection of vulnerable adults during induction. Some advocacy information was available if required by service users or their relatives. County Homes Nursing Home DS0000020949.V298269.R01.S.doc Version 5.2 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Since the previous inspection the environment on Chester Unit has deteriorated and is not conducive of a homely, safe environment. EVIDENCE: On each of the three units the small corridor opposite the lounge / dining areas has been nicely ‘themed’ with different aspects. One has been painted and decorated as a seaside resort, complete with ‘guest house’ room for communal use. Another unit has a ‘1940’s’ themed ‘street’ and ‘living room’ complete with furnishings of that era. Chester unit on both days of this site visit had deteriorated considerably since the previous inspection earlier this year. The entire unit was malodorous, in corridors and individual rooms, and was not helped by a member of staff being seen carrying an un-bagged used continence product across the main corridor. The senior company representative spoke to this staff member after the County Homes Nursing Home DS0000020949.V298269.R01.S.doc Version 5.2 Page 14 inspector’s site visit; and other staff apparently have had additional training in how to maintain cleanliness and prevent malodour. A follow up visit to meet with senior company representatives was conducted on 22 August 2006, when another tour of Chester Unit took place. During this tour there had been no improvement, and in fact, a further deterioration and increase in malodour was clearly evident. The company representatives were aware of this breach, and had prior to this visit agreed an improvement plan for the environment. This plan includes replacing some carpets, refurbishing, deep cleaning and decorating other areas. Timescales for a significant improvement to be evidenced were agreed to mid September 2006, when a further follow up visit will be done. County Homes Nursing Home DS0000020949.V298269.R01.S.doc Version 5.2 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a consistency of care within the home provided by permanent staff, which helps to offer safety and stability for the residents. EVIDENCE: A selection of staff personnel files were examined as part of the case-tracking process. All files now contain the required documents and records, with CRB and POVA evidence available; as were references, some training information, NVQ training, proof of identification and basic inductions. The senior general manager was able to evidence that most of the staff have now completed mandatory training (training that is required by law to do the job), and some resident specific training (such as care of the resident who has Parkinson’s Disease, Dementia, etc.) had taken place, with more planned. This care home also benefits from having specialist trainers that produce guidelines, policies and procedures; and conduct staff training and development to a recognised level. County Homes Nursing Home DS0000020949.V298269.R01.S.doc Version 5.2 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,37,38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is inadequate leadership, guidance and direction to staff which does not ensure residents receive consistency of care in this home. EVIDENCE: Since County Homes had a new manager in March this year, and the home was no longer under the direct control of the senior general manager, standards of leadership have deteriorated. This was clearly evidenced during both site visits, when it was directly observed that some staff were lacking in their knowledge about basic policies and procedures. Senior management have been made aware of these problems and have developed measures and timescales in which to address and rectify regulatory breaches. County Homes Nursing Home DS0000020949.V298269.R01.S.doc Version 5.2 Page 17 Quality assurance is in place for all aspects, and is audited both internally and externally to a good standard. Residents and representatives are asked for their opinions and ideas about how the home can improve it’s quality of life for residents. This information is obtained via face to face meetings, and using questionnaires. Records and documents are stored in accordance with the Data Protection Act1998, and all have limited access to maintain confidentiality. Required health and safety records and service contracts were in place, up to date and valid. County Homes Nursing Home DS0000020949.V298269.R01.S.doc Version 5.2 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 x 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X X 3 3 County Homes Nursing Home DS0000020949.V298269.R01.S.doc Version 5.2 Page 19 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 OP26 Regulation 16 Requirement The registered person must keep the care home clean and free from malodour at all times. Previous timescale of 31/03/06 not met. The registered person must ensure that the care home is well maintained and in good order at all times. The registered person must ensure that the manager is a fit person to manage the care home. Timescale for action 13/09/06 2. OP19 16 23 9 30/09/06 3. OP31 31/10/06 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 OP19 Good Practice Recommendations Additional pictures are obtained for the corridors and communal areas. County Homes Nursing Home DS0000020949.V298269.R01.S.doc Version 5.2 Page 20 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 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 County Homes Nursing Home DS0000020949.V298269.R01.S.doc Version 5.2 Page 21 - 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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