Inspection on 15/05/06 for Cow Lees Nursing Home

This inspection was carried out on 15th May 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 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

Cow Lees Nursing Home 24/09/08

Cow Lees Nursing Home 14/05/07

Cow Lees Nursing Home 22/11/05

Cow Lees Nursing Home 01/07/05

Cow Lees Nursing Home 29/09/04

Cow Lees Nursing Home 20/04/04

Similar services:

Coton Hill House

Doddington Lodge

Far Croft

Churchill House Nursing and Residential Home

Field Farm House

Church Terrace Nursing & Residential Home

Fountain Court

The Forbury

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

CARE HOMES FOR OLDER PEOPLE Cow Lees Nursing Home Astley Lane Bedworth Warwickshire CV12 0NF Lead Inspector Michelle O`Brien Key Unannounced Inspection 15th May 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cow Lees Nursing Home DS0000004391.V295494.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. Cow Lees Nursing Home DS0000004391.V295494.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cow Lees Nursing Home Address Astley Lane Bedworth Warwickshire CV12 0NF 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) 02476 313794 02476 316750 cowleescarehome@yahoo.co.uk Mr John O`Sullivan Mrs Carole O`Sullivan Margaret Bailey Care Home 52 Category(ies) of Dementia - over 65 years of age (52) registration, with number of places Cow Lees Nursing Home DS0000004391.V295494.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may also provide care for the person named in the variation application dated 14 December 2005 22nd November 2005 Date of last inspection Brief Description of the Service: Cow Lees Nursing Home is approximately 2 miles from Bedworth town centre in a rural setting. The Home is registered to provide accommodation to 52 elderly residents with dementia who may require nursing care. The accommodation is provided in two main care areas, Cow Lees House (existing building) and Astley House (new building). Accommodation in Cow Lees House is provided in mainly shared rooms. Astley House is a purpose built facility with single en-suite accommodation. Access to all care areas is via passenger lift/stairs. A number of rooms in Cow Lees have limited access; residents occupying these must be able to negotiate small flights of stairs. Gardens areas are easily accessible to all residents; garden areas are mature and well maintained. The current scale of charges is £447 - £485 per week. Additional charges are made for chiropody and hairdressing. Cow Lees Nursing Home DS0000004391.V295494.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced fieldwork visit to this service as part of a key inspection process involving looking at a range of information. This included the service history for the home and inspection activity, notifications made by the home and information shared from other agencies and the general public. This visit took place between 10am and 6.30pm. On the day of the visit 50 service users were accommodated in the home and it was the assessment of the manager that half of the service users had high dependency needs and half had medium dependency needs. The inspector had the opportunity to meet and chat with 17 service users about their experience of the home. Some of the service users found it difficult to engage in conversation due to their dementia but were able to express their feelings with verbal and non-verbal communication. Five service users were ‘case tracked’. This involves investigating an individual’s experience of living in the care home by meeting with them, talking to them and their families (where possible) about their experiences, looking at their care files and focusing on outcomes. A pharmacist inspector examined the management of medicines in the home. The manager and deputy manager were present throughout the visit. The inspector also talked to two relatives of service users, two of the care staff, a senior nurse and the kitchen staff. Ten completed comment cards were received from service users and 16 completed comment cards were received from relatives before this visit. Documentation maintained in the home was examined including policies and procedures and records maintaining safe working practices. The inspector would like to thank staff and residents for their co-operation and hospitality during this visit. What the service does well: There is a cheerful and welcoming atmosphere in the home. The positive comments from service users and their relatives demonstrate that service users feel well cared for and are happy in the home. Staff interact well with service users and are attentive to their needs. Cow Lees Nursing Home DS0000004391.V295494.R01.S.doc Version 5.2 Page 6 The home provides tasty, nutritious meals which reflect the preferences of people living in the home. What has improved since the last inspection? What they could do better: The management of medicines in the home is poor and needs to be improved to protect service users from harm. The specialist pharmacist inspector made a thorough examination of the home’s systems for managing medication. 18 requirements for improvement were made including the ordering, receipt, storage and administration of medicines. Cow Lees Nursing Home DS0000004391.V295494.R01.S.doc Version 5.2 Page 7 The information gathered during the pre admission assessment process needs to be recorded better to ensure staff have sufficient written information to develop and implement care plans for service users. Nursing staff need to ensure that there is a care plan for each of the identified needs of service users. This should include writing a care plan for any new or short term needs. Staff need to respond to risks to service users’ health, such as weight loss; referrals to other health professionals should be made as appropriate and action taken to reduce the risk. The manager, along with the activities co-ordinator, need to review the activity programme within the home so that all service users in both house groups are given opportunities for stimulation through leisure and recreational activities which match their cultural preference. The manager needs to develop and implement a Quality Assurance programme to monitor all the working practices in the home and develop action plans for improvement where necessary. The opinions of service users and their relatives which have been gathered during the recent surveys should be incorporated into any action plans produced. 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. Cow Lees Nursing Home DS0000004391.V295494.R01.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 Cow Lees Nursing Home DS0000004391.V295494.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 was assessed. Quality in this outcome area is adequate. Service users have their needs assessed before they move into the home to ensure their needs can be met by the service. EVIDENCE: Three service users admitted since the last inspection were case tracked. Records demonstrate that service users are visited by the home manager to make an assessment of their needs before they are admitted to the home. An assessment form is used to record the abilities and needs of service users with particular attention to their psychological needs. It was evident through discussion with the manager and deputy that they were very aware of the needs of recently admitted service users; however, the information gathered is not written down in sufficient detail to enable staff to develop care plans or identify the resources needed for an individual prior to their admission. Service users’ files contained information from social workers and hospital staff detailing needs but this is often brought with the person on the day of their admission. Cow Lees Nursing Home DS0000004391.V295494.R01.S.doc Version 5.2 Page 10 For example, it was evident during discussion with staff that one very recently admitted person had swallowing problems and needed to have their drinks thickened. This was not recorded on the assessment form but was included in detailed care plans from a previous care home that accompanied the person on the day of admission to the home. Staff had been informed verbally of the need to thicken fluids for this service user. The inspector met with the service users that had been case tracked and although they had difficulty communicating because of their dementia it was evident that the home was meeting their needs. The information gathered during assessment is used to develop care plans to meet the identified needs of service users. On the day of their admission risk assessments are completed for pressure sores, falls, nutrition and moving and handling. It was discussed with the manager that the assessment process could be further enhanced by developing the home’s assessment form to include more written detail about service user’s daily living needs and completing the risk assessments when the pre-admission assessment takes place. Cow Lees Nursing Home DS0000004391.V295494.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 were assessed. Quality in this outcome area is poor. Care plans are in place to meet most of the identified needs of service users but medicine management must be improved to protect service users from potential harm. EVIDENCE: The general appearance of service users indicated that that they were cared for. Most service users were observed to have had attention paid to their personal care. Fingernails were trimmed and clean, hair looked clean and groomed and clothes were well laundered. The relative of one service user commented, ‘He always looks clean and nicely dressed’, another commented, ‘The level of care and attention is very good.’ The manager and staff have worked hard reviewing the care planning documentation in the home to ensure that service user’s care files are organised and contain information about service users in a way that is easily accessible to staff. A total of five service users were case tracked. Their care files contained care plans to meet most of their identified needs. Care plans are reviewed each Cow Lees Nursing Home DS0000004391.V295494.R01.S.doc Version 5.2 Page 12 month. Risk assessments are completed for nutrition, tissue viability, falls and moving and handling. Three service users chatting to the inspector over lunch commented ‘we are well looked after’ and ‘I get what I need’. One newly admitted service user had a swallowing problem and required thickened fluids to reduce the risk of aspiration or choking. There was no care plan for this risk although it was evident through discussion with staff that they had been informed verbally and were taking the appropriate action to reduce risk. It was discussed with the manager and deputy the importance of recording risks and devising written care plans as well as giving verbal instruction in order that staff have clear direction and the needs of service users are not overlooked. The number of incidents of challenging behaviour has reduced dramatically since the last inspection. Some of this is due to the fact that some service users that had been involved in incidents are no longer living at the home. However, it is commendable that the management of challenging behaviour has significantly improved. Strategies have been developed and implemented for individuals that have reduced the number of incidences. This has improved the atmosphere in Astley House in particular and has improved the quality of life for people in the home by reducing anxiety and increasing their feeling of safety. Psychological care plans identified the known behaviours of people with details of how staff should deal with them to reduce any risks to service users. It was discussed how these could be further developed by analysing the incidence of challenging behaviour to identify possible reasons for it. Care plans are not always implemented for short term or new needs. For example, the records of one service user described a urinary tract infection and ‘bladder problems’ over a two week period but a care plan was not implemented. Another service user with a history of weight loss was identified as having a further 4Kg weight loss over a one month period but no action was recorded and no care plan was implemented. There was evidence of service users having access to GP, chiropody, optician, dentist and consultant psycho-geriatrician. It was informed that none of the service users have pressure sores. One service user has very compromised tissue viability and this is being managed well by the home to prevent further skin damage. Staff were observed to address service users by their preferred names and were respectful of their rights to privacy and dignity when attending to their care needs. Cow Lees Nursing Home DS0000004391.V295494.R01.S.doc Version 5.2 Page 13 The pharmacist inspector examined the management of medicines in the home and the following concerns were raised:The medication room in Cow Lees unit was too hot to safely store the medicines so they do not deteriorate. The medicine refrigerator was too hot and the thermometer could not read the maximum, minimum temperatures to check the true temperature of the refrigerator at all times to confirm that the medicines inside were stored correctly. Medicines had been recorded as administered when they had not been. Medicines were missing at the time of the inspection. Gaps on the Medicine Administration Record (MAR) chart were found. Some medicines had been administered to the service users but not signed as such whilst others had not been administered and the reasons not recorded. Many medicines were found in the home that had not been recorded on the MAR chart. The nursing staff are responsible for recording all the medicines the doctors prescribe and their administration to the residents. This did not always happen. Some medicines had been recorded as given to the residents but none were found in the home to give. This showed that the staff did not always look at the MAR chart before they gave the medicines and signed the MAR chart without any consideration of what they actually did. The MAR chart therefore was not a true reflection of what had actually occurred at all times. Many residents were recorded to be given medication without their consent (covert administration). The protocols found did not support this method of administration as residents were recorded as having a right to refuse if offered their medicines but they were still given them even if they refused. This was a decision made by the nursing staff and not the decision of the multidisciplinary team as it should be. Many medicines had been prescribed by the doctor on a “when required” basis. Protocols had been written to support these medicines being administered but these did not give a true reflection of the actual reasons or dose why medicines are administered to the residents. The information following what happened after these medicines were given was recorded in the resident’s daily log and not the MAR chart so the nursing staff could not review the administration of these particular medicines. Some medicines had not been stored in a locked cabinet but left on an open shelf in the medication room. If the room was not locked by mistake the residents could get hold of the medicines within which may be dangerous. The nursing staff did not adequately check in the medicines received into the home. The doses of some medicines could not be checked with what the doctor actually wanted. This may result in the wrong dose of medicine being given to the resident. Quantities of medicines received into the home or balances carried over from previous months were not always recorded making audits difficult to undertake to check that the nurses do give the medicines out Cow Lees Nursing Home DS0000004391.V295494.R01.S.doc Version 5.2 Page 14 correctly. One medicine could not have been given at the correct dose, as there was no equipment to measure the correct dose available. Many residents were prescribed sedating medicines with poor protocols to support their use. One resident was being given twice the recommended dose of one medicine and two medicines with the same effect. Neither had been questioned with the pharmacist or the doctor. One medicine had not been supplied by the pharmacy. Nursing staff had not obtained a further supply from the hospital or doctor. This resulted in the medicine not being given for 22 days. Nursing staff had moved one medicine from one box to a different pharmacy labelled box. (Secondary dispensing). The labelled box contained two different medicines. This is considered bad practice as the wrong medicine may be given to the service user. The registered manager supported some medicines being given to the resident without being prescribed by the doctor (a homely remedy). No homely remedies were found in the home at the time of the inspection as the nursing staff had not brought a further supply from the pharmacy. There were no supporting policies to give them against but records indicated that some had been given. The Controlled Drug register was incorrect at the time of the inspection. Two Controlled Drugs had been recorded as returned the pharmacy when they had not been and were still in the Controlled Drug cabinet. Two further Controlled Drugs were recorded to be available on the premise when they were not. Cow Lees Nursing Home DS0000004391.V295494.R01.S.doc Version 5.2 Page 15 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): Standards 12, 13, 14 and 15 were assessed. Quality in this outcome area is adequate. The home satisfies the social, cultural and recreational needs of some of the service users to enhance the quality of their lives. EVIDENCE: The home employs an activities co-ordinator and has an activity programme that includes skittles, ball games, hand massage, darts and quizzes. On the day of the inspection visit a clothing sale was taking place in the home and some of the female service users in particular enjoyed trying on and choosing new clothes. Staff ensured that people in both Cow Lees and Astley House had the opportunity to attend the sale. The service users accommodated in Cow Lees House participate in more of the activity programme that the service users in Astley House. One service user commented ‘there is always something to do’. It was discussed that the range of activities could be broadened to enable the service users in Astley House to engage in meaningful activity. Care files of service users did not contain much information about peoples’ past lives, current relationships and enduring interests although this information was held in separate files for some of the service users. It was discussed with the manager that this information could be collected and Cow Lees Nursing Home DS0000004391.V295494.R01.S.doc Version 5.2 Page 16 analysed for all service users in order to produce a programme of activities that reflected the social and cultural preferences of service users. Some service users in the home find it difficult to engage in group or scheduled activities because of their dementia. Staff were observed to sit and talk to some of the more frail service users. Relatives commented that ‘Staff sit and talk to patients’ and ‘Staff have wonderful patience’. The home has an ‘open visiting’ policy and service users were observed to receive their visitors both in the privacy of their own rooms and in the communal areas. One relative commented ‘staff greet me with smiles’. Service users were observed to move around the home freely and safely. The majority of bedroom doors were unlocked so that service users could come and go as they wished. Some service users were supported by staff to make choices about how they spent their everyday lives; for example, being accompanied into the garden to have a cigarette or pottering about in their rooms organising their personal belongings. However, there was still some evidence of a lack of choice as a general conversation with a group of service users included them talking about the set times for having a bath - their ‘bath day’, and, when asked if they could have a ‘lie in’ if they wanted to, commented that they had to get up ‘when they put the lights on’. The inspector joined a group of service users in the music room Cow Lees House for their midday meal. Each of the houses has a dedicated dining room as well as several other areas in which service users can eat their meals. It was evident that some service users were grouped together during mealtimes with others with similar needs and abilities. It was quite chaotic throughout the lunchtime service in the dining room in Cow Lees House with service users requiring assistance to eat their meals. The dining areas were quite sparse and bare with no attractive table settings such a tablecloths or flowers; people wore plastic aprons to protect their clothing when large napkins may have been more dignified. Service users were offered a choice of beef stew or sausages with mashed potato, broccoli and green beans followed by apple crumble and custard. The meal was tasty, well presented and nourishing. Service users commented that the food was ‘always very good’ and a cooked breakfast is available every day. The kitchen provides a separate menu for one person who is vegetarian. Cow Lees Nursing Home DS0000004391.V295494.R01.S.doc Version 5.2 Page 17 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): Standards 16 and 18 were assessed. Quality in this outcome area is good. Service users and their relatives are confident that their concerns are listened to and are protected from harm by the home’s policies and procedures. EVIDENCE: Because of the nature of their dementia, many of the service users in the home depend upon their relatives to raise concerns on their behalf. Relatives commented that staff ‘always answer any questions or worries’ and ‘there’s always someone to ask if I want to know anything’. The home has a complaints policy which is displayed on the notice board in the home. People are encouraged to raise their concerns with senior staff on duty and one relative spoken to confirmed that this is what she does if she has any worries. During a discussion with a group of service users over dinner they were able to identify senior staff by name that they ‘talk to’ about ‘anything that’s bothering them’. The home has received two complaints since the last inspection which were investigated by the home. One investigation was inconclusive as it dealt with concerns about communication and care received by a person who lived at the home two years ago. The other complaint involved a concern about a delay in a medical investigation for one of the service users. This was arranged through the district nurse and GP and the delay was through no fault of the home. Cow Lees Nursing Home DS0000004391.V295494.R01.S.doc Version 5.2 Page 18 The home has an adult protection policy to give staff direction in how to respond to suspicion, allegations or incidences of abuse. It was evident through discussions with the manager, deputy and senior nursing staff that they are aware of local Social Services and Police procedures for responding to allegations of abuse. Staff have received abuse awareness training. The home enables service users to access Advocacy services. There are currently three people living in the home that use an Advocacy service. Cow Lees Nursing Home DS0000004391.V295494.R01.S.doc Version 5.2 Page 19 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): Standards 19, 24, 25 and 26 were assessed. Quality in this outcome area is adequate. Service users are provided with safe and comfortable surroundings to live in and enjoy but unpleasant odours must be eliminated to protect the dignity of service users. EVIDENCE: Accommodation in the home is provided in two separate buildings. Cow Lees house is a converted building and Astley House is a purpose built extension. The home has an ongoing plan of maintenance and refurbishment. The bedrooms of five service users case tracked were viewed. Rooms were comfortable and cosy. All the rooms were personalised with service users’ own belongings and looked as though it belonged to the person. Privacy screening was available in shared rooms. One service user invited the inspector to view her room and said how she liked to spend time there ‘sorting through’ her belongings – of which there were many! Cow Lees Nursing Home DS0000004391.V295494.R01.S.doc Version 5.2 Page 20 Fluorescent lights were being installed in the communal areas of Cow Lees house on the day of inspection providing improved lighting in these areas. Rooms are refurbished as they become vacant and two of these rooms in Cow Lees house were seen during the inspection. They were redecorated and had new furniture, carpets and soft furnishings to provide an attractive and comfortable environment for people living in them. The laundry is housed in outbuildings and separate laundry staff deal with most of the washing. Service users were observed wearing well laundered clothes. Systems are in place for the management of soiled laundry to minimise the risk of cross infection. The home employs cleaning staff and both Cow Lees House and Astley House were clean. One relative commented that ‘rooms are clean’. An unpleasant odour of urine was noted in the bedroom of one of the service users. Systems must be in place to eliminate offensive odours to protect the dignity of incontinent service users. Cow Lees Nursing Home DS0000004391.V295494.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 were assessed. Quality in this outcome area is adequate. The numbers of staff are sufficient to meet the needs of residents accommodated in the home and the planned training programme should lead to appropriate care provision and support an increase in the quality of life of individual residents. EVIDENCE: Four weeks of duty rota between 13th February and 12th March 2006 were examined and demonstrated the usual staff complement for the home as detailed below: Cow Lees House 8am – 2.45pm 1 Registered Nurse 4 or 5 care staff 1 Registered Nurse 4 or 5 care staff 1 Registered Nurse 2 care staff Astley House 1 Registered Nurse 4 or 5 care staff 1 Registered Nurse 4 or 5 care staff 1 Registered Nurse 2 care staff 2.45pm – 9.30pm 9.30pm – 8am Cow Lees Nursing Home DS0000004391.V295494.R01.S.doc Version 5.2 Page 22 On several occasions there were 6 care staff on duty in both Cow Lees and Astley House. It was informed than when there are extra care staff on duty a management decision is made as to whether they work in Astley House or Cow Lees House depending on the needs of the service users at the time. Two service users have been identified as needing ‘one to one’ care from a member of care staff. One of the service users has a ‘one to one’ member of staff for approximately 10 hours each day and another service user has ‘one to one’ care for periods during the day as necessary. There are also occasions when there is more than one registered nurse on duty in each house. This allows for a newly qualified nurse to be supernumerary working alongside another nurse for her professional development and to allow supernumerary management time to the deputy and senior nurse. There are no vacancies in the home for registered nurses. There are some vacancies for care staff but the home seldom uses agency staff as it has its own ‘bank’ of staff. The owner made a prompt response to immediate requirements made during the last inspection to review the supernumerary time available to the manager and to review the number of registered nurses on duty at night. The home now has one registered nurse on duty in each house during the night. The manager is supernumerary to the complement of nursing staff in the home although she occasionally works shifts as a nurse during peak period of annual leave or during unplanned absence. This has had a positive impact in allowing the manager to have sufficient time to discharge her responsibilities effectively. Only 6 out of the 37 care staff employed have achieved a National Vocational Qualification (NVQ) in Care at level 2 or above which, at 16 , is well below the National Minimum Standard for 50 of staff to be qualified. However, a training plan has been developed and implemented for care staff to achieve this qualification with 20 care staff registered and 5 care staff currently undertaking the award at present. The personnel files of 4 recently recruited staff were examined and all contained evidence that pre-employment checks are carried out. The home does not have an induction programme for new staff that meets National Training Organisation standards. This must be implemented to ensure that care staff have the necessary basic knowledge and skills to undertake the delivery of care to service users. One recently recruited member of care staff described her induction and although she did not have a formal workbook it was evident through discussion that she was mentored by experienced care staff and shown how to undertake caring tasks. Cow Lees Nursing Home DS0000004391.V295494.R01.S.doc Version 5.2 Page 23 A programme of statutory training for staff includes fire prevention, abuse awareness, moving and handling and food hygiene. All staff have undertaken dementia awareness training. Other training has included continence and bereavement. Plans for future training includes cross infection, first aid and tissue viability. Cow Lees Nursing Home DS0000004391.V295494.R01.S.doc Version 5.2 Page 24 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): Standards 31, 33, 35, 36 and 38 were assessed. Quality in this outcome area is adequate. The home has a competent and qualified manager to provide direction and guidance to ensure residents receive consistent quality care but the systems for the management of medicines must be improved to protect service users from harm. EVIDENCE: The manager of the home has been in post for 5 years. She is a registered nurse and has recently completed the Registered Manager’s Award (NVQ 4). The provider made a prompt response to the requirement made during the last inspection to consider the supernumerary time available to the manager. The manager is now supernumerary with the exception of the occasional shift worked as a nurse during periods of annual leave or unplanned absence. The manager discussed the positive impact of having more time to discharge her responsibilities effectively. There has been a good response to requirements made during the last inspection and this is reflected in the improved outcomes Cow Lees Nursing Home DS0000004391.V295494.R01.S.doc Version 5.2 Page 25 for people in the home. There are clear lines of responsibility in the home. The owner of the home is often on the premises. The manager is responsible for the whole home and has a deputy responsible for Cow Lees House and a Senior Nurse responsible for Astley House. Care staff spoken to were able to identify who they were responsible to and commented that senior staff were very approachable. A relatives’ survey was made in April 2006 to find out the opinions of relatives about the service received at the care home. A good response has been received and the manager discussed plans to generate an action plan from the results of the survey. Further progress is required to ensure that the home develops a Quality Assurance system. There was no evidence that the home has a system for reviewing and updating its policies and procedures. The home does not hold personal monies for safekeeping for any of the people living in the home. Bills are produced for additional charges for chiropody and hairdressing and sent to the person appointed to manage the service users’ finances. This is usually a relative, solicitor or Advocacy service. The owner of the home is appointee for one person who has lived in the home for many years, but an advocacy service is currently being set up for this person. Evidence was seen in staff files that staff supervision is undertaken with senior staff undertaking the supervision for each of their identified teams. The home has effective systems for maintaining equipment and services to the home to promote the safety of people in the home. A sample of service and maintenance records were examined and found to be up to date; fire alarm tests are carried out weekly, hoists were serviced in April 2006 and Electrical Portable Appliance Testing was completed in April 2006. The programme of mandatory training in fire prevention, moving and handling and food hygiene along with planned training in Health and Safety further protects the safety of people in the home. However, the poor management of medicines, as detailed in the ‘Health and Personal Care’ section of this report, does not protect service users from the risk of harm. Cow Lees Nursing Home DS0000004391.V295494.R01.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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 3 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 1 Cow Lees Nursing Home DS0000004391.V295494.R01.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 OP3 Regulation 14 Requirement Timescale for action 15/07/06 2 OP7 15 Schedule 3 The registered manager must ensure that the needs of service users are fully assessed and documented before providing them with accommodation in the home. The registered manager must 15/08/06 ensure that care plans set out in detail the actions needed to ensure all aspects of the health; personal and social care needs of the service user are met. Care plans must be implemented for any change in need or short term need identified. The registered manager must 15/06/06 ensure that risks to the health of service users are recognised and appropriate action is taken. All medicines must be stored 15/08/06 below 25°C at all times to ensure their stability in line with their product licences. The installation of an air conditioning system may be required in the medication rooms. The maximum, minimum and 15/06/06 current temperatures of the DS0000004391.V295494.R01.S.doc Version 5.2 3 OP8 13(1)(b) 14 13(2) 4 OP9 5 OP9 13(2) Cow Lees Nursing Home Page 28 6 OP9 13(2) 7 OP9 13(2) 8 OP9 13(2) 9 OP9 13(2) 10 OP9 13(2) medicine refrigerator must be read on a daily basis to confirm that medicines requiring refrigeration are stored in compliance with their product licences to maintain their stability. The purchase of a thermometer that can read the three temperatures is required. A system must be installed to check the prescription before it is dispensed and to check the dispensed medicines and MAR chart upon receipt into the home. Appropriate action must be taken when discrepancies are found. New service users to the home must have their medicines confirmed with their doctor before any administration The quantities of all medicines received or balances carried over must be recorded to enable audits to be undertaken to demonstrate that all the medicines are administered as prescribed and the transaction accurately recorded Staff drug audits must be undertaken before and after a drug round to confirm staff competence in medicine management Any covert administration of medicines must be the decision of a multidisplinary team and must be in the best interests of the service user. The nursing staff alone cannot make that decision. All “When Required” medicines must be administered against a robust protocol clearly recording the clinical reasons why a medicine is to be given, the dose, the maximum daily dose and times between doses. Any administration must be reviewed DS0000004391.V295494.R01.S.doc 15/06/06 16/05/06 15/06/06 15/06/06 15/06/06 Cow Lees Nursing Home Version 5.2 Page 29 11 OP9 13(2) 12 OP9 13(2) 13 OP9 13(2) 14 OP9 13(2) 15 OP9 13(2) 16 17 OP9 OP9 13(2) 13(2) 18 OP9 13(2) 19 20 OP9 OP9 13(2) 13(2) to confirm its use The right medicine must be given to the right service user at the right dose and time and the MAR chart must accurately reflect this. The MAR chart must be referred to before the administration of all medicines and accurately record the transaction Medicines prescribed for one service user must not be administered to another service user under any circumstances. All medicines prescribed must be available to administer and any medicines that are no longer required must be removed from the premise The use of sedating medicines administered to the service users must be reviewed within the home on a regular basis All medicines must be secured in a locked cabinet within the medication room. This includes medicines awaiting collection by the clinical waste company The Controlled Drug register must accurately reflect practice The purchase of a Controlled Drug destruction kit is required. It is advised that all CD’s that are destroyed on site are witnessed by the pharmacist if possible All medicines must be administered as prescribed. Equipment must be purchased to enable accurate doses to be administered if necessary All secondary dispensing must cease A homely remedy policy must be written and medicines purchased to reflect the policy. Staff must be trained to adhere to the policy DS0000004391.V295494.R01.S.doc 16/05/06 16/05/06 16/05/06 16/06/06 16/05/06 16/05/06 15/06/06 22/05/06 16/05/06 15/06/06 Cow Lees Nursing Home Version 5.2 Page 30 21 OP9 13(2) 22 OP12 16 23 OP14 12 24 25 OP26 OP30 12, 13, 16, 23 12, 18 26 OP33 24 27 OP38 12(1)(a) 13(2) The medication policy must be reviewed and rewritten to reflect any change in practice within the home. Staff must be trained to adhere to the new policy and procedures The registered manager must ensure that all service users are given opportunities for stimulation through leisure and recreational activities which match their cultural preference. The registered manager must ensure service users are offered choice and the opportunity to exercise some control over their lives. The registered provider and manager must ensure that all unpleasant smells are dealt with. The registered person must ensure that a staff induction programme is developed and implemented so that staff receive foundation training to National Training Organisation standards within the first six months of employment The registered person must implement a suitable quality assurance and monitoring system and outcomes of service users’ surveys must be made public. (Partially met since the last inspection) The registered person must make arrangements for the recording, handling, safe keeping, safe administration and disposal of medicines received into the care home. 15/06/06 15/08/06 15/07/06 15/07/06 15/09/06 15/09/06 15/08/06 Cow Lees Nursing Home DS0000004391.V295494.R01.S.doc Version 5.2 Page 31 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 OP9 Good Practice Recommendations Nursing staff must receive training to understand the clinical reasons the medicines are administered together with their general side effects and common doses Cow Lees Nursing Home DS0000004391.V295494.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 Cow Lees Nursing Home DS0000004391.V295494.R01.S.doc Version 5.2 Page 33 - 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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