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Inspection on 11/07/07 for Denham Manor Nursing Home

Also see our care home review for Denham Manor Nursing Home for more information

This inspection was carried out on 11th July 2007.

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.

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

The care needs of potential residents are identified with them, prior to their move to the home, to ensure that they can be met. Residents have contracts, which describe the service that they should expect, and the responsibilities of both parties. Potential residents and their families have the opportunity to visit the home and although one resident commented `I thought it would be residential` most felt that they had the information that they required before moving to the home. In general residents` social and recreational needs are met. Their autonomy is protected as far as possible and they have access to advocacy services if they wish. There is an enthusiastic activities coordinator and one resident said he is `a good bingo caller`. There are plans for a variety of activities and which take into account residents` individual likes and dislikes. The food is of a good standard and meal times were observed to be a sociable occasion for residents. There are complaints policies and procedures in place although not everyone is aware of them. The home is aware of the local safeguarding procedures and staff have had training in this area to protect residents from abuse. There is an ongoing refurbishment programme, which will greatly improve the communal areas for residents. Rooms are redecorated as and when they become vacant. There is a corporate colour scheme, although residents are encouraged to bring small items of furniture and personal belongings to personalise their rooms. There is a training programme to give staff the basic skills to care for residents with complex needs and residents said that the staff were `very kind although busy`.

What has improved since the last inspection?

Medication management has improved since the last inspection and residents receive their medication in a safe and timely way. There is an ongoing refurbishment programme. New window frames have been installed in most windows although there are a couple which remain to be done. Work is in progress to build two conservatories to provide additional lounge and dining areas. Recruitment procedures have improved although there is still room for further improvement. A quality assurance programme has been introduced.

What the care home could do better:

The standard of care planning must be improved if residents` needs are to be identified and fully met. All residents must have up to date care plans, which accurately reflect their needs and the care that they require to meet those needs. Residents` healthcare needs are not met in full nor in a timely way and their moving and handling needs are not met in a safe manner. All residents should have nutritional assessments and clear plans put in place to prevent weight loss. Wound dressings must be renewed regularly. Residents moving and handling needs must be reviewed and appropriate hoists, height adjustable beds and individual hoist slings must be provided. Residents who are prone to falls should have regular falls assessments and appropriate levels of supervision must be put in place to minimise these. The provider should ensure that all residents and their families are aware of the way in which they should bring concerns to the attention of the manager or make a formal complaint if they need. The provider must ensure that sufficient bathing facilities are maintained and that residents, using appropriate hoists where necessary, can use them safely. The provider must undertake an assessment of the, building, facilities and equipment to determine which areas are suitable to meet the care and support needs of those residents who require nursing care. The staffing levels are insufficient to meet residents` needs in a timely manner and must be reviewed. The provider must ensure that there are sufficient staffon duty at all times to meet the needs of residents, to answer call bells in a timely way and provide supervision on all floors. The provider must ensure that references are obtained from the employee`s previous employer if residents are to be fully protected from unsuitable carers. The provider must ensure that fire safety requirements are addressed within the timescales set, to reduce the risk to residents from fire.

CARE HOMES FOR OLDER PEOPLE Denham Manor Nursing Home Halings Lane Denham Bucks UB9 5DQ Lead Inspector Christine Sidwell Unannounced Inspection 11th July 2007 10:30 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 DS0000019195.V339291.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. DS0000019195.V339291.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Denham Manor Nursing Home Address Halings Lane Denham Bucks UB9 5DQ 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) 01895 834470 01895 832845 denham@caringhomes.org Caring Homes Healthcare Group vacant Care Home 53 Category(ies) of Dementia - over 65 years of age (53), Old age, registration, with number not falling within any other category (53) of places DS0000019195.V339291.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users may be admitted from the age of 60 years. 43 Beds are registered for nursing care. The total number of people accommodated must not exceed 53 at any one time. 4th April 2006 Date of last inspection Brief Description of the Service: Denham Manor is a care home providing nursing and residential care for up to 53 service users. The home is situated in a pleasant, but relatively isolated country lane, on the outskirts of Denham. Public transport and other amenities are not easily accessible. The home was registered in 1988 and consists of a two-storey building, with three conservatories. The home has forty single and three shared bedrooms. Some bedrooms have en suite facilities. There is a passenger lift. The home has extensive gardens, which are well maintained. The current scale of charges at the time of writing this report range from £374.29 to £950.00. Additional costs are incurred for hairdressing, newspapers, transport and personal items. DS0000019195.V339291.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted over the course of three days and included a one day unannounced visit to the home. The key standards for older people’s services were covered. Information received about the home since the last inspection was taken into account in the planning of the visit. Prior to the visit, the manager completed an Annual Quality Assurance Assessment of the service and questionnaires were sent to service users, relatives and visiting professionals. Fourteen residents or their family members and one healthcare professional returned the questionnaires. Residents and families were also spoken to on the day of the unannounced visit. Discussions took place with the manager, nursing, care and ancillary staff. Care practice was observed and the care of four residents followed through in detail. A tour of the premises and examination of records was also undertaken. The homes approach to equality and diversity was considered throughout. What the service does well: The care needs of potential residents are identified with them, prior to their move to the home, to ensure that they can be met. Residents have contracts, which describe the service that they should expect, and the responsibilities of both parties. Potential residents and their families have the opportunity to visit the home and although one resident commented ‘I thought it would be residential’ most felt that they had the information that they required before moving to the home. In general residents’ social and recreational needs are met. Their autonomy is protected as far as possible and they have access to advocacy services if they wish. There is an enthusiastic activities coordinator and one resident said he is ‘a good bingo caller’. There are plans for a variety of activities and which take into account residents’ individual likes and dislikes. The food is of a good standard and meal times were observed to be a sociable occasion for residents. There are complaints policies and procedures in place although not everyone is aware of them. The home is aware of the local safeguarding procedures and staff have had training in this area to protect residents from abuse. There is an ongoing refurbishment programme, which will greatly improve the communal areas for residents. Rooms are redecorated as and when they become vacant. There is a corporate colour scheme, although residents are encouraged to bring small items of furniture and personal belongings to personalise their rooms. DS0000019195.V339291.R01.S.doc Version 5.2 Page 6 There is a training programme to give staff the basic skills to care for residents with complex needs and residents said that the staff were ‘very kind although busy’. What has improved since the last inspection? What they could do better: The standard of care planning must be improved if residents’ needs are to be identified and fully met. All residents must have up to date care plans, which accurately reflect their needs and the care that they require to meet those needs. Residents’ healthcare needs are not met in full nor in a timely way and their moving and handling needs are not met in a safe manner. All residents should have nutritional assessments and clear plans put in place to prevent weight loss. Wound dressings must be renewed regularly. Residents moving and handling needs must be reviewed and appropriate hoists, height adjustable beds and individual hoist slings must be provided. Residents who are prone to falls should have regular falls assessments and appropriate levels of supervision must be put in place to minimise these. The provider should ensure that all residents and their families are aware of the way in which they should bring concerns to the attention of the manager or make a formal complaint if they need. The provider must ensure that sufficient bathing facilities are maintained and that residents, using appropriate hoists where necessary, can use them safely. The provider must undertake an assessment of the, building, facilities and equipment to determine which areas are suitable to meet the care and support needs of those residents who require nursing care. The staffing levels are insufficient to meet residents’ needs in a timely manner and must be reviewed. The provider must ensure that there are sufficient staff DS0000019195.V339291.R01.S.doc Version 5.2 Page 7 on duty at all times to meet the needs of residents, to answer call bells in a timely way and provide supervision on all floors. The provider must ensure that references are obtained from the employee’s previous employer if residents are to be fully protected from unsuitable carers. The provider must ensure that fire safety requirements are addressed within the timescales set, to reduce the risk to residents from fire. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000019195.V339291.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 DS0000019195.V339291.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. The care needs of potential residents are identified with them, prior to their move to the home, to ensure that they can be met. Residents have contracts, which describe the service that they should expect, and the responsibilities of both parties. EVIDENCE: The files of four residents were examined. All had evidence that the manager had visited them prior to their move to the home and that their needs had been assessed. Of those who returned the questionnaires most said that they were happy with the information that they had been given, although one thought that the home would be ‘more residential’. There was evidence in the files that care manager’s assessments have been sought where appropriate. The documentation used to guide the assessment of potential residents who are self funding is comprehensive. Care plans are drawn up following assessment and the family of one resident spoken to confirmed that they had DS0000019195.V339291.R01.S.doc Version 5.2 Page 10 been involved in this. Resident’s cultural and religious needs are identified as part of the assessment. All of the residents or family members who returned the questionnaires said that they had received a contract and evidence to verify this was seen in the files examined. The home does not offer intermediate care. DS0000019195.V339291.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. The standard of care planning must be improved if residents’ needs are to be identified and fully met. Residents’ healthcare needs are not met in full or in a timely way and their moving and handling needs are not met in a safe manner. Medication management has improved since the last inspection and residents receive their medication in a safe and timely way. EVIDENCE: The care of four residents was looked at in detail and a number of other care plans were examined. All residents had care plans although they were in a variable state of completeness. Not all entries were signed nor dated and they had not been updated regularly or at least on a monthly basis. They did not in all cases reflect residents’ needs. One resident was noted on the hospital discharge documentation to be prone to falls. He had a falls assessment, which was incomplete and therefore only placed him at medium risk of falling and no specific care was described. Some care plan entries were very general in nature, e.g. stating ‘good nutrition needed’, without describing the steps to be taken to achieve this. One resident was noted by the district nurse to have macular degeneration leading to poor eyesight. This was not reflected in the DS0000019195.V339291.R01.S.doc Version 5.2 Page 12 care plan. The care plans are being revised and the deputy manager has been undertaking regular audit of the care plans and has noted an improvement. She is working with staff to improve them further. This must be maintained as some care plans do not yet contain reliable information to describe residents’ needs accurately and to describe the steps needed to address them. The residents seen and spoken with had been helped with their personal care. The residents spoken to said that the carers helped them although they were very busy and one commented that she had sometimes had to ‘wait a while’. She said that this was difficult if she wished to go to the toilet. Of the residents and family members who returned the questionnaires, five people said that they always received the care and support that they needed, five that they usually received the care and support that they needed and three said that they sometimes received the care and support that they needed. Those who elaborated said that the carers were very kind but often very busy and therefore not always able to help them. There was evidence in the care plans that residents had been assessed as to their potential to develop pressure damage, nutritional deficiency and as to their moving and handling requirements. However the results of these assessments were not translated into effective action. One resident was assessed as being of low risk nutritionally despite losing twelve kilograms over seven months. He had a grade three pressure damage to his heel and a rightsided stroke but was assessed as being able to use the standing hoist. The carers spoken to said that they felt uncomfortable and did not feel safe moving him in this way. The dressing to his heel had been due to be changed two days earlier. This had not been dealt with. The staff had met the needs of a second resident, whose care was considered in detail to a better level, although he too had lost five kilograms over a sixmonth period. His care plan stated that he liked company yet he was isolated on the top floor of the building. He was also prone to ‘urgency’ and had had a number of falls, two of which were unobserved. When spoken to he said that the care staff were ‘very kind but very busy’ and he often had to ‘wait for help, which lead to an ‘accident’. A number of residents moving and handling needs could not be met safely as they required a hoist and were being cared for on a divan bed. The feet of the appropriate hoist do not go under this type of bed. This must be addressed as a matter of urgency. There are medication policies and procedures in place. Storage facilities are satisfactory. Records are kept of medication entering and leaving the home. The medication administration records were accurately completed. Two people signed handwritten entries to the medication administration record. Controlled drugs were stored in a satisfactory manner and all entries to the controlled register were signed. A nurse spoken to said that medication was not DS0000019195.V339291.R01.S.doc Version 5.2 Page 13 administered covertly. If a resident refused medication this would be recorded. If the medication was essential and the resident lacked the capacity to make to the decision the doctor and family would be informed and a way forward agreed. The staff were observed to be polite and courteous to residents. All care is given in their own rooms. All residents were wearing their own clothes and those residents who required help had been assisted to choose matching items, with an attention to detail. The residents and relatives who returned the questionnaires and those spoken to on the day confirmed this. DS0000019195.V339291.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. In general residents’ social and recreational needs are met. Their autonomy is protected as far as possible and they have access to advocacy services if they wish. The food is of a good standard and meal times were observed to be a sociable occasion for residents. EVIDENCE: There is an activities organiser in post who arranges a number of activities which residents are assisted to participate in if they wish. A Bingo afternoon was being held on the afternoon of the unannounced inspection. On most days there is a ‘pick and choose’ afternoon in the lounge when games are played. Coffee mornings, sherry mornings, cream teas and quizzes are featured. The activities organiser said that he also meets with residents on a one to one to basis if they do not wish to participate in communal activities. He also chairs a residents/ family meeting and is responsive to requests. Funding to support activities is raised through raffles. A summer fete is planned. Most of the residents who returned the questionnaires said that they enjoyed the activities. An advocate from Age Concern continues to visit the home regularly and meets residents in a group or one to one if they wish. DS0000019195.V339291.R01.S.doc Version 5.2 Page 15 The serving of lunch was observed and seemed to be a relaxed occasion with background music which was age appropriate. Tables were covered with tablecloths with appropriate cutlery and condiments. Plate guards and other specialist cutlery and protective clothing were in place to support those residents who needed assistance and to promote independence. There was a choice of menu and staff were observed to be helping those residents who required feeding in a sensistive and discrete manner. Meals to meet residents’ cultural needs are available. The residents spoken to said that they enjoyed their meals as did those who returned the questionnaires. DS0000019195.V339291.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. There are complaints policies and procedures in place although not everyone is aware of them. The home is aware of the local safeguarding procedures and staff have had training in this area to protect residents from abuse. EVIDENCE: There are complaints policies and procedures in place. A complaints log is kept and action was seen to be taken in response to concerns and complaints. The organisation has received twelve complaints in the last year and all were responded to within the timescales prescribed within the organisations complaints policy. Eight of the nine residents who returned the questionnaires said that they knew who to speak to if they were unhappy and how to make a complaint. Only two of the four family members however said that knew who to make a complaint to. One had made a complaint and was unhappy with the response and that of the social services. The Commission for Social Care Inspection has received four complaints about care since the last full inspection. The information from these complaints was used in the planning of this inspection. The home had a copy of the local multi-agency strategy for the Protection of Vulnerable Adults and staff have had training in this topic. The Commission for Social Care Inspection has not been notified of any allegations made to the local authority under the safeguarding procedures. DS0000019195.V339291.R01.S.doc Version 5.2 Page 17 DS0000019195.V339291.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 24 and 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. There is an ongoing refurbishment programme, which will greatly improve the communal areas for residents. There is a need to ensure that fire safety requirements are addressed and that bathing facilities are improved to assure residents’ well-being and safety. There is also a need to determine which areas of the building have the facilities and equipment to meet the needs of people needing nursing care. EVIDENCE: There is a programme of ongoing maintenance. Two additional communal areas are being built as conservatories at the present. Whilst this is causing some disturbance the result will be better dining and lounge facilities for residents. There has been a programme of window replacement, which is almost completed although the windows in room 112 and 110 need replacing. This should be completed. On the day of the unannounced visit the home was clean and tidy although there was a strong odour of urine in several bedrooms. DS0000019195.V339291.R01.S.doc Version 5.2 Page 19 The manager said that of the four members of the housekeeping team, one was ill, one on annual leave and one had to help in the laundry. The home was inspected by the Buckinghamshire Fire and Rescue service on 21/09/06. A number of requirements were made including the need to undertake a fire risk assessment. This was undertaken on the 12/12/06. The manager stated that she has contacted the head office and the operational manager several times but that the action required by the fire officers’ report and the fire risk assessments has not yet been completed. This must be addressed as a matter of urgency. Several bathrooms are in a poor state of repair. There is no shower or bathroom on the top floor, which has five resident’s rooms. Two rooms, which were originally bathrooms, have been taken out of commission and residents have to be taken to the middle or ground floor for a bath or shower. The toilet in one was taped up and not used. The carers spoken to said they tried to give people as good a wash as possible in their ensuites. There are two bathrooms on the second floor, which are small but just accessible to people with disabilities. There are two bathrooms on the ground floor. One of which is large enough to be used by people with disabilities and needing a hoist. The second contains a ‘Parker bath but there is insufficient space beside this bath for a hoist and carers said that it was rarely used. Because of the shortage of bathing facilities residents have a set bath day although the carers said that they tried to be flexible to accommodate residents wishes or needs. The bathing facililities are inadequate and should be upgraded to meet the needs of residents. The proprietors should maintain at least the same number of bathrooms as were provided when the home originally registered and the bathrooms must be suitable to meet the needs of older people with limited mobility The homes own internal audit showed that there were seven people who required hoists who had divan beds and did not have height adjustable beds. Two residents, whose care was followed through in detail and were cared for on the top floor, had complex needs. Their care is provided by staff who are based on the ground floor. The bathroom facilities on this floor had been taken out of action, the hoist has to be brought from another floor and one had had a number of falls. There is a need for the organisation to undertake an assessment of the building, facilities and equipment to determine which areas are suitable to meet the care and support needs of those residents who need nursing care. Residents’ individual rooms very in size. Residents are encouraged to bring personal items and many had chosen to do so. Their rooms reflected their diverse lives and interests and were homely. One resident said ‘I have everything I need around me’. The manager said that rooms are decorated when they become vacant. The colours are neutral. Not all residents who require nursing care had height adjustable beds and this must be addressed in DS0000019195.V339291.R01.S.doc Version 5.2 Page 20 a planned way. In particular those who require assistance using a hoist must have a bed which can accommodate this. There are control of infection policies and procedures in place and the manager stated that these have been updated since the Department of Health issued updated guidance to care homes in June 2006. In some cases however residents still have to share hoist slings, which is contrary to the guidance and puts them at risk of acquired infection. DS0000019195.V339291.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience poor outcomes in this area. This judgement has been made using available evidence, including a visit to this service. There is a training programme to give staff the necessary skills to care for residents with complex needs although the staffing levels are insufficient to meet residents’ needs in a timely manner and must be reviewed. In general recruitment procedures are thorough although the provider must ensure that references are obtained from the employee’s previous employer if residents are to be fully protected. EVIDENCE: The home has three floors. The workload is arranged such that the staff who are allocated to the ground floor also cover the five residents on the top floor. There are two qualified nurses on duty throughout the day and one at night, supported by six carers between 8.am and 2pm, four between 2pm and 8pm and three between 8 pm and 8am. On the day of the unannounced visit, the call bells rang continuously throughout the inspection and it was clear that carers could not answer them in a timely manner. The inspector timed the response rate of four and all took longer than ten minutes. This was particularly marked during the afternoon, before meals and during the handover at 8pm. In one case the inspector intervened to ensure that the resident was safe. At that time the carers were downstairs in the kitchen preparing and collecting the supper for those on the middle floor. In the afternoon two carers are allocated to the ground floor and two to the first floor. If both are needed to care for an individual resident and the qualified nurse is busy or undertaking the medication round there is no one supervising or DS0000019195.V339291.R01.S.doc Version 5.2 Page 22 available to other residents. Residents on the top floor were observed to be unsupervised for long periods Two family members who were visiting were spoken to. Both said that the call bells rang throughout the home continuously and they found it distracting. There was a sign on the call bell console to state that putting the bells to mute was a disciplinary offence. Closer examination of the call bell system showed that not only could a resident in one room be ringing but that calls may have been stacked up behind, that had not been unanswered. The care staff spoken to said that they had to prioritise constantly and explain to residents that they could not always assist them especially if two carers were required. The pre inspection information supplied by the home stated that of the forty five people in the home at the time, thirty-five required help with dressing and undressing, nineteen were doubly incontinent and fifteen people required two carers assist them. The staffing levels must be reviewed to ensure that residents’ call bells can be answered in a timely manner and that there are sufficient staff to supervise and support residents on all floors, particularly in the afternoon and evenings. Nine of the twenty-four carers hold the National Vocational Qualifications in Care at Level 2 and four are working towards it. Whilst the home does not yet meet the standard that 50 percent of care staff hold this qualification, there is a plan in place to achieve this. The recruitment files of four recent employees were examined. All had completed an application form and had been interviewed. Interview records had been kept. Criminal Records Bureau checks had been undertaken for all prior to the employee starting work. One employee had only had one reference taken up and two had references from colleagues and not the last employer. This must be addressed and two references should be sought, one of which is from the last employer, for all employees. There were copies of training certificates in each staff member’s file and evidence that they had undertaken or commenced an induction programme. The home appears to have a high turnover of full time staff. The information provided by the organisation prior to the inspection stated that eight of the fifteen full time staff had left over the last twelve months, a fifty-three percent turnover. DS0000019195.V339291.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. The provider has introduced a quality assurance programme to improve the quality of care offered to residents although there is a high turnover of managers, which has led to a feeling of inconsistency for both staff and residents and their families. Residents’ needs may not be met safely due to lack of or insufficient basic equipment. The recommendations of fire safety professionals must be met if residents are to live in and be cared for in a safe environment. EVIDENCE: There was an experienced manager in post at the time of the inspection although she said that she would be leaving shortly. Concerns were expressed in the questionnaires received about the frequent change in managers and perceived high staff turnover. The staff spoken to felt that the current manager was approachable and had tried to address the issues that were of DS0000019195.V339291.R01.S.doc Version 5.2 Page 24 concern to them. These were the shortages of care staff and some poor working relationships between members of the team. Some relatives also picked up on low staff morale and made comments in the questionnaires such as a ‘sad and highly charged place’ and ‘no one seems loyal as they are too tired’. Other relatives however said that they were happy with the care offered to their family member and that they were always made welcome at the home. The inspector spoke to care staff on the day of the unannounced visit and although staff were reassured that everything they said would be confidential they were anxious and afraid they would be seen as disloyal. Their main concerns were that there are insufficient care staff to care for residents, the qualified nurses and care staff do not always work together and that the local management team try hard but are limited as to what they can do. Caring Homes has a quality assurance system in place and regularly audits the service. An operational manager visits the service regularly and a record of her visits is kept within the home. A part time quality and development coordinator has been appointed. She has begun a regular audit programme and her weekly audit of medication management has shown an improvement in the management of this aspect of care. The organisation undertook a residents and staff questionnaire in January 2007 and an action plan is being developed to address issues arising from this. The organisation has addressed or is in the process of addressing the requirements made as a result of the last full inspection. The home does not manage any residents’ moneys on their behalf. There is a procedure for the safekeeping of small amounts of money on behalf of residents. Each resident has a transaction sheet and receipts are given for money deposited and expenditure incurred on behalf of residents. Two were checked at random and found to be correct. There are health and safety procedures in place and risk assessments have been undertaken and COSHH data sheets are available for hazardous substances. Most staff have had moving and handling training although some said that they were not always able to put this into practice as the most appropriate hoist may have to be shared between floors and is not always available. Some residents who require a hoist to assist with moving have divan beds which cannot be used with some types of hoist. The provision of suitable hoists, height adjustable beds and the moving and handling needs of individual residents must be reviewed as a matter of urgency to ensure that residents and staff are safe. Infection control policies and procedures have been updated in line with the Department of Health guidance issued in 2006 although hoist slings may still be shared between residents, which is contrary to this guidance. The Buckinghamshire Fire and Rescue Service inspected the home in December 2006. A fire risk assessment has been undertaken. The manager said that the recommendations identified in this report have not yet been implemented although she has contacted the organisation’s head office about this on a number of occasions. This must be addressed and the provider DS0000019195.V339291.R01.S.doc Version 5.2 Page 25 must address all fire safety recommendations to ensure that residents are not put at risk. DS0000019195.V339291.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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X 2 1 X 2 X 2 STAFFING Standard No Score 27 1 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 1 2 X 3 X X 1 DS0000019195.V339291.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 OP7 Regulation 15 Requirement All residents must have up to date care plans, which accurately reflect their needs and the care that they require to meet those needs. All residents must have accurate nutritional assessments and action must be taken and recorded to demonstrate that action has been taken to prevent weight loss. All residents who require a hoist to assist them in being moved safely should be cared for on a height adjustable bed. Residents who are prone to falls must have a falls risk assessment and detailed care plan and should be supervised more closely to minimise unwitnessed falls. The wound dressings of residents who develop pressure damage must be changed regularly, in line with guidance given by the Primary Care Trust tissue viability nurse. The requirements identified by Buckinghamshire Fire and DS0000019195.V339291.R01.S.doc Timescale for action 31/10/07 2 OP8 12(1)a 30/09/07 3 OP8 13(5) 31/10/07 4 OP8 12(1)a 30/09/07 5 OP8 12(1)a 30/09/07 6 OP19 23(4A)b 30/09/07 Version 5.2 Page 28 7 OP22 23(1)(a) 8 9 10 OP26 OP26 OP27 16(2)k 13(3) 18(1)a 11 OP28 19(1)b and Schedule 2 13(5) 12 OP38 Rescue service and those identified in the home’s own fire risk assessment must be completed. The provider must consult with the Buckinghamshire Fire and Safety service if any are not to be completed, within the timescales set. The provider must undertake an assessment of the, building, facilities and equipment to determine which areas are suitable to meet the care and support needs of those residents who require nursing care. The offensive odours in some resident’s rooms must be eliminated. Residents must not share hoist slings. There must be sufficient care staff on duty at all times to meet residents care needs in a timely way. You must assess the dependency levels of all residents, and provide staff in sufficient numbers to meet the needs of all residents, also taking into account the layout of the building. Two references must be sought for all employees before they commence work. One should be from the staff member’s last employer. The moving and handling assessment for all residents must be reviewed and suitable beds and equipment must be provided to ensure that they can be moved in a safe and timely manner. 30/09/07 30/09/07 30/09/07 30/09/07 30/09/07 30/09/07 DS0000019195.V339291.R01.S.doc Version 5.2 Page 29 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 OP16 Good Practice Recommendations The company should ensure that all residents and their families know how to raise concerns and to whom they should make a complaint. The organisation should review the bathing facilities to ensure that there are sufficient, accessible and adapted bathrooms to meet the needs of residents. Staff should feel able to raise concerns and that they will not be penalised if they do so. 2 OP21 3 OP32 DS0000019195.V339291.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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. 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