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Inspection on 01/11/05 for Derby House Nursing Home

Also see our care home review for Derby House Nursing Home for more information

This inspection was carried out on 1st November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

Service users spoken to said they liked their bedrooms and these were well personalised, homely and individual. Many service users said they liked the location of the home overlooking a park.

What has improved since the last inspection?

Work had been undertaken to record service users preferences regarding daily routines and these were held within the care files. A new staff call system had been fitted. A performance review of staff had been completed with a view to implementing a staff supervision system.

What the care home could do better:

Recruitment procedures were not being robustly followed and checks were not in place that are designed to ensure service users were cared for by appropriate staff. Care plans were not in place for all service users and it was not possible to establish if care had been delivered according to assessed needs. The provision of staff training and induction were basic consisting of moving and handling and Basic Food Hygiene training for the majority of staff. It is acknowledged that some staff were enrolled on NVQ (National Vocational Qualification) courses however the current level of training for nursing staff would be unlikely to meet the requirements to maintain nursing registration. It is identified throughout the report that some records were not kept well. For example there was a lack of validation of financial records, an inaccurate duty rota and activities records not held as required by the data protection act.

CARE HOMES FOR OLDER PEOPLE Derby House Nursing Home 12 Broad Walk Buxton Derbyshire SK17 6JS Lead Inspector Bridgette Hill Unannounced Inspection 1st November 2005 09:50 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 Derby House Nursing Home DS0000002052.V260838.R01.S.doc Version 5.0 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. Derby House Nursing Home DS0000002052.V260838.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Derby House Nursing Home Address 12 Broad Walk Buxton Derbyshire SK17 6JS 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) 01298 23414 01298 23334 Derby House Nursing Home Limited Mr Derek Andre Brindley Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Derby House Nursing Home DS0000002052.V260838.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. One of variation for 2 ypd clients Date of last inspection 4th July 2005 Brief Description of the Service: The home provides nursing care for up to 31 older people. It is situated in the heart of Buxton in a residential area. The home is an older building which has been adapted to meet the needs of people with mobility problems. Bedrooms are on three floors. Derby House Nursing Home DS0000002052.V260838.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced one which took place over 5 hours. During the inspection 2 staff members and 3 residents were spoken with. Various records including care planning records were examined the findings are recorded in the body of this report. What the service does well: What has improved since the last inspection? What they could do better: Recruitment procedures were not being robustly followed and checks were not in place that are designed to ensure service users were cared for by appropriate staff. Care plans were not in place for all service users and it was not possible to establish if care had been delivered according to assessed needs. The provision of staff training and induction were basic consisting of moving and handling and Basic Food Hygiene training for the majority of staff. It is acknowledged that some staff were enrolled on NVQ (National Vocational Qualification) courses however the current level of training for nursing staff would be unlikely to meet the requirements to maintain nursing registration. It is identified throughout the report that some records were not kept well. For example there was a lack of validation of financial records, an inaccurate duty rota and activities records not held as required by the data protection act. Derby House Nursing Home DS0000002052.V260838.R01.S.doc Version 5.0 Page 6 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. Derby House Nursing Home DS0000002052.V260838.R01.S.doc Version 5.0 Page 7 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 Derby House Nursing Home DS0000002052.V260838.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,5,6 Service users are given opportunities to visit the home prior to admission and make a positive choice regarding placement. EVIDENCE: The care file of a recently admitted service user was examined. This confirmed that the service user did visit the home prior to admission and the service users family was also involved in choosing the placement. Information from a care manager was available detailing assessed needs. There was no formal record available to confirm that staff at the home had completed an assessment. The home does not offer intermediate care as defined by the National Minimum Standards. Derby House Nursing Home DS0000002052.V260838.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,Partial 9,11 Care plans were not in place for all service users and it was therefore possible that service users assessed care needs would not be met. EVIDENCE: A sample of two service users care files were requested to be examined. These revealed that there was not a care plan in place for one service user. Some care records were held on a computer and updated daily by nursing staff. Examination of these also indicated that not all interventions for example dressings had been recorded. For one service user a form of restraint was occasionally used as an agreed care intervention. This was discussed with staff who stated that each period of restraint was not formally recorded. A copy of care plans had been sent out to relatives for them to sign. Some of the care plans observed contained a number of abbreviations which service users and their families were unlikely to understand. There was not documentary evidence available in the care files examined to confirm that service users post death wishes had been discussed or records held that to confirm that this had been considered but not assessed as being possible. Staff spoken with said that post death wishes were discussed prior to Derby House Nursing Home DS0000002052.V260838.R01.S.doc Version 5.0 Page 10 admission but no records were held or review of wishes undertaken in order to try to ascertain wishes and ensure that they are respected. The storage and administration of medicines was not formally inspected at this visit however a requirement is listed as an unnamed and undated topical preparation was found in one bathroom. Derby House Nursing Home DS0000002052.V260838.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, partial 15 There was dedicated time given to providing activities and records held of service users participation and preferences. EVIDENCE: The provision of the homogenised diet was discussed with staff as this had been highlighted at a previous visit. Staff confirmed that this was still served with meat and vegetables liquidised together. This does not afford service users the dignity of being served a well-presented meal where the individual flavours of foods can be distinguished. It is required that this is addressed. There was one designated staff member who had some time allocated to the provision of activities although all staff did contribute. A programme of activities was organised each week. A record of activities offered was kept. This was a central record with a number of service users progress being recorded within one record, this is not in keeping with data protection guidance. A record of how service users had enjoyed and participated in activities was also recorded. Derby House Nursing Home DS0000002052.V260838.R01.S.doc Version 5.0 Page 12 A Halloween evening had been held and decorations from the evening were still evident in the lounge. Some craft activities had been completed to provide these decorations. Staff spoken to said that service users were sometimes offered to go out of the home to enjoy the park or go shopping but some service users were reluctant to try this. The philosophy spoken of by staff was to encourage but not to insist on service users participation in activities. Communion was held in the home on a monthly basis. Derby House Nursing Home DS0000002052.V260838.R01.S.doc Version 5.0 Page 13 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): 18 Procedures and training were not adequately in place to ensure that staff would appropriately respond to any allegations of abuse. EVIDENCE: No complaints about the home had been received at the home or by Commission for Social Care Inspection since the last inspection. Three staff at the home had received Protection of vulnerable adults training facilitated by Social services. The majority of staff however had not received training. A booklet from Social services describing locally agreed Protection of vulnerable adults procedures was available. The Protection of vulnerable adults procedure however did not refer to this and advocated internal investigation. This difference could be confusing to staff and could potentially if any allegations are handled appropriately. Derby House Nursing Home DS0000002052.V260838.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22,23,24,26 The home was a generally well maintained one with the majority of service users preferring to use their own bedrooms as opposed to using the communal areas. EVIDENCE: The location of the home on the edge of a park was a positive point for many service users. The home was found to generally well maintained with just a little wear and tear in places. A handy man is employed at the home to deal with any maintenance issues. The Fire officer last visited the home on 20/09/05 and fire safety measures were found to be satisfactory. Service users bedrooms were found to be well personalised and service users spoke positively about liking their rooms. There tended to be a culture in the home of service users spending time in their room, eating meals in their room and using them like bed sits. Derby House Nursing Home DS0000002052.V260838.R01.S.doc Version 5.0 Page 15 Where bedrooms were shared screening to provide privacy was available. One communal lounge/dining room was available on the first floor. This was on the small side for 31 service users as it did not provide adequate seating for everyone; only 4 seats were available at the dining table. As many service users had large bedrooms which they tended to use this was not considered to present any difficulties. A range of adaptations were available including a hoist on each floor of the home. A hoist was available over the bath to aid those with mobility problems. A new staff call system had been fitted. One service user was observed to have a modified call bell that they were able to easily use. A number of toilet and bathrooms were not fitted with privacy locks. The seal of the flooring around one toilet also required attention. Nail brushes were found to be at a number of wash basins and present a possible cross infection risk. The laundry area had 2 washers (with a sluicing programme) and 2 dryers. A mechanical sluicing disinfector was available. Bedroom doors were not fitted with any safety locks. Staff said that service users were offered this and no one had requested one but there were not records in place to confirm this had been offered and declined. This is an outstanding requirement from previous inspections Generally the home was found to be clean and tidy. Derby House Nursing Home DS0000002052.V260838.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Staff recruitment practices and induction programme were not comprehensively and robust implemented in a way that would ensure service users were protected. EVIDENCE: The staffing rota was accurate to the number of staff on duty as it had had not been amended to reflect staff holidays. Staffing levels varied according to the time of day and as at previous visits afternoon appeared to have the lowest number of staff on duty. Staff said they felt the numbers of staff on duty to be adequate. This must be kept under review to ensure the level of 1 qualified nurse and 2 carers is sufficient. There were currently out of 20 care staff at the home who held at least NVQ (National Vocational Qualification) level 2 in care. Discussions with staff revealed that more staff were currently enrolled on NVQ (National Vocational Qualification) level 2 & 3 in care. Two staff personnel files were examined. One staff member had begun work at the home without a Criminal Records Bureau or POVA first check being completed and no references or even referees being known. An immediate requirement was issued regarding this. Derby House Nursing Home DS0000002052.V260838.R01.S.doc Version 5.0 Page 17 The induction programme in place was not a skill based one aimed at ensuring staff were assessed and adequately inducted in the delivery of care. There was also not a foundation programme in place for staff which should be completed within 6 months of commencing employment. This was discussed with one of the Providers who said they were aware of the need for a skill based induction programme but had not developed this. The provision of training at the home in the past year appeared to be basic consisting of fire safety training, moving and handling, and basic food hygiene. 2 staff had completed first aid training. There were also no records to confirm that night staff were receiving bi annual fire safety training. There appeared to be a heavy reliance that NVQ (National Vocational Qualification) qualifications would provide staff with the sufficient training. Derby House Nursing Home DS0000002052.V260838.R01.S.doc Version 5.0 Page 18 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): 33,34,35,36,37,38 Managerial systems were not being fully implemented in all areas to ensure that required standards were being met however the general maintenance of the home appeared to be well managed. EVIDENCE: Small amounts of money were held safely on service users behalf. Records of a sample of these were examined. These confirmed records of transactions were recorded but were not validated by signatures. Some receipts were seen. Staff spoken to said that monies for each service user were held separately. A valid public liability certificate was displayed. Records for establishing financial liability were not requested at this visit. Derby House Nursing Home DS0000002052.V260838.R01.S.doc Version 5.0 Page 19 Some records which are required to be available were not being kept accurately or completed. There were also some records that were not being kept in accordance to data protection guidance. Some questionnaires had been given out to service users and relatives. 6 service users had completed these and 4 relatives. Generally comments were found to be positive with some suggestions being forward. No service users meetings were held or systems for recording informal feedback. There were no regular forums for staff or service users in the form of meetings or recorded informal discussion held to demonstrate an ongoing commitment to monitoring quality. There were no mechanisms in place to ascertain feedback from visiting professionals. The system for implementing staff supervision had begun with a performance review being completed by each staff member. The structure for ensuring staff supervision was being completed that covered all aspects of clinical practice, philosophy of care and training had not yet been fully implemented and the requirement remains listed from previous inspections. Service records for the home including gas and electrical testing certificates were found to be in good order. Derby House Nursing Home DS0000002052.V260838.R01.S.doc Version 5.0 Page 20 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 2 3 x 2 3 3 3 x 2 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 3 2 2 2 2 Derby House Nursing Home DS0000002052.V260838.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement Documentary evidence of staff completing preadmission assessments of service users must be available in order that service users can be assured their needs are able to be met Where any forms of restraint are utilised as part of an agreed plan of care periods where restraint is used must be recorded A care plan must be in place for each service user based on assessed needs detailing how care needs are to be met Topical preparations must be used on a named person basis only and dated upon opening Residents must be consulted regarding their post death wishes This must be reviewed regularly. Where this is considered inappropriate the reasons for this must be recorded Homogenised foods must be served with foods separately liquidised to ensure they are well presented Timescale for action 31/12/05 2 OP7 3 30/11/05 3 OP7 15 30/11/05 4 5 OP9 OP11 13 12 30/11/05 31/01/06 6 OP15 16 30/11/05 Derby House Nursing Home DS0000002052.V260838.R01.S.doc Version 5.0 Page 22 7 OP18 13 8 9 OP18 OP21 13,18 23 10 11 OP21 OP23 23 16 (1) (2) (c) 13 18 12 13 OP26 OP28 14 15 16 17 18 OP27 OP30 OP30 OP31 OP35 Schedule 4 18 18 8 16 Schedule 4 The protection of vulnerable adults policy must be clear in what action staff must take following any allegations and refer to locally agreed procedures where service users are funded by local authorities All staff must receive Protection of vulnerable adults training Privacy locks of a type where it is possible to gain access from outside in a n emergency must be fitted to all bathrooms and toilets The flooring around the toilet must be sealed A programme must be introduced to provide locks to bedroom doors. (Original timescale (31/8/04) Nail brushes must not be used unless they are sterilised fully between each use A plan must in place to ensure at least 50 of care hold at least NVQ (National Vocational Qualification) level 2 qualifications in care The staff rota must accurately reflect the actual staffing compliment A skill based induction package for staff must be in place and implemented A skill based foundation training package for staff must be in place and implemented The registered manager must hold a relevant managerial qualification All financial transactions must be signed to provide an audit trail 31/12/05 31/05/06 31/12/05 31/12/05 30/11/05 30/11/05 31/12/05 30/11/05 31/01/06 28/02/06 31/12/05 30/11/05 Derby House Nursing Home DS0000002052.V260838.R01.S.doc Version 5.0 Page 23 19 OP36 18 (2) 20 OP37 17 21 OP37 17 22 OP38 18,23 All care staff should receive formal supervision at least six times a year From inspection on 4/7/05 timescale not yet passed Records as required by Schedules 1,2,3 & 4 must be retained accurately and be made available for inspection All records containing personal data must be held securely in accordance with the Data Protection Act 1998 All staff working night duty must undertake bi annual fire safety training 30/12/05 31/12/05 30/11/05 31/12/05 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 2 3 4 5 Refer to Standard OP9 OP7 OP33 OP33 OP35 Good Practice Recommendations The home should check with their pharmacist that the siting of the Controlled Drugs cupboard meets the current guidelines and standards. Care plans must not include abbreviations that service users or their relatives may not understand Consideration should be given to holding minuted service users and staff meetings on a regular basis to enable views to be aired There should be consideration given as to how to ascertain feedback from visiting professionals All financial transactions should have double signatures to verify them Derby House Nursing Home DS0000002052.V260838.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Derby House Nursing Home DS0000002052.V260838.R01.S.doc Version 5.0 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!