Inspection on 20/08/08 for Donness Nursing Home

This inspection was carried out on 20th August 2008.

CSCI found this care home to be providing an Adequate service.

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

Other inspections for this house

Donness Nursing Home 14/07/09

Donness Nursing Home 03/09/07

Donness Nursing Home 13/07/06

Donness Nursing Home 14/09/05

Donness Nursing Home 07/04/05

Donness Nursing Home 15/11/04

Donness Nursing Home 05/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

CARE HOMES FOR OLDER PEOPLE Donness Nursing Home 42 Atlantic Way Westward Ho ! Bideford Devon EX39 1JD Lead Inspector Susan Taylor Unannounced Inspection 11:00 20 & 21 August 2008 th st 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 Donness Nursing Home DS0000026712.V367491.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. Donness Nursing Home DS0000026712.V367491.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Donness Nursing Home Address 42 Atlantic Way Westward Ho ! Bideford Devon EX39 1JD 01237 474459 01237 479349 pydon@supanet.com 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) Mrs Yvonne Lesley Thelma Newton Mr Paul Christopher Newton, Mrs Esther Waldron Mrs Yvonne Lesley Thelma Newton Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Donness Nursing Home DS0000026712.V367491.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 34 3rd September 2007 Date of last inspection Brief Description of the Service: Donness is a detached, three storey property situated in the Westward Ho! area of Bideford which has been extended in recent years. It provides services for 34 people over the age of 65 years, with either personal or nursing care needs. It occupies an elevated position and offers far ranging views to the nearby coastline. There is a selection of communal areas on different floors of the building - this includes two dining rooms, three sitting rooms and a visitors lounge/quiet room. Private rooms comprise of four double rooms and twentysix single rooms, many of which have en-suite facilities. All areas of the home can be accessed by one of the two passenger lifts. There is a large sun balcony with lovely sea views. This provides the outdoor space for people to sit. Some private rooms also have a small balcony. A direct bus route to and from Bideford is available. The cost of care at the time of the inspection was £435 to £565 per week. Chiropody, toiletries, newspapers/magazines, personal items, clothing and hairdressing are additional costs which are not included in the fees. The latest CSCI report is held in the manager’s office of the home and would be available upon request. Donness Nursing Home DS0000026712.V367491.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is One star. This means the people who use this service experience Adequate quality outcomes. This was a key inspection of Donness Nursing Home under the Inspecting for better lives arrangements. We were at the home with people for 11.5 hours over two days. The purpose for the inspection was to look at key standards covering: choice of home; individual needs and choices; lifestyle; personal and healthcare support; concerns, complaints and protection; environment; staffing and conduct and management of the home. We looked at records, policies and procedures in the office. A tour of the home took place. We sent surveys to all the staff and received none back. We tracked the care of four people and met some of their relatives. We also looked at the care plans, medical records and daily notes for these four people. We spoke to another four people that live in the home about their experiences there. We watched staff caring for people. We sent surveys to all of the people living in the home and received 8 back. The comments of these people and our observations are in the report. As at August 2008, the fees ranged between £435 and £565 per week for personal care. Extra charges are made for chiropody, hairdressing, newspapers and magazines and toiletries and these vary. People funded have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk People describe Donness Nursing Home as being a “lovely” place to live. Staff are said to be “excellent” and “caring”. Comments like “the staff are busy” and ‘I would like to be taken to the toilet more often’ tell us that the availability of staff to care for people is the most important area that needs to improve. Donness Nursing Home DS0000026712.V367491.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? People have been involved in reviewing and planning their care since the last inspection. Their care plans are more detailed and give staff a good picture of what needs a person has. The home is able to show that medicines are stored at the correct temperatures. Staff ensure that the privacy and dignity of people is respected and maintained. In particular, they make regular checks of people that have a tendency to undress themselves in public. Donness Nursing Home DS0000026712.V367491.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Donness Nursing Home DS0000026712.V367491.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 Donness Nursing Home DS0000026712.V367491.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): 1,3 & 6 Quality in this outcome area is good. People are fully involved in the assessment process and information is gathered from a range of sources to ensure that individual’s needs are known. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a Statement of Purpose (SOP), which had been updated since the last inspection. This helps people to understand what the home offers and whether it is suitable for their individual needs. Information that the provider sent to us verified that a brochure is given to all people which sets out what the service will provide and includes a contract of terms and conditions, fees payable and other useful information to help people decide whether the home is right for them. Surveys received from people living at the home showed Donness Nursing Home DS0000026712.V367491.R01.S.doc Version 5.2 Page 10 that six out of eight (75 ) had received enough information about this home before deciding to live there. Information sent to us by the provider verified that shared care assessments are obtained from health and social care professionals before people are admitted to the home. These are obtained to ensure the home can fully meet an individual’s needs. We looked at four care files to establish whether the care delivered was based on detailed assessment of people’s needs. Assessments were comprehensive and person centred outlining details such as a person’s bedtime routine. Where appropriate the individual’s advocate had also been involved in the process. Hazards had been identified for each person and the level of risk was clear with regard to issues such as tissue viability, falls, manual handling, mental health, behaviour and continence. Assessments had been regularly reviewed. We read a continence assessment and saw that appropriate aids had been obtained for the individual concerned. We looked at the file of an individual with dementia whose care plan stated that they needed prompting at mealtimes to ensure that their nutritional intake was sufficient. There was a detailed care plan about this, which we observed being followed at lunch. However, it was unclear as to why this was in place as no assessment of the person’s nutritional needs had been done. Similarly, three other care files, which did have nutritional assessments, were out of date. One of which was last reviewed on 10/11/2006. We discussed this with the manager and have made a recommendation about this. We tracked the care of a person that had a history of falls due to epilepsy. Records demonstrated that the person needs to be monitored closely to ensure that their safety is maintained during a seizure. Records demonstrated that an alarm is used to alert staff when the person is having a seizure during the night. Staff told us that they did not want to disturb the person unnecessarily at night. However, the person’s safety is also paramount and they need to know when the individual is having a seizure so that they can immediately give care to them. The persons mental capacity had been assessed to establish whether they have the ability to consent to using such equipment and this is good practice. Agreement to use this had been obtained from the person’s advocate, GP and occupational therapist. Donness Nursing Home DS0000026712.V367491.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 & 10 Quality in this outcome area is adequate. Peoples’ health and personal care needs are generally met but the effectiveness of this can be dependent upon staffing numbers. Medications are well managed but best practice needs to be followed when giving people their tablets to ensure they are not put at unnecessary risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the care files for 4 people to establish whether they had a care plan that had been discussed and reviewed with them and/or their advocate. Peoples needs included individuals with diabetes, cognitive impairment, mental health issues, and physical frailty. Those that were able to told us that the manager had spoken to them about their needs and aspirations. Similarly, relatives acting as advocates said that they had been totally involved in the Donness Nursing Home DS0000026712.V367491.R01.S.doc Version 5.2 Page 12 care planning process. Three out of four of the care plans seen had recently reviewed showed improvement and are much more person centred since the last key inspection. We looked at the care outcomes for a person with dementia. A nutritional assessment had not been done, as discussed under section one. A comprehensive care plan had been written, which gave staff clear guidance about how this persons nutritional needs should be met. In particular, it highlighted that the individual should be weighed weekly because they were at risk of malnutrition. We were unable to find a record to show that the individual had been weighed as planned and discussed this with the nurse in charge and manager who were also unable to locate the information. Therefore, it was impossible to establish whether this aspect of care was being met. The person was prompted to eat their meal at their own pace as the care plan had stated. The person also needed help to maintain their personal hygiene because they were forgetful and had continence problems. We observed that they were dressed in clean clothes and shaven. We looked at a period of one month, in which personal care (washing or bathing) should have been recorded as having been given every day. According to the records the individual had been washed on 5 occasions during that period, with no other record of the person having been bathed. We saw a similar pattern of gaps in recording in 3 other care files that we examined. Staff said that they believed that people had received the care they needed, however they did not always have time to complete records because they were “so busy”. We discussed these concerns with the provider/manager who verified that staff are expected to complete records every day to evidence the care given to people. Additionally, she told us there had been a high turnover recently and she was in the process of recruiting new care staff. This matter is discussed under the staffing section and immediate requirement was made at the inspection to increase staffing levels. We were shown an individuals care file to demonstrate how the complex needs of a person were being met. Staff told us that the individual was being cared for on a mattress on the floor at night, rather than in a bed, for safety reasons to protect the person from falling out of bed. Bedrails had been considered unsuitable. The measures had been discussed and agreed with the persons advocate, their GP and Community Psychiatric Nurse as the individual was unable to consent themselves. Given the complex needs of this person, we concluded that the team had minimised the risk of falls for that person and had involved appropriate healthcare professionals and the person’s advocate in the decision making process about the measures they were using. Towards the end of the inspection, we met a relative who said, “sometimes there are not enough staff on duty”. Additionally, they explained that their relative had considerable care needs. We looked at their relation’s care file, Donness Nursing Home DS0000026712.V367491.R01.S.doc Version 5.2 Page 13 which highlighted that the person had two significant pressure sores. Turning charts showed when the person’s position was changed and notes stated that the person’s position should be altered every two hours. However, the turning charts covering the two days of the inspection highlighted that on 20th August 2008 the person’s position was changed six times in a 24 hour period. On 21st August 2008 their position had been altered six times in 19 hours. Staff assured us that the person was being turned every two hours and that the records were incomplete. The individual’s relative also verified that their relation’s position was changed regularly. We discussed this at length with the provider/manager and decided that a more in-depth examination of the person’s records was needed after the site visit to the home. We seized a number of records relating to that person and have examined these in detail. From this we have established that risk assessments regarding the likelihood of developing pressure sores were in place. Care plans reflected this information and provided in depth information for staff to follow to minimise the risk of tissue breakdown. Additionally, records demonstrate that the person had a pressure-relieving mattress on their bed and the same on their chair from the point at which the risk of pressure damage increased. However, the person’s tissue continued to breakdown. Wound care planning documentation contained information that mapped the size and grade of the wounds. Basic information about what wound care products being used was documented. Often dressing products were changed and the rationale for this was not consistently recorded. Therefore, it was not always possible to determine whether treatment was effective or not. It was unclear as to whether the tissue viability nurse had been contacted for advice as stated in the care plan as there was no record of this having happened between January – August 2008. Those people who were spoken with during the course of the inspection said that the staff are kind and helpful, and that they are treated respectfully. Comments made on many CSCI survey forms included the following ‘I am very happy with my life here and I wouldn’t want to be any where else’ and ‘my relative is very well looked after and nothing is too much trouble’. Staffs were observed during the course of the inspection to be assisting the people who live in the home in a polite and friendly manner. One person commented, “I consider the staff to be my friends”. Staff knocked on bedroom doors before entering bedrooms to help to protect their privacy. The home uses a monitored dosage system. Qualified nurses are responsible for stock taking and carry out regular audits of the medication system at night. Records of ordered drugs and a register of controlled drugs were seen and tallied with those being stored. The system was easy to audit and we tracked medication given to four people. Records accurately reflected medication having been given as prescribed by the GP. Medicines were kept in a secure place. We observed people being given their tablets after lunch and the evening meal. Medicines were put into pots with the individuals’ name on it, Donness Nursing Home DS0000026712.V367491.R01.S.doc Version 5.2 Page 14 and were then taken by tray to each floor and given to one person after another. We told the member of staff that this was unsafe because there was an increased risk of giving the wrong medicines to a person. We discussed our findings with the provider who verified that what we observed was accepted practice in the home. Best practice guidance is available on our website at: http:/www.csci.org.uk/professional/default.aspx. We saw records, which demonstrated that the temperature of the fridge was regularly checked. Creams or ointments that people had or were being treated with were recorded on the Marrs sheet with the directions of the prescriber and an expiry date recorded. The home uses controlled drugs, which are managed satisfactorily, and a random check was undertaken. Since the last inspection, the management of medicines has improved with regard to record keeping. Best practice should be implemented to fully ensure that people are given the right medicines at the right time. Donness Nursing Home DS0000026712.V367491.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. Routines and activities are flexible for people. Some people are consulted and listened to regarding the choice of daily activity, but this could be improved further for people with dementia or communication difficulties. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We saw that many relatives visit their relations. Some visited on a very regular basis and two people told us they visited every day to assist their relative to eat at mealtimes. They said that they can visit the home “at any time and are always made to feel welcome” in a friendly atmosphere. All of the relatives told us that they are “totally involved” in their relation’s care. One person when speaking about the home in general said, “I can’t fault it”. Surveys received from people living at the home showed that five people ‘usually’ took part in activities, one person ‘sometimes’ did and two did not Donness Nursing Home DS0000026712.V367491.R01.S.doc Version 5.2 Page 16 reply. One commented “there are activities twice a week. With music and songs with simple exercise and fun games”. Relatives confirmed that they thought there were enough activities in the home. One relative wrote ‘she joins in activities when she can do’. Another person wrote ‘the home has been very good for my wife’. The home offers people living there a variety of activities which are scheduled for different days of the week. Information sent to us by the provider verified that activities are available every day and include exercise to music, arts and crafts and singing and music lead by an entertainer. People’s spiritual needs are also met with visiting members of the Church. During the inspection we met an entertainer who provides musical therapy and cabaret for older people. People were animated and appeared to enjoy this, as they were encouraged to sing along to wartime classics. We spent time in the lounges observing how staff interacted with the people living there. This highlighted examples of good practice. During the period of observation, staff engaged with people continuously at the right speed and demonstrated genuine warmth and attention, which people appeared to respond to and enjoy. However, this occurred when care was being given to the person e.g. whilst feeding them or taking them to the toilet. People with advanced dementia were somewhat disengaged when not being given care. We asked staff what they did to help these people pass the time. Staff said that it was difficult to sometimes know what these people could actually do or wanted to do. Staff verified that they tended to act more on instinct rather than on assessed knowledge about peoples’ social interests and hobbies. We discussed specific tools that might be useful to gain in depth information about individual capability and interest such as the ‘Pool Activity level instrument’. This would also ensure that activities are person centred and pitched at the right level for people. We observed people having both lunch and the evening meal over the course of two days. Additional ‘hospitality’ staffs were on duty during these meals. However, some people were still eating their evening meal after 7pm on the second day of inspection. Staff told us that they were short staffed due to staff sickness. We observed that some people had fallen asleep by the time their meal arrived and were reluctant to eat it by then. People appeared to enjoy their food and eight confirmed this in their surveys. We observed a person with dementia at lunchtime being prompted to eat their meal and being enabled to do this at their own pace as the care plan had stated. Donness Nursing Home DS0000026712.V367491.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. People living in the home are listened to and their views are acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 100 of people responding in a survey verified that they knew how to complain and who to speak to if they were unhappy. The procedure was outlined in the service user guide on the table in the entrance hall. The address for the Commission stated within the document is out of date and will need to be altered. Since the last inspection one complaint had been made to the Commission for Social Care Inspection regarding this home. The manager was asked to investigate the complaint and did so promptly. Some aspects of the complaint were substantiated, namely that staffing levels have been affected on occasions by sickness. We also found evidence of this, which is discussed under the Staffing section. 100 of people responding in a survey felt that the staff always treated them well and listened to them. The home had a written policy and procedure for dealing with suspected allegations of abuse. We spent sometime observing interactions between staff and people living there. Staff engaged with people Donness Nursing Home DS0000026712.V367491.R01.S.doc Version 5.2 Page 18 continuously at the right speed and demonstrated genuine warmth and attention, which people appeared to respond to and enjoy. The home holds small amounts of cash for individuals. A sample of these was checked. There were records of all transactions and the amounts counted were correct. The service user guide is transparent about extra charges that are levied to people living in the home. These include chiropody, daily newspapers and periodicals, traveling expenses incurred by hospital appointments and private telephone connection and telephone calls and line charges. Training records demonstrated that all of the staff had attended a course covering the protection of vulnerable adults and the Mental Capacity Act in June 2008. Staff that we spoke to individually during the inspection also verified this. They had a clear understanding of the concepts of whistle blowing and adult protection issues. Therefore, staffs that are able to identify and stamp out practice that may be abusive safeguard people living at the home. Donness Nursing Home DS0000026712.V367491.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. People live in a well-maintained, comfortable and clean environment. Procedures being followed have not ensured that the risk of infection to people living in the home is minimised and these should be reviewed in line with best practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People said that they are made to feel ‘at home’ and are encouraged to bring with them items of sentimental value, such as pictures, ornaments and in some instances, items of furniture. These are used to personalise bedrooms Donness Nursing Home DS0000026712.V367491.R01.S.doc Version 5.2 Page 20 and thereby give residents a sense of ownership of their rooms and immediate environment. We toured the premises and saw that radiator guards were in place throughout the building. Fire exits were clear and accessible. We looked at a sample of five bedrooms occupied by the people whose care we looked at. All the bedrooms were clean, individualised and comfortably furnished. People living in the home told us that there is always a housekeeper on duty. All of the wcs and bathrooms had accessible locks on the doors. Communal areas were comfortable and homely. Maintenance certificates were seen for hoists, assisted baths, the electrical installation, central heating and fire alarm systems. Surveys from people living in the home or their relatives verified that the home is ‘always’ kept fresh and clean. All of the staff we spoke to had received training about the prevention of infection and management of infection control. Hand towels and soap dispensers were seen in wcs, bathrooms and bedrooms. Good hand washing practices were followed when staff were giving care to people. The laundry was clean and well organised. The Commission was contacted about infection control practices in the home, which the caller felt were unsafe. We were told that there was a outbreak of scabies and that linen was being washed below 40°C. At the last inspection, we recommended that linen should be washed properly at the right temperatures to prevent any infection risk. We wrote to the provider who then notified us that an outbreak of scabies had occurred between 19th –28th July 2008 and that people living there, staff and visitors had been treated. The provider also verified that a low temperature sluice wash has a 30°C prewash and a 40°C main wash. We advised the provider that Department of Health guidance on management of infection control stipulates that appropriate decontamination of bed linen is reached by washing it at 65°C for 10 minutes or 71°C for 3 minutes. For heat-sensitive fabrics a low temperature at 40°C should be used and tumble-dried at a minimum of 60°C. Following this guidance will ensure that people are protected from the risk of cross infection and therefore remain healthy. Donness Nursing Home DS0000026712.V367491.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 & 30 Quality in this outcome area is poor. The position regarding numbers and skill mix of staff on duty has not improved and therefore the needs of the people living at this home are not fully met. Recruitment practices have not improved, are not robust and fail to protect residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Of the eight people living in the home who returned surveys, five stated that they ‘always’ received the care and support they needed. Two verified that this was usually the case and one person wrote that they ‘would like to be taken to the toilet more often’. At the home, we asked people whether staff were available when they needed help, and they made comments like “they’re busy, they have enough to do”. Relatives told us “the staff have to sometimes work 9 days in a row” because “there’s not enough of them” and “they are always short staffed”. We observed staff to appear rushed particularly on the evening of the second day of the inspection. Donness Nursing Home DS0000026712.V367491.R01.S.doc Version 5.2 Page 22 We talked to eight staff over the course of two days about what was expected of them and whether they had enough time to meet peoples’ needs. Staff comments included, “it’s difficult” and “there’s not enough time to spend as you would like with people” and “I want to do care properly but have to rush”. At the last inspection we required the provider/manager to take account of the different dependency levels of people when setting staffing levels. We looked at duty rosters covering the period from 9th June 2008 to 21st August 2008 and these consistently showed (17 times) that when staff are sick or on leave no replacement cover had been arranged. We spoke to the provider/manager about our findings and she told us that she tended to cover sickness or leave. However, there was no record of her having done this on the duty rosters seen. We discussed dependency levels in the home and concluded that staffing levels were insufficient during the daytime period to ensure that people’s needs are met. As a result of this, we issued an immediate requirement that required the provider to review staffing levels accordingly to meet people’ needs. We spoke to the provider/manager about recruitment and they told us that they had appointed five new staff in 2008. We examined the files for these individuals to establish whether the recruitment procedure was robust and had been followed. CRB and POVA checks had been obtained for all 5 new staff. However, other pre-employment checks had been carried out properly for only 2 out of 5 [40 ] new staff. In the first file we read a written reference dated 20/3/08 and a testimonial from a place of work. No other references had been obtained and the member of staff had commenced employment on 10/3/08 (verified by the individual and duty rosters). In the second file, a reference had been obtained (dated 14/8/08) for the individual after the start date of employment. We looked at duty rosters and established that the individual had worked on 11/11/08. Therefore recruitment procedures have not improved since we last inspected and people remain unprotected because of this. We discussed our findings with the provider/manager and made them aware of the Commissions publication Safe and sound? Checking the Suitability of new care staff in regulated social care services [available at http:/www.csci.org.uk/pdf/safe_sound_tagged.pdf]. We also clarified best practice in relation to recruitment procedures. New staff had completed equal opportunities and health monitoring forms prior to employment. Information sent to us by the provider/manager tells us that 47 (8 out of 17) staff hold NVQ level 2 in care and a further 10 staff are in the process of doing it. Additionally, staff told us that they are encouraged to do training. New staff said that their induction was “thorough”. Donness Nursing Home DS0000026712.V367491.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): 31,33,35, 36, 37 & 38 Quality in this outcome area is adequate. People are confident that the home is safe. Whilst some aspects of the service have improved other areas identified at the last inspection have not been acted upon, and therefore the effectiveness of meeting peoples’ needs cannot be assured. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager has run the establishment since 1981. She is a Registered Nurse (General) and has the Registered Managers Award. She told us that she keeps up to date by using an in house training system and has Donness Nursing Home DS0000026712.V367491.R01.S.doc Version 5.2 Page 24 “good links” with the local college. Throughout the inspection we found the manager to have a fair understanding of her role. We were disappointed that three out of six requirements made at the last inspection (3rd September 2007) had not been met namely to review staffing levels, improve recruitment practices and record keeping. We issued an immediate requirement for the provider/manager to review staffing thereby ensuring that people’s needs are fully met. In light of light of this the Commission has asked the provider to prepare an improvement plan showing how these matters are being addressed. This is a legal document and will be followed up to ensure that the service improves for the people living there. The manager gave the Commission a reasonable picture of the current situation in the service, in a document entitled AQAA (Annual Quality Assurance Assessment). However, there were areas when more supporting evidence would have been useful to illustrate what the service has done in the last year, and/or explicitly how it is planning to improve. We did observe some aspects of good practice, including the assessment of mental capacity and care plans were more detailed, had been reviewed and demonstrated that people were involved in this process. Similarly, a survey seeking the views of relatives and people living in the home had been done. The provider went on to tell us that most of the quality assurance was done “informally” day to day. People responding in a survey made comments like I am very happy here at Donness and ‘the staff are very good’. People we met said, “It’s lovely here”. Staff we spoke to told us that their main role was to “make people happy” and that communication about their needs was generally good. We spent lengthy periods observing interactions between people living in the home. The atmosphere was open and friendly. Staff told us that their meetings do take place every couple of months. We received mixed views about the effectiveness of these. On the one hand staff felt that some of their suggestions were not acted upon and therefore “don’t feel valued”. Conversely, other staff commented that the aspirations of the provider were not always valued and strong leadership was needed to ensure that there is effective two-way communication so that the service improves for people living there. We listened to handovers being given at each change of shift, which gave staff a useful indication of any change in a person’s condition. We looked at financial records for four people that live in the home. All were accurate when crosschecked with the balance kept for safekeeping. Entries had been signed for. Receipts corresponded with entries for items such as outings, magazines and toiletries. Secure facilities were in place to safeguard personal documents and money. As discussed previously, there were gaps in information about care and therefore do not provide an accurate record of the care received, and is an area that needs improvement. Daily records, such as turning charts were incomplete. Therefore, policies and procedures have not been followed and the rights of people living in the home have not been promoted. Donness Nursing Home DS0000026712.V367491.R01.S.doc Version 5.2 Page 25 We spoke to staff during the inspection, which told us that 1:1 supervision sessions were infrequent. We looked at five personnel files; none had a record of a supervision session having taken place in 2008. Information from the provider also highlighted that this was an area for improvement and verified that training for senior staff responsible for doing this had been booked for September 2008. We have made a requirement about this. Comprehensive Health & Safety policies and procedures were seen, including a poster displayed near to the office stating who was responsible for implementing and reviewing these. Staff we spoke to told us that they had been regular training. We were shown the induction pack and saw that completion of this had been recorded in the files we looked at. We toured the building and observed that cleaning materials were stored securely. Records of accidents were kept and showed that appropriate action had been taken. The fire log was examined and demonstrated that fire drills, had taken place regularly. Similarly, the fire alarm had also been regularly checked. People living in the home told us that the alarm was regularly “checked once a week”. Certificates verified that an engineer had checked the fire alarm. First aid equipment was clearly labelled. Maintenance certificates were seen for fire alarm and electrical systems. The provider had verified in information sent to the Commission that a local electrician had inspected both the electrical system and appliances. We read a handling plan for an individual, which stated that staff always had to use equipment to help the person transfer to another position. We observed handling equipment in the person’s room that staff used to do this. Information that the provider sent to the Commission verified that 10 staff had attended moving and handling training in 2008 and staff verified this also. We later observed two staff moving the person. They did so, by explaining first what they were going to do and then used the equipment provided to safely help the person transfer into a wheelchair. We observed that one of the staff was wearing a handling belt that helps to protect their back when they need to move people into a different position. Donness Nursing Home DS0000026712.V367491.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 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 3 17 x 18 3 3 x x x x x x 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 1 2 3 Donness Nursing Home DS0000026712.V367491.R01.S.doc Version 5.2 Page 27 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 OP27 Regulation 18 (1) a Requirement The home must have the right numbers of qualified, competent and experienced staff working at the home at all times, which takes into account the different dependency levels of the residents. This is to ensure that the people who live there will have their care needs met fully and in the correct manner. This requirement is repeated from the last report dated 3/9/07. An immediate requirement was issued, in which staffing levels had to be reviewed and increased by 30/8/08. 2. OP37 17 (1) (a)(b), (2), (3) (a)(b)Sch edule 3 and Schedule 4 03/12/08 The provider must ensure that all records listed relating to residents and staff must be up to date, held in the home at all times and be available upon request. This is to ensure that all authorised parties can review the health, safety and welfare of residents living in the home. This requirement is repeated DS0000026712.V367491.R01.S.doc Version 5.2 Page 28 Timescale for action 30/08/08 Donness Nursing Home from the last report dated 3/9/07 3. OP29 19 (1) (a)(b)(c) Schedule 2 1-7 The provider must ensure that no member of staff is employed to work at the home without first obtaining all the necessary information required, in this case two satisfactory written references. This will ensure that people are not put at unnecessary risk of harm. 03/12/08 4. OP36 18(2)(a) This requirement is repeated from the last report dated 3/9/07. The provider must ensure that 31/03/09 staff receive regular one to one supervision so that their care practice is formally reviewed and their training and development needs are identified and planned. This will ensure that staff that follow best practice cares for people. 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 OP3 Good Practice Recommendations The nutritional needs of people living in the home should be known by being properly assessed with a tool such as the ‘Malnutrition Universal Screening Tool’ (available at www.bapen.org.uk). People living in the home need to be confident that staff responsible for giving out medicines always follow Donness’ procedures so that they receive the right medication at the right time. 2. OP9 Donness Nursing Home DS0000026712.V367491.R01.S.doc Version 5.2 Page 29 3. OP12 4. OP16 The recreational needs of people, particularly those with dementia or communication difficulties, should be assessed using a tool such as the ‘Pool Activity level instrument’. Activities would then be person centred and pitched at a level that is suitable for the individual. People should have access to the correct contact details for the Commission so that they can tell us about any concerns they might have. The risk of infection to people living in the home should be minimised by ensuring that washing procedures are reviewed in line with best practice issued by the Department of Health. This recommendation is repeated from the last report. 5. OP26 Donness Nursing Home DS0000026712.V367491.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Donness Nursing Home DS0000026712.V367491.R01.S.doc Version 5.2 Page 31 - 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. 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