Inspection on 14/09/06 for Douglas Bank Nursing Home

This inspection was carried out on 14th September 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Douglas Bank Nursing Home 09/04/08

Douglas Bank Nursing Home 18/10/07

Douglas Bank Nursing Home 22/03/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Douglas Bank Nursing Home Douglas Bank Nursing Home Lees Lane Appley Bridge Wigan Lancashire WN8 0SZ Lead Inspector Vivienne Morris Unannounced Inspection 09:30 14 September 2006 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Douglas Bank Nursing Home DS0000065686.V309884.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. Douglas Bank Nursing Home DS0000065686.V309884.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Douglas Bank Nursing Home Address Douglas Bank Nursing Home Lees Lane Appley Bridge Wigan Lancashire WN8 0SZ 01257 255823 01257 255982 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) Tudor Bank Ltd Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Douglas Bank Nursing Home DS0000065686.V309884.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. This home is registered for a maximum of 40 service users in the category OP - Old age, not falling within any other category. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. 22nd March 2006 Date of last inspection Brief Description of the Service: Douglas Bank Nursing Home provides personal and nursing care for elderly people of both sexes over the age of 65 years. The home is situated on the outskirts of the rural village of Apply Bridge, although there is easy access by road and rail. The home is surrounded by countryside, overlooking the picturesque village itself. Private accommodation is provided on two floors, accessible by passenger lift and comprises of 32 single rooms and 4 shared rooms, the majority of which have en-suite facilities. There are two large lounge areas, a conservatory and a separate dining facility. The fees charged for the service as at 14th September 2006 ranged from £366.00 to £500.00 per week. Douglas Bank Nursing Home DS0000065686.V309884.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection of Douglas Bank Nursing Home involved an unannounced site visit to the service by two regulatory inspectors from the Commission for Social Care Inspection. The inspectors toured the premises, viewing a selection of private accommodation and all communal areas were seen. Some residents, staff and relatives were spoken to and all relevant records were examined. A range of other historical evidence gathered since the previous inspection was also taken into consideration in order to formulate this report. However, the pre-inspection questionnaire had not been returned to the Commission for Social Care Inspection by the service prior to the site visit. The entire inspection process focused on the outcomes for people living at the home. Those living at the home who were spoken to were happy with the service provided and the care received. They felt that the staff were very kind and caring. The home was found to be clean, tidy and pleasant smelling, providing a comfortable environment for those living at Douglas Bank. The inspector was pleased to see a great improvement in the care planning process, which provided a more individualised approach to the care being delivered. Some comments about the service had been received prior to the site visit in relation to inappropriate care being delivered. The issues raised were looked into at the time of the site visit and the outcomes are reflected within this report. The Commission for Social Care Inspection had received one anonymous complaint about this service since the last inspection, in relation to inadequate staffing levels, which were affecting resident care and staff morale. The issues raised were looked into at the time of the site visit and the outcomes are reflected within this report. What the service does well: The staff team respected people living at the home, ensuring that their privacy and dignity was consistently upheld. The leisure interests and hobbies of those living at the home had been taken into consideration so that they were supported to maintain their individual interests. An experienced member of staff provided a variety of activities in order to promote stimulation and motivation. Nutritious, well-balanced meals were served for residents and snacks were available at all times to ensure that dietary needs were being adequately met. People were able to choose where they ate their meals and those spoken to enjoyed the food served. Douglas Bank Nursing Home DS0000065686.V309884.R01.S.doc Version 5.2 Page 6 People living at the home were supported to remain independent for as long as possible and they were encouraged to maintain contact with their family and friends so that they continued to have links with the outside community. Residents’ finances were adequately protected by the home’s policies and procedures, clear record keeping and audited practices. Complaints were well-managed and robust policies and procedures adequately safeguarded people living at the home against abusive situations. Staff felt that the manager was approachable, supportive and good at her job. The home was clean, tidy and pleasant smelling, providing a comfortable environment for the people living at Douglas Bank. Robust infection control policies and procedures had been adopted by the home so that people were adequately protected from infection. People working at the home had been appropriately trained and were competent to do their jobs. The systems and equipment within the home had been checked and serviced at regular intervals, ensuring that they were safe for use so that residents and staff were adequately protected. What has improved since the last inspection? What they could do better: The home must involve the resident or their representative in the care planning process so that they are supported to make some decisions about the care received. Douglas Bank Nursing Home DS0000065686.V309884.R01.S.doc Version 5.2 Page 7 The home must ensure that external professional advice is sought when indicated as necessary, so that health care needs are consistently and fully met. The overall management of medications needed to be improved to reduce the potential for any drug errors or drug misuse in order to consistently safeguard those living at the home. Some daily routines within the home were not always flexible so that those living there were sometimes restricted in making choices about their care. The routines at meal times should be improved so that people are able to dine in a relaxed, unhurried environment and to find the experience enjoyable. A programme of routine maintenance and renewal of the fabric and decoration of the premises should be produced and implemented with records kept to ensure that the home is well maintained. The gutters around the home needed attention, as the constant noisy dripping sound was disturbing for some people living at the home. Attention to upgrade the décor in some areas of the home was needed and some furnishings were in need of renovating or replacement in order to provide a more homely environment for residents. Minor maintenance work should be addressed promptly and the pieces of equipment in the kitchen, which were out of order, should be repaired. At the time of the site visit, staff were seen to be under pressure to complete their duties due to time constraints, staff morale was low and residents were having to wait long periods of time for staff assistance, which resulted in the last breakfast being served at 11.20am, shortly before lunch. The registered person must be able to demonstrate that the dependency levels of people living at the home and the layout of the building have been taken into consideration when calculating staffing levels to ensure that individual needs can be adequately met. The general consensus was that staff morale was low due to a reduction in staffing levels and also cut backs in various areas within the home. The recruitment practices needed to be improved, as they did not demonstrate that the people living at the home were adequately protected. An annual plan should be implemented, which shows how the home intends to progress, so that the outcomes of services provided are focused on the needs of those living at the home. The systems for monitoring the quality of service provided should be further developed so that the views of stakeholders within the community are sought as to how goals for residents are being achieved. The views of residents should be published anonymously so that those wishing to move into the home can see what life is like at Douglas Bank. Douglas Bank Nursing Home DS0000065686.V309884.R01.S.doc Version 5.2 Page 8 Some practices within the home needed to be reviewed so that the health and safety of people living at Douglas Bank was consistently protected. 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. Douglas Bank Nursing Home DS0000065686.V309884.R01.S.doc Version 5.2 Page 9 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 Douglas Bank Nursing Home DS0000065686.V309884.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were provided with sufficient information about the service to allow them to make an informed choice about moving into the home, and the preadmission process was thorough enough to ensure that the staff team were able to meet individual needs. EVIDENCE: Standard 1 was not fully assessed at this site visit, as it is not a key standard. However, the statement of purpose and the service users’ guide had been reviewed and updated since the previous inspection so that the current management of the home was accurately reflected. Therefore, the outstanding requirement and recommendation had been appropriately addressed. Standard 6 was not applicable to this service and was therefore not assessed. The care of four people living at Douglas Bank was ‘tracked’ at the time of the site visit, when it was found that admissions were not made to the home until a full needs assessment had been undertaken so that the home was able to confirm that they could meet the needs of the individual through the service they delivered as detailed in the Statement of Purpose. For people whom were Douglas Bank Nursing Home DS0000065686.V309884.R01.S.doc Version 5.2 Page 11 self funding and without a Care Management Assessment the assessment was always undertaken by a skilled and experienced member of staff, to ensure that individual needs were effectively assessed. Evidence confirmed that the assessment was conducted professionally and sensitively and had involved the family or representative of the resident. Where the assessment had been undertaken through Care Management arrangements the registered person had insisted on receiving a summary of the assessment and a copy of the plan, so that the home were fully aware of the needs of people before they moved into Douglas Bank. One resident spoken to confirmed that a visit to the home had taken place before admission so that an informed choice about moving into Douglas Bank Nursing Home could be made. The information obtained before admission had been used to write the basic care plan so that all assessed needs were taken into consideration. A key worker system had recently been implemented, which demonstrated that individualised care was being promoted and staff spoken to were fully aware of the individual needs of those living at the home. Douglas Bank Nursing Home DS0000065686.V309884.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care planning process was thorough, but the health care needs of people living at the home were not consistently met in day-to-day practice and the management of medications needed to be improved. EVIDENCE: Each resident had a care plan in place, but practice in involving residents in the development and review of the plan was variable, which did not demonstrate that they were always supported to make some decisions about the care received. However, the inspector was pleased to observe the great improvement in the care planning process. The new documentation supported staff in providing individualised personal and nursing care and adopting a holistic approach in meeting people’s needs, which was further enhanced by the implementation of a key worker system. The plans of care were very well written documents, providing staff with clear guidance about how individual needs were to be appropriately met. At the time of the site visit it was evident that dietetic advice had not been requested for one resident who had been assessed as being at high risk from malnutrition and people living at the home were not able to freely access dentistry services. Douglas Bank Nursing Home DS0000065686.V309884.R01.S.doc Version 5.2 Page 13 Although it was evident that some external professionals were involved in the care of people at the home, this shortfall demonstrated that health care needs were not being consistently met. However, one resident felt that their health care needs were being adequately met and another resident stated, “The doctor is called out when people are not well”. Staff spoken to were familiar with the care planning process and were fully aware of individual assessed needs and how to access further information, should they require it. It was evident that instructions from the General Practitioner had not been completely followed to ensure adequate monitoring of a medical condition. The plans of care examined demonstrated that appropriate care and equipment was being provided for those requiring pressure relief in order to promote good skin care and to reduce the possibility of pressure wounds developing. A variety of detailed assessments had been conducted so that any hazards were identified and strategies were put in place to eliminate or minimise the element of risk. The policies and procedures in relation to medications were in line with the Royal Pharmaceutical Society of Great Britain guidelines to cover all aspects of medicines management. The handling of controlled drugs and waste medication was in accordance with current legislation so that those living at the home were protected from drug misuse. The home had implemented systems in order to monitor the management of medications so that any errors or potential risks could be easily identified. However, the overall management of medications needed to be tightened up to ensure that people were adequately safeguarded from drug misuse or drug errors. The criteria for the administration of when required and variable dose medication had not been clearly defined and recorded for all service users prescribed such items so that their administration could be monitored. Hand written annotations on Medication Administration Record charts had not consistently been signed, witnessed and countersigned, to reduce the possibility of drug errors. None of the medication charts had been signed at teatime on the previous date by the nurse responsible for the administration of medications at this time. This shortfall had the potential to put people at risk. External preparations and dietary supplements had not been recorded on the Medication Administration Records to show that these had been given when required. The plans of care examined demonstrated that the privacy and dignity of those living at the home was an important aspect of care provision. The statement of purpose showed that the home ensured that the privacy and dignity of people was upheld at all times and the residents spoken to confirmed this information. Douglas Bank Nursing Home DS0000065686.V309884.R01.S.doc Version 5.2 Page 14 Staff were seen to be treating residents with respect and were heard talking to them in a kind manner. One visitor stated, “I go away from here knowing my relative is well looked after”. One service user informed the inspector that mobile screens are used when treatment is provided in communal areas. Any treatment or personal care should be provided within the privacy of the residents’ bedrooms or in a treatment room in order to completely promote privacy and dignity. Douglas Bank Nursing Home DS0000065686.V309884.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some routines within the home were not always flexible or most beneficial for the people living there. However, the lifestyle experienced by them satisfied their leisure interests, religious needs and hobbies. EVIDENCE: One resident confirmed that independence was promoted as far as possible and it was established that facilities required were provided in order to make people’s lives as comfortable as possible, whilst living at the home. However, two residents had recently moved rooms and were anxious to have their telephones reinstalled into their new accommodation. It was established that this had been arranged. Some restrictions were evident in relation to the flexibility of the service as residents informed the inspectors that they had to wait for staff availability before they were assisted out of bed in the morning. The inspectors observed this practice on the day of the site visit, when two people had not been served breakfast at 10.45am, because they were late being assisted out of bed, the last resident was seen being helped to get up at 11.20am, which showed that that those who were more dependent on staff assistance were not being provided with the same opportunities as those who were more able to help themselves. Douglas Bank Nursing Home DS0000065686.V309884.R01.S.doc Version 5.2 Page 16 The inspector observed breakfast being served, which appeared to be rushed, not promoting a relaxed experience for residents. At breakfast time staff were not conversing with the residents, but talking amongst themselves and one member of staff was observed giving a resident a drink without choices being considered. It was established that the activities co-ordinator had been employed at the home for many years and that a variety of activities were provided on a daily basis, in order to stimulate and entertain those living at the home. A group of external entertainers visited the home on the day of the site visit, which people enjoyed and evidence was available to show that ministers of different denominations visited the home, so that people’s religious needs could be met. The activities organiser demonstrated that both group and individual activities were provided so that no one was isolated regardless of their abilities or disabilities, which showed that the provision of activities was in line with equality and diversity guidelines. Resident’s leisure interests, preferences and hobbies were recorded in individual care records and any events were displayed throughout the home. Those spoken to thoroughly enjoyed the activities available, although a number were disappointed that two barge trips had recently been cancelled, due to staffing issues. The plan of care for one person living at the home stated, ‘talk to the resident so that she is loved’, which showed an empathetic approach to this person’s care. One resident said that people were able to choose what they wanted to eat up to a point, such as sandwiches instead of a hot meal, and another stated that if anyone wanted a snack, they just needed to ring their buzzer, demonstrating that food and beverages were always available. One resident stated that activities provided were very much enjoyed and that the staff had a good attitude, adding, They (the staff) are always kind and polite. Residents spoken to confirm that they generally enjoyed their meals and were able to dine within the communal areas of the home or within the privacy of their own bedroom, should they choose to do so. Staff were observed assisting people with their lunch, and although this was carried out in a pleasant manner, it would have been more appropriate for staff to sit beside residents, in order to promote a friendly environment when helping them, rather than standing or squatting next to them. The meals served looked well presented and wholesome, providing residents with a nutritious and well balanced diet. Two visitors spoken to confirmed that the home worked to open visiting arrangements and residents knew that they could entertain their family and friends in their own rooms if they wished. If they preferred they were also able to use community areas of the home to talk to visitors and relatives and Douglas Bank Nursing Home DS0000065686.V309884.R01.S.doc Version 5.2 Page 17 friends were encouraged to participate in the various events taking place in the home. Information was available around the home about the use of advocates and a relevant policy was in place, showing that people would have the option of accessing an independent person to act on their behalf, should they so wish. At the time of the site visit one person was managing their own finances with the assistance of a relative, demonstrating that people were supported to be independent for as long as possible. Douglas Bank Nursing Home DS0000065686.V309884.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints were managed well and people living at the home were safeguarded from abusive situations. EVIDENCE: There was a detailed complaints procedure in place, which was examined at the last inspection and was found to be satisfactory then. No changes had been made to this procedure since and the standard was fully met, demonstrating that complaints received by the home were adequately managed. The complaints procedure was widely distributed, and had a high profile within the service, so that people were fully aware of how to make a complaint, should they wish to do so. A system was in place for the recording of complaints, which was seen to be satisfactory. Those spoken to knew what they needed to do should they wish to make a complaint. Robust procedures were in place in order to safeguard those living in the home from abusive situations. The procedures were in line with the Department of Health guidance No secrets and incorporated a whistle blowing policy so that staff were aware of their responsibility in reporting any concerns. A monthly report submitted to the Commission for Social Care Inspection showed that staff training had been provided in relation to safeguarding adults and records seen showed that 20 members of staff had completed this training in September 2006, which is commendable. Douglas Bank Nursing Home DS0000065686.V309884.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment was clean, comfortable and hygienic but it was not well maintained throughout. EVIDENCE: At the time of the site visit the inspectors toured the premises and found that Douglas Bank was generally clean, tidy and pleasant smelling, providing people with a comfortable environment in which to live, although some people spoken to felt that the standard of cleanliness had deteriorated. The bedrooms were personalised with residents’ belongings, providing a homely atmosphere for those living at the home. The inspectors noted that the décor in some areas of the home was in need of upgrading, as some walls were marked in places and picture hooks or holes were left in walls where pictures had been removed. More attention to detail was needed so that the environment was maintained to a satisfactory standard. The inspectors established that the home did not Douglas Bank Nursing Home DS0000065686.V309884.R01.S.doc Version 5.2 Page 20 have an ongoing maintenance programme in place and that the handyman only worked at the home one day every week. Therefore, minor maintenance work could take up to a week to rectify, which is not a satisfactory situation. Some items of furniture were worn, some chair cushions were in need of replacement and others did not match the chairs, which did not enhance the environment for those living at the home. The inspectors noted that two items of equipment in the kitchen were not working, the small oven being out of action for the past two months, which did not assist the kitchen staff in completing their duties in an effective way. The gutters around the building were in need of attention as they were not effective during heavy rainfalls and at the time of the site visit they were constantly dripping noisily in several areas around the exterior of the home, which was disturbing to residents. The laundry department was fit for purpose, although the inspectors established that care staff often completed laundry duties, which took them away from their caring roles for periods of time. It was established that this was the case on the day of the site visit and therefore staff were seen to be extremely busy, trying to do several jobs at once, which gave the impression of a hurried environment, which was not relaxing for those living at Douglas Bank. However, one service user said that there was no problem with laundry and was happy with standard of cleanliness Detailed policies and procedures were in place in relation to infection control and appropriate training had been provided for staff. Controlled waste was being disposed of in the correct manner, ensuring that people in the home were adequately protected. Evidence was not available to demonstrate that confirmation had been obtained to show that the services and facilities complied with the water supply (water fittings) regulations 1999 in order to protect those living at the home. Douglas Bank Nursing Home DS0000065686.V309884.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The number of staff on duty did not consistently meet service users’ needs, although people working at the home had been appropriately trained and were competent to do their jobs. People living at the home were not consistently protected by the recruitment practices. EVIDENCE: The inspectors established that there had been a reduction in the numbers of staff on duty since the change of ownership and this was confirmed by examination of minutes of residents’, relatives and staff meetings, when those present at the meetings were informed that the previous wage cost was too high and that this could not be sustained, so the staffing levels were lower under the new ownership and new working regimes may need to be introduced. It was suggested that the night staff attend to the more poorly residents in the morning, which would free day staff to get residents up for breakfast and then attend to residents in bed later in the morning. People felt that resident care was being affected by the reduction in staffing hours and this was evident from the hurried environment and residents having to wait for long periods of time to be assisted with getting up in the morning, resulting in two people still without their breakfast at 10.45am, the last breakfast being served at 11.20am. The inspectors established that due to the reduction in staffing levels the residents requiring assistance had to go to bed earlier than they wished and had to get up later than they wished, due to the enormous pressure on staff time. The inspectors noted that staff morale Douglas Bank Nursing Home DS0000065686.V309884.R01.S.doc Version 5.2 Page 22 was low and staff were not being replaced as they left employment, which had the potential to also affect resident care. Care staff needed to complete laundry duties, as there was often no one designated specifically for this role. Some visitors had noticed a reduction in staffing levels, but felt that their relatives were well looked after and that, the staff do their best. The staff rota was examined, which showed the grade of staff on duty at any one time. On the day of the site visit there were 29 people living at the home and there were five people on duty from 7.30am to 8.30pm and three people on duty at night time, including a registered nurse at all times. There was no evidence available to demonstrate how these staffing levels had been calculated. It is the responsibility of the registered person to ensure that sufficient staffing levels are maintained in accordance with the dependency of service users and the layout of the building. At the time of the site visit there were 23 care staff employed, including 3 bank staff members, 9 of whom had obtained a National Vocational Award in care, which demonstrated that the home were working towards achieving 50 of care staff having gained this qualification in accordance with the National Minimum Standards. A variety of training courses had been provided for staff and it was evident that those working at the home had received a period of in depth induction and were appropriately trained and competent to do their jobs. The personnel records of three people working at the home were examined. The inspectors found that the service had a poor recruitment procedure with shortfalls in processes being evident. One staff member commenced employment on the 24th August 2005 with one reference being written by the manager of Douglas Bank Nursing Home at the time the employee commenced work, which is not considered to be appropriate. Another staff member, who was the registered nurse in charge of the home on the evening of the site visit had not had POVA first or CRB disclosures completed, therefore this could potentially put people at risk. An immediate requirement notice was issued at the time of the site visit, and the manager of the home found alternative cover for this nurses shifts until appropriate checks had been conducted in order to protect those living at the home. Douglas Bank Nursing Home DS0000065686.V309884.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management and administration of the home did not consistently focus on the outcomes for residents. EVIDENCE: Standard 31 was not assessed on this occasion, as the manager of the home had not been registered with the Commission for Social Care Inspection. However, staff spoken to felt that the new manager was approachable and supportive. One staff member stated, “The manager is really lovely. She is very good at her job”. Several meetings had been held for residents, their relatives and staff so far this year and minutes had been recorded, so that any new information could be passed on to all concerned and those present were given the opportunity to raise any issues which they wished to discuss. Douglas Bank Nursing Home DS0000065686.V309884.R01.S.doc Version 5.2 Page 24 A variety of audits had been conducted, which had been reviewed at regular intervals in order to ensure that the quality of service was being periodically monitored. However an annual development plan was not available for inspection to demonstrate that aims and outcomes for residents had been considered and reflected within the plan. Customer satisfaction surveys had been conducted for residents and their relatives in order to obtain people’s views about the quality of service provided. A high percentage of these surveys had been returned. However, the results had not yet been published, as the manager was waiting to receive some more before the surveys were audited and published. The system in place for monitoring the quality of service provided should now be extended to provide stakeholders within the community with the opportunity to provide their views about how the home is achieving goals for residents. The inspectors established that the extra pressure on staff was affecting staff morale and motivation. Staff were unhappy since the change of ownership and felt that they were being put under great pressure and that they no longer had time to spend with residents, which was affecting resident care, as reflected within other sections of this report. The home now does not employ an administrator or any office staff, which put additional pressure on the manager of the home, as she was responsible for administrative duties as well as management of the home. Clear, easy to follow records were retained for small amounts of money, held on behalf of some residents. These records were audited every month, which was found to be good practice so that the potential for financial errors or financial abuse was reduced. Personal allowances were retained safely and receipts were obtained for any expenditure, including hairdressing and chiropody, so that a clear audit trail was evident. One resident was taking the responsibility for managing their own finances, with some support from a relative, showing that financial independence was encouraged as far as possible. Clear records showed that systems and equipment in the home were serviced at regular intervals to ensure that they were safe for use. A contractors’ policy was seen, which was good practice, demonstrating that any contractors working in the home had signed the policy indicating that they had been made aware of the homes safety guidance and fire procedure. Accidents were recorded appropriately, in line with the data protection act 1998, so that confidentiality was maintained at all times. A variety of internal checks had been conducted on a regular basis, showing that systems and equipment were monitored to ensure the safety of both residents and staff. A lot of relevant training had been provided to ensure that staff had received sufficient guidance to enable them to do the job expected of them. Douglas Bank Nursing Home DS0000065686.V309884.R01.S.doc Version 5.2 Page 25 Detailed policies and procedures were in place in relation to Health and Safety and the premises were found to be safe with no environmental hazards identified. However, one staff member was observed transferring a resident along the corridor in a wheelchair. There was no conversation between them and the staff member was using the wheelchair with the resident in it as a means to push open two doors. This practice did not promote the safety of the resident and must therefore be stopped. Douglas Bank Nursing Home DS0000065686.V309884.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score N/A X 2 X 3 X X 2 Douglas Bank Nursing Home DS0000065686.V309884.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(1) Requirement Timescale for action 31/10/06 2. OP8 13(1)(b) 3. OP9 13(2) Unless it is impractical to carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (“the service user’s plan”) as to how the service user’s needs in respect of his health and welfare are to be met. The registered person shall make 15/10/06 arrangements for service users to receive where necessary, treatment, advice and other services from any health care professional. The registered person shall make 15/10/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of medications received into the care home. Any medications administered must be appropriately recorded. The registered person shall, so far as practicable enable service users to make decisions with respect to the care they are to DS0000065686.V309884.R01.S.doc 4. OP12 12(2) 31/10/06 Douglas Bank Nursing Home Version 5.2 Page 28 5. OP19 23(2)(b) 6. OP19 23(2)(d) 7. OP27 18(1)(a) 8. OP29 19(1)(a)( b) 9. OP38 13(4)(c) receive and their health and welfare. The registered person shall having regard to the number and needs of the service users ensure that the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally. The registered person shall having regard to the number and needs of the service users ensure that all parts of the home are kept reasonably decorated. The registered person must be able to demonstrate that, having regard to the size of the care home, the statement of purpose and the number and needs of service users, suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The registered person shall not employ a person to work at the care home unless the person is fit to work at the care home and he has obtained in respect of that person an enhanced criminal record certificate and a POVA first declaration. The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. 31/03/07 31/03/07 15/10/06 16/09/06 15/10/06 Douglas Bank Nursing Home DS0000065686.V309884.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 OP8 Good Practice Recommendations Instructions made by external professionals should be consistently followed, unless it is felt that this would be detrimental to the resident, in which case the reasons should be discussed with the prescriber. Criteria for the administration of when required and variable dose medication should be clearly defined and recorded for all service users prescribed such items. All hand written annotations on Medication Administration Record charts should be signed, witnessed and countersigned. A record must be retained of all external preparations applied and all dietary supplements provided. Any treatment or personal care should be provided within the privacy of the residents’ bedrooms. It is recommended that the daily routines within the home be assessed, particularly in relation to mealtimes. A programme of routine maintenace and renewal of the fabric and decoration of the premises should be produced and implemented with records kept. The items of equipment in the kitchen, which were out of order, should be repaired and minor maintenance work should be addressed promptly. The registered person should conduct an audit of furnishings within the home and renovate or replace those in poor condition. It is recommended that the home ensure that services and facilities comply with the Water Supply (Water Fittings) Regulations 1999. The home should continue to work towards 50 of care staff achieving a National Vocational Qualification at level 2 or above. It is recommended that the manager of the care home refrains from supplying written references for any prospective employees wishing to work at the same care home. The registered manager should implement strategies for enabling stakeholders within the community to affect the DS0000065686.V309884.R01.S.doc Version 5.2 Page 30 2. OP9 3. 4. 5. 6. 7. 8. 9. 10. OP10 OP12 OP19 OP19 OP19 OP26 OP28 OP29 8. OP33 Douglas Bank Nursing Home way in which the service is delivered and to determine their views on how the home is achieving goals for residents. The results of residents’ surveys should be published and made available to current and prospective residents, their representatives and other interested parties. An annual development plan should be produced based on a systemic cycle of planning - action - review, reflecting aims and outcomes for those using the service. Douglas Bank Nursing Home DS0000065686.V309884.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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 Douglas Bank Nursing Home DS0000065686.V309884.R01.S.doc Version 5.2 Page 32 - 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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