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Inspection on 11/12/07 for Drummuir Nursing and Residential Home

Also see our care home review for Drummuir Nursing and Residential Home for more information

This inspection was carried out on 11th December 2007.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People using the service were complimentary about the kindness and support provided by the staff. Medication systems are well organised and managed by the qualified staff at the home. People using the service spoken with all confirmed that the quality, quantity and variety of food is always good, there was evidence that individual preferences are catered for.Maintenance issues previously identified have been addressed and maintenance is ongoing. Suitable beds, seating and specialist equipment was seen throughout the home. Accident audits were very well undertaken with clear identification of incidences and trends and included an action plan to address any findings. Staff training is well monitored and organised with a comprehensive matrix to oversee when training is next required. Recruitment records are well maintained.

What has improved since the last inspection?

Adjustable beds have been purchased for those people using the service with an identified nursing need. Gaps in employment history are now explored and documented to ensure that people using the service are not placed at risk. Substances hazardous to health are now stored securely to ensure there is no risk of accidental ingestion. The inspector observed that staff treated people using the service were treated with dignity and respect and confirmed that they were assisted to the toilet when requested. Recruitment files were robust and ensured that all recruitment checks are received prior to admission. Risk assessments for free standing radiators are now in place to prevent the risk of injury. Worn linen has been replaced but previous linen has been used whilst the washing machine out of use is repaired. The boiler and hot water system has been repaired and Thermostatic valve controllers have been fitted in all people using the service rooms to prevent the risk of burns and scalds. Bed rails are monitored for correct fitting to ensure that there is no risk of entrapment/ injury. Dietary supplements are now recorded as administrated in the Medication Administration Records.

What the care home could do better:

The registered manager is required to ensure that plan of care is in place for each person using the service which is fully completed, regularly updated and contains all the relevant detail for each identified need. The care plan is required to be completed within a suitable period of time after admission to ensure that staff have clear direction to provide for all care needs. Hand transcribed medications should be signed by 2 staff to ensure there is no risk of error in recording and administration of medication. Creams are required to be recorded as administered. The registered manager is recommended to review the provision of activities for people using the service to incorporate all people using the service to include the people who choose to remain in their rooms. Staff induction is recommended to be reviewed to include the Skills for Care Common Induction Standards to support new staff to provide for all of their care needs. Some areas of the home require attention to ensure the health and safety of people using the service, this includes the carpets in some areas of the home. A malodour was noted, the registered manager is to investigate the malodour and its source. Records relating to the health and well being of people using the service must be stored in line with the Data Protection Act to ensure the privacy and confidentiality of people using the service.

CARE HOMES FOR OLDER PEOPLE Drummuir Nursing & Residential Home 9-11 Northfield Bridgwater Somerset TA6 7EZ Lead Inspector Gail Richardson Unannounced Inspection 11th December 2007 09:45 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 Drummuir Nursing & Residential Home DS0000065814.V355363.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. Drummuir Nursing & Residential Home DS0000065814.V355363.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Drummuir Nursing & Residential Home Address 9-11 Northfield Bridgwater Somerset TA6 7EZ 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) 01278 422144 01278 420397 www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Caroline Williamson Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38) of places Drummuir Nursing & Residential Home DS0000065814.V355363.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Elderly persons of either sex, not less than 60 years, who require general nursing care Up to two persons of either sex, between the ages of 50-60 years who require general nursing care Up to eight places for personal care Date of last inspection 5th March 2007 Brief Description of the Service: Drummuir Nursing Home is situated in a quiet residential area close to the town centre of Bridgwater, Somerset. The home is not purpose built. Drummuir is registered with the Commission for Social Care Inspection to provide general nursing care for up to 38 older people, although the home can only accommodate a maximum of 31 service users. This includes up to 8 service users who require personal care. There is a registered general nurse on duty at all times. The home has recently been taken over by Southern Cross Healthcare and has had a new manager in place. The fee range is between £487.00 and £550.00 , this does no include hairdressing, newspapers, toiletries, optician and some activities not provided by the home. Drummuir Nursing & Residential Home DS0000065814.V355363.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection by Inspector Gail Richardson, which took place over one day on the 11th December 2007. A tour of the home took place and a selection of the bedrooms and all communal areas were seen. There were 28 people using the service currently residing at the home 1 was residential and 2 were short term respite admissions. The inspector spoke to 7 people using the service and 7 members of staff, and the registered manager was available throughout the inspection. As part of this inspection the inspector surveyed the opinions of a random selection of people using the service and their representatives, GP’s, District Nurses and staff. A good amount of responses were received and the outcomes will be included in the body of the report. An Expert by Experience also accompanied the inspector for a period of time and spent time with the people using the service. The inspector would like to thank the people using the service and staff for their time and hospitality through out the inspection. The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are; - excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: People using the service were complimentary about the kindness and support provided by the staff. Medication systems are well organised and managed by the qualified staff at the home. People using the service spoken with all confirmed that the quality, quantity and variety of food is always good, there was evidence that individual preferences are catered for. Drummuir Nursing & Residential Home DS0000065814.V355363.R01.S.doc Version 5.2 Page 6 Maintenance issues previously identified have been addressed and maintenance is ongoing. Suitable beds, seating and specialist equipment was seen throughout the home. Accident audits were very well undertaken with clear identification of incidences and trends and included an action plan to address any findings. Staff training is well monitored and organised with a comprehensive matrix to oversee when training is next required. Recruitment records are well maintained. What has improved since the last inspection? Adjustable beds have been purchased for those people using the service with an identified nursing need. Gaps in employment history are now explored and documented to ensure that people using the service are not placed at risk. Substances hazardous to health are now stored securely to ensure there is no risk of accidental ingestion. The inspector observed that staff treated people using the service were treated with dignity and respect and confirmed that they were assisted to the toilet when requested. Recruitment files were robust and ensured that all recruitment checks are received prior to admission. Risk assessments for free standing radiators are now in place to prevent the risk of injury. Worn linen has been replaced but previous linen has been used whilst the washing machine out of use is repaired. The boiler and hot water system has been repaired and Thermostatic valve controllers have been fitted in all people using the service rooms to prevent the risk of burns and scalds. Bed rails are monitored for correct fitting to ensure that there is no risk of entrapment/ injury. Dietary supplements are now recorded as administrated in the Medication Administration Records. Drummuir Nursing & Residential Home DS0000065814.V355363.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. Drummuir Nursing & Residential Home DS0000065814.V355363.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 Drummuir Nursing & Residential Home DS0000065814.V355363.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 2 3 4 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home continues to be able to provide prospective residents and relatives with sufficient information in the format of brochures, the Service User Guide and Statement of Purpose for them to make an informed decision about the home. These documents remain unchanged since the last key inspection. Prospective residents receive a pre admission assessment by the registered manager to ensure the home can meet the assessed needs identified. The registered manager must review the management of admissions to ensure that all areas of the pre admission, care planning and management are robust to meet people using the service and staff needs. Emergency admissions are supported by assessments undertaken by relevant health professionals. EVIDENCE: Drummuir Nursing & Residential Home DS0000065814.V355363.R01.S.doc Version 5.2 Page 10 9 Residents surveys received stated that they had received a contract and all felt they had received enough information prior to admission, about the home to make an informed decision. Each resident receives a pre admission assessment to ensure that the home can meet all assessed needs. 1 care plan confirmed that this had taken place and was detailed enough to ensure that staff were aware of the needs of the person when admitted. 3 care plans were examined which had been emergency admissions at short notice. These records contained SAP (Single Assessment Process) assessments made by a relevant health professional which identified any equipment and care requirements the home would need to supply. It was noted that care plans had not yet been formulated (See standard 7) The registered manager must review the management of emergency admissions to ensure that all areas of the pre admission, care planning and management are robust to meet people using the service and staff needs. A sample contract was examined and contained all relevant information. Drummuir Nursing & Residential Home DS0000065814.V355363.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 poor. This judgement has been made using available evidence including a visit to this service. Each person who uses the service does not have a care plan, the assessed areas of need were not all reflected in each persons documentation and the detail recorded did not ensure that staff were advised of all the care needs identified. The management of medications systems meets the required standard in most areas. Staff were observed to treat the people using the service with dignity and respect and people using the service felt well cared for. EVIDENCE: The inspector examined 4 care plans, 2 of which were emergency admissions and one was a short term admission. The registered manager advised that due to time constraints care plans for the 2 emergency admissions had not yet been completed. Drummuir Nursing & Residential Home DS0000065814.V355363.R01.S.doc Version 5.2 Page 12 It is concerning that the emergency admissions had been admitted between 8 and 10 days previously. This together with the lack of pre admission assessment undertaken by the home, means that staff had no plan of care to follow, to ensure that all the people needs would be identified and met. One person had some risk assessments undertaken but not all areas of risk identified in the SAP and daily record had been assessed and no areas had been care planned. No moving and handling assessment and care plan were in place for this person who required assistance to transfer and needed a wheelchair to mobilise. This persons mobility needs had changed whilst at the home and no care plan was in place to reflect this. There was note in the daily record of dressings being used but no care plan available from staff at the home or visiting health professionals regarding this area and no directions for staff as to the actions to be taken to address this need. No further areas of care plan were available for this person. There was evidence of input by visiting health professionals and record of contact with relatives. Another care plan identified a wound care plan had been undertaken but only identified one wound when further documentation had identified 2 areas. Some risk assessments had been undertaken but no further areas of care plan were available for this person to support these assessments. This person was seen to transfer in a wheelchair with no footplates, which may present a risk of injury. No risk assessment or care plan was available to advise staff of the safest and preferred choice of transfer. A further care plan was examined of a person admitted 12 days previously who also had no assessments undertaken and no care plan in place to support staff to give the care needed. This persons records had identified wound care but no update was available within the care plan or daily record. This shortfall in care planning places people using the service at risk. One further care plan was examined and this was seen to be detailed and of a very good standard reflecting all areas of risk and identifying a care plan to meet those risks. The registered manager must ensure that all care plans are completed within an appropriate timescale to ensure that staff can identify all care needs and follow an agreed plan of care. When asked do you receive the care and support you need, 9 surveys said always and 1 said usually, 9 responded that staff listen and act on what the residents say and 1 said no and 9 felt they always received the medical support they needed and 1 said usually. Drummuir Nursing & Residential Home DS0000065814.V355363.R01.S.doc Version 5.2 Page 13 People using the service confirmed on the day of inspection that they felt the staff were kind and caring. Comments received from surveys from people using the service and their relatives/representatives included; ‘The nursing care they give is to a good standard’ ‘Home cares well for my mother’ ‘Most of the carers are very caring and look after them well’ ‘The Drummuir staff do an excellent job of looking after my relative. She is clean tidy and well cared for, we have no complaints’ ‘The care home does meet there needs’ Staff were observed during the inspection and some staff appeared to be very caring and attentive. Medication systems were examined and found to be of a good standard with evidence of ongoing audits and clear systems of organisation. Systems were not seen for the recording of prescribed creams and the registered manager will review this. Medications which are hand transcribed were noted to not all to be signed by 2 staff, this is required to ensure a clear audit trail of commencement of medication, this was feedback to the manager at inspection. Drummuir Nursing & Residential Home DS0000065814.V355363.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are opportunities for social stimulation and people are supported to join in with organised activities or pursue their own interests. Further development is needed to ensure that activities are specific to peoples choices and preferences and that they are recorded regularly. The meals in the home are of a good quality and a range of choice is available. EVIDENCE: Resident’s surveys asked are there activities arranged by the home that you can take part in, 4-usually,5 -sometimes,1-never. The Expert by Experience spent considerable time in the lounge and noted within her report “A young helper was playing a quiz game with one lady, apart from this the dozen or so other residents were sitting in chairs, mostly asleep although some were looking at newspapers. The television was on; although noone was watching it, probably because it was showing pop music videos, It was quite loud and I would guess of no interest to anyone!. “ Drummuir Nursing & Residential Home DS0000065814.V355363.R01.S.doc Version 5.2 Page 15 Further observations noted by the Expert by Experience were “There were notice boards outside in the passage and in the room, but these were very sparse – a selection of official notices, eg fire action, plus Holy Communion on the first Wednesday of every month. I could see no evidence of other activities, and the residents to whom I was able to speak did not seem to know of any. I did eventually find a list of the week’s activities on a notice board in the entrance hall, together with two weeks menus. This seemed a strange place to put them and I wondered how many residents would actually see them. The activities listed included a number of “individual sessions with carers”, bingo, arts and crafts, baking, floor games, exercise to music, sports programme, ending on Sunday with newspapers and church service.” It is recommended that this notice also be placed in the lounge to inform people using the service of planned activities. In the lounge there was a TV, radio, books, magazines and newspapers. The registered manager confirmed that activity provision within the home requires further review to ensure that peoples preferences and choices for recreational activity are met. On the day of inspection a member of staff was seen to do a quiz with one person and the planned activity for the afternoon was ‘Pets corner’. This activity was not seen in the afternoon. In the late morning visitors were seen at the home and visitors were enabled to talk to their relatives both in the lounge and in their bedrooms. This was a very social period of time within the home. Everyone who expressed an opinion stated that they have choice about all aspects of their care and are comfortable to request any particular preferences for times to get up and return to bed. 2 people using the service confirmed that delays in this preference may be due to staff being delayed or staff shortages. One comment received from a relative stated ‘Need more staff to get them up earlier as went to visit at 11oclock and they weren’t up’ Morning coffee and afternoon tea was served all around the home accompanied by cake/biscuits. There is a choice of meal at both lunch and teatime , on the day of inspection the lunch menu was a choice of liver and bacon or broccoli and cauliflower cheese with potato and green beans. Desert was apple crumble and custard. Evening meal was homemade tomato soup, pork pie and pickle and salad or a selection of sandwiches. Puree diet was served individually to ensure that people could discern texture and taste. The kitchen staff are aware of peoples preferences and any special dietary requirements. The Expert by Experience stated that “Everyone spoke very highly of the food provided which seemed to be plentiful and included a cooked breakfast, twoDrummuir Nursing & Residential Home DS0000065814.V355363.R01.S.doc Version 5.2 Page 16 course lunch with two choices, an evening meal, midmorning and afternoon snacks and a milky drink and sandwiches in the evening. The dining area had separate tables and watching at lunch-time I can confirm that the food looked and smelt very appetising. “ Resident’s surveys asked if residents like the meals at the home, 1-always,5usually and sometimes. On the day of inspection all people using the service were complementary about the quality, quantity and choice of food. It was observed that people using the service were sat at the dining table for a period of up to one hour prior to lunch being served. This is not appropriate for people with physical disability and this practice is strongly recommended to be reviewed. The Expert by Experience also stated that “The arrangements for helping those who had difficulty feeding themselves seemed rather disorganised, and it was noticeable that several who could not use a knife and fork were able to eat unaided when offered a spoon. I’m sure if these arrangements were formalised it would make life a lot easier for both residents and staff, and I did notice that a lot of food was wasted.” Drummuir Nursing & Residential Home DS0000065814.V355363.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 17 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff and people using the service are confident that the homes management team would deal with any complaints or concerns. Policies, procedures and training are available to staff to ensure they have the knowledge to prevent service users from the risk of abuse. EVIDENCE: The homes complaints policy is displayed in the hallway of the home and contains details of how to make a complaint and further details of the process. 4 relatives surveys and 10 people using the service surveys, confirmed that they knew how to make a complaint and surveys confirmed that people knew who to speak to if they were unhappy, 2 said they did not know. Residents surveys confirmed that if unhappy they would know who to talk too, 6-always, 1.-usually, 1-sometimes and 1-never. There have not been any complaints made to the home or CSCI since the last key inspection. 4 staff surveys confirmed that they were aware of policies about protecting vulnerable adults and how you report any concerns about poor care practice or allegations of abuse. The home demonstrated the use of an Advocacy service and all people using the service are registered to vote. Drummuir Nursing & Residential Home DS0000065814.V355363.R01.S.doc Version 5.2 Page 18 All 3 staff surveys received confirmed that they had received a Criminal Record Bureau Check and examination of recruitment files confirms that these check were undertaken before staff commenced employment and 2 said they were not. Drummuir Nursing & Residential Home DS0000065814.V355363.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 20 21 22 23 24 25 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is a large building with some parts of the building suffering from wear and tear that would be typical of a building of similar age and usage. Maintenance is seen to be ongoing, the standard of hygiene is adequate. Appropriate equipment is made available were there is an assessed need. The gardens are laid out and suitable for people using the service use. EVIDENCE: The home is a large older building which has been converted and extended. There is a communal lounge and dining area, these are adequately furnished and decorated and the registered manager confirmed that as part of the ongoing maintenance program the carpets are due to be replaced in the lounge area. Drummuir Nursing & Residential Home DS0000065814.V355363.R01.S.doc Version 5.2 Page 20 Personal accommodation is located on each of the 3 floors of the home and is accessible to people with all levels of mobility. Lift access is available to each floor. All bedrooms seen by the inspector varied in size and were comfortably furnished and had been personalised to reflect the tastes of the individual person. People are able to bring personal effects and small items of furniture with them when they move to the home, which gives rooms an individual homely feel. Various aids and adaptations have been put in place to assist people to maintain their independence. Specialist pressure relieving cushions and mattresses were seen were there was an assessed need and bedrails have been replaced with appropriate equipment. Profile beds have been purchased for people with nursing needs. Toilet and bathing facilities are provided in sufficient numbers and the development of a ‘wet’ room is planned, the bath side was not fixed on the upstairs bath and the downstairs bath was also being used as a store and contained 2 hoists, 1 sit on scales, 1 mat and a variety of empty wrappings, net pants and aprons left out on the side. The home has made several environmental improvements which include a re organisation of the lounge dining area and has plans for several room refurbishments in the near future. The boiler has been replaced and was being further repaired on the day of inspection. Alternative heating was made available whilst this took place and every effort was made to ensure that that people using the service were warm and comfortable. The garden area is maintained and accessible for people using the service. Residents surveys confirmed that the home is always clean and fresh, 1always, 2-usually and 1-sometimes. On the day of inspection it was noted that there was an underling odour within the home which was not specific to any immediate cause. This odour was also commented on within the Expert by Experience’s report. The home employs 34 domestic staff each day who were seen cleaning throughout the day. This is unidentified odour is to be investigated by the registered manager. Drummuir Nursing & Residential Home DS0000065814.V355363.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 adequate. This judgement has been made using available evidence including a visit to this service. Evidence supplied would suggest that staffing levels do not currently meet the dependency of the people using the service taking into the consideration the geographical layout of the home. Staff training is ongoing and mandatory and further training is undertaken by all staff. The homes recruitment procedures are robust and protect people using the service from the risk of harm EVIDENCE: Resident’s surveys asked if staff were available when you need them said, 4always, 2-usually and 4-sometimes. Evidence from staff, residents and relatives surveys would indicate that staffing levels at the home are variable and do not always meet the needs of people using the service. It was noted that the home has recently had 3 urgent admissions which have increased the dependency level of care, staff confirmed that staffing levels have not been increased to meet that need either as a short term measure or as a routine increase. Drummuir Nursing & Residential Home DS0000065814.V355363.R01.S.doc Version 5.2 Page 22 Staff confirmed that usually all people using the service have been assisted to get up by 10:00 hours. On observation staff appeared busy and were still assisting people to get up at 13:00 hours. Staff comments included : ‘The Manager expects too much in too little time. Seems unaware of the ‘pressures’ of the ‘care floor’ and can have unrealistic expectations of staff. Can be unwilling to discuss and change views.’ ‘High dependency of residents is not matched to numbers of care staff well. Working guidelines(staff/residents) ratios need to be reassessed to provide quality care.’ ‘sometimes due to short notice sickness, unable to cover a shift in house or with agency’. ‘needs more staff-especially on early shift.’ Staff also commented that they felt the home had improved : ‘Patient choice’ ‘environment much improved’ ‘good induction programme’ ‘investigates complaints’ Surveys for people using the service included ; ‘when staff can spare time with you when fully staffed, Sometimes when you use the buzzer for assistance you have to wait because of staff shortages through illness and holidays.’ ‘There is not enough staff to give all the residents the care they need.’ ‘The staffing numbers need to be increased. There’s not enough staff’ These comments were discussed with the registered manager who agreed that staffing related matters can be variable when staff ring in sick at short notice and agency staff is not available. 4 staff returned comment cards to CSCI, 1 staff confirmed that they felt they had received adequate induction and supervision when they commenced their job and 2 said mostly, 1 said not at all. The home have recently implemented the Skills for Care, Common Induction Standards as part of the induction process as previously the home did not have a formal induction process. This will be reviewed at the next inspection. Staff confirmed that training is ongoing and the staff training matrix supplied would indicate that all staff receive mandatory training and further training in Abuse and POVA is available to staff.3 staff have completed NVQ 2 and 2 staff have completed NVQ 3. A further 6 staff have commenced the NVQ training. The registered manager later confirmed that NVQ status is at 51 with further Drummuir Nursing & Residential Home DS0000065814.V355363.R01.S.doc Version 5.2 Page 23 staff commenced training. The level of staff qualified at NVQ level will be reviewed at the next inspection. 3 recruitment files were examined and contained all of the required employment check prior to staff commencing employment. One reference was received after the staff members start date and one photograph was missing, however all remaining documentation was in place to ensure that people using the service were not at risk. Drummuir Nursing & Residential Home DS0000065814.V355363.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 35 37 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home benefits from the proactive management style of the registered manager. Some areas of management require further review. Financial systems for people using the service personal monies are managed in an auditable manner. The storage of records is mostly secure but should be monitored to avoid any situations were files may be left out and may affect people using the service right to confidentiality. Systems are in place to ensure the health and safety of service users whilst encouraging and promoting independence. EVIDENCE: Drummuir Nursing & Residential Home DS0000065814.V355363.R01.S.doc Version 5.2 Page 25 The registered manager is Carrie Williamson who has managed Drummuir for over a year. During that time significant improvements have been seen at the home. Some staff were happy to confirm that there have been improvements for both people using the service and staff. The registered manager must review the management of admissions to ensure that all areas of the pre admission, care planning and management are robust to meet people using the service and staff needs. Quality assurance questionnaires are distributed every 2 months and the results returned the homes head office for audit. Surveys seen were reflective of comments made within this report. There are established systems in place for dealing with people using the service personal finances. The inspector evidenced that each person’s personal monies were recorded and receipts checked. All accounts are held by the companies accounts and a float of accessible cash maintained for people using the service to access should they need any money. An invoice of cash flow by each person was sent with the fee request each month. All records are stored confidentially in line with the Data Protection Act with one exception, it was noted that a file containing some personal data was observed on the table in the dining room and was removed by the registered manager. The registered manager confirmed that practice would be discontinued immediately. All substances hazardous to health were seen to be stored securely and staff confirmed that had access to COSHH sheets should they need them. Accident records were viewed and were seen to be reviewed and audited monthly for trends and regular occurrences and action taken to reduce any risks of further accidents taking place. Maintenance records were well maintained and up to date, these included ; * * * * * * * Fire Extinguishers last tested 04/05/07 Fire alarms are tested weekly 05/11/07 Fire Alarm servicing 04/05/07 Hoist Servicing last undertaken 02/11/07 Emergency lighting checked monthly 14/11/07 Boiler servicing and repair 11/12/07 Lift servicing records last undertaken 28/08/07 DS0000065814.V355363.R01.S.doc Version 5.2 Page 26 Drummuir Nursing & Residential Home * * * * Hot water temperatures are being monitored monthly Electrical Hard Wiring certificate 02/02/06 Accident audit is ongoing monthly Nurse call system 10/12/07 PAT test certificates were not available and a certificate is requested to be forwarded to CSCI offices. Drummuir Nursing & Residential Home DS0000065814.V355363.R01.S.doc Version 5.2 Page 27 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 3 1 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 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 3 18 3 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 1 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X 2 3 Drummuir Nursing & Residential Home DS0000065814.V355363.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1)(c) and (d) Requirement A Pre admission assessment is required to ensure that the home can meet all the identified needs of the service user prior to admission. The registered manager must ensure that all care plans are completed within an appropriate timescale to ensure that staff can identify all care needs and follow an agreed plan of care. This is with particular reference to emergency admissions. The registered manager is required to ensure that staffing levels are calculated by the dependency levels of the Service users. Timescale for action 01/01/08 2. OP7 15(1) 01/01/08 3. OP27 18(1)(a) 01/01/08 Drummuir Nursing & Residential Home DS0000065814.V355363.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 OP9 Good Practice Recommendations The manager is recommended to provide a clear indication on the Medication Administration Records were the prescribed creams are to be signed for as administered. The activity coordinator is recommended to ensure that the choices, preferences and abilities of service users are considered when activities are planned. The manager is strongly recommended to review the times spent by Service users sat at he dining table prior to meals arriving. The manager is recommended to investigate the malodour identified at inspection and rectify as required. The manager is recommended to ensure that a minimum of 50 of staff have achieved an NVQ level 2 qualification. The manager must ensure that all records are stored in line with the Data Protection Act 1988. 2. OP12 3. OP15 4. 5. OP26 OP28 6. OP37 Drummuir Nursing & Residential Home DS0000065814.V355363.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Drummuir Nursing & Residential Home DS0000065814.V355363.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. 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