Inspection on 26/06/06 for Drummuir Nursing and Residential Home

This inspection was carried out on 26th June 2006.

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

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

Other inspections for this house

Drummuir Nursing and Residential... 29/03/10

Drummuir Nursing and Residential... 03/03/10

Drummuir Nursing and Residential... 02/02/10

Drummuir Nursing and Residential... 02/09/09

Drummuir Nursing and Residential... 03/03/09

Drummuir Nursing and Residential... 11/04/08

Drummuir Nursing and Residential... 11/12/07

Drummuir Nursing and Residential... 05/03/07

Drummuir Nursing and Residential... 10/01/06

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

CARE HOMES FOR OLDER PEOPLE Drummuir Nursing & Residential Home 9-11 Northfield Bridgwater Somerset TA6 7EZ Lead Inspector Gail Richardson Unannounced Inspection 26th June 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 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.V294552.R01.S.doc Version 5.1 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 Ashbourne (Eton) Limited 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.V294552.R01.S.doc Version 5.1 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 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 32 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 does not currently have a registered manager. The home has recently been taken over by Southern Cross Healthcare. Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection by Inspectors Gail Richardson and Kathy McCluskey, which took place over one day on the 26th June 2006. A tour of the home took place and all the bedrooms and communal areas were seen. There were 26 service users currently residing at the home. The inspectors spoke to 7. service users,1 visitor and 10 members of staff, the Registered manager was available throughout the inspection and was joined later in the day by the Operations Manager for the home. As part of this inspection the inspectors surveyed the opinions of a random selection of service users and their representatives, GP’s , District Nurses and Care Workers. A small amount of responses were received. Records relating to care, staff, finances and health and safety were examined The inspectors noted that service users appeared comfortable. Staff spoken felt able to express concerns about working in the home and time spent by the inspectors observing staff, evidenced that they were kind and caring towards service users and mostly spoke to them with support and reassurance. One visitors spoken to confirmed that they were always made very welcome to the home at any time. The inspectors would like to thank the service users 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. What the service does well: The home ensures that prospective service users are fully assessed prior to a placement being offered. Prospective service users and/or their representatives are also invited to visit the home. Visitors are made welcome to the home at all times. Staff undertake the appropriate mandatory training. Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: The homes brochure requires amendment to ensure it accurately reflects the environment and facilities the home can offer. Care planning is being addressed but continues to require further work to ensure a holistic approach to care planning and ensuring staff have enough detail to provide for all the care needs of service users. Medication systems with regard to disposal systems require review and staff training in this area as required. The home must ensure the correct disposal of sharps waste. This was discussed and dealt with by the Manager at the time. Immediate Requirement issued under Regulation 13(2)(a) of the Care Homes Regulations 2001. The home requires refurbishment and redecoration to improve the general environment for service users. The provision of suitable beds and bathing facilities is required to ensure all needs are appropriately met. Wardrobes are required to be secured to the walls in some bedrooms. Immediate Requirement issued under Regulation 13(4) of the Care Homes Regulations 2001. The reorganisation of the dining room is required to promote improvement in dining for service users. The garden area is untidy and requires further maintenance. The storage of wheelchairs and equipment also requires addressing and the correct fixing of wardrobes to walls to prevent the risk of injury to service users is also needed. Some areas of the home require curtains to avoid service users being overlooked by neighbouring homes and the car park. The promotion of social and recreational activities requires further review, with the provision of a suitable environment for groups or individual service users to enjoy recreational activities. Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 Page 7 The staffing of the home in all areas requires review to ensure that service users receive the care they required. Further staff training is also required to promote a greater understanding of service users needs. Staff recruitment procedures do not completely protect the service users from the risk of abuse. Further detail of previous employment is required when recruiting staff. It is recommended that the manager review the financial procedures of the home to enable service users to access their individual monies. Staff supervision is required to be reviewed to meet all aspects indicated in the National Minimum Standards. Storage of service users personal records is not in line with the Data Protection Act and is in need of review. The home is required to improve the storage of cleaning materials and dental tablets. The home must ensure that all substances hazardous to health are stored in accordance with the COSHH Regulations. Immediate Requirement issued under Regulation 13(4)(abc) of the Care Homes Regulations 2001. Health and Safety issues requiring attention are listed in this reports requirements and recommendations. 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. Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 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.V294552.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 3 5 The overall quality rating for this section is assessed as adequate. The brochure and service user guide do not reflect the environment and levels of care available at the home. Service users receive a pre admission assessment to ensure all service user needs can be met. EVIDENCE: The home has recently been taken over by Southern Cross Healthcare. A revised Statement of Purpose was made available to the inspector. Information provided by the home indicated the home’s current fee range is between £470 and £501 per week. Extra charges are made for hairdressing, personal toiletries, papers/magazines and taxis. Inspectors were provided with the brochure of the home. The description of the environment did not match the environment of the home. The brochure described wide corridors and attractive gardens, neither of which is available at Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 Page 10 the home. This issue was discussed and agreed by the Manager and Operations Manager. Prospective service users and/or their representatives are invited to visit the home prior to making a decision about moving to the home. Prospective service users are fully assessed at their home/hospital by the Registered Manager. This is to ensure that the home is able to meet the assessed needs of an individual. Assessments are also obtained, where appropriate, from other professionals. Documented evidence of pre admission assessments was not available in all of the care records of the service users, who were case tracked. No contracts were available on the day of inspection. Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 The overall quality rating for this section is assessed as poor. Care plans do not fully reflect individuals assessed needs. The home does not have an adequate supply of specialist equipment to enable them to meet an individual’s assessed needs. The systems in place for the disposal of medications are not in line with the homes policies and procedures. The home ensures that the privacy and dignity of service users is respected. EVIDENCE: Four service user care plans were examined in detail. Care plans did not all contain appropriate and up to date assessments; Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 Page 12 One care plan examined, had been reviewed in January 2006 for moving and handling and the service user had been assessed as high risk. The care plan showed no indication of equipment to be used. The same care plan evidenced that there had been no service user representative involvement and no consent signed for the use of bedrails. There was no record of personal hygiene, oral hygiene, professional visits or details regarding the directions to be taken when deceased. A further care plan for a service user who is remaining in bed with all care, had been assessed as having poor nutritional intake, but no action had been taken to address this. Wound care plans required more detail to ensure all staff were aware of the changing needs and treatment being prescribed. The Registered Manager was reminded that pressure sores of grade2 and above, requires notification to CSCI. Some personal comments noted in the care plans were considered by the inspectors to be inappropriate and this was discussed with the Registered Manager at the time of inspection. Generally, throughout all the care plans examined, it was noted that care needs and interventions for staff required more detailed information to ensure that staff were able to provide the person centred care required to support service users needs. 6 survey cards were sent to GP and District Nurse Practices, 2 replied. Both felt that staff demonstrated a clear awareness of service users needs and contacted other health professionals when required. One GP commented that further consultation by the home with service users relatives with regard to care planning would help communication. On examination of bedrooms, the inspector was able to see evidence that appropriate and identified pressure relieving equipment was in place where there was an assessed need. It was very concerning to note that a number of service users, continue to be nursed on domestic type beds. The Registered Manager confirmed that several Nursing Beds had been purchased but further purchases are required to ensure all service users who’s needs indicate, are supplied with the correct bed. The Divan beds seen by the inspectors are worn and stained and require disposal. The home does not have adequate baths available to the number of service users. The staff are currently only using 2 baths, one on the ground floor and one on the middle floor. Two bathrooms are out of use. Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 Page 13 The bathroom on the middle floor is awaiting further repair and the bathroom is shabby and in need of redecoration. Service users spoken with during the inspection were positive regarding the care they received though some service users confirmed that staff availability is an issue and staff are not always available to assist service users to the toilet when required. Where regimes have been agreed to help promote continence, the home must ensure that the dignity and wishes of service users is respected with regard to staff assistance to use the toilet. The involvement of service users and staff members in the care planning process with reference to these issues should promote a more person-centered approach to care. Three completed CSCI service user comment cards were received and all indicated that they felt safe at the home. Inspectors observed that generally staff treated the service users with dignity and respect; however, staff were clearly very busy and under pressure and this was reflected in their attitude to the care given. Further training is required is some areas of practice to ensure staff continue to communicate with service users when being hoisted and transferred. Medication systems were examined. The ordering, administration and recording procedures were all satisfactory. However, it was noted that staff were incorrectly disposing of medication due to the lack of the correct disposal equipment. Further more, the disposal of sharps equipment was also incorrect and provided a health and safety risk. An Immediate Requirement was made to ensure that the home must take appropriate steps to ensure that staff adheres to the correct procedure for the disposal of medicines/sharps. In line with Regulation 13(2)(4) of the Care Homes Regulations 2001. The nurse in charge confirmed that no service users are currently selfmedicating. Oxygen was not stored securely and is required to be secured to the wall. Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 The overall quality rating for this section is assessed as poor. The social and recreational activities within the home require reorganisation and further input to ensure all service users needs are met, including those service users who remain in bed. The home enables service users to maintain contact with family and friends. Where ever possible, service users are supported to exercise control and choice over their lives. The dining room environment requires reorganisation to improve the mealtime experience. EVIDENCE: The home employs an activity organiser for 16 hours per week, who provides games and quizzes in small groups or one to one. The organiser was seen playing an exercise game at the time of inspection, this activity was designed to provide stimulation and promote physical exercise. The activity organiser explained that service users who were regularly encouraged to exercise had seen an improvement in ability. Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 Page 15 The activities were principally one to one and the remaining service users were not provided with any other stimulation. There is a notice board situated in the dining room. On the day of inspection the board displayed the correct menu but the incorrect day and date. The environment of the lounge was very noisy and distracting and one service user complained to the inspector about the level of shouting and general noise. This environment is not suitable for activities to take place and the Registered Manager is required to review this situation and provide suitable provision for appropriate activities to take place. The activity organiser explained that one of the main difficulties was that each time a group activity was underway the activity had to be cut short to begin the lunchtime routine. On the afternoon of the inspection is was observed that three staff stood in the dining room folding laundry, no activities were being undertaken with service users. It was commented by one service user that there was no access to a call bell in the lounge to summon any assistance. Care plans evidence that social care is assessed and some records indicate some activity had taken place. There is no regular review of social activities undertaken and the activities record supplied to inspectors was blank. There are no planned and recorded social activities for those service users who remain in bed. Visitors are made welcome at any reasonable time and on the day of inspection visitors were seen throughout the day. One visitor confirmed that they visited frequently and were always made welcome. Two Relatives surveys were received and both confirmed that they were always made welcome and that they were happy with the care their relative received. Service users are encouraged to personalise their bedrooms. Bedrooms examined at this inspection were seen to reflect the individual’s personal tastes. Service users spoken with, who were able to express a view, informed the inspector that they chose how or where to spend their day. At the previous inspections, it was recommended that staff duties were arranged to ensure that sufficient numbers of staff were on duty to enable appropriate assistance for service users with drinks, this continues to be under review. The inspector was able to see service users in the lounge being assisted with morning drinks by the ‘house-assistant’. Most service users Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 Page 16 appeared to enjoy a hot drink with appropriate levels of assistance. This should continue to be monitored. On the day of inspection lunch was mince beef and onions with potato and cauliflower cheese, desert was stewed rhubarb and custard. For evening meal the cook was preparing soup, pork pies and sandwiches. The cook confirmed that special diets could be catered for and pureed diet was served individually. Lunch appeared plentiful and appetising was enjoyed by service users. Staff gave suitable and discreet assistance to those service users who required assistance with eating and drinking. Service user surveys and comments on the day indicated that service users enjoy the food. The dining area of the home is adjacent to the lounge and dining tables were arranged in a long line. It was discussed with the Registered manager that perhaps rearrangement of the tables into smaller groups might improve the dining experience for service users. Service users who required assistance with eating and drinking remained in their armchairs around the edge of the room. Staff explained that it was more comfortable for service users to remain in armchairs, however, further rearrangement of the room may promote the dining experience for these service users. Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 The overall quality rating for this section is assessed as adequate. The home’s procedures for reporting complaints require updating to contain all relevant details. The whistle blowing policy provided for staff requires more detail regarding signs of abuse. EVIDENCE: As required at the last inspection, the home’s complaints procedure has been updated and now includes timescales for action and clear contact details, including the contact details of the CSCI. However the copy displayed in the front hallway does not contain the full contact details for CSCI. Service users spoken with did not raise any concerns with the inspector and stated that they would raise any concerns, should they have any. Staff spoken to explained that each Monday they have the opportunity to discuss any concerns with the Manager. The staff confirmed that several issued with reference to staffing levels had been discussed with the Manager and are awaiting outcomes. At the last inspection it was required that the home’s whistle blowing policy is updated to include contact details of appropriate external agencies, and to include appropriate information on the types of abuse. It was also required that the home takes appropriate action to raise staff awareness. Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 Page 18 The registered person should ensure that staff’s understanding and awareness is monitored through regular supervision sessions and/or staff meetings. Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 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 20 21 22 23 24 25 26 The overall quality rating for this section is assessed as poor. Redecoration of some areas would have a positive outcome for service users. The out-door areas are in need of maintenance. The home does not have sufficient suitable bathroom facilities. The home does not have an adequate supply of specialist beds. Service users bedrooms are decorated to reflect their own personal tastes. EVIDENCE: Drummuir is a large Victorian property, which, as far as possible, has been adapted to meet the needs of service users. Accommodation is arranged over three floors, with a shaft lift giving access to the first and second floor, the third floor is accessed by stairs. The home has a very small garden area. Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 Page 20 Although registered for 38 service users, the home can only physically accommodate 32 service users. On a tour of the home inspectors observed that the home requires decorating in many areas. The manager explained that the home has a redecoration programme underway and that all areas would be addressed. On the ground floor is a large communal lounge/dining room and smaller quiet lounge. This area has a small area to the rear, which is currently being used as a nurse’s station. The inspectors advised that this area be reorganised to ensure that the nursing staff have a suitably quiet area to enable confidential telephone calls to be taken. Also this would ensure the safe storage of service user information in line with the Data protection Act. The dining room requires reorganising into smaller groups to attempt to improve the dining experience for service users. The larger and smaller lounges require redecoration to improve service user outlook and general environment. Currently service users do not use the smaller lounge. The work unit in the lounge/dining area is damaged and unhygienic and in need of replacement. The Garden area was untidy and in need of some attention. All bathrooms are in need of decoration and repair and as previously mentioned in this report, there are inadequate bathrooms available for the service users. Bath hot water outlets checked at this inspection and were found to be within HSE recommended guidelines. 4 of the 8 double bedrooms are fitted with en-suite toilet facilities. Screens are available in double bedrooms. The water outlets in the en-suit and bedroom facilities were tested and the water was tepid. This was discussed with the manager at inspection. It was noted that the adjacent houses overlooked bedrooms on the ground floor. On the day of inspection, Service Users being nursed in bed can be observed by people passing the window from the car park area. It is recommended that those rooms which are overlooked have net curtains or blind fitted to ensure privacy and dignity of service users. All bedrooms are fitted with a wash hand basin and bedroom doors are fitted with a lock, which can be accessed by staff in the case of an emergency. The inspectors observed that several wardrobes were not secured to the wall. An Immediate Requirement was made to ensure that all wardrobes are secured the wall to prevent risk of injury to service users. Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 Page 21 Lockable storage space is not available in all bedrooms. As mentioned in the previous inspection report, it was concerning to note that adjustable beds were not available for all service users. The Registered manager confirmed that 11 new beds have been purchased. A requirement has been raised that this is addressed within a given timescale, which has not been met in total. Call bells are fitted throughout the home. The home appears to have an appropriate number and selection of hoists with up to date servicing records. Wheelchairs are available to service users where there is an assessed need. It is recommended that storage of the wheelchairs is addressed. Current practice involves the storage of the wheelchairs in the corner of the dining room, which takes up valuable space. It was noted that a freestanding radiator was located in the dining room. The Manager is required to ensure that a robust risk assessment is in place, which will ensure that service users would not be at risk of injury. The home has two sluice areas and an automatic sluice disinfector. The sluices were not locked on the say of inspection. Locks are fitted to bathroom and toilet doors to ensure the privacy of service users. Staff in the event of an emergency can override these. Staff hand washing facilities are appropriately sited around the home. Inspectors noted that incontinence products were stored on the top of a radiator on the middle floor, this is unsuitable and it is recommended that this practice is reviewed. The general standard of cleanliness within the home was adequate, however, the tables in the lounge were noted to be dirty and the lounge had a malodour. Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 The overall quality rating for this section is assessed as poor. Staffing levels at the home are not adequate at all times. Staff training is on going, staff morale is very low. The home’s recruitment procedures are not adequate. EVIDENCE: A registered nurse is on duty covering a 24hr period. In addition to the nurse, 5 care staff are on duty during the morning, 1 RGN and four care staff are in duty in the afternoon and 1 RGN and 2 Care Staff 2 over night. Staff spoken with during the inspection expressed serious concerns about staffing levels. Service users also confirmed that staffing levels appeared low. Inspectors evidenced the daily work record, which evidenced that for periods of time staff worked with 4 cares staff in the morning and 3 care staff in the afternoon. During the inspection, staff morale was noted to be very low. The inspector was able to speak to some staff in depth about this and was informed that due to changes in staffing arrangements Southern Cross no longer permitted the use of agency Staff. Therefore if staffing levels were below the required level the staff were expected to continue without any further support. Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 Page 23 Staff explained that on days when staffing levels were low, they were unable to bath service users, due the pressure of the workload. Staff members spoken with, felt that the lack of staff was having a direct effect on the level of care being given to service users. The Registered manager and Operations Manager confirmed that the Manager is currently addressing these areas. In addition to care staff, the home employs suitable numbers of ancillary staff. The home also employs an activities person for 16 hours a week and an administrator. The inspectors examined three staff files, two of which did not contain records, which supported the homes recruitment procedure. One record contained a reference addressed “To Whom it May Concern”, it was noted that gaps in employment history had not been explored or documented and in one instance a reference was not received from the most recent employer without explanation. Further POVA and CRB checks were complete. Staff training records were available and staff were also able to confirm that mandatory training had taken place. The staff induction training was examined and lacked sufficient detail to ensure all areas of practice would be suitable covered. Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 35 36 37 38 The overall quality rating for this section is assessed as poor. The home has a new Registered Manager and Operations Manager. The financial procedures of the home are adequate. Staff are not adequately supervised. The storage of records is not in line with the Data Protection Act Further improvements are required to ensure the health and safety of service users, staff and visitors to the home. EVIDENCE: Standard 31 and 32 were not fully assessed on this occasion, as the home has only recently employed a Registered Manager. Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 Page 25 Staff and service users spoken with at the inspection were positive regarding the management style of the manager and found her approachable. As required the company, in accordance with Regulation 26 of the Care Homes Regulations 2001, carries out monthly visits. Weekly staff meetings have been conducted each Monday. Meetings have taken place for service users, staff and relatives. The home displays an appropriate and up to date employers liability insurance certificate, which expires 29/09/06. Records seen at this inspection were inappropriately stored. Service users have access to their personal records in accordance with the Data Protection Act 1998. Administrative records were suitable stored. The systems in place for service users personal money were examined. The administrator maintains the system of all service users monies being paid into one account and records kept of the individual amounts. This system is audited every 3 months. Service users requiring any money receive it from a float and the amount spent is deducted from their own records. It was discussed with the manager that a more suitable system be put in place to enable service users direct access to their funds. It was also discussed that correct receipts were maintained for hairdresser etc. Payments. One service users funds were being managed by the home, the inspectors recommended that this practice be reviewed. Supervision records for staff required further review to ensure that all areas of practice described in the National minimum Standards are covered during staff supervision. Maintenance records were examined for; Lift Servicing Gas certificate Hoist maintenance certificates Fire extinguisher service Fire Alarm service Emergency Lighting Certificate Insurance Certificate Environmental Health Community Pharmacist Fire Alarm test Records. Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 Page 26 Some improvements are required to ensure the health and safety of service users, staff and visitors. This was ascertained by a tour of the premises and on examination of records; *An Immediate Requirement was made that all substances hazardous to health used within the home, are stored correctly in line with the COSHH Regulations. This is to include cleaning solutions stored in bathrooms and toilets and dental tablets. *COSHH Risk assessment for the home was last reviewed in 2004. *Fire Risk Assessment for the home was not available *Monthly checks of the Emergency Lighting were not available *Hot Water checks of all rooms and bathrooms were not available, water temperatures appeared tepid. *Bed Rail risk assessment consents had not been signed by service users/representatives. Bedrails in some areas required risk assessment and adjustment to ensure there is no risk of entrapment to service users. *Nurse Call Alarm System service records require updating. *Service Users prescribed dressings are required to be stored in the treatment room and not stored in bathrooms and bedrooms. *Divan beds in use are required to be reviewed and replaced as required. *Nebuliser machine was last PAT Tested as serviced in 2004. *Food items stored in the fridges were not labelled. Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 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 2 X 3 X 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 1 1 1 3 3 1 1 2 STAFFING Standard No Score 27 1 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 2 2 1 1 Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement The registered person must ensure that service user care plans are fully reflective of assessed needs and that they identify clear instructions for staff. (Previous timescale not met) The registered manager must ensure that all staff are aware of the correct medications systems for the safe disposal of medicines/sharps. Immediate Requirement made 3 4 OP9 OP10 13(2) 12(4)(a) The manager must ensure the safe storage of oxygen cylinders. The registered manager is required to ensure that all service users are treated with dignity and respect with reference to being taken to the toilet as requested. The manager must ensure that a suitable communal space is DS0000065814.V294552.R01.S.doc Timescale for action 01/09/06 2. OP9 13(2) 26/06/06 26/07/06 01/09/06 5 OP12 23(2)(h) 01/09/06 Drummuir Nursing & Residential Home Version 5.1 Page 29 made available to promote social, cultural and religious activities. 6 OP12 16 (2)(m) The home must provide an assessed plan of activities for each service user to ensure that opportunities for social interaction and stimulation are provided. This must also include specific social care plans for those service users with dementia or who are nursed in bed. 7 OP19 23(2) The Provider must ensure that a 01/09/06 programme of refurbishment and redecoration is undertaken to improve the environment for service users. The manager is required to ensure that the gardens are appropriately maintained to ensure the safely and wellbeing of service users who may wish to use the gardens. The registered manager is required to ensure that adequate and suitable bathing facilities are available to maintain the personal hygiene of service users. The registered person must ensure that suitable adjustable beds are provided for those service users with an assessed need. (Previous timescale not met) The registered person must ensure that appropriate risk assessments are completed and kept under review, for free standing radiators in use. DS0000065814.V294552.R01.S.doc 01/09/06 8 OP20 20(2)(o) 01/09/06 9 OP21 12(1)(a) 01/09/06 10 OP24 16(1) & 16(2)(c) 01/09/06 11 OP25 13(4) 01/09/06 Drummuir Nursing & Residential Home Version 5.1 Page 30 (Previous timescale not completely met) 12 OP27 18(1)(a) The registered manager is required to ensure that suitable staffing levels are maintained at all times. The registered person must ensure that two satisfactory references are obtained for employees, which include one from the most recent employer. Gaps in employment history should be explored. (Previous timescale not met) 14 OP30 18(1)(c)(i ) The manager is required to ensure that staffs training needs are assessed and further training provided as required. 01/09/06 01/09/06 13 OP29 19 & Schedule 2 (5) 01/09/06 15 OP37 17(1)(b)( a) The manger is required to ensure 01/09/06 that all records kept in respect of each service user are stored in accordance with the Data Protection Act. The manager is required to ensure that all substances hazardous to health are stored in line with e the COSHH Regulations Immediate Requirement Made. It is further required that he COSHH risk assessment for the home be updated. 26/06/06 16 OP38 13(4)(a) 17 OP38 13(4)(a) The manager is required to ensure that all wardrobes are secured to the wall to prevent risk of injury to service users Immediate Requirement 26/06/06 Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 Page 31 Made 18 OP38 13(4)(a) The manager is required to ensure that the fire risk assessment for the home is reviewed and updated. The manager is required to ensure that a record is maintained of monthly check of the emergency lighting. The manager is required to ensure the correct fitting of all bedrails to prevent the risk of entrapment and also that consent for bedrails has been received from the service user/representative. It is required that all foods stored in the fridge be correctly labelled with the date and time. 01/09/06 19 OP38 13(4)(a) 01/09/06 20 OP38 13(4)(a) 01/09/06 21 OP38 13(4)(b) 01/09/06 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 OP1 Good Practice Recommendations The Manager is recommended to review the descriptions contained within the brochure to correctly reflect the services available within the home. It is recommended that the dining room be reorganised to into smaller dining groups to attempt to improve the dining experience for service users. The inspector recommends that the Whistle Blowing Policy be reviewed to contain further details with reference to the signs of abuse. 2 OP15 3 OP18 Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 Page 32 4 OP22 Storage of wheelchairs in the dining room is inappropriate. It is recommended that alternative storage be arranged for wheelchairs. For the protection of dignity and privacy, it is recommended that some form of curtail be provided to ensure service users on the ground floor are not overlooked. It is recommended that the hot water system be reviewed to ensure water dispensed to bedrooms is of the correct temperature. The registered person should ensure that staffs training achievements and needs are clearly identified on a training matrix. The home is recommended to review the procedure for storing service users personal monies to enable access to individuals own money and not a pooled source . It is further recommended that all receipts stored on behalf of service users are formal in nature. It is recommended that the supervision of staff encompass all aspects stated in the National Minimum Standards. 5 OP25 6 OP25 7. OP28 8 OP35 9 OP36 Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 Page 33 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Drummuir Nursing & Residential Home DS0000065814.V294552.R01.S.doc Version 5.1 Page 34 - 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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