Random inspection report
Care homes for older people
Name: Address: Drummuir Nursing and Residential Home 9-11 Northfield Bridgwater Somerset TA6 7EZ one star adequate service 04/09/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Justine Button Date: 0 3 0 3 2 0 1 0 Information about the care home
Name of care home: Address: Drummuir Nursing and Residential Home 9-11 Northfield Bridgwater Somerset TA6 7EZ 01278422144 01278420397 drummuir@ashbourne.co.uk www.southerncrosshealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Caroline Williamson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ashbourne (Eton) Limited care home 38 Number of places (if applicable): Under 65 Over 65 38 old age, not falling within any other category Conditions of registration: 0 Elderly persons of either sex, not less than 60 years, who require general nursing care Up to eight places for personal care Up to two persons of either sex, between the ages of 50-60 years who require general nursing care Date of last inspection Brief description of the care home Drummuir Nursing Home is situated in a quiet residential area close to the town centre of Bridgwater. The home is not purpose built. Drummuir is registered with the Care Quality Commission provide general nursing care for up to 38 older people, although the home can only accommodate a maximum of 31 people. This includes up to 8
Care Homes for Older People Page 2 of 15 0 4 0 9 2 0 0 9 Brief description of the care home people who require personal care. The fee range does not include hairdressing, newspapers, toiletries, optician and some activities. Care Homes for Older People Page 3 of 15 What we found:
This unannounced random inspection was conducted over one full day (6hrs) by regulation inspector Justine Button. The purpose of this inspection was to follow up on some of the requirements raised at the homes last key inspection which was carried out in February 2010. During the inspection we were given unrestricted access to all parts of the home and all records required for this inspection were made available to us. At the end of the inspection, feedback was given to the interim manager. At the last key inspection concerns were raised with the company with regard to the level of care and support people at the homes were receiving. Concerns have also been raised to Somerset Social Services from the Primary Care Trust (PCT) via GPs and the community Nursing Service. As a result of these concerns meetings have been held under Somerset Adult protection Policy with the company, CQC, Adult Social Care and the PCT. The aim of these meetings was to discuss the progress made to addressing the shortfalls in the care and support provided. At the last inspection concerns were raised with regard to the care planning process and how the care plans did not reflect the care needs of people at the home nor did they give clear guidance to staff on how to meet peoples individual needs. This was particularly relevant for people with diabetes, those at the end of their lives and those people who have or who are at risk of loosing weight. At this inspection we confirmed that the home had recently purchased weighing scales which enable staff to more robustly monitor peoples weight. Recent weights showed that the majority of people had recently put on a small amount of weight. One person who was seen to be dehydrated and loosing weight at the last key inspection appeared to have improved at this visit. The individual was well hydrated and had fluids available. Despite this when we viewed the care records for this individual these had not been completed to an adequate standard. The individual had been prescribed supplements by the GP. On the medication records these had been signed as being given however these were not robustly recorded on the diet and fluid charts which were in place to monitor the individuals care. Due to this contradiction we were not able to ascertain the care and support that staff were providing to the individual. The diet charts that were in place demonstrated that the individual did not always eat the meals that were provided. The individual clearly had a reduced appetite. Despite this the care plans did not tell staff what they should do if meals were not eaten. The nursing records did not show that staff took proactive action when meals were not eaten in line with the plan of care. During the inspection visit we did not see the individual being supported by staff to have snacks between meals. During the inspection we identified that staff were not adequately recording meals and fluids for people who were at risk. Staff were observed to be completing records for the previous day. This was raised with the interim manager who stated that she would address this with staff. During the inspection we reviewed the lunch time meal. Improvements were seen in the standard of the meal provided with less processed and shop bought food on offer. A range of vegetables were available on this occasion. We spoke to the kitchen staff during
Care Homes for Older People Page 4 of 15 the inspection visit. It was clear that the kitchen staff did not have any up to date information with regard to the dietary needs of people at the home. It is unclear therefore how such things as fortified foods or specialist diets are provided to those people who require them. As a result of the concerns previously raised the PCT and Adult Social Care have conducted reviews for people living at the home. Feedback from these reviews confirm concerns with regard to issues around care planning, diet and fluids, time people get up and go to bed and standards of personal hygiene offered to people at the home. At the last inspection and the concerns raised under the Somerset Adult Protection meetings identifed concerns with regard to the skills and competencies of the qualified nursing staff working at the home. At this visit the interim manager stated that a skills audit for staff had been completed. The skills audit however did not adequately demonstrate if and when staff had completed any updating training. The manager agreed to review this. It should be noted that the number of Registered Nurses employed by the home is currently low and as such agency staff are being used on a regular basis. The manager told us that the company are currently recruiting additional staff. This will include a clinical lead for the home. As there remain deficits at the home the Community Nursing are continuing to visit the home several times a day to complete some clinical duties. At the last safeguarding meeting it was agreed that this was over and above what would normally be provided at a care home with nursing and that this could only continue for a time limited period. The company have given assurances that they are currently arranging any required training and that this would be delivered as a matter of urgency. Progress in this area will be reviewed at the next inspection and meetings arranged under the safeguarding policy. The manager has told us that she intends to submit an application to become registered with us. What the care home does well: What they could do better:
Some improvements have been made since the last key inspection conducted in February 2010. There are however still some serious shortfalls in the care and support provided to people at the home. Main areas of concern relate to the care planning process, accurate recording of the care and support given, the numbers, skills and competencies of the registered nurses employed at the home. As result of this people may not be having clinical needs met by th staff at the home. The levels of personal hygiene offered to people at the home is also a concern. Care Homes for Older People Page 5 of 15 At the reviews conducted by Adult Social Care and the PCT families and relatives have raised concerns with regard to the time people get up and go to bed , general decor and cleanliness of the building and equipment. As there are still concerns about the quality of care in Drummuir safeguarding procedures will remain in place and monitoring and measuring from CQC and Adult Social Care will continue. The management team at Drumuir and Southern Cross Healthcare must now address the outstanding requirements as a matter of urgency if additional action is to be avoided. As a result of the ongoing concerns about the care and support provided at the home Adult Social Care are not currently placing any people at the home. Southern Cross Healthcare have also agreed not to admit anyone to the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 15 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 18 All new staff employed should complete a robust induction in line with best practice This will ensure that all new staff are adequately supported and develop the skills to meet the needs of people at the home. 18/02/2010 2 18 All staff should receive all 26/02/2010 mandatory training according to their job role. This may include moving and handling, fire training, Abuse prevention, health and safety and Control of Substance Hazardous to Health (COSHH). This will ensure that staff can meet the needs of people living at the home 3 7 12 An urgent audit is completed 04/02/2010 for two identified individuals which assess their current health needs. Associated care plans and assessments are formulated to ensure that staff have clear guidance on the care needs of the individuals This will ensure that both Care Homes for Older People Page 7 of 15 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action individuals receive the care and support that they require. 4 7 12 The responsible individual is 08/05/2009 required to ensure that each person has been risk assessed and has a suitably detailed supporting care plan in place to ensure all identified needs are met. This is required to ensure that staff can provide the care needed and the person using the service is not placed at risk. 5 8 12 People at the home should be supported to complete oral hygiene in line with the assessed need and plan of care This will ensure that peoples preferred level of personal hygiene and maintains peoples comfort 6 8 12 All people living at the home 04/02/2010 should receive an adequate fliud and dietary intake. everyone living at the home should have an up to date weight and nutritional assessment completed. associated care plans should be developed giving clear and specific guidance to staff on the nutritional needs of people living at the home. care plans should give clear guidance on actions to be taken where concerns are
Page 8 of 15 18/02/2010 Care Homes for Older People Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action highlighted fluid and diet charts should be accurately completed where applicable To ensure that people at the home receive adequate diet and fluids 7 8 12 People who are risk of choking are supported with diet and fluids in line with a completed risk assessment and up to date care plan This will ensure the safety of people living at the home 8 8 12 People living at the home 18/02/2010 who are at risk of developing pressure ulcers should have a regular change of position in line with the care plan and their assessed need. This will ensure that people do not develop pressure ulcers and help to maintain peoples comfort. 9 8 12 Charts and records used to monitor care such as fluid charts, positional change charts and nutritional charts are completed accurately where applicable This is required so that the health care needs can be monitored and appropriate care and support provided 10 9 13 Action must be taken to ensure that medicines are given as prescribed and that 18/02/2010 18/02/2010 18/02/2010 Care Homes for Older People Page 9 of 15 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action accurate records are kept of all medicines given by staff, including creams and ointments. If regular medicines are not given a reason must be recorded. This is to safeguard peoples health. 11 9 13 If medicines are prescribed with a variable dose the amount given must be recorded. This is so that it is clear how much medicine is needed and has been given. 12 15 16 People on specialist diets should be able to make choices with regard to the meals they receive. This will ensure all people ahve a choice 13 15 16 A range of snacks should be available to people on specialist diet according to their needs. This will provide support to those people who have lost or are at risk of loosing weight and those who have swallowing difficulties. 14 15 16 The management need to review the menus and ensure that they are nutritional balanced with a mix of frozen, fresh, tinned and powdered foods. 18/02/2010 18/02/2010 18/02/2010 18/02/2010 Care Homes for Older People Page 10 of 15 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action This will ensure that the food served meets the nutritional needs of people at the home. 15 18 13 All staff must receive training 25/02/2010 with regard to the prevention and recognition of abuse This will ensure that people at the home are safegaurded 16 22 13 The management must 18/02/2010 ensure that the home is adequately equipped to meet the needs of people living at the home. This should include weighing scales and hoists used in moving and handling This will ensure that staff can meet the needs of people at the home. This will ensure that safety at the home is not compromised. 17 26 16(2)(j)(k) The registered provider is required to ensure that all areas of the home have a satisfactory standard of hygiene and ensuring that there is no malodour. The management need to ensure that there are adequate numbers of suitably qualified staff on duty at all times. This will ensure that there are enough staff on duty to meet the needs of people at
Care Homes for Older People Page 11 of 15 01/10/2008 18 27 18 18/02/2010 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action the home. 19 27 17 The management need to ensure that the duty rotas reflect the staff working at the home at all times This will help to ensure that adequate staff are on duty to meet the needs of people at the home. 20 30 18 The management of 19/02/2010 Southern Cross Healthcare should complete an audit of the skills of the regsitered nurses. Where training needs are identifed Southern Cross healthcare need to develop a plan as to how these training needs will be adressed This will ensure that staff at the home can meet the needs of people living at the home. 21 31 37 The home must notify us of any event as described in regaultion 37 of the care home regulations This will ensure that people liivng at the home are protcted and action taken for any shortfalls 22 31 10 The registered person must ensure that there is a clear management structure To give clear leadership and direction to the home and ensure that care and support
Care Homes for Older People Page 12 of 15 18/02/2010 19/02/2010 19/02/2010 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action is of a high standard and appropriate to the needs of people living there. 23 31 8 The responsible individual is required to ensure that a manager is registered with the Commission. This is required to promote the stable management of the service. 24 33 24 Quality Assurance systems must be more robust. To ensure that shortfalls in the service are identified and action is taken to address them. 19/02/2010 08/04/2009 Care Homes for Older People Page 13 of 15 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 14 of 15 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 15 of 15 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
