Inspection on 14/08/08 for Elderholme Nursing Home

This inspection was carried out on 14th August 2008.

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

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

Other inspections for this house

Elderholme Nursing Home 17/03/08

Elderholme Nursing Home 09/10/07

Elderholme Nursing Home 11/01/07

Elderholme Nursing Home 06/09/06

Elderholme Nursing Home 31/05/06

Elderholme Nursing Home 27/02/06

Elderholme Nursing Home 17/03/05

Elderholme Nursing Home 22/09/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Elderholme Nursing Home Clatterbridge Road Bebington Wirral CH63 4JY Lead Inspector Joanne Revie Key Unannounced Inspection 14th August 2008 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 Elderholme Nursing Home DS0000020938.V367770.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. Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elderholme Nursing Home Address Clatterbridge Road Bebington Wirral CH63 4JY 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) 0151 334 0200 0151 3431312 elderholme@btconnect.com Wirrelderly Post Vacant Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60) of places Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing: Code N, to people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category: Code OP The maximum number of people who can be accommodated is: 60. Date of last inspection 17th March 2008 Brief Description of the Service: Elderholme is situated within the grounds of Clatterbridge Hospital, Wirral. It is a single storey purpose built care home for elderly people, offering both nursing and personal care. The home has a capacity for 60 residents and a full range of aids such as assisted bathrooms and wheelchair access to all areas. Elderholme has 2 dining rooms and 3 separate lounges, each overlooking the pleasant courtyard. There is good parking to the front of the home and gardens are well kept providing a pleasant outlook from rooms. The home is accessible by public transport, which is routed through the hospital grounds. The cost of staying at the home is £526.11 to £590.00 per week Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes The service received a key (main) inspection in March 08. Prior to that inspection taking place the manager was asked to complete a document called an AQAA. This document provides information on the services strengths and weaknesses and any future plans to develop the home. An AQAA was not completed prior to this inspection, as the other one was still current. Surveys were not sent out to people who live at the home or their relatives as this happened in October 2007.However surveys were sent out to staff but these were not distributed as we found them later in the manager’s office. We (the commission) visited the home on two separate days and spent a total of sixteen hours talking to the people who live there, relatives and staff. Time was also spent reviewing a variety of records. We were accompanied by an “expert by experience”. This is a person who is someone who has experience of using services for older people and has received training in taking part in and contributing to the CSCI inspection process. The expert spent time meeting with the people who live at Elderholme, and focusing in particular on mealtimes and opportunities for taking part in activities. Following the visit the expert prepared a report of their findings and those views are included within this report. Comments from the discussions held have been included in the summary section of the report. The records viewed related to people’s care, how risk was managed, the service provided by the home and how peoples health and safety was promoted. The environment was viewed and personal information relating to staff as well as staff training was also viewed. At the time of our visit we were aware that the registered manager had left the service. A deputy manager had been employed who had agreed to become” acting manager” until a replacement could be found. The “ acting manager” had only been in post for a very short time. Each service has to have a responsible individual as well as a registered manager. The responsible Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 6 individual for this service is the company secretary. A board of trustees helps to manage the home. Reference is made to these people within this report What the service does well: What has improved since the last inspection? Requirements, which we made following our last visit, have been met. This means that the cleanliness of the kitchen, Laundry and home in general is greatly improved. In particular the laundry service is much better and efforts are made to ensure that everyone’s personal clothing is properly cared for. This means that people are supported to wear clean freshly ironed clothes, which can help to promote their self-esteem. Nursing staff have implemented routine checks to ensure that medications are managed safely. This reduces the risk of medications being mishandled. Staff have received support from the local primary care trust to reduce the risk of infection spreading within the home. This has included using specialist soaps and hand rubs, which have been clinically proven to reduce bacteria forming. This helps to promote people’s health and welfare. Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 7 A new call bell system has been installed and is in operation. This means that people are more likely to have their requests for help responded to sooner by staff. An activities organiser has been employed who is enthusiastic about her role. People told us “ she’s great- really interested and keen to do things”. The Responsible Individual for the service has familiarised herself with her role and is carrying out monthly monitoring visits of the home. This means that a second pair of eyes (other than just the manager) is looking at standards within the home and this also shows a willingness to work within the law, which governs care homes. (Care Standards Act 2000 and Care Home Regulations 2001) What they could do better: Staff are completing records to show whether or not peoples health is at risk of deteriorating. Although we saw that people were receiving correct care we could not find any records showing us how staff were reducing that risk. We saw that some aspects of how people are supported to have their privacy and dignity respected need exploring. This included keeping care records in bedrooms and leaving bedroom doors open to passers by. Although medicines management has improved staff need to understand what to do if the medicine fridge temperature rises above expected levels. Not taking action could affect how medicines work as they could be being stored at the wrong temperature. Mealtimes need to be thoroughly explored to ensure people are supported to have a pleasant experience. How food is seasoned and cooked should be explored as well as whether people are receiving sufficient support from staff. Specialised cutlery, plates and correct support when seated must be provided. Not taking action could lead to people losing their appetite, which could impact on their health and welfare and could also mean a loss of independence, as they may be unable to feed themselves. Consideration should be given to displaying menus in other areas of the home instead of the foyer only. This could help people remember what choices are available and help them in their decision-making. Individual activities need to be developed for those people who do not like or who are unable to join in group activities. This will help to promote people’s quality of life. Staff sickness and staff morale needs to be monitored and addressed. Not providing staff in sufficient numbers can seriously impact on people’s health and welfare. Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 8 Staff have undertaken a variety training to ensure people are safe however plans needs to developed to include specialist training so that staff have the skills to meet peoples needs. This should include refresher medicine management training and wound care training for nursing staff. 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. Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with the opportunity to meet with senior staff from the home and are also provided with information to enable them to make a choice about moving in. EVIDENCE: We looked at peoples care records, which showed us that staff meet with them before they move into the home. On the day of our visit the acting manager had been to meet with someone who was interested in moving in and had also planned to visit another person later that day. The acting manager had identified that the records used to record information about people needs needed to be improved as not all expected areas were covered. For example no space was available on the form for staff to record Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 11 what medication people were taking or their past medical history. This should be addressed so that staff are able to gather comprehensive information about peoples needs. This will mean that staff will then have all the information available so that they can plan their care. One person who had recently moved into the home told us that the staff had been” very kind” and that this had helped them to settle into the home well. We saw that this lady had been supported to furnish her bedroom with personal belongings, which helps people to adapt to the move. Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s health care needs are met but their right to privacy may not be promoted EVIDENCE: We looked at four sets of care records that belonged to people who lived in the home. We talked to people about the care that they received and had discussion with some relatives. Everyone spoken with was positive about staffs ability to care and comments were made which included “ they’re very kind” and “ nothing is too much trouble”. People also stated, “Girls are good “, ” Night staff very good”, and ” Can’t complain. We found that the care records that we looked at were up to date and that staff spent time each month checking the records to make sure they reflected the persons needs. However we noticed that staff were assessing Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 13 the risk of peoples health deteriorating but did not always record how the risk would be reduced on the persons care records. For example we looked at one set of records, which showed that someone was at high risk of developing ulcers. Although an ulcer had not occurred staff had not recorded what support they were giving to prevent ulcers forming. This should be addressed as staff need clear written up to date instructions to follow about each persons care. Not addressing this could mean that staff do not give the necessary care and support required which could impact on people’s health and welfare. We saw that efforts have been made to include instructions oh how people would prefer to spend their day and what activities they have participated in. This is an improvement since last time we visited. We saw that in some cases people and their families had been involved in deciding what is written in the care of plan. This consultation should be offered to all people and/or their representatives as it helps to empower people by encouraging them to have some control over their lives. We saw that staff had the skills and understood how to manage wound care. Clear records were in place providing details of which dressing to use and how often these dressings should be changed. The records we looked at showed that the wound was healing. We saw that staff are quick to consult with other health care professionals such as G.P.s, specialised nurses, chiropodists, dentists etc when someone’s heath care needs change. We looked at how staff respect peoples privacy and promote their dignity. We saw that a lot of people spend time in their bedrooms and that nearly all bedroom doors within the home were open so passers by were able to see in. We discussed this with people who were using their rooms and they commented that they would feel” isolated” if the bedroom door is closed. This should be explored further as we also saw that another person had become distressed, as they were unable to walk to their bedroom door and shut it without staff support. Staff were reluctant to do this as they believed that this person may come to harm behind a closed door. Everyone who lives in the home should be consulted about whether bedroom doors are to remain open or closed. Records should be developed to support people with their choice. We also saw that peoples care records were kept in each of their bedrooms. In some cases this could be very good practice as it means that people have access to their records and can see at any time what staff are writing in them. However we saw that a number of people who live in the home are very frail and these people may not understand what the records are for. As the records are accessible too anyone who enters their bedroom they could Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 14 be viewed by anyone who wishes to see them and this could impinge on people’s right to privacy. This must be explored. The acting manager had identified this issue and stated that she intended to start discussions about the most appropriate place to keep peoples care records. We held discussions with people who live in the home after breakfast and after lunch. We observed that some people before lunchtime were wearing clothes that were stained with food from their breakfast meal. We discussed this with the acting manager and the responsible individual at the end of our visit. At our last visit we commented that it may be more respectful if people who used protective clothing when eating were provided with linen tabards rather than plastic disposable aprons. The responsible individual stated that this advice had been misinterpreted and that management at that time had told staff that people were not to use any form of protective clothing when eating. This issue needs to be addressed. People should be supported to change their clothes if they become stained and appropriate protective clothing should be provided for those who require support at meal times. Not taking action could infringe on peoples right to dignity. We looked at how staff manage peoples medications. People who live in the home can look after their own medications however no one was doing this on the day that we visited. We saw that storage has been improved and that staff had taken action to ensure that people were receiving medications at the right time. However despite this one person did comment that medications were often late. This should be explored and action taken to ensure that people receive their medications when they choose. Explanations should be given if people are not receiving their medications when they would like. For example some medications may need to be given after food so that they work better. We saw that staff were carrying out stringent stock control checks, which helps to ensure that medications are being managed safely. We also saw that staff are keeping very clear records of what was given and when. The home has very good storage systems in place so that medications and records are stored securely. We saw that a medications fridge was available for staff to store any medications that required a storage temperature of between 2-8 degrees Celsius. We saw that staff were checking the temperature of this fridge on a daily basis. Records showed us that at times staff were recording that the fridge temperature had risen to greater than 8 degrees and no action had been taken to address this. Staff should be reminded of what to do if the fridge temperature exceeds 8 degrees Celsius. Not storing medications at the correct temperature can impact on how they work. Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 15 We looked at staff training records and saw that many staff had not taken any refresher training in managing medications since 2006. This should be addressed. Providing staff with updated refresher training could reduce the risk of medications being mishandled. Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 16 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. People have some control over the lives. Consultation is taking place to improve this. Mealtimes are not as pleasant as they could be. EVIDENCE: We looked at what activities were available in the home for people to take part in. We saw that since we last visited an activities organiser has been employed. People and staff told us that she was very enthusiastic about her role and when we looked at records we saw that time had been spent asking people how they would like to spend their day. Photographs were displayed which showed that a donkey from a local donkey sanctuary had visited the home. People told us that they had enjoyed this very much. We saw that plans had been made to hold a barbeque with live music and that family and friends had also been invited to this. Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 17 On the day that we visited no activities had been planned. The activities organiser was on holiday and the acting manager agreed that this was a shortfall and activities should have continued in her absence. However we did see a group of people being supported to take part in an exercise class during the afternoon. We also saw that although group activities were taking place no arrangements had been made for people to receive individual support to pursue their own interests. We did meet with one person who enjoys painting however more individual activities should be explored and people supported to take part in these if they choose. The home has a mini bus however trips have not occurred for some time. The acting manager explained that it would be more cost effective to use local transport which is equipped to take wheelchairs for those people who have mobility problems and that she intended to explore this further. This should be followed through. We saw that some people are supported to go out with their family and friends when they choose. We had discussions with staff about how people are supported to follow their religious beliefs. We were told that visitors from the Roman Catholic Church and Church of England churches visit the home regularly and provide communion for those people who wish to take it. We had a lunchtime meal with people who live in the home in one of the dining rooms. We saw that although the dining room is pleasant the table settings could be improved by ensuring condiments i.e. salt and pepper were available on each table and that people were supported to use them. This is important as we found that the lunchtime meal was unseasoned and therefore tasted bland. The meal provided was presented nicely however we found that the meat was tough and three other people who live in the home also agreed with our opinion. We found that the dessert had not been sweetened and therefore tasted sharp. These concerns must be addressed. People must be offered food, which is appealing .Not, provided tasty food could impact on someone’s appetite, which could affect their health and welfare. We looked at the homes menu. We saw that a three week rota is in place and that choice is available. We saw one menu displayed in the reception of the home. Despite this people were not able to tell us what they had chosen to eat for lunch or what choices were available on the menu. Consideration should be given to displaying menus in other areas of the home as well as maybe providing a menu on each of the dining tables. We did hear staff asking people what they would like to eat before mealtimes occurred and one person in particular was supported to have a different meal as none of the choices available appealed. Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 18 We observed how staff support people to eat their meals. We saw that some people required cushions to enable them to sit in a better position so that they were closer to their food however no cushions were provided. Staff were available to support people to eat however they often left the person who they were helping to carry out another task. This should be addressed. Staff should provide necessary support so that people can eat their meal in a dignified manner. Leaving people unaided during meals can result in people attempting to eat cold food or eating in a rushed manner. We saw that most people were using domestic style cutlery and plates and in some instances some people’s independence could have been promoted by using equipment, which was specially adapted. This should be explored. We saw that the last manager had asked people to complete surveys about the quality of food provided. It was not known whether the information within these surveys had been acted on. These should be reviewed and the comments regarding the lunchtime meal explored. People should be supported to eat nutritious, tasty food that they enjoy. People should receive the correct support either through sitting correctly or by using specialised cutlery/plates so that they are able to eat independently. Efforts must be made to ensure Meal times are a pleasant and enjoyable experience for all. Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People concerns and complaints are not always listened to and acted on EVIDENCE: We looked at records that we had about the home and had discussions with relatives and staff. We saw that since we last visited one complaint had been made about the service, which suggested that someone’s care needs had been neglected. The manager at that time had taken the right action by involving the social services safeguarding team. After consultation with this team the manager was asked to investigate the concerns, which she did. A full copy of the investigation was sent to us, which suggested that the manager had the skills to investigate complaints and uphold people’s rights. However during our visit this time we saw a statement that had been written by staff sometime ago stating that “unexplained bruising” had been found and that the cause was unknown. We looked into this matter and could see that this persons medical condition had resulted in the bruising occurring. However when staff wrote this statement this information was not known. The staff statement should have been passed directly to the safeguarding team to investigate in case abuse had occurred. This was discussed with the acting Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 20 manager of the home who understood the severity of this incident and was aware of the actions that should have been taken. We looked at complaint records in the home. One complaint has been made since we last visited. This had involved a person’s social worker meeting with their relative and the manager of the home at that time. We looked at a copy of the social workers investigating report, which showed that the concerns that had been raised had occurred and had not been addressed. We spoke with the relative involved in this matter who told us that despite meeting with the manager of the home at that time the concerns remained outstanding( “ nothings changed”). The acting manager told us that she had already met with this relative to discuss progress and a director for the service has told us that they intend to ensure that all concerns are addressed. This evidence shows that complaints and concerns have been addressed erratically and actions taken have been inconsistent. Efforts must be made to deal with peoples concerns and complaints effectively so that trusting relationships can be built. Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a clean comfortable home. Staff understand how to prevent infection spreading. EVIDENCE: We walked around the home and had discussions with staff and people who live there. We saw that improvements had been made to the cleanliness of the kitchen and that staff were happy with the changes that had taken place. In particular the laundry now has staff that only work in this section. It was obvious that they took pride in their work and took pleasure from seeing people dressed in clean, ironed clothes. All areas that we visited appeared clean. This is an improvement since we last visited. We saw that the last manager had taken action to address cleaning Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 22 issues in the home by sending out questionnaires to people who live in the home and their relatives to complete. The acting manager had not been given any information showing whether any concerns raised had been addressed however she intended to rectify this by meeting with the housekeeper soon after our visit. The company secretary was able to tell us that cleaning schedules had been introduced and that she was also monitoring the cleanliness of the home when she performed her monthly visit as the responsible individual for the service. Each service registered with us has to have a responsible individual as well as a registered manager. The responsible individual has to perform a monthly visit and review key areas of the home to ensure standards are maintained. We know that the maintenance officer has left since we last visited. We saw that some bedrooms and corridors required redecoration. The acting manager told us that a new maintenance officer had been employed and although he had not started work yet he had visited the home and was devising a redecoration programme. These plans should be followed through so that the home appears well maintained. As stated by staff during the visit, it appears ”Unloved”. We noticed that carpets to communal areas and corridors were stained and that these either needed shampooing or replacing. The acting manager also identified this issue and intended to take action to ensure that this was resolved. We saw that people are encouraged to make their bedrooms their own by furnishing them with personal affects. This helps people to feel” at home”. We saw that despite the home having well maintained gardens no seating or garden furniture was available for people to use. The acting manager told us that she was also aware of this shortfall and that plans had been discussed with the relatives group for the home to raise funds to provide this. When we last visited we saw that the home had purchased a new call bell system for people to use to summon staff help. Part of this new system provided remote call ells for people to take into the lounge or for use in the garden. We saw that these were not in use and discussed this with the acting manager. The remote call bells systems were found and the acting matron explained that they had not been used, as staff had not received training on how to use them. The acting manager had tried to use one and found that without proper instruction this was impossible. She addressed this during our visit by arranging for a representative from the call bell system to visit the home in the near future to provide training. This will help to make the gardens more accessible and support people to feel confident to use the lounge areas and summon help if needed from staff. Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 23 We saw that improvements have been made by ensuring all areas in the home are equipped with liquid soap and alcohol rub. This helps to reduce the risk of infection spreading if used correctly. The acting manager explained that the primary care trust had been visiting the home to promote awareness of how to reduce the risk of infection spreading. A registered nurse from the home has volunteered to be the link person on this subject and to attend future meetings with the PCT so that the home can stay up to date. This is good practise. Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 24 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 good. This judgement has been made using available evidence including a visit to this service. People receive care and support from staff that they like. However staff sickness and turnover is impacting on the care that people receive. EVIDENCE: We had discussions with staff and looked at staff training records, personnel files and duty rotas. People who live in the home told us that in general they liked the staff. Comments included “Girls are good “” Night staff very good” Can’t complain “”Only petty things”. We saw that in some instances staff interacted very well with people however other instances showed that staff appeared rushed and had little to say. We also noticed that consideration had not been given to peoples mobility needs. For example the home has spacious corridors, which could be used for people to exercise with staff support however we didn’t see this happening. These comments should be explored so that people’s quality of life is promoted. Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 25 We looked at duty rotas, which showed us that the home is staffed consistently with a staff team of various abilities. However we saw that at times and particularly weekends the staffing rota falls short mainly due to staff sickness. The acting manager was fully aware of this issue and had plausible ideas to resolve this issue. Staff must be provided in sufficient numbers to meet the needs of the people who live at the home. We saw that since we last visited a number of staff have left the home. We discussed morale with staff that were on duty during our visit. They agreed that morale had been low and that they felt this issue would resolve itself due to the recent changes in management. The acting manager also felt that reliable staff turned up regularly for weekend shifts and that the implications of working short staffed when other staff didn’t turn in also impacted on staff morale. We looked at how staff are recruited and we found that necessary checks are undertaken to make sure that new staff are suitable to work with vulnerable people. These included ensuring nurses were still enrolled on a professional register and therefore eligible to work. We saw that a training programme is in place however we found that qualified staff had not undertaken any specialist training recently. In particular we found that qualified staff had not had refresher training in medicines or wound care management for almost two years. This should be addressed so that staff can care for people properly. We saw that care staff are supported to achieve NVQ qualifications in care and that over fifty percent of the staff employed have achieved this qualification. This is good practice however plans should continue to help all staff to achieve this qualification. Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a safe home however the management structure needs to stabilise before quality can be developed EVIDENCE: We saw that the acting manager had been recruited correctly and that she had the skills and `experience to manage the home. Although she had not been in post long staff and people commented positively on her openness and staff commented that they felt supported by her. We found the atmosphere in the home was happy and relaxed during our visit and we heard staff singing and talking to each other. Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 27 We have met with the management board for the home on two occasions since our last visit. Structures have been developed so that the two responsible people (registered manager and responsible individual) work alongside each other. On the day that we had visited the responsible individual had completed a monthly visit report, which is required by regulation. This had been shared with the acting manager also. Although improvements have been made by addressing requirements that were made at our last visit the management structure of the home needs to stabilise before any real progress can be made. We saw that the previous manager had worked hard to consult people and their relatives about their views of the service. This work included sending out questionnaires based around quality of food, care provided, and housekeeping. These have been returned but as yet not acted on. The acting manager voiced her intention to organise relatives meetings and to meet with people who lived in the home and staff employed there. Further work should be taken to review the completed surveys and were necessary take action. We looked at how the home manages people’s health and safety. We saw that a variety checks are undertaken on a regular basis to ensure equipment is functioning correctly. This includes fire fighting equipment and testing water temperatures. We saw that contracts are in place to ensure larger items such as hoisting equipment are regularly serviced. Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 3 Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 29 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 OP15 Regulation 16.2(g),(i) Requirement People must be offered a tasty, nutritious diet. Action must be taken to ensure people receive the support they need either by providing equipment or by ensuring staff support is available. These actions will help to ensure that mealtimes are a pleasant experience and reduce the risk of someone not having an adequate diet. Efforts must be made to deal with peoples concerns and complaints effectively so that trusting relationships can be built. Not taking action could result in people feeling disillusioned with the service provided. Staff sickness and turnover must be explored and monitored. Not providing staff in sufficient numbers can impact on people’s health and welfare. Timescale for action 31/10/08 2. OP16 22. – (3),(4). 31/10/08 3. OP27 18.-(1)(a) 31/10/08 Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 30 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 OP7 Good Practice Recommendations Care plans should be developed so that records contain clear instructions showing how the risks to someone’s health deteriorating are being reduced. Staff are completing assessments which show high risks but are not demonstrating how this risk is to be reduced. Staff who are responsible for administering medication should receive refresher training on this subject. This will help to reduce the risk of medications being mismanaged. Staff must take action if the temperature of the medications fridge rises above 8 degrees Celsius or drops below 2 degrees. Not taking action could affect how medications are stored and therefore impact on how they work. This could be detrimental to someone’s health and welfare. The manager should explore why so many people have their bedroom door open when spending time in their room and if necessary take action to ensure peoples privacy and dignity is respected. Storing people’s care records in their bedroom should also be explored as in some instances visitors could have access to that persons personal records which may not be appropriate and may breach their right to privacy. People who live in the home must be supported to wear clean clothing at all times. Not providing this support could reach a persons right to dignity. Activities should be planned and carried out in the absence of the activities organiser. People should be supported to spend their time in a fulfilling way. Menus should be made available in key areas of the home including the dining room. This would help people to remember the choices available. The acting manager should follow through her plans to address the stained carpets in the communal areas of the home and to ensure that the new redecorating schedule is implemented. A training plan should be implemented for qualified nurses so that they can update specialist skills such as wound care and medicine management. Not providing this training could mean that staff are delivering care, which is DS0000020938.V367770.R01.S.doc Version 5.2 Page 31 2. 3. OP9 OP9 4. OP10 5. 6. 7. 8. OP10 OP12 OP15 OP19 9. OP30 Elderholme Nursing Home 10. OP33 not appropriate for people’s needs. Comments in the surveys completed by people who live in the home and their relatives should be acted on. This will show people that their opinion is important and is listened to. Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries.northwest@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 Elderholme Nursing Home DS0000020938.V367770.R01.S.doc Version 5.2 Page 33 - 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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