Inspection on 17/03/08 for Elderholme Nursing Home

This inspection was carried out on 17th March 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 14/08/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Elderholme Nursing Home Clatterbridge Road Bebington Wirral CH63 4JY Lead Inspector Mrs Joanne Revie Unannounced Inspection 17th March 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.V360736.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.V360736.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 Mrs Christine Mary Whiteside Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60) of places Elderholme Nursing Home DS0000020938.V360736.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 9th October 2007 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. Elderholme Nursing Home DS0000020938.V360736.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 October 2007. 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. Two inspectors visited the home on this occasion and spent eight and a half hours talking to the people who live there, relatives and staff. Time was also spent reviewing a variety of records. Comments from the discussions held have been included in the summary section of the report. In total discussions were held with three relatives, nine people who live at the home, two visitors and eleven members of staff. 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. A pharmacist inspector also visited the home several days after the main visit took place. Pharmacist inspector’s focus on how medications are managed by care homes to ensure that people’s health and well being are promoted. The findings from the pharmacist inspector’s visit are also included within this report and can be found under standard 9 in the evidence section called “Health and Personal Care”. Elderholme is progressing with meeting the equality and diversity needs of individuals however further progression is still needed as identified within the report. The cost of living at the home ranges from £525.00 to £555.00 per week. Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 6 What the service does well: People told us that staff are welcoming, kind and attentive. Everyone spoken with believed that they were well, cared for and in some cases felt that their health had improved since they moved into the home. People told us that: “ Staff are very kind, you only have to ring the bell and they come”, “I like the staff “they are very good, they know what I want and look after me”, “Staff are kind and caring, and always have time for you”, And “Staff are very attentive, nothing is a trouble to them, anything you need in the night, staff are there, that makes me feel safe”. We found that staff are quick to seek advice from doctors and other health professionals if a persons health deteriorates. People told us that “ I just have to say and the doctors here” Nursing staff keep themselves up to date with nursing skills by having refresher training and have the skills to promote wounds to heal. Visitors are made very welcome by the staff and people are supported to go out with their visitors if they choose. People told us that they felt safe living at the home. “ I don’t worry about anything any more- this is my home and that’s that- I trust them to sort everything out for me” And “ Yes – I trust the staff I feel safe here- They’re a good bunch” The national minimum standards recommend that over 50 of staff should have achieved a National Vocational Qualification in care. 63 of staff have achieved this at the home with plans for a further 9 staff to undertake the award. This reflects good practice and shows a commitment from the home to develop the staff team and ensure that they have the rights skills to care for the people who live there. We found that the staff team are committed and that they often cover one another’s shift if staff are absent. This is very good practice and reduces the Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 7 risk of people receiving care from strangers who may not know their needs like the regular staff team would. Despite significant changes to the staff team believe that morale is good in the home. They told us that “Staff moral is not low, change affects people in different ways”. The home employs a full time maintenance officer. We found that this staff member takes his responsibilities seriously and undertakes a number of checks to try to ensure that the home is a safe place to live. What has improved since the last inspection? The manager has developed the records that are used to assess new people further. This means that staff are able to record their needs and wishes in more detail and pass this information on to other departments within the home. This means that staff have more information than before to make the transition as smooth as possible for new people who decide to move into the home. We found that although care planning (peoples care records) still needs more development, improvements had been made so that staff were recording better information than before. Care plans are the written instructions that each person has telling staff how to care for them and how they would like their care delivered. It is important that these documents clearly reflect the care that a person needs. Staff have undertaken a variety of training, which means that they have developed their skills so that they can provide better care and support to the people who live at home. A newsletter has been introduced for the people who live at the home and a “residents committee” has been formed. This reflects good practise as it is encouraging the people who live at the home to have an opinion about how the home develops. One relative who has experience in this area has volunteered their services to work with the manager to look at quality issues and raise standards within the home. The home was replacing the old call bell system when we visited. This means that people can be confident that staff will hear the bell when they ask for help and can also sit outside the home and summon help if needed. Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 8 What they could do better: Care plan documentation could be developed further so that people are involved in what is written about their care and they can choose how they would like to receive that care. For example personal prefences such as “ prefers a shower rather than a bath” or rising and going to bed times could be included. This would mean that staff would have written instructions about how people want to be supported. Some equality and diversity issues were noted during the visit and although in the main the majority of peoples needs are met there are occasions when peoples individual needs are not being met. We met with some one who couldn’t speak to us but could communicate through nodding. No information was available in this person room to help them communicate with others. We also met with some one who was struggling to use basic equipment within the home due to dexterity problems. This information was passed to the manager. Staff were very supportive to people during mealtimes however we didn’t see anyone using specialised cutlery or plate guards which could help promote peoples independence rather than relying on staff support. We saw that staff were only giving medications to people after they had eaten. Some medications should be given before food is taken. Medicines must be given to people at the correct time as receiving medicines at the wrong time could seriously affect their health and wellbeing. Some people who live in the home have been prescribed medication that needs to be given to prevent an episode of ill health rather than being given regularly on a daily basis. Clear records must be developed to ensure staff have accurate instructions to follow about when and how these medications are to be given. This will ensure that people are given the correct medication for their individual needs. The controlled drugs cupboard in use within the home does not comply with the law, which governs this type of medication. A legally compliant controlled drug cupboard must be available to help prevent controlled drugs from being mishandled or misused. Many of the people who live at the home were spending time in their bedrooms. We saw that the majority of bedroom doors were open. We didn’t know whether this was because people chose to have them open or whether staff had encouraged them to be open so that they could observe. This should be explored to ensure that people are given the opportunity for privacy if they desire. The manager should implement audits to ensure staff are carrying out their role correctly. These audits should include checking medications are managed safely, ensuring care plan records are up to date and updating staff training records. The manager was carrying out these tasks but has not done lately. Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 9 The home is in the process of appointing a new activities person. Some large group activities have been occurring in the home, but small group or individual activities have not. The weekly outing has not been occurring also. These shortfalls must be addressed to ensure people are offered a stimulating quality lifestyle. We saw that staff interact very well with people but that they were too busy to stop and chat for any length of time to people. The manager explained that staffing levels had been reduced due to a number of resident vacancies. Consideration should be given to using the residential forum guidelines staffing tool to determine what staffing levels will be in the home. This will show that the home is being staffed according to people’s needs rather than occupancy levels. Time could be built into this for staff to sit and chat to people or to organise small group activities such as discussing the daily news. The manager told us that she was aware of the shortfalls in activity provision and also shortfalls in the catering department. Surveys are to be sent out to people requesting their opinion before action is taken. People told us that they liked the food. They said that: “I like the food, and I have a choice of what is available”, “I haven’t seen a menu, but staff tell me what is for lunch, and tea, the food is nicely laid out”. “ Food is very good, meat is always lovely and tender and I like my food” And “I am eating better since being here, the food is nice” Despite these comments we would agree that there are shortfalls in the homes catering. For example during the visit we saw that the menu stated that a mixed grill was available. We saw people being served sausage, black pudding beans and tomato. This content was rather disappointing and may not meet people’s expectation of what a mixed grill is. We also found that people were right to say that they had never seen a menu. This should be addressed so people are consulted and aware of all food on offer at the home. We raised serious concerns about the lack of cleanliness in the kitchen. We issued an immediate requirement, which is a warning notice that requires the home to address these concerns in a short timescale. This notice is the first step in our enforcement procedure and if not complied with could result in prosecution. We visited the home two days later and found that the kitchen had been deep cleaned to ensure that the risk of infection occurring had been reduced. We informed the Environmental Health Officer of our concerns who also visited the home. Environmental health have not raised any further concerns to the commission. Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 10 We could not find cleaning schedules for any areas of the home (kitchen included) and found that the housekeeping team worked in all areas depending on what they were asked to do that day. This needs rectifying. Allowing staff to work in one area could encourage a sense of pride and ownership, which could resolve some of the concerns that we found. For example no one person is responsible for managing the laundry. We saw that this room was disorganised with poor storage and as a consequence peoples clean clothes were being returned to them crumpled and creased. This needs to be addressed so that people who live at the home are supported to dress with dignity. We found that some bedrooms were very clean and tidy and nicely decorated and others weren’t. This should be addressed by introducing cleaning and redecoration schedules so that all rooms receive equal attention. We also noticed that some day-to-day tasks could be improved to reduce the risk of infection occurring . For example we saw staff pushing an uncovered tea trolley around the building- Cleaning staff were spraying aerosols near it and the trolley was parked close to a toilet. We saw staff carrying uncovered meals around the building to people’s bedrooms and we had very serious concerns about some poor hygiene practices that we observed in the kitchen. We also had concerns about recruitment practises in the catering department which need to be addressed to ensure that staff who work at the home are suitable to work with vulnerable people. The home employs a manager (the registered manager) and a general manager as well. Each has responsibility for different departments, however the board of directors must consult the registered manager about the duties that they have delegated to the general manger. This must be addressed as a matter of urgency so that there is a clear management structure in place. Confusion could occur without a clear management structure, which could impact on the welfare of the people who live in the home. For example the home recent had a gas safety inspection. The inspection had failed due to a faulty extractor fan. The General manager knew about this and had taken action to address this however the registered manager did not know that the inspection had taken place. This highlights communication problems between the managers of the home. The present confusion could seriously impact on the health and welfare of the people who live at the home . We were provided with information regarding the homes recruitment of staff. We found that a significant number of staff have left the home in the last eighteen months. Although valid reasons were given for staff leaving this must Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 11 be thoroughly explored, as it is matter of concern. It is important that the people in the home receive care and support from staff that they know. It can be very unsettling for people who live at the home to regularly form new relationships which are then terminated because the member of staff has left. Generally we found that the manager responds to all concerns and complaints according to the homes policy. However some relatives of some people remain dissatisfied and appear to be regularly raising concerns both to the home and to the commission. These issues must be explored and rectified to promote good relationships with the families of the people who live at the home. 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.V360736.R01.S.doc Version 5.2 Page 12 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.V360736.R01.S.doc Version 5.2 Page 13 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): . Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are discussed with them before they move into the home so that staff can plan their care and support. People are provided with written information to help them decide whether they want to move into the home. EVIDENCE: We looked at three sets of records and had discussions with two people and one of their relatives who had recently moved into the home. The manager explained that the records had been improved so that staff were able to record peoples needs in better detail. Improvements had also been made so that the records reminded staff to pass on any information to the other departments within the home. For example staff are now reminded to pass the persons food likes and dislikes to the chef Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 14 so that the kitchen can prepare food that people enjoy. The records also showed us that other people such as social workers had been involved in deciding the type of care that the person needed. The records also showed us that staff meet with anyone who is interested in moving into the home before admission takes place. Detailed discussions are held so that people can discuss any concerns that they may have and staff are able to gather information so that they can plan for the persons arrival. This means that staff can make sure that the person will be cared for properly. One person told us that they believed that their health had improved since they moved into the home and this person’s relative also held this view. Another person told us that they had settled into the home and had found that the staff were very kind. The manager told us that people are given written information about the home which includes information from the commission’s last report and people are also given a document called a “service users guide” This document gives the reader an overview of what they can expect when they move into the home. The manager also explained that people are welcome to look around the home and we saw this happening during our visit. Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 15 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 adequate. This judgement has been made using available evidence including a visit to this service. Staff promote peoples health and people believe they are well cared for. However, the Management of Medication is not always carried out safely. This could impact upon the health and wellbeing of the people who live at the home. EVIDENCE: We looked at care plans that belonged to four of the people who live at the home. Care plans are instructions for staff to follow about the care and support that each person needs and how they would like to receive that support. One person told us that they knew that they had a care plan and that staff kept records of the care and support that they had received. The other three care plans did not show that the person had been involved or was aware of what it was or what it was for. Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 16 Everyone who lives at the home has a care plan in their room. This means that their personal records are accessible to them should they wish to look at them. However this also means that they are also accessible to everyone else who enters the person’s bedroom, which could breach confidentiality. This could be improved by ensuring staff sit down and discuss the plans with people and support people to decide where they would like their care plan to be kept. Some improvements have been made since the last visit as the plans are more detailed but there is room for further improvement by ensuring the persons choices are recorded. For example some people may prefer to have a shower rather than a bath, some people may prefer to get up early in the morning or some may prefer to lie in. This should be recorded on the persons plan so that they receive the support that they want. One plan did refer to the person by their chosen name throughout which reflects good practise. Some concerns were identified around the management of medications (see below). In particular written information was lacking about when to give one off medications to prevent seizures occurring. These instructions should have been included in the care plan. We met with one person who couldn’t talk to us but could communicate by nodding their head. Information was missing from the care plan about how to support this person to communicate. These shortfalls should be rectified so that staff have access to up date written instructions on how to provide care and support to promote peoples well being. Each of the plans viewed showed that other health care professionals regularly visit the home. These included G.P.s, dieticians, continence nurse assessors, chiropodists and dentists. We looked at records, which showed us that staff requested a doctor to visit within 24 hours of a person developing symptoms of ill health. Staff were also monitoring peoples health through recording weight, blood pressure, pulse etc. Staff had identified that one person had lost weight and had recorded clear instructions on how to monitor this situation, which is good practice. The plans showed that staff had considered the risk of a persons health deteriorating and that once identified these risks continued to be monitored. This shows that staff are trying to promote peoples health and well being. The people who live at the home supported this opinion by praising the staff for their ability to care and the kindness that they had been shown We saw that specialised equipment such as bedrails; airflow mattresses (to prevent pressure sores occurring) were available for those people who needed them. We saw that the home is well stocked with continence products and that each person has had an individual assessment by a specialist to ensure that these products are used correctly. A number of these products are provided free of charge to the home. However we looked at invoices that showed that the home purchased the same amount again every month to ensure that people were kept clean and dry. This is good practice. Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 17 We met with people who live at the home (nine) and we noticed that they appeared cared for. For example, ladies were wearing stockings and matching outfits, gentleman were clean shaven and everyone had clean short fingernails. Two visitors who regularly visit the home commented that they always found this to be the case. This is important as it promotes peoples self esteem. A number of people appeared to spend a lot of time in their bedrooms. We noticed that a large number of bedroom doors were open and wondered whether this was because the person preferred the bedroom door open or whether staff preferred doors to be kept open so that they could observe. This should be explored and if necessary action taken to ensure peoples privacy and dignity is respected. As part of the inspection a specialist pharmacist inspector looked at the handling of medicines. We looked at the records of medicines receipt, administration and disposal and found that they were usually detailed and accurate. We checked medicines records against current stock and found that most medicines were usually given correctly, ‘as prescribed’. However some of our checks found recording mistakes and we told the managers about them. We looked at the timing of medicines administration and found that most medicines were given after food, however staff had failed to identify all medicines that should be given before food. We gave some advice on how best to organise this as giving medicines at the wrong time can affect the way they work and in some cases increase the chances of side effects. We checked seven care plans to see if they supported the use of medicines. We found that the care plans to help manage seizures were not detailed enough because they lacked important information about how the medicines were to be used when a seizure happened. On one occasion the care plan had not been followed resulting in a medicine being given incorrectly, this placed the resident at unnecessary risk. Having clear written plans is important to ensure residents have their medicines administered correctly. We found the medicines storage room to be secure, clean and well organised. Five separate trolleys were used for transporting medicines to residents and this helped nursing staff administer them in an organised and timely way. A suitable lockable fridge was used to keep medicines in that required cold storage and this was regularly checked to ensure it worked correctly. Having secure, organised storage helps prevent mishandling and misuse. We looked at how controlled drugs were stored and we found the cupboard did not meet the requirements of law so we advised the manager how to put this right. Records of controlled drug handling were made in a suitable register and the entries that we checked were detailed and accurate. Having suitable arrangements for controlled drugs helps prevent mishandling and misuse. Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 18 We saw some evidence of medicines being checked by the manager and senior staff but a full audit had not been carried out for over a year and the smaller weekly stock checks had not been carried out for several months. We gave some advice on how to improve the content; recording and frequency of the checks to ensure all mistakes are identified. Having good checks helps ensure staff are competent and helps to show whether medicines are being administered correctly. Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 19 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 are offered some group activities but shortfalls in staff have meant that individual activities are not occurring. Staff are welcoming to visitors and people are supported to spend time with them inside and outside the home. People enjoy the food offered but meal content and consultation with people could be improved. This would ensure that people are being offered an imaginative diet that they have chosen and like. EVIDENCE: We discussed the provision of activities with the manager who told us that the home was recruiting a new activities organiser. We saw this happening during our visit. The manager explained that staff were trying to support people with some activities and bigger group activities such as the recent Mothers day lunch were still occurring. Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 20 The weekly outing has not been happening, as no driver has been available for the minibus. The manager told us that she is hopeful that this will be rectified in the near future. When we had discussions with people about activities they appeared indifferent with many people preferring to spend time in their bedrooms (except for meal times). Activities did not appear to be occurring for those people who are unable to socialise without staff support. We saw that the main activities occurring appeared to be task orientated such as getting washed, bathing, cleaning of rooms by domestic staff and distribution of laundry. Staff interacted well with the people who live at the home during these times however they appeared busy, seldom stopping to engage in conversation for any length of time. It would be beneficial if time was set aside each day on each unit for staff and people who live at the home to get together even if it is just to discuss what’s in the news that day. This would encourage people to interact and help to promote a quality lifestyle. We saw that Television is the main activity for those people who chose to spend time in their rooms however when engaged in conversation people became animated and appeared to enjoy the contact. A range of stimulating activities must be provided with the opportunity to go on outings so that people do not become isolated and out of touch with the outside the world. Everyone we spoke with agreed that the staff at the home are very welcoming to visitors. People are supported to go on outings with their friends and family when they choose and are also supported to attend church if they wish. Visitors from a local church come to see several people each week and they were complimentary about the openness and willingness of staff to please. We watched how staff supported people during a mealtime. Staff were pleasant, helpful and chatted amiably to people. The home has two dining rooms and each was set with tables with linen tablecloths and linen serviettes were provided for people to use. Teacups and glasses for juice were available with domestic cutlery. We saw that staff gave appropriate support to help people eat their food however we didn’t see anyone using specialised cutlery or aides. The use of these should be considered as these aides can help promote independence for people with dexterity problems rather than people having to rely on staff support. Everyone we spoke with (nine people) was complimentary about the food provided by the home. However the meal content should be reviewed to ensure that it meets people’s expectations. For example a menu was displayed in the hall stating that the lunchtime meal was a mixed grill. The meal when it arrived contained sausage, black pudding tomatoes and beans. There is an Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 21 expectation that this type of meal would contain mushrooms, bacon and possibly some other kind of grilled meat. People told us that they didn’t see the weekly menu but relied on staff to tell them what was available before each mealtime. This should be reviewed so that people are consulted about what meals are available. This will help to empower the people who live at the home and help to ensure that people are being offered choices that they enjoy. We discussed this concern with the manager who told us that she was aware of the need for consultation to take place and was preparing to survey everyone who lived in the home and their relatives about the food provided by the service. This should be carried out, as it is good practise and would help people to feel involved in the development of the home. Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live at the home are confident that staff will listen to their concerns and take action to put things right. However some ongoing concerns have been raised by relatives, which have not been resolved. Staff have the skills and knowledge to protect people from abuse EVIDENCE: We held discussions with two people who told us that they believed that staff would help them if they were unhappy with anything in the home. We saw that the a copy of the homes complaints procedure is displayed near the front door and that this tells people how to complain, and what will happen next .We looked at records which showed us that the manager investigates complaints and following the investigation writes to people with an outcome of her investigation. These records showed us that the manager responds to complaints within 28 days. This shows that complaints are addressed as stated in the homes complaints procedure. Some relatives have been raising concerns to the manager for some time and although records showed us that she had addressed these, the relatives continue to remain dissatisfied with the home and have raised concerns to the commission. The manager must be supported to resolve these concerns so Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 23 that peoples expectations are met and good relationships are promoted between family and staff at the home. We saw that the manager has a copy of the local authorities safeguarding procedures. This means that staff have access to written information telling them what to do if they suspect that abuse has occurred. The manager told us that a member of staff had completed training in this area so that she can train other staff. We looked at a booklet that this staff member had produced to give out to new staff which showed us that she has the knowledge to deliver this training. We looked at records and had a discussion with the manager that showed us that staff have had training in prevention of abuse and that Senior staff have also had training in how to alert Social services if they suspect abuse has occurred. Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 24 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): 19,23,26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. No structure is in place to ensure that all areas of the environment are maintained to a good standard. The risk of infection spreading (particularly in the kitchen) is not reduced as much as it could be which puts people’s health and welfare at risk. EVIDENCE: We looked at the homes service file before we visited and were aware that the home had recently had an outbreak of a serious infection. Staff confirmed that they were given clear instructions and directions from the manager.on how to manage the infection. We walked around the home so that we could look at people bedrooms, communal lounges, dining rooms, bathrooms, toilets, the laundry and the Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 25 kitchen. We saw that the home had good quality furnishings and fixtures. (Including bedding and linen) We met with the maintenance officer who explained that he was responsible for the day to day maintenance of the building as well as redecoration of bedrooms. He explained that whenever a bedroom was vacated his policy was to redecorate it. As there has been a high turn over in occupancy recently this has meant that certain bedrooms have been redecorated several times. We looked at the décor of some of the bedrooms. Whilst some were decorated to a good standard others required redecoration. For example one person who has lived at the home for some time was found to be living in a bedroom with stained walls, which needed redecoration. Storage in the room was also an issue. The manager explained that as this person had resided in the home for some time so a number of belongings had been acquired. A maintenance plan needs to be established so that all bedrooms that require redecoration are attended to. Storage solutions such as providing storage elsewhere in the home should be explored and discussed with people and/or their relatives. This would ensure that everyone has a nicely decorated uncluttered room. People told us that they thought the cleaning staff worked very hard and that their room was cleaned to a very high standard. We saw that in some cases this was accurate however standards of cleanliness varied throughout the home. We noticed that the home smelt fresh and pleasant with the exception of one room, which was discussed with the manager at the end of our visit. We visited the laundry and found this to be untidy and disorganised. We watched staff returning clothing to people’s rooms and noticed that items (particularly men’s shirts) had not been ironed. We saw that the laundry lacks hanging space for clothing once it has been ironed. We discussed how the laundry was staffed. We discovered that the cleaning of the home and the laundry is shared by all domestic staff and is undertaken by a different member of staff each day. This means that no one is responsible for set duties or areas within the housekeeping team. We asked for copies of cleaning schedules for the cleaning of the home and the laundry but none existed. This means that there is no structured plan for the cleaning of the home which means that some areas could be missed whilst some areas could receive excessive cleaning. This should be addressed to ensure that consistent levels of cleanliness in all areas are achieved. This should ensure that the home is a clean and pleasant place to live. We looked at how the home prevents infection and found standards to be varied. Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 26 The home is equipped to prevent infection by ensuring staff are supplied with disposable products and alcohol handrub. However we watched staff carrying meals around the home uncovered. We saw cleaning staff spraying aerosols near an uncovered tea trolley and saw the same tea trolley being parked near toilets. These concerns show that the control and possible spread of infection is not managed consistently by the service. This must be addressed to ensure that all staff practice safe hygiene to promote the health and safety of the people who live at the home. We visited the kitchen and had serious concerns about the cleanliness of certain appliances and parts of the kitchen. We met with the Assistant Cook (chef) who explained that cleanliness had fallen behind due to staffing shortages. We were concerned that the lack of cleanliness could seriously impact on the health and safety of the people who live at the home so we issued an immediate requirement notice. This notice is the first step in our enforcement procedure and if not complied with could result in prosecution. We informed the environmental health department of our concerns also. We visited the home two days later to find that the general manager had ensured that the kitchen had been deep cleaned and had addressed Health and safety hazards, which we had identified. An Environmental health officer had also visited the home and they have not raised any further concerns to the commission. We were also concerned that no strict cleaning schedule existed for the kitchen. This means that certain areas and appliances are not being regularly cleaned. We watched a member of kitchen staff prepare food and found that they did not adhere to the strict handwshing guidelines required to maintain good food hygiene. We noticed that the protective clothing worn by kitchen staff looked stained, old and worn. We also noticed that another member of the kitchen team had uncovered burns exposed on their arms. These concerns show that staff that work in the kitchen are not following the strict hygiene rules required to reduce the risk of the spread of infection. We saw during our visit that kitchen staff leave the kitchen to visit other parts of the home. During this time they do not wear different clothing. Before we entered the kitchen we put on a protective overall but could not find a hat to reduce the risk of us taking infection into the kitchen. Refresher training must be provided to all kitchen staff as a matter of urgency to ensure the health and welfare of the people who live at the home is protected. Cleaning schedules must be drawn up and adhered to, to ensure the kitchen is clean and suitable for food preparation. Audits must be carried Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 27 out by management to ensure that standards are maintained and that the above concerns are addressed. Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 28 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): 27,28,2930 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People receive care and support from staff that they like who have received training to do their job well. Not all staff have been recruited correctly which means that not all staff may be suitable to work at the home. EVIDENCE: We spoke with nine staff and the manager for the home. We also looked at staff personal files and duty rotas, which showed us how many staff, were on duty at any one time. We also held discussions with nine people who live in the home. Everyone spoken with praised the staff and believed that the staff team worked hard and cared for them well. The duty rotas showed us that the staff team has been decreased and the manager explained that this had happened, as there were a number of resident vacancies in the home. Staffing numbers should be reviewed and increased or decreased in line with the residential forum guidelines. This is a tool, which works out how many staff should be on duty according to the amount of staff people need not the Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 29 amount of people living in the home. This would show that the home is staffed according to peoples needs and would reflect good practise. People and staff told us that Agency staff can be used when shortages occur but in general the staff team tends to cover any shortfalls as they know the peoples needs better than strangers would. This is good practise and shows commitment from the staff team to give people the best care possible. We saw records, which showed us that 63 of the staff team have achieved national vocational qualifications in care. The manager explained that a further six staff are undertaking this award and a further three are awaiting to start. This is greater than the 50 recommended by the national minimum standards for older people. We discussed staff training with the manager. The manager explained that due to other management activities the records, which are usually, kept showing, which staff have done which training had not been updated. However staff had undertaken a variety of training since the last visit. This included topics specifically for nursing staff so that they could keep their skills up to date and topics such as continence care and the correct use of products had been delivered to care staff. This type of training helps to ensure that staff are delivering the best care that they can. However the manager should ensure that the training matrix is updated so that clear evidence exists to show who undertook this training and when and “ at a glance” decisions can be made about which staff need to undertake refresher training. We looked at information that the manager provided , which showed us that considerable changes have occurred in the staff team which are cause for concern. Valid reasons were given for these changes however this must be thoroughly explored and rectified to ensure that people receive care and support from staff that they know and to give people who live at the home the opportunity to form relationships with staff which can only occur over time. We discussed this with staff and the consensus of opinion was that staff moral was not low, although it was acknowledged that there have been changes in the management structure and “change affects people in different ways”. Staff told us that they believed that they had received a good induction when they started work at the home, and that updated training for nursing staff is available. This helps staff to understand their role and the needs of the people who are they are supporting. We looked at staff records for new recruits. Their files contained the information that we would expect to find which would show the home has carried out necessary checks to ensure they are suitable to work with vulnerable people. However we looked at one file for a new staff member, Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 30 which didn’t contain this information. This must be addressed to ensure that all staff who work at the home are suitable and that people are in “ safe hands”. Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 31 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 are living in a home that does not have a clearly defined, cohesive management structure. This could impact on people’s health and welfare. EVIDENCE: We know that the manager is registered to manage the service with the commission. This means that a number of checks have been carried out by us to ensure that she is suitable to carry out her duties. We spoke with staff who told us that they found her approachable and commented that she had been particularly supportive following the recent deaths in the home. Staff felt the recent serious outbreak of infection was handled well, and that hey had been Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 32 given clear instructions from the manager on how to prevent the infection spreading further. We had discussions with the manager about her role at the home. In particular we focused on the serious concerns that we had found in the kitchen. The manager explained that although she had some concerns relating to food hygiene she had not been aware that the problems was as great as it was. The home employs a second manager known as the general manager who has responsibility for the kitchen and housekeeping. During the visit we found that the service had recently failed its gas safety test. The general manager explained that this was due to faulty extractor fan in the kitchen, which had been replaced that day. She confirmed that arrangements had been made for a further gas safety test to take place. The Registered manager was unaware of this failure or of the actions taken to rectify it. This highlights a break down in communication between the Senior managers of the home. The manager is aware that as the registered manager for the service she is in fact responsible for these areas and has raised her concerns to the board of directors. This matter needs to be addressed as this confusing management structure could seriously impact on the health and welfare of the people who live at the home. The registered manager must be supported to take full responsibility for all aspects of managing the service. During previous visits we saw that the manager had been carrying out audits on medication management and care planning. These audits have not been repeated and should be re introduced to ensure staff are fulfilling their duties. We discussed how the home manages quality assurance with the manager. Since the last visit the manager has formulated a newsletter, which is sent out to the people who live at the home so that they are kept up to date with what is going on. We read a newsletter, which showed us that a residents committee has been formed and people have voted for a chairperson. The registered manager explained that the first meeting had taken place and that a meeting had been arranged with the chair for her to receive feedback. This is very good practise as it encourages the people who live at the home to have a say in how they would like the home to be run. The registered manager was also able to show us surveys, which had been completed by people who live at the home and their relatives. These surveys had been used to seek peoples opinion about how the home is run, The manager stated that she intends to send surveys out three monthly with different focus each time i.e. plans are being developed to send surveys out regarding provision of activities, standards of catering etc etc. The registered manager also told us that a relative whose profession involves raising standards in care has volunteered her services to the home. The manager Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 33 believes this is beneficial and is working with this person to raise the quality of care and support offered. The general manger explained to us that the home does not manage anyone’s personal allowances or finances. In all cases relatives or representatives are encouraged to manage this. The home only holds small amounts of money on behalf of people and relatives and representatives are billed four weekly for any expenses. The general manager also explained that if a person doesn’t have a relative or representative then solicitors are involved to ensure that their money is managed safely. We looked at a number of records, which relate to the maintenance of the equipment inside the building. This equipment includes that which is used for fire fighting and fire safety. The records for these areas were very well organised and showed that the maintenance officer acts responsibly by ensuring all necessary checks are carried out. Records showed us that staff have received training in health and safety, manual handling, fire safety and in most cases food hygiene. Since the last visit the service has replaced the call bell system. We saw that this was occurring during out visit. Additional call bells have been purchased for the communal areas of the home and remote bells have also been purchased so people can summon help if they are sitting in the garden. This is a big improvement on the call bell system that was in use. Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 34 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 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X 2 X X 1 STAFFING Standard No Score 27 2 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 35 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 OP9 Regulation 13.2 Requirement A legally compliant controlled drug cupboard must be available to store controlled drugs to help prevent mishandling or misuse. Medicines must be given to residents at the correct time as receiving medicines at the wrong time could seriously affect their health and wellbeing. People must be offered a range of fulfilling activities both inside and outside the home. The manager must be supported to resolve all concerns so that people’s expectations are met and good relationships are promoted between family and staff at the home thus ensuring positive outcomes for people living in the home. Schedules must be developed, implemented and audited by management to ensure that all parts of the home are clean and free of infection. This will help to reduce the risk of infection occurring, which will promote DS0000020938.V360736.R01.S.doc Timescale for action 30/06/08 2 OP9 13.2 30/05/08 3 4 OP12 OP16 16.m.n. 22.3 31/05/08 31/05/08 5 OP26 13.3 30/05/08 Elderholme Nursing Home Version 5.2 Page 36 6 OP26 16.j 7 OP29 19.1a.b. 8 OP29 18.1 9 OP31 10.1 people’s health and welfare. Kitchen staff must receive training to ensure that they all understand the importance of food hygiene and general kitchen hygiene. This will help to reduce the risk of infection occurring, which will promote people’s health and welfare All new staff must have necessary checks carried out to ensure that they are suitable to work with vulnerable people. This will help to ensure that people are receiving care and support from staff that they can trust. Staff recruitment and the significant changes to the staff team must be thoroughly explored so that people who at the home are receiving care and support from staff that they know well. The registered manager must be consulted by the board of directors regarding the delegation of management duties . The confusing management structure of the home could seriously impact on the health and welfare of the people who live there. 30/05/08 30/05/08 01/06/08 30/04/08 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 further to include people’s choices. This would show that people are involved in their care and help them to feel in control of their lives. DS0000020938.V360736.R01.S.doc Version 5.2 Page 37 Elderholme Nursing Home 2 OP10 3 OP9 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. Information on how to use medicines prescribed as ‘when required’ should be detailed and up to date to help ensure they are administered correctly. Staff should have access to clear written instructions on how to administer these. The manager should ensure that medication management is audited monthly. This will help to ensure that staff are competent and that medications are being managed safely. The manager should carry through her intention to consult people who live at the home and their relatives about the standard of food served by the service. Consultation should take place around menus and people should have access to these so that they know what food is available. This will help to make people feel included in the service and enable them to have some control over their lives. A decorating schedule should be introduced so that all rooms receive attention when required. This will help to ensure that everyone who lives at the home has a nicely decorated bedroom. The laundry room and management of laundry in general needs restructuring so that people clothes are cared for correctly. People should be provided with crease free clothes, which would help to promote their self esteem. Staff should be reminded of the importance of reducing the risk of infection when carrying out every day tasks. This will help to reduce the risk of infection occurring and will help to promote people’s health and welfare. Residential forum guidelines should be used to determine staffing levels rather than increasing/decreasing the staff team according to occupancy levels. This will ensure that people receive care and support according to their needs. All staff training should be recorded on a training matrix so that “ at a glance” decisions can be made about whether staff are up to date. This will help to ensure that staff have up to date skills to care and support the people who live at the home. 4 OP9 5 OP15 6 OP19 7 OP19 8 OP26 9 OP27 10 OP30 Elderholme Nursing Home DS0000020938.V360736.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection North West Region CSCI Preston 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@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.V360736.R01.S.doc Version 5.2 Page 39 - 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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