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Inspection on 31/05/06 for Elderholme Nursing Home

Also see our care home review for Elderholme Nursing Home for more information

This inspection was carried out on 31st May 2006.

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

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

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

What the care home does well

Residents were complimentary in their view of the home and all of the staff. Comments such as `I am very happy here` and `the staff are lovely` reinforced this view. The positive view of the home was confirmed by the unanimous responses to the questionnaires. Personal choice and autonomy are promoted and assistance given to help residents exercise their choices in relation to flexible daily routines. The standard of food served at Elderholme is good with a strong emphasis on home cooking.

What has improved since the last inspection?

The environment and general safety has improved with the removal of numerous toiletries from bathrooms. Additional bed rails have been provided and all beds that require them now have two rails fitted as required. The gas appliances in the kitchen have all been replaced and the appropriate gas safety inspection carried out.

What the care home could do better:

The standard of record keeping in relation to care records and associated documents still needs to improve in order to meet the minimum standards. Whilst the documentation has been changed the information on the forms remains poor. The system for ordering, receipt, storage and administration of medications also need to be addressed urgently. Staff supervision has not been started and staff training falls short of the standards required. These issues are all outstanding requirements and the Commission for Social care Inspection is considering taking action to ensure compliance.

CARE HOMES FOR OLDER PEOPLE Elderholme Nursing Home Clatterbridge Road Bebington Wirral CH63 4JY Lead Inspector Les Smith Unannounced Inspection 31st May 2006 09:00 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.V288892.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Elderholme Nursing Home DS0000020938.V288892.R01.S.doc Version 5.1 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 343 1312 Wirrelderly Mrs Sandra Edge Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60) of places Elderholme Nursing Home DS0000020938.V288892.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 60 beds nursing care 6 named adults under 65 years of age Date of last inspection 27th February 2006 Brief Description of the Service: Elderholme is situated within the grounds of Clatterbridge Hospital, South Wirral. It is a single storey purpose built care home for elderly people, offering both nursing and personal care. The new extension has now been commissioned and the home now offers 60 places for nursing care. Fees at the home range from £510 to £540 per week. Elderholme has a large dining room and 3 separate lounges, each with a conservatory overlooking the pleasant courtyard and central garden area. Elderholme Nursing Home DS0000020938.V288892.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days and was conducted by a regulatory inspector and a specialist pharmacy inspector. A total of 30 hours were devoted to the inspection. The inspectors examined care records and associated documents, staff files, management records and had discussions with staff of all grades, residents and visitors to the home. A full tour of the premises took place in the company of the manager. A number of staff, relatives and residents were spoken to during the course of this inspection. A total of 20 questionnaires were sent out to relatives and 6 responses were received. A further 7 comment cards were sent to GPs’ who have patients at the home with 1 response. Responses to questionnaires sent to a random selection of relatives / representatives of residents Yes 1 2 3 4 5 6 7 8 9 10 Do staff welcome you in the home at any time Can you visit your relative/friend in private Are you kept informed of important matters affecting your relative/friend Make decisions, are you consulted about their care In your opinion are there always sufficient members of staff on duty Are you aware of the homes complaints procedure Have you ever had to make a complaint Are you made aware of forthcoming inspections Do you have access to a copy of the inspection reports on the home Are you satisfied with the overall care provided 6 6 6 6 4 4 4 2 4 6 No 0 0 0 0 2 2 2 4 2 0 Comments Responses to questionnaires sent to a random selection of General Practitioners with patients residing at the home Yes 1 1 1 1 No Comment 1 2 3 4 Does the home communicate clearly and work in partnership with you Is there always a senior member of staff to confer with Are you able to see your patients in private Do staff demonstrate a clear understanding of the care needs of service users Elderholme Nursing Home DS0000020938.V288892.R01.S.doc Version 5.1 Page 6 5 6 7 8 9 10 If you give any specialist advice is this incorporated into the service users plan Is service users medication appropriately managed in the home Do management/staff take appropriate decisions when they can no longer manage the care needs of the service user Have you received any complaints about the home Is the inspection report made available to you on request Are you satisfied with the overall care provided to service users within the home 1 1 1 1 1 1 What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Elderholme Nursing Home DS0000020938.V288892.R01.S.doc Version 5.1 Page 7 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.V288892.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents or their representatives have access to sufficient information to allow them to make an informed decision in relation to accepting a place but cannot be confident that the home is able to meet their needs. EVIDENCE: The Statement of Purpose and Service Users Guide have recently been updated and both documents contain all the required elements. Copies of the documents are given to all residents or their representative on admission and are available to prospective residents when assessing the home for suitability before making a decision as to whether to accept a place at the home. It is recommended that the revised Service Users Guide be distributed to all current residents or their representatives as appropriate. All residents’ files examined had an appropriate Statement of Terms and Conditions or contract in place. Elderholme Nursing Home DS0000020938.V288892.R01.S.doc Version 5.1 Page 9 Pre-admission assessments were seen in the care files examined. The assessments seen were inadequate in that they did not provide sufficient information for an initial care plan to be constructed and some areas had been left blank. Several assessments were not signed or dated by the assessing person. Where specific needs had been identified there was no indication of actions to be taken to meet those needs. The home has all the appropriate equipment and facilities to meet residents’ needs. Equipment and aids provided by the home include assisted baths and shower rooms, toilet adaptions such as raised toilet seats and grab rails, hoists and slings and slide sheets for transferring and moving residents comfortably and safely. Wheelchair access is available to all areas of the home including the garden areas. Elderholme has a large number of high dependency residents with complex needs. Whilst evidence was seen that referrals are made and advice is sought from members of the multi-disciplinary team the requisite level of skills and experience both individually and collectively is not present due to a lack of staff training and effective care management. This is demonstrated by the fact that at the time of inspection there were five residents with severe confusion and memory loss but there has been no training in caring for the older person with cognitive inpairment or challenging behaviour. Visitors and prospective residents are encouraged to visit the home at any time and as often and for as long as they as they wish when deciding whether to request or accept a place at the home. The home also offers trial stays with a view to permanent residency subject to availability. Elderholme Nursing Home DS0000020938.V288892.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lack of comprehensive and consistent care planning, risk assessment, review and ongoing noncompliance with previous requirements places residents at risk of harm or injury. EVIDENCE: A range of care plans and associated documentation were examined on the day of inspection. These included residents with differing needs such as sensory impairment, specialist nursing needs and varying levels of cognitive ability. The care planning documentation has been changed since the previous report and is a clear improvement. At the time of inspection 50 of care files had been changed to the new documentation. Better documentation however is only as good as the information entered on it and the care planning process remains neither comprehensive nor consistent. Lack of one or more required care plans was noted in most care files. The care plans that were not present ranged from basic activities of daily living to complex needs. It is a serious concern that some of the missing care plans related to major and complex problems such as peg feeds, diabetes and pain management. The lack of Elderholme Nursing Home DS0000020938.V288892.R01.S.doc Version 5.1 Page 11 required care plans fails to demonstrate that the interventions to meet known needs have been put in place. The risk of required care not being given due to lack of appropriate care plans is not acceptable. The standard of regular care plan review was poor with inadequate statements such as ‘no change’ or ‘reviewed’ with no justification as to why the care plan is to continue. The regular evaluation of care plans is essential to monitor the effectiveness of the care delivered and therefore the evaluation must detail the effectiveness or otherwise of care delivered thereby justifying any changes or no change to the plan. Daily report sheets were completed in variable amounts of detail. Some members of staff record a good level of detail whilst others record non-specific comments such as “settled and slept well”, “satisfactory morning”, appears bright”, and “no change”. Statements such as these give no indication as to the actual care delivered, the outcome of that care or how the resident has spent their day. The promotion of independence invariably involves an element of risk, which is managed via the completion of relevant risk assessments. The required risk assessments were not always present in the care files examined. Where risk assessments were present and reviewed, examination showed that the assessments were not always accurate and any reviews did not always reflect changes, which were evidenced in other parts of the care file. Associated documentation such as fluid intake charts, repositioning charts, investigations done with relevant results and regular observations are poorly maintained and do not demonstrate the level of care given. The associated care documentation provides the evidence that relevant care interventions have been carried out, the effectiveness of care delivery and ongoing progress or otherwise and accurate record keeping is essential. Examination of wound management records showed that information was not always present in the detail required. Full mapping of wounds or sores must be undertaken to ensure that improvements and deteriorations can be identified in the early stages to further plan the treatment to be given. Residents identified as having sensory impairment had no plans in place to address their special needs and plans in relation to their activities of daily living failed to reflect the additional input and care required due to their sensory impairment. It is a concern that whilst staff was aware that one resident had ‘poor vision’ it was clearly recorded in the care notes that the resident was registered as blind. Documentation in several care files showed that concerns in relation to aspects of care had been identified e.g. loss of weight, but no appropriate changes to care had been made nor had any referrals been made for specialist advice Elderholme Nursing Home DS0000020938.V288892.R01.S.doc Version 5.1 Page 12 from available services e.g. dietician. Evidence was seen that a member of the multi-disciplinary team had seen one resident but the recommendations made in relation to further management had not been acted upon. There have been seventy-six recorded accidents in the home over the previous six months, which equates to 3 per week and whilst not an exceptionally large number given the size of the home evidence was seen that appropriate and relevant actions are not always taken e.g. the taking and documenting of neurological observations following a head injury. Evidence was seen of accidents requiring attention at hospital and no notification being sent to CSCI as required. A commission pharmacy inspector inspected medication receipt, storage, administration and disposal. The inspectors report is not published but is available on request but requirements made are included in this report. Unlabelled creams found in a room. Creams are prescribed for individual residents and labelled as such. The removal of the labels and use for another resident is not acceptable. Thick and Easy food thickener is prescribed on an individual basis and two rooms were found to have cans in belonging to other residents. It is of particular concern that one of the rooms belonged to a resident that had been discontinued this particular item by their GP. A can was also found in the lounge clearly being used to thicken drinks for all residents present. The sharing of prescribed items is not acceptable Tub of cream in use in one room was three years past its expiry date Residents and visitors to the home during the inspection were very positive when spoken to in terms of the respect shown to the residents and the steps taken to ensure that privacy is maintained at all times. Residents made comments such as ‘the staff do more than their job’, ‘the staff are our friends’ and ‘I am very well cared for’. This is confirmed by the responses to the questionnaires sent to relatives. Staff members were observed interacting with the residents in a manner that respected their dignity and always addressed residents appropriately. Residents were all dressed appropriately in their own clothes and all personal care was carried out in private. Elderholme Nursing Home DS0000020938.V288892.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. As far as possible residents have choice and flexibility in how they spend their day in the home, and pursue social and recreational activities according to their choice and preferences thereby promoting independence and individuality for each resident. Meals at Elderholme are good, offering choice and variety whilst catering for residents dietary needs or cultural preferences EVIDENCE: The homes’ has recently increased the hours of the activities co-ordinator to 20 hours per week and the range and participation in social and recreational activities has increased. Activities include trips out in the homes mini-bus to local attractions, visiting library, group exercises, patient dog visits, and pampering and visiting entertainers. However in view of the size of the home and the differing requirements there is a need to establish the likes and preferences to provide a fully inclusive activity programme. It is recommended that consideration be given to increasing the hours of the activities coordinator to full-time. This would enable more to be done to provide stimulus for those residents who cannot participate in-group activities. Whilst the coordinator keeps records of activities it is strongly recommended that Elderholme Nursing Home DS0000020938.V288892.R01.S.doc Version 5.1 Page 14 participation in activities be recorded in the daily reports. This would help to develop a profile of likes and dislikes of individual residents. Access to the courtyard is via the conservatory and together with the well cared for gardens provides an opportunity for fresh air in good weather and these facilities are appreciated by the residents. The home has a policy of open visiting with friends and family welcome at any reasonable time and to stay as long as they and the resident wished. Visitors were observed to be arriving at the home throughout the day and residents were able to see their guests in one of the communal areas or in their own rooms as they wished. Daily routines are kept as flexible as possible in order to maximise individual choice and autonomy. Residents spoken to were complimentary about the assistance they received from the staff in relation to their personal choice, which was encouraged in many aspects of the daily routines. Dietary needs are well met both in terms of quantity and quality. Meals seen were well presented with staff members available to assist in a sensitive and discrete way if required. Menus seen demonstrated a good variety with alternative choices being available. The kitchen was clean and well organised with all gas appliances having recently been replaced. Members of the catering staff have valid food hygiene and handling certificates. Elderholme Nursing Home DS0000020938.V288892.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their representatives may be confident that most complaints will be dealt with in an appropriate, timely and effective manner but protection from abuse is compromised by a lack of awareness and training which places residents at risk of harm or injury EVIDENCE: There have been no complaints to the home and one anonymous complaint to the CSCI since the last report. The anonymous complaint was forwarded to the provider for investigation and following an appropriate response the matter is considered closed. Verbal complaints are dealt with by the registered manager but not documented. It is strongly recommended that a complaints register be established and that verbal complaints and actions taken are documented in order to demonstrate an open and transparent process. All residents are registered on the electoral roll and assistance is available to exercise their right to vote if required. Examination of training records showed that only 27 of staff has received training in the various forms of abuse, their recognition and the procedures to follow if abuse is alleged or suspected. Not all members of staff spoken to were able to demonstrate knowledge of abuse and the procedures to follow if abuse was suspected and the protection of the vulnerable adult processes. Training in Protection of the Vulnerable Adult needs to be completed for all staff. Elderholme Nursing Home DS0000020938.V288892.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment at Elderholme is good providing a homely, safe and comfortable place to live. EVIDENCE: Residents’ rooms are well furnished, bright and spacious with many rooms personalised by residents’ with personal possessions and memorabilia. A programme of redecoration in the older part of the home has been commenced and this should continue as and when rooms become vacant. Communal areas seen were well furnished with comfortable chairs and well used by residents. Two sluice rooms and the switch room were found to be open giving free access to contents to any wandering residents. Two rooms had beds fitted with bed rails but protective bumpers were not in use on either. Elderholme Nursing Home DS0000020938.V288892.R01.S.doc Version 5.1 Page 17 Two old rusty commodes found in one bathroom that need to be disposed of. The laundry was clean and tidy with relevant COSHH documents available for the staff. The kitchen has been refurbished with all new gas appliances and was clean and tidy. Temperatures of the fridges and freezers were recorded as required. There are sufficient numbers of toilets and washing facilities available for the residents use and facilities are close to the communal areas. The independence of residents is promoted by a large variety of aids including grab rails; assisted baths, raised toilet seats and residents who require them have wheelchairs. On both days of the inspection the home presented as being clean and hygienic. Elderholme Nursing Home DS0000020938.V288892.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff members are deployed in sufficient numbers to meet the residents’ needs. Residents’ are supported and protected by the homes recruitment policies but health, safety and welfare is compromised by a lack of staff training. EVIDENCE: Levels for both trained and untrained members of staff appear sufficient to meet residents’ needs at all times. The levels of agency used at the home in the previous eight weeks amounts to 84 Registered Nurse shifts and 180 hours care assistant shifts. This in total equates to 44 x 6 hr shifts. The use of agency on this scale compromises the wellbeing of residents and staff morale and needs to be addressed by relevant means. A selection of staff personnel files were examined and found to contain all the required documents. The home has seventeen members of staff with NVQ2 or above which equates to 48 and when those currently working towards the qualification complete their studies the home will be well above the target of 50 . Other training as detailed on the homes training records is as detailed below: Manual handling First Aid Elderholme Nursing Home 35 11 51 16 All expire July 2006 DS0000020938.V288892.R01.S.doc Version 5.1 Page 19 Abuse & Pova Infection control Health & safety Fire awareness 17 1 0 34 27 None since 2004 01 00 50 The last fire lectures were in June 2005 so all staff have a need for this training The mandatory training needs to be brought up to date. It is recommended that a system be put in place to enable tracking of training to help ensure that all staff attends. The home has obtained the commercially produced Induction and Foundation in care that was being considered at the time of the previous inspection. This has been introduced for new starters and subject to completeness will fully meet the requirements for induction and foundation training. It is essential that induction particularly is carried out in a timely and effective manner but the booklets seen for two recent starters only had minimal entries completed at a time when they should have been completed. The home also needs to consider providing additional specialist training in areas such as diabetes, stroke care, tissue viability and caring for the older person with cognitive impairment to help promote an awareness and competence in these specialised fields Elderholme Nursing Home DS0000020938.V288892.R01.S.doc Version 5.1 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The health, safety and welfare of residents continues to be compromised due to the lack of leadership, guidance and supervision at this home EVIDENCE: The registered manager is a first level nurse who has managed the home for the last five years and is registered with the CSCI. The recent changes in the organisational structure of the home when the management of catering, domestic and administrative areas was passed to the recently appointed general manager have resulted in improvements in these areas. As detailed in earlier sections of this report there are serious deficiencies in the nurse management of residents’ care records including pre-admission Elderholme Nursing Home DS0000020938.V288892.R01.S.doc Version 5.1 Page 21 assessments, care planning, risk assessments and associated documents and all aspects of medication receipt, storage and administration. Requirements made at the last inspection have not been met and there has been a further deterioration in some aspects. There is no comprehensive quality assurance system in place at the home although the home holds the ‘Investors in People’ award and has recently been reassessed. The situation remains that there is no formal supervision of care staff in place. This is a serious concern as staff supervision is a key integral component of effective staff management and has an important part to play in Quality Assurance. Records are securely stored and held in accordance with the Data Protection Act. Training in fire awareness, first aid, manual handling and health and safety all need addressing as detailed in the staffing section of this report. Appropriate service and safety certificates were seen for the fire alarm system, fire extinguishers, emergency lighting and relevant regular testing was seen in the fire logbook. The service certificates were seen for hoists. The contract for inspection and servicing of assisted baths has recently changed and four baths have been put out of commission by the home due to failure at the inspection and replacements are currently being sought. The gas safety certificate has been issued following refurbishment of all the gas appliances and cooking ranges. Elderholme Nursing Home DS0000020938.V288892.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X 3 1 2 2 Elderholme Nursing Home DS0000020938.V288892.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement The registered person must ensure new service users are admitted only on the basis of a full assessment undertaken by people trained to do so, and to which the prospective service user, his/her representatives (if any) and relevant professionals have been party. Timescale for action 31/07/06 2 OP7 14(2)(a)(b) The registered person shall ensure that the assessment of the service user’s needs is (i) (ii) kept under review; and revised at any time when it is necessary to do so having regard to any change of circumstances. 31/07/06 3 OP7 15(1) (iii) The registered person shall, after 31/07/06 consultation with the service user, or a representative of his, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. Elderholme Nursing Home DS0000020938.V288892.R01.S.doc Version 5.1 Page 24 4 OP8 12(1) The registered person shall ensure that the care home is conducted so as (a) to promote and make proper provision for the health and welfare of service users; (b) to make proper provision for the care and, where appropriate, treatment, education and supervision of service users The registered person must ensure that medication policies and procedures be reviewed in line with Royal Pharmaceutical Society of Great Britain and Nursing & Midwifery Council guidelines to cover all aspects of medicines management. Previous timescale of 30/04/06 not met The registered person must ensure that self-medication is promoted where appropriate. Risk assessments must be completed (and reviewed) and the resident provided with secure storage facilities within their private room. Previous timescale of 31/03/06 not met The registered person must ensure that full and accurate records are kept of all medicines received, administered and leaving the care of the home. There must be a full record of all medication currently prescribed for each resident. Previous timescale of 17/03/06 not met The registered person must ensure that all medication is only administered in accordance with the General Practitioners DS0000020938.V288892.R01.S.doc 31/07/06 5 OP9 13(2) 31/07/06 6 OP9 13(2) 30/06/06 7 OP9 13(2) Sch 3 (i) 01/06/06 8 OP9 13(2) 01/06/06 Elderholme Nursing Home Version 5.1 Page 25 9 OP9 13(2) 10 OP9 13(2) Sch 3 (i) 11 OP9 13(2) 18(1) 12 OP9 13(2) 13(6) 13 OP9 13(2) instructions Previous timescale of 17/03/06 not met The registered person must ensure that medicines are only administered to the resident for whom they were prescribed. There must be no sharing of prescribed preparations. Previous timescale of 17/03/06 not met The registered person must ensure that there is a detailed protocol and procedure in place for the administration of medication via the PEG tube. Written authorisation for this practice must be obtained from the residents General Practitioner. Administration must be recorded clearly. Previous timescale of 17/03/06 not met The registered person must ensure that staff authorised to administer medication receive accredited medicines management training and have an assessment of their competence, prior to performing these tasks. Previous timescale of 31/03/06 not met The registered person must ensure that nurses take and record the residents pulse prior to the administration of Digoxin. Written authorisation to administer this medication when the pulse drops below 60 should be obtained from the prescriber. Previous timescale of 17/03/06 not met The registered person must ensure that medication is stored securely at all times. Previous timescale of 17/03/06 not met DS0000020938.V288892.R01.S.doc 01/06/06 30/06/06 31/07/06 01/06/06 30/06/06 Elderholme Nursing Home Version 5.1 Page 26 14 OP9 13(2) 15 OP9 13(2) 16 OP9 13(2) 17 OP11 12(4) The registered person must ensure that residents have sufficient supplies of medication at all times The registered person must ensure that all waste medication is disposed of and recorded inline with current legislation The registered person must ensure that a system for date checking syringes and other medical equipment is implemented, to safeguard residents’ health and wellbeing The registered person shall make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service particularly in relation to service users receiving palliative care 30/06/06 30/06/06 30/06/06 31/07/06 18 OP12 16(2)(n) 19 OP30 18(1)(c) 31/07/06 The registered person shall having regard to the size of the care home and the number and needs of service users – consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation, fitness and training 31/07/06 The registered person shall having regard to the size of the care home, the statement of purpose and the number and needs of service users - ensure that the persons employed by the registered person to work at the care home receive – (i) training appropriate to the work they are to perform; and (ii) suitable assistance, including time off, for the purpose of obtaining DS0000020938.V288892.R01.S.doc Version 5.1 Page 27 Elderholme Nursing Home further qualifications appropriate to such work 20 OP31 9(2(b)(1) A person shall not manage a care home unless he has the qualifications, skills and experience necessary for managing the care home. The registered provider and the registered manager shall having regard to the size of the care home, the statement of purpose and the number and needs of service users carry on or manage the care home with sufficient care, competence and skill The registered person shall establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home including the quality of nursing where nursing is provided at the care home. The registered person shall ensure that persons working at the care home are appropriately supervised. The registered person shall give notice to the Commission without delay of the occurrence of any serious injury to a service user The registered person shall after consultation with the fire authority make arrangements for persons working at the care home to receive suitable fire training in fire prevention. The registered person shall make suitable arrangements for the training of staff in first aid The registered person shall make suitable arrangements to provide a safe system for moving and handling service users DS0000020938.V288892.R01.S.doc 31/07/06 21 OP32 10(1) 31/07/06 22 OP33 24(10 31/07/06 23 OP36 18(2) 31/07/06 24 OP38 37(1)(c) 31/07/06 25 OP38 23(4)(d) 31/07/06 26 27 OP38 OP38 13(4) 13(5) 31/07/06 31/07/06 Elderholme Nursing Home Version 5.1 Page 28 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. 2 Refer to Standard OP1 Good Practice Recommendations It is recommended that the revised Service Users guide be distributed to all residents or their representatives as appropriate. Criteria for the administration of when required and variable dose medication should be clearly defined and recorded for all service users prescribed such items. Verbal dose changes and new medication should be accurately entered onto Medication Administration Record charts with staff signature, date and authority where appropriate. Verbal dose changes should be confirmed in writing by the prescriber. A second member of staff should witness all hand written annotations on Medication Administration Record charts. 3 OP9 Medicines must be stored at the appropriate temperature. A record of temperature must be maintained for all areas where medicines are kept (fridge should be monitored daily) The opening date should be recorded on eye drops and other items with a short shelf-life Residents requiring blood glucose tests should have individual blood glucose meters appropriate to the strips prescribed for them Blood glucose meters should be calibrated and checked using control solutions on a regular basis (monthly) The suction device should be serviced by an appropriate person and a record maintained of weekly tests to ensure its readiness for use in an emergency. 4 OP9 Manufacturers Patient Information Leaflets should be available for medicines in the custody of the home There should be a ‘signature’ list for staff authorised to administer medication OP9 Elderholme Nursing Home DS0000020938.V288892.R01.S.doc Version 5.1 Page 29 5 OP9 There should be a formal system for prompting medication reviews in line with National Service Framework for Older People It is strongly recommended that the Liverpool Pathway for Palliative Care or similar protocol be referred to when providing palliative care. It is recommended that participation in social and recreational activities be documented on the daily report records within the individual care files. It is strongly recommended that a complaints register be established and that verbal complaints and actions taken are documented in order to demonstrate an open and transparent process. 6 OP11 7 OP12 8 OP16 Elderholme Nursing Home DS0000020938.V288892.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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