Inspection on 06/09/06 for Elderholme Nursing Home

This inspection was carried out on 6th September 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.

Other inspections for this house

Elderholme Nursing Home 14/08/08

Elderholme Nursing Home 17/03/08

Elderholme Nursing Home 09/10/07

Elderholme Nursing Home 11/01/07

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 Les Smith Key Unannounced 6th September 2006 11:00 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.V307524.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.V307524.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 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.V307524.R01.S.doc Version 5.2 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 31st May 2006 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 a large dining room and 4 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. Fees at the home range from £510 to £540 per week. Elderholme Nursing Home DS0000020938.V307524.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit took place over 1.5 days. During the visit care records and associated documents, staff files and management records were examined. A number of staff, relatives and residents were spoken to during the course of this visit to obtain their views in respect of the care and service provided at the home. Relatives spoken to were unanimous in their praise for the care provided and staff members were very positive about the current changes and the future. On the day of the visit there were 56 residents accommodated at the home. Residents appeared happy and expressed their satisfaction with comments such as ‘its’ great here’, ‘the food is excellent’,’ the staff are exceptional, they will do anything for you’. Members of staff were observed to be going about their work in a cheerful manner and clearly had good relationships with the residents. What the service does well: What has improved since the last inspection? What they could do better: Medication management remains a serious concern. The weaknesses in the administration and recording of medicines were so serious that the Commission is taking enforcement action. A Statutory Notice will be issued. Record keeping in relation to all areas of care including pre-admission assessment, care planning, risk assessments and associated documentation needs to improve. Records in relation to complaints whether written or verbal need to be strengthened. Elderholme Nursing Home DS0000020938.V307524.R01.S.doc Version 5.2 Page 6 Recruitment processes need to be made more robust particularly in relation to examination and verification of references. The induction of new staff must be monitored to ensure that induction of new staff is timely and effective. Formal staff supervision must be put in place and carried out at appropriate intervals. 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.V307524.R01.S.doc Version 5.2 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.V307524.R01.S.doc Version 5.2 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 both contain all the required elements. However, updating is required to reflect the recent changes in management. 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.V307524.R01.S.doc Version 5.2 Page 9 Pre-admission assessments were seen in the care files examined. The assessments seen were a significant improvement to those seen at the previous visit but still fall short of the standard required. The ability to construct an initial care plan is limited by the lack of detail e.g. assessed as requiring Oxford hoist for transfer but no sling size specified, requires assistance with diet but level of assistance not recorded. There was no indication on the assessments as to who and when they had been carried out or whether the assessment had been made with input from either a family member of any other relevant health care professionals. It is commendable that the assessments now include a brief life history and social activity profile. 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 remains poor due to a lack of staff training. This is demonstrated by the fact that at the time of this visit there were four residents diagnosed as having dementia but there has been no training in caring for the older person with dementia, 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 does not provide intermediate care. Elderholme Nursing Home DS0000020938.V307524.R01.S.doc Version 5.2 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 care planning process has improved but still falls short of the standard required and serious weaknesses in all areas of medication management place residents at risk of harm or injury. EVIDENCE: A range of care plans and associated documentation were examined this visit. These included residents with differing needs such as sensory impairment, specialist nursing needs and varying levels of cognitive ability. The care planning process is not consistent with three different formats being used at the present time. The manager said that a review of the different formats had been carried out and a decision has been made as to the format that will be used at Elderholme and that all care files will be changed in the very near future. The overall standard of regular care plan review was poor. Examples were seen of reviews not being done at all, inadequate reviews consisting of just a date and signature and good reviews depending upon the member of staff Elderholme Nursing Home DS0000020938.V307524.R01.S.doc Version 5.2 Page 11 responsible. 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 “no conditional change overnight”, and “satisfactory morning, appears bright”. 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. One care file showed a signed consent for the use of bed rails but the appropriate risk assessment whilst present, had not been completed. 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. The recording of regular observations such as weight are essential to identify at an early stage any deterioration and 3 care files examined showed that these residents had not had their weight taken for at least 2 months. 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 so that improvements or deteriorations can be identified in the early stages to further plan the treatment to be given. The details of prescribed dressings must be clear and reasons for any variation recorded. Residents identified as having sensory or cognitive impairment had no plans in place to address their special needs. Care plans in relation to their activities of daily living failed to reflect the additional input and care required due to their sensory or cognitive impairment. Documentation in care files showed that once concerns in relation to aspects of care had been identified e.g. loss of weight, referrals been made for specialist advice from available services e.g. dietician. The speech therapist was present in the home on the day and confirmed that referrals were made appropriately, Elderholme Nursing Home DS0000020938.V307524.R01.S.doc Version 5.2 Page 12 her recommendations were carried out and that she was happy with the care given. A specialist pharmacy inspector examined all aspects of medication management. The inspectors report is not published but requirements made are included in this report and it is available on request. The weaknesses found in the administration and recording of medicines were so serious that the Commission is taking enforcement action. A statutory notice will be issued. 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 ‘I am very happy with the care here’, and ‘the staff are lovely’. Staff members were observed interacting with the residents in a manner that respected their dignity and always addressed residents in a polite and friendly way. Residents were all dressed appropriately in their own clothes and all personal care was carried out in private. Elderholme Nursing Home DS0000020938.V307524.R01.S.doc Version 5.2 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 wellbeing 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 an activity co-ordinator for 20 hours per week and the range and participation in social and recreational activities is increasing. Activities include trips out in the homes mini-bus to local attractions, visiting library, group exercises, patient dog visits, pampering and visiting entertainers. The activity coordinator also provides one to one activities when appropriate. There is a need to establish the likes and preferences of individual residents to provide a fully inclusive activity programme and this will improve with the new life history and social activity profile completed during assessment. However in view of the size of the home and the differing requirements 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 co-ordinator Elderholme Nursing Home DS0000020938.V307524.R01.S.doc Version 5.2 Page 14 keeps records of activities it is strongly recommended that participation in activities be recorded in the individual care files. This would help with the development of individual preference records and a fully inclusive social recreational programme. 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 home places a strong emphasis on home cooking and fresh food with minimal reliance on frozen produce. Fresh fruit and vegetables and meat are delivered to the home three times per week. The kitchen was clean and well organised and all the members of the catering staff have valid food hygiene and handling certificates. Elderholme Nursing Home DS0000020938.V307524.R01.S.doc Version 5.2 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 complaints will be dealt with in an appropriate, timely and effective manner but protection from abuse is compromised by a lack of training which potentially places residents at risk of harm or injury EVIDENCE: The home has an appropriate complaints policy and procedure in place. There has been one complaint to the home and one allegation of abuse since the previous visit. The manager is dealing with the complaint in accordance with the policy and investigation is ongoing. The allegation of abuse was referred to the Wirral Adult Protection unit and following investigation was found to be unsubstantiated. It is essential that full records of all complaints be maintained that include details of investigation and any actions taken. These records should also include verbal complaints, which are currently dealt with by the manager but not documented. 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 18 of staff members have received appropriate training in protection of the vulnerable adult and this was in November 2004. Whilst staff members spoken to were able to demonstrate Elderholme Nursing Home DS0000020938.V307524.R01.S.doc Version 5.2 Page 16 a basic awareness of abuse, appropriate training in the various forms of abuse their recognition and the procedures to follow if abuse is alleged or suspected must be completed for all staff. Elderholme Nursing Home DS0000020938.V307524.R01.S.doc Version 5.2 Page 17 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: A tour of the home was undertaken accompanied by the manager. Residents’ rooms are well furnished, bright and spacious with many rooms personalised by residents’ with personal possessions and memorabilia. Rooms, particularly in the older part of the home are redecorated as and when they become vacant and maintenance is of a high standard with minor repairs carried out promptly. Many of the residents have a need for repositioning at regular intervals when in bed. There is a need for staff to be able to access both sides of the bed to complete this procedure and the placement of beds next to the wall prohibits this. The moving of the bed out from the wall each time presents a risk to the staff involved and wherever possible beds should be placed in a position that Elderholme Nursing Home DS0000020938.V307524.R01.S.doc Version 5.2 Page 18 gives access to both sides to eliminate any risk. Where it is not possible to place the bed appropriately then a comprehensive risk assessment must be in place to manage and minimise any risk. Two bathrooms are in the process of refurbishment with new assisted baths. Three rooms had beds fitted with bed rails but protective bumpers were not in use on either whilst another two beds had only one protective bumper in place. Communal areas seen were well furnished with comfortable chairs and well used by residents. 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.V307524.R01.S.doc Version 5.2 Page 19 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 adequate. 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 are compromised by a lack of staff training. EVIDENCE: Staffing levels for both trained and untrained members of staff appear sufficient to meet residents’ needs at all times. The number of agency used at the home in the previous eight weeks amounts to 93 shifts. The use of agency on this scale compromises the wellbeing of residents and staff morale. The manager stated that at present 4 staff members were hospitalised and a further three on maternity leave. The home has had a recruitment drive for both trained and untrained staff. Documents seen showed that a significant number of staff had been recruited and were waiting for the appropriate clearances before being able to commence duty. The manager has taken steps to address staff absences and is implementing a key worker system at the home, which will give much greater continuity of care. The home has seventeen members of staff with NVQ2 or above which equates to 54 with the majority of the other 46 working towards the qualification A selection of staff personnel files were examined and found to contain all the required documents. The home is reminded of the need to ensure that best practice is maintained when assessing the suitability of staff particularly in Elderholme Nursing Home DS0000020938.V307524.R01.S.doc Version 5.2 Page 20 relation to acceptable references, their verification and checking of employment history. Staff members employed at the home are not currently provided with a copy of the General Social Care Council’s code of conduct and practice and this needs to be addressed. Training as detailed on the homes training records is as detailed below: Manual handling First Aid Abuse & Pova Infection control Health & safety Fire awareness 61 0 17 11 1 34 66 00 18 12 00 37 Planned and booked training sessions were seen which showed that all staff will have completed the mandatory fire and manual handling training by the end of October 2006. The general manager was at the time of this visit arranging for first aid training. The home still needs to consider providing additional specialist training in areas such as tissue viability, diabetes, dementia, challenging behaviour, stroke care, sensory and cognitive impairment to help promote the wellbeing of all residents. The home has obtained a commercially produced Induction and Foundation in care for use of all new staff. 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 is carried out in a timely and effective manner but one recent starter in post for three months had still only completed 25 of her induction. The issue of completing induction was a cause for concern at the previous visit and must be addressed so that all new staff members complete their induction within an acceptable timeframe. Elderholme Nursing Home DS0000020938.V307524.R01.S.doc Version 5.2 Page 21 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): 31,33,35,36,37,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management and administration at Elderholme have improved and is focussed on the promotion of the health, safety and welfare of residents. EVIDENCE: The new matron at Elderholme commenced in July 2006 some six weeks prior to this visit. A first level nurse Mrs Whiteside has considerable experience in the provision of care for the older person. An application for registration has been made to the CSCI and is currently being processed. Mrs Whiteside is currently working towards her registered managers award. A new deputy matron has also been appointed and additional administration staff is in post to support the general manager and matron. Since her appointment the matron has made has reviewed all aspects of the service provided together with relevant record keeping and has commenced a Elderholme Nursing Home DS0000020938.V307524.R01.S.doc Version 5.2 Page 22 major change process in order to address the problems identified in this and previous reports. Changes implemented to date have achieved the support of the staff and all staff members spoken to were unanimous in their view that the changes were good with comments such as ‘things needed changing here’, ‘the changes are overdue and good for the home’, ‘there was a need for change and I am very confident about the future’. Mrs Whiteside has an open and transparent management style with a clear sense of direction and strategies to promote and enable an inclusive way forward for staff, residents and their representatives. As detailed in earlier sections of this report there are serious deficiencies in the standard of record keeping in relation to care records including pre-admission assessments, care planning, risk assessments and associated documents and all aspects of medication receipt, storage and administration. 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 notification to the CSCI of deaths, serious accidents or any events having an adverse effect on the health, welfare or safety of residents such as serious drug errors is not being It is a concern that formal supervision of care staff is still not in place. This should be addressed as a priority 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 has improved particularly in respect in the mandatory areas and the training programme needs to continue to provide a well trained and competent workforce. Appropriate service and safety certificates were seen for the fire alarm system, fire extinguishers, emergency lighting, boilers, hoists, gas and electrical systems and relevant regular testing was seen in the fire logbook. Elderholme Nursing Home DS0000020938.V307524.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 1 1 2 Elderholme Nursing Home DS0000020938.V307524.R01.S.doc Version 5.2 Page 24 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 OP1 Regulation 6 Requirement Timescale for action 31/10/06 2 OP3 14 3 OP4 18(1)(a) The registered person shall – (a) keep under review and, where appropriate,, revise the Statement of Purpose and the Service Users’ Guide; and (b) notify the Commission and service users of any such revision within 28 days. 31/10/06 The registered person shall ensure that pre-admission assessments are carried out in consultation with the service user or their representative and any health care professionals involved in their care and the assessment provides the relevant information to ensure that the home can meet all identified needs. Previous timescale of 31/07/06 not met The registered person shall 31/10/06 ensure that staff both collectively and individually have the skills and knowledge to provide the service and care provided by the home. (refer specifically to specialist training) DS0000020938.V307524.R01.S.doc Version 5.2 Elderholme Nursing Home Page 25 4 OP7 17(1)(a) (3)(a) The registered person shall maintain in respect of each service user a record which includes the information, documents and other records specified in items 1 and 2 of schedule 3 relating to the service user and ensure that such records are kept up to date Previous timescale of 31/07/06 not met The registered person shall keep the service users plan under review and after consultation with the service user or their representative revise the service users plan. Previous timescale of 31/07/06 not met 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 Previous timescale of 31/07/06 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 timescales of 17/03/06 and 01/06/06 not 31/10/06 5 OP7 15(2)(b)(c) 31/10/06 6 OP8 12(1)(a)(b) 31/10/06 7 OP9 13(2) Sch3 (i) 30/09/06 Elderholme Nursing Home DS0000020938.V307524.R01.S.doc Version 5.2 Page 26 met 8 OP9 13(2) The registered person must ensure that all medication is only administered in accordance with the prescribers instructions Previous timescales of 17/03/06 and 01/06/06 not met 9 OP9 13(2) 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 timescales of 17/03/06 and 01/06/06 not met 10 OP9 13(2) 18(1) The registered person must ensure that staff authorised to administer medication receive appropriate medicines management training and have an assessment of their competence, prior to performing these tasks. Previous timescales of 31/03/06 and 31/07/06 not met 11 OP9 13(2) The registered person must ensure that medication is stored securely and at the recommended temperature at all times. Previous timescales of 17/03/06 and 30/06/06 not met 12 OP9 13(2) The registered person must ensure that residents have sufficient supplies of all medication at all times Previous timescale of Elderholme Nursing Home DS0000020938.V307524.R01.S.doc Version 5.2 Page 27 08/09/06 08/09/06 31/10/06 30/09/06 09/09/06 30/06/06 not met 13 OP9 24(1) The registered person must ensure that there is a robust system to assess and improve the quality of medication handling and recording within the home 30/09/06 14 OP16 17(2) The registered person shall Sch. 4 (11) maintain in the care home the records specified in schedule 4 (11) – A record of all complaints made by service users or their representatives or relatives of service users or by any person working at the care home about the operation of the care home, and the action taken by the registered person in respect of such complaint 31/10/06 15 OP18 13(6) The registered shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. (refer specifically to use of bed rails and protective bumpers) 30/11/06 16 OP19 13(4)(c) 31/10/06 17 OP29 18(4) The registered person shall make 31/10/06 arrangements for providing persons who work at the care home with appropriate information about any code of practice published under section 62 of the Act. (refer specifically to the GSCC code of conduct and Elderholme Nursing Home DS0000020938.V307524.R01.S.doc Version 5.2 Page 28 practice) 18 OP30 18(1)(c) 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 including structured induction training suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work. 30/11/06 (ii) Previous timescale of 31/07/06 not met 19 OP33 24(10 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. Previous timescale of 31/07/06 not met 20 OP36 18(2) The registered person shall ensure that persons working at the care home are appropriately supervised. Previous timescale of 31/07/06 not met 21 OP38 37(1)(c) The registered person shall give notice to the Commission DS0000020938.V307524.R01.S.doc 30/11/06 31/10/06 31/10/06 Page 29 Elderholme Nursing Home Version 5.2 without delay of – (a) the death of any service user (b) the outbreak of any infectious disease (c) any serious injury to a service user (d) any event that adversely effects the wellbeing or safety of a service user (e) any theft, burglary or accident in the care home (f) any allegation of misconduct by the registered person or any person who works at the care home 22 OP38 13(5) The registered person shall make 31/10/06 suitable arrangements to provide a safe system for moving and handling of service users (refer specifically to placement of beds) 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 OP9 Good Practice Recommendations Full details for the administration of when required and variable dose medication should be clearly 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 entries on Medication Administration Record charts. Elderholme Nursing Home DS0000020938.V307524.R01.S.doc Version 5.2 Page 30 2 OP9 The suction device should be serviced regularly and a record maintained of weekly tests to ensure it is ready for use in an emergency. 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 3 OP9 4 OP9 There should be a formal system for prompting medication reviews in line with National Service Framework for Older People It is recommended that participation in social activities be recorded within residents individual care files It is strongly recommended that the registered person obtain a copy of the publication ‘Safe and Sound’ in relation to strengthening the recruitment process. 5 6 OP12 OP29 Elderholme Nursing Home DS0000020938.V307524.R01.S.doc Version 5.2 Page 31 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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