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Inspection on 24/09/08 for Elm View Nursing Home

Also see our care home review for Elm View Nursing Home for more information

This inspection was carried out on 24th September 2008.

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

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

The home is clean and tidy. Meals at the home are good, offering choice and variety. Relatives are made to feel welcome when they visit. There are enough staff on duty to meet people`s needs. People living in the home say that they like the staff.

What has improved since the last inspection?

People moving into the home are being given the terms and conditions of residence document, which means they are being told about their rights and responsibilities. Care staff are no longer working excessive hours. This means that they can do their job properly. There is a shower available so that people have a choice of either a bath or shower.

What the care home could do better:

The home is not being managed properly. There is no one responsible for developing the service. There has been very little improvement since we last inspected the home in March 2008. People`s care plans must be up to date and accurate to make sure that people`s needs are being identified and met. Individuals and/or their relatives must be involved in the care planning process to make sure they are consulted about their care and support. Improvements must be made to the risk assessment process to make sure that any risks to people living in the home are identified and measures put in place to reduce them. Staff must then follow these assessments to make sure people are kept safe. Improvements must be made to the management of the medication system. Staff must follow the medication administration procedures. This will make sure people get their medication at the right times. Activities need to be provided on a regular basis to keep people living in the home stimulated. The adult protection procedures must be followed. This will make sure people living in the home are kept safe. New staff must be properly checked before they start work at the home. This will make sure they are suitable and safe to work with older people. More staff training needs to take place to make sure staff have the right skills to look after people. The quality assurance system needs to be introduced to make sure people are consulted about the way the home is run.

CARE HOMES FOR OLDER PEOPLE Elm View Nursing Home 2 Elm View Huddersfield Road Halifax West Yorkshire HX3 0AE Lead Inspector Paula McCloy Key Unannounced Inspection 24th September 2008 09:35 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 Elm View Nursing Home DS0000001050.V372207.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. Elm View Nursing Home DS0000001050.V372207.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elm View Nursing Home Address 2 Elm View Huddersfield Road Halifax West Yorkshire HX3 0AE 01422 362538 01422 362538 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) Mr Philip Bentley Mrs Barbara Bentley Manager post vacant Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Elm View Nursing Home DS0000001050.V372207.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Can accommodate one named service user under 65 years of age Date of last inspection 28th March 2008 Brief Description of the Service: Elm View is a care home for older people that provides both personal and nursing care. The home is a converted property and provides accommodation over three floors. Single and double bedrooms are available. There is a lounge/dining room on the ground floor and a separate quiet lounge. Each floor is accessed by a passenger lift. Elm View is situated on the main Huddersfield Road about a mile from Halifax town centre. There is a small car park and on street parking close to the home. At the rear of the car park there is a small, garden seating area that people can use in nice weather. The current weekly charges at the home range from £331 - £443 per week. Additional charges are made for hairdressing and chiropody. Elm View Nursing Home DS0000001050.V372207.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 0 star. This means the people who use this service experience poor quality outcomes. The last inspection of the home took place on 28 March 2008 and the service was assessed as being poor. We asked the owners to provide us with a plan and tell us how they were going to make the necessary improvements. Since then we have met with the owners and been back to visit the home to follow up on a complaint that was made to us. This inspection was carried out by two inspectors to assess the quality of care provided to people living at the home. The inspection process included looking at the information we have received about the home since the last key inspection as well as a visit to the home, which was carried out over one day and lasted approximately 6 hours. During the visit we spoke to 4 people who live in the home, 1 relative and 6 staff. We observed care staff delivering care, looked at various records and looked around the home. We sent the home a self assessment form before the inspection asking them to give us with some information about the service. They did not send this back to us. We also sent out comment cards to 10 people living in the home, 10 staff and 5 health care professionals; these cards provide an opportunity for people to share their views of the service with us. No one wrote back to us with any comments. What the service does well: The home is clean and tidy. Meals at the home are good, offering choice and variety. Relatives are made to feel welcome when they visit. There are enough staff on duty to meet people’s needs. People living in the home say that they like the staff. Elm View Nursing Home DS0000001050.V372207.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The home is not being managed properly. There is no one responsible for developing the service. There has been very little improvement since we last inspected the home in March 2008. People’s care plans must be up to date and accurate to make sure that people’s needs are being identified and met. Individuals and/or their relatives must be involved in the care planning process to make sure they are consulted about their care and support. Improvements must be made to the risk assessment process to make sure that any risks to people living in the home are identified and measures put in place to reduce them. Staff must then follow these assessments to make sure people are kept safe. Improvements must be made to the management of the medication system. Staff must follow the medication administration procedures. This will make sure people get their medication at the right times. Activities need to be provided on a regular basis to keep people living in the home stimulated. The adult protection procedures must be followed. This will make sure people living in the home are kept safe. New staff must be properly checked before they start work at the home. This will make sure they are suitable and safe to work with older people. More staff training needs to take place to make sure staff have the right skills to look after people. The quality assurance system needs to be introduced to make sure people are consulted about the way the home is run. Elm View Nursing Home DS0000001050.V372207.R01.S.doc Version 5.2 Page 7 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. Elm View Nursing Home DS0000001050.V372207.R01.S.doc Version 5.2 Page 8 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 Elm View Nursing Home DS0000001050.V372207.R01.S.doc Version 5.2 Page 9 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): 1, 2, 3 & 5 (standard 6 does not apply) People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People are assessed before they move in but staff are not using this information to plan for their care and support. This means there is no guarantee that people’s needs will be met. EVIDENCE: There is a service users guide available that contains information about the home and the service it provides. It has been updated since our last inspection but because of staff changes is not up to date. There is a copy of the terms and conditions of residence document in the service users guide. We found that the two most recent admissions to the Elm View Nursing Home DS0000001050.V372207.R01.S.doc Version 5.2 Page 10 home had been given this document. This means that people are being given information about their rights and responsibilities. Staff at the home are making sure that they assess people before they move in and collect the relevant information from social workers. This should mean that staff are sure that they can meet people’s needs before they move in, however, staff are not using this information to plan for people’s care. This means that there is no guarantee that they will meet people’s needs. Staff said that they encourage people to come and have a look around the home, although sometimes relatives do this. This gives people the opportunity to see the home for themselves and decide if it is suitable for them. The home does not provide intermediate care. Elm View Nursing Home DS0000001050.V372207.R01.S.doc Version 5.2 Page 11 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 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Care plans are not up to date and do not accurately reflect or identify the care people need. This means that people’s needs are not being met. EVIDENCE: We looked at a selection of care plans because we wanted to see what individual needs had been identified and what action staff are expected to take to meet these needs. There was no evidence in any of the care plans we looked at of people and/or their relatives being involved in the care planning process. We spoke to one relative who told us that she hadn’t been involved at all in the care plan and didn’t know what it contained. It is important that people are involved in the Elm View Nursing Home DS0000001050.V372207.R01.S.doc Version 5.2 Page 12 care planning process so that they have the opportunity to influence the care and support they receive. Staff at the home are not following the advice from other health care professionals. One person has a pressure sore. A specialist nurse has visited and prescribed a treatment plan. She has requested that the persons position is changed every 2 hours. During our 6 hour visit we did not see staff do this. When we asked staff if she was moved during the day they said that she was taken to the toilet before or after lunch. The specialist nurse also asked for the dressings to be changed 3 times every week. The records show that over 3 weeks the dressing has only been changed 5 times instead of 9. This means that staff have not followed her instructions about wound care. We looked at one persons nutritional risk assessment. Staff have not completed this properly using all of the information available. Their assessment is that there is ‘cause for concern.’ If all the available information had been used it would indicate that the person is at ‘high risk of malnutrition.’ We saw this person was being assisted by a member of staff with her meal at lunchtime. The risk assessment states that she eats independently. The care plan also states that she should be weighed monthly, she was not weighed in July. This means that staff are not completing the risk assessments properly and they are not identifying and meeting people’s needs. One risk assessment identifies that the person is at risk of getting skin tears and advises staff to be careful when using the wheelchair. The accident records show that she has received skin tears on 4 separate occasions, one of which required hospital treatment. Staff have not updated the risk assessment following these accidents to look at any further action they can take to reduce the risk. We could see from the assessment information for one person that they have rheumatoid arthritis there was nothing in the care plan about this or about the medication they are taking an the side effects. There was also nothing about pain management. The assessment information also said that this person had experience some ‘fitting,’ again there was nothing in the care plan about this. This person’s medication record showed that she is taking anti ‘fitting’ tablets and there was an entry in the daily records about her having a fit. One member of staff we spoke to did not know anything about the possibility of this person having a seizure. We talked to a member of staff about the care of another person at the home. She told us that it is very important that staff all follow exactly the same routine otherwise the individual gets very anxious. The care plan for this person is not detailed and doesn’t give staff the information they need to support this person in her preferred way. In each care plan there is a sheet where staff are supposed to record visits by health care professionals, so that it is easy to find out when people were last seen and what treatment was prescribed. Staff are not keeping these up to Elm View Nursing Home DS0000001050.V372207.R01.S.doc Version 5.2 Page 13 date and it is difficult to establish if staff are looking after people’s health care needs. For example at the inspection in March there was an issue about one person not having dentures. We looked at the records on this visit and there was nothing written down about a dentist visiting. We saw an entry in the daily records that about her daughter being concerned about the dentures bit couldn’t see that any action had been taken. We spoke to a member of staff who told us that the dentist has been but the person concerned had refused to have impressions taken. We also found that the GP had visited and prescribed antibiotics for a urinary tract infection, again this visit was not recorded on the correct document. There is nothing in people’s care plans about the medication they are taking. On the medication administration records various topical ointments and creams have been prescribed but there is no information about where and when these should be used. We looked at the medication records. We found that there were ‘gaps’ on some of the medication administration record. Staff are not signing them either to show that medication has been given or a reason that it has not. We also found that dressings, topical creams and fortified drinks are not being signed for on the sheets. Without the sheets being completed properly there is no guarantee that people are receiving the right treatment to keep them healthy. We also found that ‘ pharmacy sticky labels’ had been used on the medication records with details of the medication that had been prescribed. These should not be used as they could cover up something else on the sheet. We also saw that the names of some of the medications couldn’t be read properly on the medication administration record because holes had been punched through the name. Medication records must be clearly maintained so that staff can check they are giving the correct treatment. Elm View Nursing Home DS0000001050.V372207.R01.S.doc Version 5.2 Page 14 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 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Social activities are not provided consistently or on an individual basis to keep people stimulated. Relatives are made to feel welcome and can visit at any time. The meals are very good offering choice and variety. EVIDENCE: Some of the care plans we looked at had lots of information about people’s preferred routines, likes and dislikes, interests, life history and religious needs. For others there was no information at all about people’s past lives and experiences. At the last two inspection visits (November 2007 and March 2008) we told staff that this information needed to be collected used to develop social care plans for each person. Again this has not been done. It is Elm View Nursing Home DS0000001050.V372207.R01.S.doc Version 5.2 Page 15 important that staff do this to make sure that people’s individual social needs are met. We spoke to one member of staff and asked her what she knew about one of the people that moved into the home more recently, as there is nothing in her care plan about her. All she knew was that family visit. Staff need to have information about people so that they can make conversation with them and make sure they cater for their individual preferences. Staff told us that there is some entertainment coming into the home that people enjoy. Again on this visit we saw that staff do have time to spend with people living in the home, but they need training in how to provide stimulating and interesting activities on either an individual or group basis. We could see that relatives are made to feel welcome when they visit. Staff know people well and have developed good relationships. The meals at the home are very good. There is a wide choice at breakfast time and choices available for all of the other meals. Lots of drinks were offered throughout the day. During the week there is a dining room assistant on duty. She has a really good knowledge of people’s likes and dislikes and their individual dietary needs. She talks to the cook about what people like and the menus are changed accordingly. People living in the home, relatives and staff all said that the food was really good. The lunchtime meal was observed. The meal was nicely presented, everyone was served in a timely way and those people who needed assistance were supported appropriately. Elm View Nursing Home DS0000001050.V372207.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Adult protection issues are not being identified and dealt with properly, this means that people are not being kept safe. EVIDENCE: The home has received one complaint since the last inspection in March 2008 that was sent to them to investigate by social services. We have received 3 complaints about the home. We visited the home to look at some of the issues raised and asked the owner to investigate the others. We also involved the adult protection co-ordinator because one of the complaints was an allegation of physical abuse. The owner has investigated the complaints and has taken appropriate action. There were no details of the complaints we sent the home in the complaints log or the outcome. It is important that each complaint has an outcome to show if the action taken has been satisfactory or if there are further improvements that need to be made. Recently staff have received some training about adult protection and keeping people safe. This was covered with a variety of other topics and was only a ‘taster’ session. Staff will need to do further training to make sure they fully understand their responsibilities. From the accident reports we could see that Elm View Nursing Home DS0000001050.V372207.R01.S.doc Version 5.2 Page 17 staff are reporting any bruising they see on people living at the home, however, they are not investigating any possible cause or reporting using the adult protection procedures. It is not enough for staff to write ‘? cause’ on the accident reports they must show that the have fully investigated any injury, reported it using the adult protection procedures and reviewed the risk assessment to show they are trying to reduce the likelihood of the same thing happening again. Equally they need to make sure there is no element of neglect regarding accidents. For example one accident report we saw was about someone slipping from the wheelchair onto the floor. Again there is no follow up report that would tell us more about this and the action taken. For example we would expect the following type of questions to be asked: was there a lap belt available, should it have been used, was there an up to date risk assessment in place and was it reviewed following the accident? Again this was not reported using the adult protection procedures. It is important that staff make appropriate referrals to the adult protection coordinator. This will show that they are recognising safeguarding issues and are making sure people in their care are safe and protected. Elm View Nursing Home DS0000001050.V372207.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People live in a clean, safe, comfortable, well maintained home. EVIDENCE: Elm View is situated on Huddersfield road in Halifax. The town centre is easily accessible by car or public transport. There is a small car park to the front of the building. The kitchen was inspected by environmental health in January 2008 and was awarded 4 stars for hygiene. Elm View Nursing Home DS0000001050.V372207.R01.S.doc Version 5.2 Page 19 There is an assisted bath on the ground floor and since the last inspection in March 2008 the shower room on the second floor is now in use (although it is still waiting for a toilet to be installed). This means that people living in the home have a choice of a bath or a shower. There are still two bathrooms at the home that are not used. There needs to be a bathroom or shower that people can use on the middle floor and this should be included in the next refurbishment plan. The home was clean and tidy and people told us that this is the norm. People also told us that the laundry system is good and people always have clean clothing to wear. Elm View Nursing Home DS0000001050.V372207.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. There are enough staff on duty to meet the needs of people living in the home. Staff are not being properly checked before they start work, which leaves people at risk of being cared for by staff who may not be suitable. EVIDENCE: At the time of the inspection there were 19 people living at the home. The duty rotas were examined. These show that during the day there is one nurse on duty with four care assistants in the morning and one nurse and four care assistants in the afternoons/evenings. At night there is one nurse and two care assistants on duty. There is cook, domestic and laundry assistant cover during the day. During the week there is also a dining room assistant who takes responsibility for serving breakfast and lunch. Staff said that at the current time the numbers of staff on duty were adequate to meet people’s needs. People living in the home said that they liked the staff and found them helpful. At previous inspection we have been concerned that some staff have been working excessive hours and this could affect their performance. The owners Elm View Nursing Home DS0000001050.V372207.R01.S.doc Version 5.2 Page 21 have now addressed they have told us that staff will now be rostered to work over 48 hours per week. Some care staff that were qualified to NVQ level 2 in care have left the home since the last inspection. There are now less than the required 50 of staff with this qualification. More staff need to undertake this training to make sure there are always suitably qualified and competent staff on duty. Recruitment practices at the home are poor. Staff files do not contain all of the necessary information. We looked at the recruitment files for the two newest members of staff. One included two references and a POVA first check (this is the initial check to make sure someone can work with older people as long as they work with another member of staff). There was no application form and no criminal records bureau check (this is that check made with the police). The other file contained an application form, a POVA first check and two references but there was no criminal records bureau check. It was not possible from the files to find out when staff had started working in the home. We looked at the duty rotas and found that one member of staff had started work before the POVA first check had been completed. It is very important that before staff start working in the home that all of the necessary checks are made. This will make sure that staff are suitable and safe to work with older people. In September 2007 and March 2008 it wasn’t possible to establish what training each individual member of staff had completed and if their training was up to date. In August 2008 two training sessions were arranged and delivered. Each day covered induction, health and safety, food hygiene, infection control, protection of vulnerable adults, fire safety, moving and handling and dementia awareness. Staff have been given workbooks to complete as to cover so many topics in one day is only an introduction to each area. The acting manger told us that a further session on dementia awareness has been booked. There are still some care staff who haven’t received this training and need to do it to make sure they have basic skills and understanding. We will be asking the owners to give us more information about their ongoing plans for staff training. We looked at the induction training for the two newest care staff, who have worked in the home for 7-8 weeks. According to this they have both been given fire training and one has been told about accident reporting. There is nothing recorded about what training they have been given to enable them to be a care assistant and to deliver personal care. It is important that staff receive good induction training that provides them with the skills they will need to care for older people to make sure they are competent in their role. Elm View Nursing Home DS0000001050.V372207.R01.S.doc Version 5.2 Page 22 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 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home is not being managed properly. There is no registered manager and no one taking overall responsibility for the development of the service. EVIDENCE: The home is not being managed properly. There has been no registered manager at the home since October 2004. Following the last inspection in March 2008 the owner wrote to us to tell us that two of the nurses were going to ‘share’ the management of the home each having their own areas of responsibility. We wrote to both nurses to tell them that they must register Elm View Nursing Home DS0000001050.V372207.R01.S.doc Version 5.2 Page 23 with us if they are managing the home. We haven’t received an application. Since then one of the nurses has left. When we talked to a relative and staff they all said that they see the remaining nurse as the manager. The service users guide also names this person as the acting manager. We sent the home an annual quality assurance assessment document that asked them for a lot of information about the service. This was not sent back to us. The management of the home is poor. Following the inspection in September 2007 and March 2008 we met with the owners, they provided us with an improvement plan telling us what they were going to do to meet the requirements that were made after those inspections. We found that very few improvements have been made. Staff are not being provided with the leadership and direction they need to improve the service they provide. No one is actively looking at how improvements can be made. The acting manager told us that she needs help with the care planning process, as she doesn’t know how to bring about the necessary improvements. Examples of poor management highlighted in this report are: Care plans are not developing. People and/or their relatives are not being consulted about their care. Staff are not taking appropriate action when risks are identified. Adult protection issues are not being dealt with properly. The staff recruitment process is not through. Work has taken place regarding introducing a quality assurance system, but this has not been implemented. There are no systems in place to consult people about the way the home is run or to monitor practices in the home. One of the owners undertakes monthly visits to the home and as part of his visits talks to residents, relatives and staff about the service provided. Written reports of these visits are available at the home. He is not picking up on issues during these visits. For example during the August visit he checked Some staff files and said ‘they all appeared to be in order.’ We found the two files we looked at to be incomplete. He also looked at 5 accident reports and stated that no further action was required. One of the issues we have raised previously is that staff are not looking at how they can reduce or eliminate risks to people living in the home. We would, therefore, expect that the risk assessments would be checked as part of this visit. For example the accident reports showed that one person had slipped out of a wheelchair and two people has sustained skin tears. The owner should have check that staff had Elm View Nursing Home DS0000001050.V372207.R01.S.doc Version 5.2 Page 24 put good risk management plans in place to show what they were doing to stop these accidents reoccurring. At the last inspection in March 2008 we were concerned that the home were not telling us about certain things that had happened in the home that they need to tell us about. We call these ‘notifications’. For example the death of anyone living at the home and any accident in the home that people need medical treatment for. We have received no notifications since that inspection. We found three things staff should have told us about, two deaths and treatment for one person at A & E. It is important that the home let us know about certain things that happen so that we can check they have taken the right action. The manager holds money for people living in the home. There are records of the money held and receipts available for any purchases. We did find that there were a large number of receipts and it was difficult to cross check these with the entries on the cash sheet as some receipts gave the date and month but not the year. The system for ‘matching’ receipts to purchases needs to be better to make sure all purchases can be quickly accounted for. One of the cooks has identified a health and safety issue in the kitchen, which she has reported to the manager and owners but nothing has been done. There is an extractor canopy over the washing up sink, which doesn’t work and is in a low position. It’s position means that staff have to bend in an awkward way to avoid hitting their head. A risk assessment needs to be completed and action taken to make sure that staff are working safely. Elm View Nursing Home DS0000001050.V372207.R01.S.doc Version 5.2 Page 25 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 ENVIRONMENT CHOICE OF HOME Standard No Score 1 2 3 4 5 6 Standard No 19 20 21 22 23 24 25 26 Score 2 3 1 1 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 2 X X 2 Elm View Nursing Home DS0000001050.V372207.R01.S.doc Version 5.2 Page 26 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 OP33 Regulation 24 Requirement The quality assurance system must be implemented. This will enable the provider to monitor the quality of services offered and make sure any areas of concern are identified quickly. Staff must make sure that all of the available information about a resident is considered at the monthly reviews and use this information to make sure the care plan is up to date. Staff must also involve people and/or their relatives in the reviews. This will make sure that people’s current care needs and wishes are identified and planned for. (Previous timescales of 30/11/06, 14/10/07 & 2/7/08 not met) This is being dealt with under the Commissions enforcement procedures. The registered person must make sure that any risks that people may be subjected to because of their care needs are assessed. Control measures must be put in place to ensure DS0000001050.V372207.R01.S.doc Timescale for action 31/12/08 2. OP7 12 15 28/11/08 3. OP7 13,15 28/11/08 Elm View Nursing Home Version 5.2 Page 27 4. OP9 13(2) people are cared for safely. This must be done in consultation with people. This will that peoples needs are met safely and in a way that they wish. The registered person must make sure that all medication that is administered as prescribed is signed for. This includes ointments and creams. The medication administration records must clearly show what medication has been prescribed. This will make sure that people get the right medication at the right time. Information about what people like to do and what activities they would like must be recorded and a care plan put in place to show how these needs will be met. This will make sure that people are kept mentally active and stimulated. The owners must make sure that any complaint that they investigate is fully recorded at the home with details of the complaint, the action taken and the outcome of the complaint. This will make sure that necessary records are in place and check that a satisfactory outcome has been achieved. The registered person must ensure that staff in the home understand and recognise the possible indicators of abuse so that incidents that should be reported are reported without delay. This will make sure people are kept safe. The owners must make sure that all of the necessary checks are made on new staff before they start working in the home. This DS0000001050.V372207.R01.S.doc 28/11/08 5. OP12 16 31/12/08 6. OP16 22 28/11/08 7. OP18 12 13 (6) 28/11/08 8. OP29 19 28/11/08 Elm View Nursing Home Version 5.2 Page 28 will make sure that staff are suitable and safe to work with older people. (previous timescale of 14/10/07 & 2/7/08 not met) This is being dealt with under the Commissions enforcement procedures. The home must make sure that they make reports to us about any notifiable incidents. This will make sure that we can check they have taken appropriate action. (Previous timescale of 2/7/08 not met) 9. OP38 37 14/11/08 10. OP38 24(A) This is being dealt with under the Commissions enforcement procedures. The registered person must 30/11/08 make sure that the Annual Quality Assurance Assessment document that we request is completed and returned to us within the timescales given. This will make sure that we have the information we require before we do an inspection. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Elm View Nursing Home DS0000001050.V372207.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Elm View Nursing Home DS0000001050.V372207.R01.S.doc Version 5.2 Page 30 - 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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