Inspection on 27/11/07 for Elstree Lawns Nursing Home

This inspection was carried out on 27th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Elstree Lawns Nursing Home 10/06/08

Elstree Lawns Nursing Home 26/04/07

Elstree Lawns Nursing Home 30/01/07

Elstree Lawns Nursing Home 26/07/06

Elstree Lawns Nursing Home 01/11/05

Elstree Lawns Nursing Home 21/12/04

Elstree Lawns Nursing Home 30/06/04

Similar services:

Claremont House

Firstlings

Fen Road

Dial House Nursing Home

Croxley House

Eversley Nursing Home

Cresta Lodge

Chilton Meadows Residential & Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Elstree Lawns Nursing Home Barnet Lane Elstree Hertfordshire WD6 3RD Lead Inspector Alison Jessop Unannounced Inspection 27th November & 13th December 2007 10:00 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 Elstree Lawns Nursing Home DS0000019344.V359704.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. Elstree Lawns Nursing Home DS0000019344.V359704.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elstree Lawns Nursing Home Address Barnet Lane Elstree Hertfordshire WD6 3RD 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) 0208 207 3255/3271 0208 207 1149 www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd Manager post vacant Care Home 54 Category(ies) of Dementia - over 65 years of age (54) registration, with number of places Elstree Lawns Nursing Home DS0000019344.V359704.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home may accommodate people (aged 50 or over) with a diagnosis of pre-senile dementia who require nursing care. 26th April 2007 Date of last inspection Brief Description of the Service: Elstree Lawns Care Home is sited in a large, three-storey building, which has been converted and extended to provide nursing care for those over 50 who have a diagnosis of dementia. The top floor of the building is no longer used for accommodation. All bedrooms are for single occupancy and 29 have en-suite facilities. Each floor has its own lounge and dining area and there is a hairdressing room for the residents’ use. The home is reached at the end of a long, secluded driveway and there is ample parking available in front of the building. There are gardens and patio areas to the rear of the home and these have been modified for the safe use of the residents. The home is set back from a busy road and is near to the village of Elstree and the town of Borehamwood. Facilities for shopping and leisure are within a short drive and there is a nearby bus service. The current accommodation charges range from £550 to £900 (£1000 for respite) per week. A copy of the homes most recent CSCI inspection report, Service user Guide and Statement of purpose is displayed in the foyer of the home. Elstree Lawns Nursing Home DS0000019344.V359704.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two Regulatory Inspectors carried this unannounced inspection out over two separate visits. The report was delayed until the minutes of a meeting held with Hertfordshire County Council were received on 3rd January 2008. The first visit to the home was on the 27th November 2007. The manager was on training and therefore some of the standards not fully inspected. The outcome of the inspection was very poor and two Immediate Requirement letters were served. Details of these can be found in the main body of this report. A response has been received to these immediate requirements. The second day of this unannounced inspection was carried out on the 13th December 2007. The manager was working at the home throughout the inspection and was available to answer any questions the inspectors had. The inspectors mainly concentrated on the care of the more vulnerable people during the second visit and it was found that the outcome for these residents was very poor. The service has been referred to the Health and Safety Executive and Hertfordshire County Council under the joint agency procedures for the safeguarding of vulnerable people. What the service does well: The inspectors did observe some sensitive and caring interaction with residents. One relative said ‘I am usually very pleased with my relatives personal appearance and the carers and nurses are good.’ Care plans contained comprehensive information about residents needs and a lot of work has been done since the last inspection to implement BUPA’s new ‘Quest’ care planning system. The majority of independent residents have access to stimulating activities and residents living on the ground floor have a better quality of life than for those living on the first floor. The service employs two activity co-ordinators who have organised a varied programme of activities, which some people clearly enjoy. Both activity co-ordinators are committed and enthusiastic about their role, however one said ‘its very difficult to find appropriate stimulation for the more vulnerable residents.’ Elstree Lawns Nursing Home DS0000019344.V359704.R01.S.doc Version 5.2 Page 6 Residents were offered drinks throughout the day however snacks were not available to those who could not ask. During meals staff were encouraging residents to eat as much as they could by continually prompting them. What has improved since the last inspection? What they could do better: The outcomes for people living at the home during this inspection were poor. Generally the more vulnerable residents do not receive good quality, sensitive care. They are not always respected and their dignity is not always preserved. Many residents were observed slumped in their chair for long periods of time with very little interaction. Several concerns raised since the previous inspection, instigated an extra inspection. During the first visit two Immediate Requirement letters were served. The first was following the observation of three residents being hoisted using the incorrect equipment. Resident’s safety was therefore put at risk. Staff do not always work in accordance with individual care plans, again putting residents safety at risk. It is a concern that incorrect moving and handling practices still continue following the recent incident where a resident sustained an injury after slipping from a standing hoist sling. On the 2nd visit Elstree Lawns Nursing Home DS0000019344.V359704.R01.S.doc Version 5.2 Page 7 one resident continued to sleep on a mattress on the floor. This puts both the resident and staff at risk as it is difficult to practice safe moving and handling from this position. Although staff have received training, this is not always reflected in the day-today practice, particularly the care provided to people with dementia, and moving and handling. Not all residents have access to snacks throughout the day and night, particularly those residents who cannot help themselves or are unable to ask. Many of the bedrooms of the residents are not homely, their personal belongings are not displayed and some of the armchairs are unclean, stained and torn. Residents clothing is left crumpled in drawers and one resident had no clothing in their wardrobe. On entering the home there was a beautifully decorated Christmas tree in the reception area and in the lounge on the first floor. There was not a Christmas tree in the large lounge on the first floor where most people on this floor spend their time and the tree in the small lounge had not been decorated. 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. Elstree Lawns Nursing Home DS0000019344.V359704.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 Elstree Lawns Nursing Home DS0000019344.V359704.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 and 3 6 does not apply, as the home does not provide intermediate care. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who may potentially use the service may not have accurate information to be able to make an informed choice about using the service from the organisations brochure, as it does not reflect the care offered in the home. EVIDENCE: The Service User Guide has been recently reviewed and is now a brochure filled with photographs of residents and staff. The inspectors’ feedback to the manager following the second visit included that some of the photographs did not reflect what was observed during the two visits. The brochure, which tells potential service users about the specialist dementia care which the home provides states ‘Care is offered within specialist units, where the layout and our experienced staff meet the unique care needs of people with dementia in a safe environment.’ Evidence found during the inspections and reported throughout this report suggests that this is not the case at Elstree Lawns. Elstree Lawns Nursing Home DS0000019344.V359704.R01.S.doc Version 5.2 Page 10 No one moves into the home without having his or her needs fully assessed. The manager or her deputy carried out a comprehensive assessment of needs to ensure that the service is suitable and that individual needs can be met. Elstree Lawns Nursing Home DS0000019344.V359704.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 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use this service cannot be assured that they will all be treated with dignity and respect or that their needs will be met appropriately putting them at possible risk. EVIDENCE: Some of the care plans and risk assessments have been reviewed since the last inspection. The ‘Quest’ care-planning system has been implemented which contains detailed information about residents care needs. It was evident in areas such as moving and handling and dementia care that staff are not following these documents. The inspectors observed three residents being moved from their armchair into their wheelchair using the incorrect equipment putting both them and staff at risk. The risk assessments for all three residents clearly stated that the Trixie full body hoist and sling must be used but all three were observed as being transferred using the Surita standing hoist. When staff were asked why they use the standing hoist, they responded that there was only one full body hoist Elstree Lawns Nursing Home DS0000019344.V359704.R01.S.doc Version 5.2 Page 12 in the home. This hoist needs to be taken between floors and due to the number of residents who require to be hoisted it is in high demand. An immediate requirement was made for extra full body hoists to be ordered to enable safe moving and handling procedures to be used. The manager of the home notified CSCI that there are in fact five hoists (type of hoists were not specified) in the home and that a new standing hoist has been ordered. The manager further stated that there were hoists available, which were being stored up on the second floor of the building and were not being used by staff. The reason why staff were not using the other hoists was not specified. Care plans did not provide adequate information in all cases to enable staff to care for that person safely. During the first visit two residents were sleeping on the floor on a mattress. The care plan for one of people who slept on the floor did not say why or how they were to be lowered or lifted to the bed. The care plan for the other person did not include their sleeping arrangements. During the second visit a specialist bed had been commissioned for one of the residents however the other resident continued to sleep on a mattress on the floor. A resident had fallen and fractured their upper arm; the GP had made a note on the care plan stating that they were discharged from the fracture clinic and that they will require physiotherapy. At the time of the inspection the resident has not received any physiotherapy; the nurse on duty was unable to explain to the inspector why physiotherapy had not been provided to this person. There has since been no change to the care plan following the fall and no mention of a fall or broken bone in the ongoing review or personal plan. Several examples of poor dementia care were observed during the inspection. Residents were being outpaced by staff, particularly when walking alongside them. (Outpaced means that the care worker or nurse undertakes tasks at a rate to suit them not the person receiving care). Throughout the two visits many of the residents were observed slumped in chairs with no stimulation, other than a television or radio playing in the background, which on one occasion was playing music that older people may not necessarily like or relate to. One person who was sitting in an armchair was noticed to have a medication capsule on their lap. This was handed to the nurse by the inspector. The nurse had signed the medication administration chart to indicate that it had been taken and that it was administered between 9-10am. Therefore the nurse was not following the services own medication procedures. Although the inspector asked the nurse on duty what the medication was for this did not prompt them to take any further action to ensure that the person got their medication until further prompting from the inspector. Failing to follow up on medication that has not been taken may leave someone at risk. Elstree Lawns Nursing Home DS0000019344.V359704.R01.S.doc Version 5.2 Page 13 During the inspection on the first day the inspectors tried to gain access to the bedrooms on the first floor. Most of these were locked. The inspector asked one of the senior care workers why the bedroom doors were locked? The care worker stated ‘they make a mess of everything, they s*** everywhere. We have the permission of the relatives.’ However, evidence of permission was not found on the records examined. It must be noted that during the second visit the bedroom doors were not locked and residents had free access to their bedrooms. One resident was sitting in the small lounge on the first floor. Their head was in their lap, the inspector said hello and they sat up and smiled, they had the remains of their lunch in their mouth. Lunch had finished at least an hour earlier. The person’s jumper, skirt and slippers were very stained, and their hair was untidy. Their nose was streaming and there were no tissues to hand. This does not promote dignity or show respect for people who use the service. One resident was observed sitting in the first floor lounge passively staring at the floor. Saliva was hanging from their mouth. When this was pointed out to the care worker, she proceeded to approach the resident and tug at the person’s clothes without any warning. The member of staff then went away and after a conversation with the other inspector she eventually returned with a tissue to wipe the residents mouth. Several residents were observed not wearing shoes or slippers and one person had large holes in their socks. One relative stated ‘my [name] clothes are brought back from the laundry and are not hung up, [name] looks creased and [name] is usually such a smart person, it’s not them really.’ Another person seen in the dining room had custard on their face and their clothes were very creased and stained. Elstree Lawns Nursing Home DS0000019344.V359704.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 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The quality of life for those people who are more independent is far better than for those who have to depend upon staff to provide them with stimulation and comfort. EVIDENCE: There was an activity programme for the Christmas period, which included an entertainment show, making decorations and other activities over the festive period. Photographs were observed of a cultural day that has been held and other activities such as garden parties in the summer. One relative stated to the inspectors ‘there’s not enough stimulation.’ The home has an open door policy and visitors are welcome at any time. On the first day of the inspection, the inspector observed three residents making cakes and listening to music with the activity co-ordinator in the reception room on the ground floor. The residents were happy and were singing along with the activity co-ordinator who was smiling and providing caring and jolly interaction. Elstree Lawns Nursing Home DS0000019344.V359704.R01.S.doc Version 5.2 Page 15 No other activities were observed during this visit, particularly for those who are unable to participate e.g. those with a dementia. No rummage boxes were observed within reach of people as they had been put away in cupboards and no items of comfort were offered for residents to hold (a rummage box contains items that may revoke memories in people or gives them comfort e.g. someone who was a tailor in their younger days may find comfort and familiarity with cotton reels and pieces of fabric). The manager could not explain to the inspectors where the residents get their comfort. The manager stated that she wanted to purchase some large fish tanks however this had not been agreed by BUPA. During the first visit it was noticed that like many of the bedroom doors, the dining room door was also locked. The inspector asked the care worker why the door was locked and she stated that this is because of the hot plate, which is a risk to the residents, when it is switched on. The care worker then unlocked the door and it was noted that the hot plate was not turned on; therefore staff had enforced restrictions on movement and choice. Residents at that time had access to one long corridor as most were unable to access the lounge due to having to negotiate three stairs. Another person tried to access the dining room where the domestic was mopping the floor. The domestic put his arm across the door to stop them from entering and said ‘where are you going.’ He then physically turned the person around and led them up the corridor and said he would take the person to the lounge, however, the inspectors saw that he did not take them back to the lounge. Another resident then entered the dining room and the domestic stood rigid and stopped the person from walking across the floor. He asked the person to sit down but they tried to hold the mop and mop the floor but the domestic took it off them. Snacks for residents are left in baskets in the lounges however during the visits on both days these were being stored out of reach of the residents on top of filing cabinets in the nurse’s stations. Snacks were not seen to be offered, however drinks were observed to be given. One resident was offered some juice by a care worker and after they drank it down in one go the member of staff appropriately offered them another. One relative stated ‘The food looks very good, they always have a lot of drinks and they should have fruit but its not available, I have seen the basket but its not being given out and my husband is unable to ask for anything.’ The lunch on the second day was Chilli Con Carne and rice or lamb chops. The inspector tasted the chilli, which was served directly from the hot trolley into a small bowl. It was quite tasty and not too spicy however it was cold. The atmosphere in the dining room was quiet and there was no background noise e.g. a radio playing. One care worker was observed chatting and smiling to the resident who she was assisting and another person on that table. However, no interaction from the staff on the other tables was observed. Residents were Elstree Lawns Nursing Home DS0000019344.V359704.R01.S.doc Version 5.2 Page 16 continually prompted to eat their meal to ensure that they received adequate calorific intake during meal times. The inspectors found on entering the home for the second visit that the communal entrance was tastefully and attractively decorated with a Christmas tree and other festive ornaments. However, the main lounge on the first floor had no such festive decorations although a small-undecorated tree was seen in the small lounge. It was noted that there was a tree in the main ground floor lounge and festive lights in the laundry room. Elstree Lawns Nursing Home DS0000019344.V359704.R01.S.doc Version 5.2 Page 17 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 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use the service cannot be assured that staff will follow their care plans to ensure their safety so putting them at possible risk of harm. EVIDENCE: The service has a complaints procedure that gives clear instructions about how to make a complaint. Relatives said that if they had any concerns they would speak to the manager. Complaints received had been responded to within a reasonable timescale and none of the complaints had been upheld. As stated in previous paragraphs, three residents were observed being moved using unsafe techniques as required in the current care plan and moving and handling risk assessments putting both the residents and staff safety at risk. It was reported in response to an immediate requirement left after the first visit that all staff will be attending further moving and handling training, if they have not done so already and new equipment has been ordered. These incidents have been reported by CSCI in accordance with Hertfordshire County Councils Safeguarding Adults Procedure and a meeting is due to be held at the end of January. The Health and Safety Executive has also been advised of the poor moving and handling observed as this also comes within their remit and legislation. Elstree Lawns Nursing Home DS0000019344.V359704.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, 20, 22, 24 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People with a dementia or impaired mobility who use the service cannot be assured that the environment will meet their needs or that it will promote independence and a sense of well being. EVIDENCE: The home has undergone some redecoration and maintenance since the last inspection. Some of the bedrooms have been redecorated and the wall in the ground floor dining room has been repaired and repainted where there had been a leak. Some of the armchairs in the lounges and bedrooms are torn and look unclean. The carpet in the lounge on the first floor is unsuitable to people who have dementia as this is heavily patterned which encourages people to bend down to pick things up, creating a greater risk of falls. One resident was observed during the inspection trying to do this. Elstree Lawns Nursing Home DS0000019344.V359704.R01.S.doc Version 5.2 Page 19 Although it is acknowledged that the home is registered for dementia care, providing care to people with dementia has changed since the registration of the service. The physical environment of the home is now recognised to provide a number of challenges for people with dementia, which now need to be overcome. The inspectors observed for those residents on the first floor who need to be moved using a hoist, and for the people who use a wheelchair, the whole procedure to get the residents from the lounge to the dining room to eat takes 45 minutes. There are three small steps along the corridor leading from the lounge to the dining room and bedrooms. Therefore residents are transferred to their wheelchairs, taken down in one lift, along the ground floor and taken up in another lift to the dining room. The manager stated that extra staff are available to help with this to ensure that the process does not leave residents sitting waiting for too long. In one bedroom inspected there was a mattress on the floor, which was positioned under the window. There was no written record of why the mattress was on the floor. There were no clothes in the wardrobe; the chest of drawers contained one very stained, creased t-shirt, one casual creased jacket and two pairs of pyjama trousers. These were all the clothes available to this person. Their room was bare and dark; there was no cover on the armchair cushion and the sponge cushion was stained. The call bell could not be reached from the mattress on the floor. One relative stated ‘my [name] had family photos on the bedroom shelf but these have gone now, the TV in the bedroom is unplugged as it is faulty.’ The inspector later checked to see if any family photos were in the bedroom and they were found in a pile, not on display on the window ledge. Generally the home was found to be clean, however there was an unpleasant odour on entering the home. The practice of restricting people’s freedom by locking bedroom doors and other doors around the home is not in keeping with the Mental Capacity Act. Any infringements on people’s liberty and the rationale for this must be recorded. Elstree Lawns Nursing Home DS0000019344.V359704.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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use the service cannot be confident that the training that has been completed by staff is reflected in their day-to-day practice; therefore they cannot be assured of being safe. EVIDENCE: On the day of the first inspection there was one nurse working on each unit. On the first floor there were four care workers. On the ground floor there was one nurse and three care workers. Staffing levels appeared to be adequate on both days. As previous inspections have found that staff recruitment procedures are followed and the appropriate checks are made on prospective staff this was not examined at this inspection as the robust systems in place ensure residents are kept safe. Certificates and records show that the staff have received moving and handling and dementia training, however there are many areas where the training has either not been understood or is ineffective, as has been identified throughout this report. Additionally a nurse spoken to during the inspection was asked by the inspector why staff were putting both themselves and service users at risk by using the standing hoist. They responded, “they do not complain about it”. Elstree Lawns Nursing Home DS0000019344.V359704.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use the service cannot be confident that Elstree Lawns is run in their best interests and that the procedures followed by some staff will not put them at risk. EVIDENCE: Elstree Lawns has not had a manager registered with CSCI since 2004 as the Commission refused the two previous applications for registration. There has been a new manager employed in the home since June 2007. The manager submitted her application to CSCI in November 2007 however this was returned, as it was incomplete. On the day of the first visit the manager was on a training course and the deputy was on leave. One nurse who was newly qualified was working on the Elstree Lawns Nursing Home DS0000019344.V359704.R01.S.doc Version 5.2 Page 22 first floor and another nurse was working on the ground floor. A senior nurse was called in who spent the majority of his time sitting in the reception area sticking photographs of staff on a world map. The financial accounting procedures are mainly carried out by the administrator. The manager stated that it can be difficult at times to obtain money from families who have control of the resident’s personal finances in order to purchase new clothes. It was pointed out by the inspector that if this is an on-going issue, this must be dealt with in accordance with Safeguarding procedures especially in view of the Mental Capacity Act. We received a Regulation 37 notification from the home that someone had fallen and fractured their hip. The notification did not report that the incident involved a hoist. Adult Care Services (ACS) held a strategy meeting under their joint agency Safeguarding procedures, and the provider was asked to investigate and report back to ACS. The police concluded that there were no criminal issues to be explored. The provider investigated and has reported back that the resident slipped from a standing hoist and lunged to their knees. The provider felt that this incident could not have been avoided. ACS advised the manager to contact the ACS moving and handling specialist for advice. CSCI have passed information about this incident to the Health & Safety Executive as during the inspection on the 27th November, incorrect and unsafe moving and handling techniques were being used. Between the date of this incident and the first day of the inspection staff were still using unsafe moving and handling procedures by using standing hoists rather than full body hoists. The manager or other senior staff members failed to address this. The manager responded to the immediate requirements and confirmed that full body hoists had been found being stored on the second floor of the home where there are no service users in residence. It was reported to CSCI that someone fell in the lounge and sustained a cut on the left temple and complained of pain. The GP visited the next day and booked the person into the fracture clinic for 5 days time, the GP advised the staff to send the person to A&E if there were any concerns. It was reported that the resident complained of pain the next morning and was given Paracetamol. When the person attended the fracture clinic they were diagnosed with a fractured femur (thigh bone). The inspector spoke to the deputy manager and enquired about why the resident was not sent to the hospital sooner. The deputy manager stated that there were no other symptoms to suggest that the femur was fractured. One person was observed by the inspectors being pulled by their arms out of the armchair by two care workers. A handling belt was put around their waist but the care workers carried out a draglift, not using the belt for its purpose. Another person was observed being pulled out of the chair by the carer worker Elstree Lawns Nursing Home DS0000019344.V359704.R01.S.doc Version 5.2 Page 23 holding the residents hands and pulling their arms. These practices leave both the resident and the staff at risk of injury. Elstree Lawns Nursing Home DS0000019344.V359704.R01.S.doc Version 5.2 Page 24 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 2 x 1 x 2 x 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 2 1 Elstree Lawns Nursing Home DS0000019344.V359704.R01.S.doc Version 5.2 Page 25 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 OP7 OP18 OP22 OP38 Regulation 13(5) Requirement Staff must carry out care in accordance with peoples individual care plan and risk assessment in order to ensure that they receive appropriate/safe care and are not put at risk of harm e.g. moving and handling. Timescale for action 27/11/07 2. OP7 3. OP8 Adequate and appropriate equipment must be available to staff at all times e.g. the correct hoists must be readily available to ensure that the right equipment is used when moving residents. An immediate requirement was made on 27/11/07 – an appropriate response has been received from the provider. 14(2)(b) Residents care plans must be reviewed following any incident such as a fall as the care plan may need to be changed as this may prevent further risks. (13)(1)(b) To ensure peoples continued health and welfare service users must be assisted to gain access to treatment as recommended by their GP or other health DS0000019344.V359704.R01.S.doc 29/02/08 29/02/08 Elstree Lawns Nursing Home Version 5.2 Page 26 4. OP9 13(2) 5. OP10 12(4)(a) 6. OP10 12(4)(b) 7. OP8 12(1)(b) professionals (e.g. Physiotherapy). To ensure peoples safety procedures must be followed on the administration of medication. Where a person has not taken their medication, their health, safety and welfare must be considered. An immediate required was made on the 27/11/07. A response has been received from the provider. People must be treated and referred to in a dignified and caring manner at all times e.g. staff should not use disrespectful language when referring to residents and their bodily functions. Care must be provided that meets peoples needs and residents must not be outpaced as staff sometimes walk too quickly when guiding them. Outstanding from inspection reports dated 30/01/07 & 26/04/07. Staff must assist residents to maintain their personal hygiene. Outstanding from inspection report 30/01/07 & 26/04/07. Residents who are unable to wash and dress themselves must be assisted to look clean and tidy. Clothing must be presentable (not stained, creased or have holes). Tissues must be available and assistance to clean away food and saliva must be given promptly in order to protect people’s dignity. 27/11/07 29/02/08 29/02/08 29/02/08 Elstree Lawns Nursing Home DS0000019344.V359704.R01.S.doc Version 5.2 Page 27 8. OP12 16 (n) 9. OP14 13 (7) 10. OP15 16(2)(i) 11. OP20 23(2)(a) To ensure residents wellbeing they must be socially stimulated and comforted, particularly those whose dementia is advanced and those who may not be able to verbally communicate or participate in group activities. Residents must not be subject to environmental restraint without full risk assessments for each individual. People must be able to make choices about which area of their home they would like to access. The rationale for any restrictions must be fully documented. To ensure people are provided with appropriate nutrition snacks must be accessible to residents and those that are unable to ask for these they must be offered on a regular basis. The premises must be suitable to the needs of the residents for which the service is registered to provide services for e.g. People with a Dementia. 29/02/08 29/02/08 29/02/08 29/02/08 12. OP22 16(2)(c) Alternative ways in which to ensure that residents can access the dining room, lounge and bedrooms must be sought. Inline with good dementia care practices alternatives to the patterned carpet in the first floor lounges must be sought so to prevent risks of falls. Where people have not been 29/02/08 provided with appropriate furniture or beds written records must be maintained to justify the rationale behind it and permission sought from the appropriate professional. Residents must have access to specialist beds if required. Mattresses must only be placed on the floor to protect the safety DS0000019344.V359704.R01.S.doc Version 5.2 Page 28 Elstree Lawns Nursing Home 13. OP22 13(4)(c) 14. OP30 18(1)(a) 15. OP37 37 (1) (e) of residents until a suitable alternative has been found. To ensure residents safety the call bells must be accessible and within reach of them when in bed. Staff competency must be assessed on Moving and handling and dementia care and action be taken where shortfalls or unsafe practices are identified. CSCI must be kept appropriately informed - Regulation 37 notifications must contain accurate information e.g. that the resident slipped out of a hoist sling rather than as stated in the Regulation 37 ‘the service user fell’. 29/02/08 31/03/08 15/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP19 OP26 Good Practice Recommendations To ensure that people are able to make an informed choice the facilities and services should be provided to people in accordance with those presented in the Service User Guide To ensure a homely environment for the people who use the service the furniture in the home should be kept in a reasonable state of repair. The armchairs that are torn or heavily stained should be replaced. The home should be kept free from offensive odours. Some of the residents’ bedrooms should be made more homely. They should be able to observe or have access to their personal belongings such as photo’s and clothing. 3. OP19 OP24 Elstree Lawns Nursing Home DS0000019344.V359704.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Inspection Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Elstree Lawns Nursing Home DS0000019344.V359704.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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