Inspection on 10/09/07 for Euroclydon Nursing Home

This inspection was carried out on 10th September 2007.

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

Euroclydon Nursing Home 11/06/09

Euroclydon Nursing Home 22/07/08

Euroclydon Nursing Home 31/01/08

Euroclydon Nursing Home 13/02/07

Euroclydon Nursing Home 04/07/06

Euroclydon Nursing Home 17/11/05

Euroclydon Nursing Home 09/06/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Euroclydon Nursing Home Drybrook Glos GL17 9BW Lead Inspector Mrs Janice Patrick Key Unannounced Inspection 09:30 10 & 11 September 2007 th th 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 Euroclydon Nursing Home DS0000063477.V342373.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. Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Euroclydon Nursing Home Address Drybrook Glos GL17 9BW 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) 01594 543982 01594 544352 Chantry Retirement Homes Ltd To be appointed Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate 5 (five) named service users under the age of 65 years - Service User Category PD. The home will revert to the original service user category when these service users no longer reside at the home or reach the age of 65 years. To accommodate 1 (one) service user under 65yrs of age on respite care. This bed to be used for respite care only of a period no longer than 1 month unless prior agreement with CSCI. Not to be used for a permanent resident under 65yrs of age. 11th March 2007 2. Date of last inspection Brief Description of the Service: Euroclydon Care home is located in the Forest of Dean on the outskirts of Drybrook and is registered with the Commission for Social Care Inspection (CSCI) to provide both nursing and personal care to predominantly older people. It does however currently accommodate a small number of younger residents who have a physical disability. The home provides thirty-eight single and five double rooms. Twenty-eight rooms offer en suite facilities. In addition, there are a number of assisted bathrooms and toilets on each floor. There are several communal areas and a separate smoking room. Two shaft lifts enable access to the first floor. The gardens are well maintained and accessible to all residents and include a summerhouse. There is ample car parking within the grounds of the home. The home has its own tail-lift mini-bus. The fees range from £400.00 to £595.00 per week (current at the time of this report). Services not included within the fees are hairdressing, chiropody (foot) care and newspapers. Public transport to and from the home is limited and buses only go as far as the local village, which is half a mile away. In certain individual circumstances and when the home is able, a lift from the village can be organised. Information regarding the home can be found in the main reception area. The Service User Guide, also in the reception area, states that the home’s previous inspection report can be made available on request. Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This inspection was carried out over two days. On the first day two inspectors were present between the hours of 9.30am and 9.50pm and on the second day one inspector was present between 10.45am and 7.25pm. Surveys were forwarded to the home prior to the inspection for distribution to residents and their relatives in order to seek their views on the services provided. The Commission for Social Care Inspection (CSCI) received six back. An Annual Quality Audit Assessment (AQAA) was also forwarded which gives the Registered Provider the opportunity to inform the CSCI of any improvements so far to their service and of those that are planned, however this was not completed. As part of this inspection the care given to residents was observed and crossreferenced with the written care records maintained by staff. This included how healthcare needs are met with specific emphasis on wound care and associated assessments. The Inspectors explored the arrangements in place that enable residents to be part of their care planning and to have their choices and preferences met. The arrangements for maintaining residents’ privacy and dignity were explored. Mealtime times were observed and related care documents inspected to ascertain how the needs of residents who are nutritionally at risk, have their needs met. The complaints and safeguarding adult processes were inspected to ensure that any complaints received were being appropriately dealt with and that the home can demonstrate that adequate arrangements are in place to protect residents from abuse or harm. The general environment, refurbishment plans and maintenance systems were inspected. Arrangements for cleaning and infection control were inspected. All staff related issues including recruitment practices, staff training, staff supervision, staffing numbers and competencies were inspected. The general management systems were inspected to include quality assurance arrangements. Records pertaining to the safe keeping of residents’ monies were inspected which included how the home imparts information relating to fees and other financial arrangements to the relevant person. Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 6 Health and safety within the home was general inspected along with relevant records. Nine requirements have not been complied with fully since the last inspection. On this occasion the time scales have been extended as indicated in the requirements made. Unmet requirements impact upon the welfare and safety of residents. The Commission for Social Care Inspection (CSCI) will be considering enforcement improvement as well to secure compliance. What the service does well: What has improved since the last inspection? Accurate information is now readily available about the service generally and related financial arrangements. The medication system has altered to one that provides more robust audit trails. Residents’ dignity and basic rights have been further explored and has been linked to further training for all staff on what constitutes abuse in a care setting. The format used for recording complaints is more comprehensive and gives the person completing this a better opportunity to record the process that follows. Bathrooms have been refurbished and some additional decoration has taken place. A selection of appropriate beds and other pieces of specialised equipment have been purchased. Residents are now able to choose between a bath and shower. Staff supervision is more organised and is being recorded. Records relating to basic health and safety and maintenance are improving. Arrangements for the regular servicing in the future of key pieces of equipment and main utilities have been improved. Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 7 What they could do better: The home needs to consistently adopt a more robust pre admission process so that accurate information is collected in order for the residents’ needs to be identified, planned for and adequately met following admission. The written care records must improve so they reflect the action required to meet the needs of the residents, so that staff receive better guidance on how to meet residents’ needs and the records demonstrate accuracy. In order to help with this process more involvement of the resident or relative at this stage maybe useful. Qualified staff must follow good practice guidelines and be aware of requirements already issued by the CSCI when administering and recording medications and those of the Nursing and Midwifery Council (NMC). Residents who are less able to instigate and organise social stimulation and activities for themselves, require more help to improve their day-to-day quality of life. The process of complaint investigation and the recording of specific meetings with complainants needs to improve. This will help avoid misunderstandings and improve the home’s transparency when dealing with a complaint or concern. The speed in which ‘wear and tear’ within the environment is dealt with needs reviewing so that the homes presentation is good at all times and residents’ private accommodation is pleasant to live in. Stained carpets must be successfully cleaned or replaced so that residents do not have to live in odorous or unpleasant surroundings. Staff need to be more aware of the environment and improve the tidiness of the home for the same reasons as above but also to meet good health and safety practices. Infection control practices must improve in order to protect residents from illness or cross infection. The home should aim to increase the numbers of staff completing the National Vocational Qualification (NVQ) in care so that higher proportions are practicing with underpinned knowledge. Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 8 Development of staff knowledge outside of the basic mandatory subjects must be provided so that staff become knowledgeable in the more specific areas of care required by some residents. Recruitment practices must be more robust, particularly where references are concerned so that the home can demonstrate that they are doing everything to reduce the risk of abuse and harm to residents. The introduction of the ‘common induction standards’ should take place as soon as possible. A comprehensive ‘in house’ period of induction must also be demonstrated. This should help to address some of the shortfalls in current practices that are still evident despite basic training having taken place. The process of registration with the CSCI needs to be completed for the acting manager. A quality assurance system must be in place so that shortfalls in the service can be identified and future improvements planned for within set timescales. This will assist the home in its completion of the AQAA in the future. Health and Safety Guidelines must be adhered to in relation to restricting the openings on windows. The home must be able to demonstrate that it is adhering to current Fire Regulation and that all staff are knowledgeable in evacuation procedures and practicalities. Residents must be able to access a call bell at all times when left on their own. Please contact the provider for advice of actions taken in response to this Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 9 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. Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 10 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 Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 11 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 & 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. For those considering living in this home there is relevant and helpful information available to help them make an informed decision. For those moving into this home the current pre admission process is not thorough enough to ensure that all of their needs will be identified or planned for however, a new system shortly to be adopted should rectify this. A lack in staff knowledge and competencies means that the needs of some of those living in this home will not be met as well as others. EVIDENCE: Although this outcome has been proportionately assessed as adequate there are fundamental shortfalls that need addressing. Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 12 The home’s Statement of Purpose and Service User Guide remains available to visitors in the reception area, but both have been reviewed and now provide a more accurate reflection of the services provided and the circumstances within the home. The Service User Guide also contains a copy of the home’s contract of residence and further information is given regarding what is and what is not included within the fees. Additional information is available in each bedroom. In order to address a shortfall in the home’s current pre admission assessment process a new format has been chosen. Although this is not fully in place the Inspector is confident that it soon will be. This will allow for comprehensive recording of residents’ needs and will demonstrate that information has also been gathered from the resident and in some situations the residents relative or main carer. An aid memoir will accompany this so that staff can check that they have completed the full process. Currently the process is open to staff not passing on information to colleagues and vital areas of the pre admission planning being missed. The Inspector spoke with one relative who had been a resident’s main carer prior to their admission. If this relative had been included in the pre admission process, important pieces of information could have ascertained as to how that resident prefers certain things done including things that are habit to that person. This would enable a more seamless and less worrying transition into care for an elderly person. The home is usually in receipt of an ‘Assessment of Care Needs’ prior to a funding authority placing an individual at the home. The acting manager has explained that although the home will accept emergency admissions, they are avoided if possible. One written pre admission assessment was inspected. A competent person carried this out ten days before the resident’s admission but unfortunately despite this it would appear that the source of the information was not wholly transparent about what the resident’s needs were. This has led to further assessments being required and the home will need to consider whether it can meet this person’s needs permanently. Current staff competencies were discussed with the new acting manager. It has been identified in past inspections that staff require further knowledge in more specific care areas. An external healthcare specialist in MS has visited the home and spoken with some staff. None of the care staff have had dementia awareness training despite many of the residents showing various symptoms related to this illness. According to the staff training records one of the qualified nurses completed an awareness day in dementia care in 2006. The care of one very poorly resident during this inspection could also have been improved upon and this relates to palliative care knowledge. Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 13 The Primary Healthcare Trust’s, Care Home Support Team are due to work with the home to help improve some care systems and increase staff knowledge, one of the areas being dementia care. Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although it is evident that some aspects of residents’ healthcare needs are being met including their medication needs, the care documentation indicates that there are shortfalls, which put residents at risk. Residents’ privacy and dignity is generally upheld. EVIDENCE: Each resident has a care folder, which contains care information written in care plans and additional assessments. The care documentation for five residents was inspected in detail, which identified that care plans are not always relevant to the residents’ current needs or that needs were not care planned. An example was of one resident’s nutritional needs and level of help needed in this area altering quite drastically due to increasing poor health. Although an entry in the care file on one day noted that the resident required help to feed, there was no subsequent care plan to alert and direct staff to this effect. A Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 15 decision at some point had been made to record the resident’s intake. On the day of this inspection this was not being completed in a satisfactory manner. Another resident’s care plans were read but the description of the care being given by the staff bore no resemblance to the written care plan. Some of the assessments used repeat themselves or give conflicting information. The same resident had three different assessments considering her appetite, all recorded something different. The Speech Therapist had reviewed the swallowing reflex of one other resident and determined that a soft diet was required. This residents care plan indicated that a normal diet could be given but that the food should be ‘cut up’. In a home that is experiencing a lot of staff change this lack of review in the care plan could place the resident at risk. Wound records are disorganised and repetitive and in three cases, according to the written record, wounds had not been attended to when they should have been. The qualified nurses spoken to were sure that in some of the cases the wounds had been cleaned and redressed but that some staff were omitting to record this. This is a serious breach of the Nursing and Midwifery Council’s (NMC’s) guidelines for record keeping. The acting manager has also viewed these as serious shortfalls, which he will rectify by introducing new documentation and a robust auditing system along with further staff training in the professional responsibilities of accurate recording. There was evidence to show that several external healthcare specialist attend as needed, including regular visits from a chiropodist. Medication administration was observed and previous requirements from the last inspection were inspected for evidence of compliance. Four of the six elements to this requirement were met. Shortfalls were still evident in the inconsistent dating of eye drops on opening and two signatures on a hand written direction. The system used provides a good audit trail from the time medication is ordered to the point of returning excess stock to the pharmacy. Medication Administration Records (MAR) sheets were well kept with no gaps. One nurse was observed signing for several medications all in one go following administration. One resident was given her medication in her bedroom. On inspecting the medication record this had been signed for before the resident had successfully taken them. This is unsafe practice, which must cease. In one bedroom a tube of prescribed ointment was present but it was out of date. Staff were observed to be speaking to residents in a polite and thoughtful manner even when one resident was heard swearing at them. This situation was dealt with professionally and in a non-judgemental manner. Staff were observed to be knocking on bedroom doors before entering and closing these during care procedures. Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 16 It was noticed that staff often talked over the heads of residents to their colleagues. They need to be aware of this and avoid such practice as it excludes the resident and potentially erodes their self-worth and esteem. One relative said that she has found the staff to be very polite and attentive. Another commented within their survey that the staff are friendly and helpful. Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. For some people living in this home their quality of life matches their expectations. However for many others unable to make choices and organise their own activities and food, arrangements are currently not enhancing their quality of life. EVIDENCE: In assessing this outcome the Inspector is aware that the new acting manager knows of these shortfalls and is trying to address these so a proportionate view has been taken. The activities co-ordinator present at the time of the previous inspection in February of this year has subsequently left. The acting manager explained that an existing member of staff has expressed an interest in carrying this on. This person has to be first replaced with another carer before this can take place. This current gap in provision was evident with many residents observed over the two days of inspection not doing anything and only receiving stimulation and interaction from staff when they were delivering care. Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 18 Some residents were clearly able to and preferred to amuse themselves by reading a paper, book or generally busying themselves. One lady explained that she did not like to mix and therefore was quite happy remaining in her room. The hairdresser was seen during this inspection and several residents were clearly enjoying her service. A communion service is held monthly and the local Roman Catholic Priest visits on a weekly basis. There is information available on advocacy within the home’s literature. Lunch was observed in the one dining room being used at the time of this inspection. The larger of the two was coming to the end of being decorated. Fourteen residents were seen all eating independently except one who required some help. One lady put her knife and fork together on her plate having not touched her food. At this point there was only the kitchen member of staff in the room so the Inspector alerted her to this. She responded by saying she would see what the problem was. Another resident in bed was being offered help by an agency carer. It was noted that the food for this resident arrived warm with the hot sweet being served at the same time as the first course. The Inspector was told that a number of residents who were eating in their bedrooms required help to feed, but this was not individually observed. Several residents said the food is always enjoyable and confirmed that there is a choice with a further alternative provided if they wish. One visitor explained that she finds food in her relative’s waste bin so she has decided to supplement her diet with food she knows her relative likes. There was no documentation indicating that staff were monitoring this. The same person explained that her relative had recently been given someone else’s meal. When this was followed up by the Inspector the other resident was diabetic therefore a careless act like this could have serious implications. The new acting manager was going to look into this and ensure that the method for naming the food trays is improved upon and that the staff are more careful. Inspectors noted that several residents were eating breakfast at 11am. One resident who is able to recall what is happening said she had not had a mid morning drink at approximately 11am but the drinks trolley had been seen to pass her bedroom earlier. Several residents in their bedrooms were seen to have drinks out of their reach. The kitchen was observed to be clean and tidy each time the inspector visited. Certificates in Food Hygiene for those that work in the kitchen were seen displayed. One carer confirmed she had received training in how to feed a resident. Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to enable residents or their relatives to complain or voice a concern, however the process of recording events needs to be more robust. Despite staffs’ knowledge on the subject of abuse being recently enhanced a serious shortfall in recruitment practices put residents at risk of abuse. EVIDENCE: There is a complaints policy with written procedures that are readily available on the notice board and within the home’s literature. This literature was seen in several bedrooms. Complaints recorded within the home’s complaint file were discussed with the new acting manager. The Registered Provider initially investigated one complaint from a relative but there was dispute over the accuracy of the recording of events and findings, which resulted in the Community Adult Care Directorate, formally Social Services, being involved. A second complaint involving the same resident has been resolved. The acting manager explained that he has also dealt with two concerns, which had not been recorded, although one had been responded to in writing. The home should seriously consider recording all concerns as well as formal complaints. Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 20 Staffs’ knowledge in safeguarding adults has improved and two members of staff were able to demonstrate this when questioned. Records show that all staff completed ‘in house’ training on safeguarding adults this year. Some attended the more in depth training provided by the local Safeguarding Adults Team. The new acting manager has past experience in adult protection processes and recently followed the correct protocol for ‘sharing information’ when a resident was found with unexplained bruising. This included a referral to the police who did not feel that a criminal act had taken place. This transparent action shows good practice and will help protect those vulnerable persons living in the home. A Whistle Blowing policy was also seen on the home’s notice board. Another area of practice open to abuse is the use of bedrails. Residents have been reassessed resulting in the use of alternative equipment and strategies instead. The surveys received back say that staff listen to what residents have to say and that residents are aware of whom to talk to if they are unhappy. However, a serious shortfall in the home’s recruitment practices put residents at risk of abuse despite all of the improvements made in other areas (read staffing outcome). Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 21 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. 21, 22, 25 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Whilst work is in progress to improve the facilities for residents in some areas, too many shortfalls in general maintenance, a lack of action when required and hygiene practice reduce resident comfort and ultimately puts them at risk. EVIDENCE: Many of the communal bathrooms and toilets have just been refitted. At the time of this inspection workmen were completing the refitting of communal toilets on the ground floor. This is very positive as it now gives residents a choice of a shower or bath and very much improved toilet facilities. The dining room in the main house along with the attached conservatory has also just been redecorated. The environment of this home is large and there are still areas that require a lot of redecoration and there is furniture that requires replacement. The Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 22 Registered Providers are aware of this and have shared a programme of phased improvements with the Inspector. However, several areas, mainly bedrooms, were in need of decorative ‘touching up’ and the home was generally untidy (this comment does not relate to the current work being carried out). There were several extractor fans in enclosed ensuites not working. One visitor had not been impressed with the condition of her relative’s bedroom on arrival. She explained that a member of the family changed the fuse in the ensuite’s extractor fan as they gave up asking for it to be done. They also reported the toilet seat as being unstable as they were concerned their relative would fall off it. They waited for one part of the seat to be purchased by the home and when it was unlikely that that this was going to be found, they brought their own complete new seat and fitted it. Another bedroom had a very large brown stain on the carpet. There was also a strong offensive odour. The resident explained that the cleaning staff had tried to remove this stain. This was one of the elements within a complaint discussed earlier in this report and which must be resolved. The Inspector is aware that some carpets have been changed but there were several bedrooms with stained carpets. Several beds which are able to change a resident’s position have been purchased for those who receive a lot of their care in bed. Some new basic pressure relief mattresses have also been purchased. New crash mats (thin mats that lie alongside a bed) were seen following the review of bedrail usage. In the last inspection two windows on the first floor were not properly restricted. These were subsequently restricted but again on this inspection a bathroom window was wide open, again on the first floor. The Inspector appreciates that workmen have recently refitted this room, however staff are presumably still not observing and checking with health and safety issues in mind. This was reported to the nurse on duty who closed it immediately. The lighting along the lower corridor leading to the extension seemed dull, although a Lux reading was not taken. It became apparent during this inspection that one part of the home was cold. New boilers and pumps had been fitted recently but residents said it had been cold for sometime. Inspectors learnt that there had also been no hot water at one point for a period of days. The Registered Provider was aware of the problems and said everything was being done to rectify the situation. During the evening of the first day one resident was observed leaving his bedroom because he was so cold, to sit in the lounge that he thought was a bit warmer. Residents examined on the second day were cold to the touch and the temperature of two residents was taken. This was below what it should comfortably be for an elderly person. The feet of another very poorly resident Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 23 were extremely cold and remained uncovered despite staff attending in other ways. The Inspector put a pair of socks on this resident’s feet and an extra blanket. An Immediate Requirement was issued for adequate warmth to be provided for residents. This was acted upon immediately and by early evening and the next morning the situation had been rectified. Inspectors were concerned that despite staff being aware that there was concern about the heating and residents were being wrapped in blankets, they proceeded to open patio doors and comment that they found it hot. This demonstrates a serious shortfall in fundamental knowledge relating to elderly people’s ability to drop their temperature quickly through lack of movement and age and needs addressing. Records show that staff have received some infection control training, however there seemed to be several shortfalls in this area. These are listed below and require addressing. • In most bedrooms essential items such as toiletries and continence pads were being stored on the floor. • The toiletry baskets were dirty and dusty and in many cases contained the toiletries along with false teeth, hearing aids, various creams (lids on and off), used paper towels in one case, bits of soap and single continence pads. • In one bedroom the toothbrush and hairbrush were side by side in this basket. • Although colour coded mops and buckets were seen, two members of staff had a different understanding of what should be used where. • One member of the cleaning staff explained that her job included the cleaning of toilets and bedrooms and ended in the cleaning of the kitchen floor. She was observed to do this in the same tabard worn throughout the morning with no extra cover, such as a plastic apron put on. • In a ground floor toilet the yellow bag used for disposing used continence pads was seen to be overfull and falling off the frame provided. • There was urine on one of the toilet floors. • Urinal and slipper bedpans were seen stored on the floor of ensuites. • Soiled washing is put in white bags, which the laundry person explained she has to physically empty into the washing machine. • Some areas of the laundry floor require retiling. • Several surfaces in bedrooms were sticky and dusty. • Two out of four washing machines were not working. Plastic aprons and gloves were seen around the home and were being used by staff. Alcohol based gels are also available for hand hygiene. Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 24 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. Although many shortfalls have been identified and some have started to be addressed, the home is still not in a position to demonstrate that residents are being cared for by fully competent staff who have been recruited in a robust manner in order to protect residents living in the home. EVIDENCE: Over the last year the home has had problems retaining staff, there has been a lot of movement with the problem still being evident at this inspection. This was discussed with the new acting manager who is aware of the issues and who is was feeling positive about the imminent employment of three new care staff and two new registered nurses. Staff morale appears low with a period of stability needed for residents and staff. The CSCI have needed to monitor staffing levels in this home before to ensure residents’ needs were being adequately met. During this inspection there were 36 residents in the home with two qualified staff on duty and six care staff in the morning and five in the afternoon. The needs of some residents were still high to the numbers of staff on duty and examples of this were discussed with the acting manager. The environment is also very spread out. With this in mind, the staffing numbers Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 25 for the rest of the week were inspected. The acting manager assured the Inspector that on days where the numbers were currently recorded as below the numbers stated above, agency care staff would be organised and that one extra member of staff would also be organised to cover the absence of the laundry person at weekends. This will continue to be monitored by the CSCI. Four out of seventeen care staff have completed the National Vocational Qualification (NVQ) in Care. This is below the national standard required of 50 . Two more staff are due to commence their NVQ training soon. Staff from overseas who are qualified nurses or therapist in their country of origin do not automatically meet the criteria of NVQ equivalent. The recruitment files of four recently employed staff were inspected. There were several gaps in the recruitment practice mainly around a lack of robustness in references and in checking gaps in employment. One file showed that a character reference had been received. Another had not been returned as yet. The Inspector advised that a further reference be obtained from the place the person had worked in fairly recently with vulnerable adults. Following this a decision was made by the acting manager to cease this person employment due to unsatisfactory references. However, this person had been employed despite an incomplete recruitment process having been completed. Another proposed employment situation at the time of this inspection was also found to be unsatisfactory and did not proceed. It is important for the acting manager to ensure that satisfactory recruitment process are being followed at all times by other key people involved in the process. The Inspector strongly recommends that the future Registered Manager checks or audits the recruitment process before a new member of staff commences work. Records show that all staff have received basic mandatory training in fire safety, health and safety, moving and handling, First Aid, Safeguarding Adults and Infection Control. There is evidence that some of these have been updated. New staff receive the above trainings during their induction period. Currently any further induction training that maybe given is not recorded well and does not follow any particular format, which then demonstrates progression. The new acting manager is aware of this and has already made enquiries about the national ‘common induction standards’ through Skills for Care. It is therefore envisaged that the home will be able to demonstrate in the future a structured induction training that will be linked to progression to NVQ training. Evidence relating to specific shortfalls in staff knowledge within this report demonstrate that more training and support is required. Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 26 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, 32, 33, 35, 36 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although the home is being now managed by a competent person, this has been for a short period of time so far and the systems are not yet in place to fully demonstrate that the home is safe at all times and is being run in the best interests of the residents living there. EVIDENCE: The current acting manager has been in post since June of this year. He is a Registered Nurse with many years experience both clinically and in management. He has yet to be successfully registered with the CSCI locally but has been successfully registered with the CSCI in other areas of the country. Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 27 He is aware of the home’s current need for improvement, which has been formally issued by the CSCI and responded to by the Registered Providers. A discussion has been held during this inspection about what has been achieved so far in relation to the outstanding requirements made at the previous inspection in February of this year. The Inspector is concerned that currently the acting manager is having to cover many clinical hours and is aware that this erodes the management time required to move the home forward. Impacting on this is the absence of a Deputy Manager or equivalent to help review and implement systems needed to meet some of the requirements within this report. There is still not a system for quality assurance, which means that this requirement originally made nearly a year ago has not been met. An Annual Quality Assurance Assessment (AQAA) required now within the Care Home Regulations was not completed either. The Inspector has taken a view that this is not a priority for the home at present and will request the AQAA again later in the year. Some auditing has naturally begun as the new acting manager explores existing systems and practices. Communication is one of the main shortfalls within this home. It has an impact across the board and can be evidenced in the pre admission process, care planning, staffs’ clinical and care handovers, in the written records kept, in reporting maintenance and health and safety issues. These are all the areas that the new acting manager has to have the management time to change. There is evidence that changes are happening such a qualified staff communicating each day within a diary and using this to plan forward things that must be carried out. The maintenance person is beginning to pick up jobs that have been communicated to him in a maintenance book. All staff have received one supervision session with the new acting manager and these will continue on a regular basis. Staff meetings have been held. A relatives meeting was held a few months ago. Residents’ personal monies and associated records were inspected. Two amounts of money were counted and were found to correspond with the records kept for each resident. The administrator was very aware of who held Power Of Attorney and arrangements were in place for relevant people to be made aware of any expenditure, on a regular basis or when requested. Receipts are also kept of any expenditure including chiropody and hairdressing. Health and Safety within the home was inspected including the arrangements for fire detection and safety The fire alarm panel is serviced and checked on a regular basis by a specialist company. Certificates for this were seen. A problem with the fire detection system occurred during this inspection caused in connection with the structural Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 28 work being carried out in the home. This was managed well at the time and the acting manager has confirmed that it has been subsequently resolved. At the time of this inspection the moving and handling equipment had not been inspected since November 2006. This has subsequently been organised and confirmation given to the Inspector by forwarding the Loler reports for each piece of equipment. The reports show that one hoist was removed at the time of inspection due to its unsafe state and that another cannot be used until it has been properly fixed to the floor; thus demonstrating that these inspections and services are important. A contract has now been organised for this work to automatically be carried out every six months. The Inspector is also aware that the Registered Provider did replace some bathroom hoists in the recent refurbishment. A certificate for the Lift has not yet been seen, although the Inspector has been assured that the lift has been serviced and a Loler report is being prepared. Contracts for servicing the boilers and heating system are being reviewed following the recent refurbishment work on these systems. Portable Appliance Testing has been carried out but there was no paperwork to confirm this. There is a Fire Risk Assessment within the home, which appeared unsatisfactory. The Fire Safety Officer has been requested to visit as there were various shortfalls including a lack of staff clarity regarding evacuation procedures. This visit will also enable the new acting manger to manage fire safety within the home from an agreed baseline. Inspectors were very concerned to observe so many residents in their bedrooms without their call bell near to hand. A certificate for Legionella testing was seen dated July 2007. The Food Safety Officer visited in February of this year and awarded the home 4 Stars for food standards and hygiene. Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 1 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 X 3 3 X X 2 1 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 1 3 3 3 2 1 Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14(1)(d) Requirement Timescale for action 15/10/07 2 OP7 15(1) 3 OP8 17 Schedule 3 (3)(n) The Registered Person must ensure that a robust pre admission process can be demonstrated and only admit residents who’s needs can be met by the services the home provides and who’s needs are within the capabilities of the staff group. (This requirement is repeated from the previous inspection timescale of 31/05/07 not fully met) The Registered Person must 15/10/07 ensure that each resident’s needs have a written care plan. This must be devised following consultation with the resident and or their representative. This plan must clearly indicate how a particular need is to be met and must be appropriately updated as required. (This requirement is repeated from the previous inspection timescale of 31/05/07 not fully met) The Registered Person must 15/10/07 ensure that records pertaining to the treatment of pressure sores DS0000063477.V342373.R01.S.doc Version 5.2 Euroclydon Nursing Home Page 31 4 OP9 13(2) 5 OP12 16(2)(n) and any other wound are accurately and appropriately completed. The Registered Person must 15/10/07 ensure that the Royal Pharmaceutical Society guidelines are met with relation to the administration and organisation of the medication system. This particularly relates to the dating on opening of prescribed topical applications (creams/ointments) eye ointments & drops. (This requirement is repeated from the previous inspection timescale of 31/04/07 not met) The Registered Person must 31/10/07 make arrangements for a programme of activities to be provided taking into account the residents individual needs, wishes and capabilities. The Registered Person must 15/10/07 make proper provision for the health and welfare of the residents by: • ensuring that adequate fluids are within reach of and provided to the resident • that support is given to residents to drink where needed • that the correct diet is provided to individual residents (This requirement is repeated from the previous inspection timescale of 31/04/07 not fully met) The Registered Person must 31/10/07 ensure that all areas of the home are adequately decorated. (This requirement is repeated from the previous inspection DS0000063477.V342373.R01.S.doc Version 5.2 Page 32 6 OP15 12(1) 7 OP19 23(2)(d) Euroclydon Nursing Home 8 OP19 13(3) timescale of 31/06/07 not fully met) The Registered Person must replace any heavily stained carpet within the home appropriate flooring that will reduce the risk of infection, this particularly relates to bedroom 24. The Registered Person must make arrangements for the home to be kept tidy and clean. This relates to the amount of items being stored on residents’ floors and the cleanliness of the containers that store toiletries. The Registered Person must through adequate training and other arrangements ensure that the risk of infection and spread of infection is appropriately reduced. This relates to the shortfalls discussed in this report. (This requirement has been repeated from two previous inspections. Timescale of 01/09/06 and 31/07/07 not met). The Registered Person must ensure that robust recruitment processes are followed in order to safeguard residents living in the home. In particular two satisfactory references must be received by the home before an individual is employed. The Registered Person must make arrangements to ensure the home can demonstrate that staff are receiving adequate induction training and development in their skills and knowledge. The Registered Provider must ensure an application is made to the CSCI in relation to DS0000063477.V342373.R01.S.doc 15/10/07 9 OP19 13(3) 15/10/07 10 OP26 13(3) 15/10/07 11 OP29 19 15/10/07 12 OP30 18(1)(c) (i) 31/10/07 13 OP31 9 31/10/07 Euroclydon Nursing Home Version 5.2 Page 33 14 OP33 24(1) 15 OP38 37(1)(e) 16 OP38 23(4)(a) (d) 17 OP38 13(4)(a) 18 OP38 12(1) registering a ‘fit person’ as the Registered Manager. (This requirement has been repeated from the previous inspection. Timescale of 31/07/07 not met). The Registered Person must devise and initiate a system for evaluating the quality of care & services provided in the home and demonstrate how these will be improved. (This requirement has been repeated from the previous two inspections. Timescale of the 01/11/06 & 30/06/07 not met). The Registered Person must make arrangements for any event, which adversely affects the well-being or safety of residents to be reported to the Commission. This relates to the interruption in hot water supply and heating supply. The Registered Person, through training and through the use of a fire risk assessment, ensure all staff working in the home are aware of fire prevention and are competent in the event of a fire. (This requirement has been repeated from in the two previous inspections. Timescale of 28/07/06 & 16/04/07 not fully met). The Registered Person must ensure that health and safety guidelines are adhered to. This relates to the safe restriction of windows. The Registered Person must ensure that each resident is provided with access to a call bell at all times, particularly when the resident is alone in his or her bedroom. DS0000063477.V342373.R01.S.doc 30/10/07 15/10/07 15/10/07 15/10/07 15/10/07 Euroclydon Nursing Home Version 5.2 Page 34 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 OP16 OP31 Good Practice Recommendations Consideration should be given to ensuring more accurate notes are made when investigating a complaint and in recording any meetings held with a complainant. Serious consideration should be given currently to ensuring that the new acting manager is completely supernumerary and able to concentrate on managing the home and making necessary changes for improvement. Consideration should be given to robust documenting of health and safety checks within the home. 3 OP38 Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Euroclydon Nursing Home DS0000063477.V342373.R01.S.doc Version 5.2 Page 36 - 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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