Inspection on 13/02/07 for Euroclydon Nursing Home

This inspection was carried out on 13th February 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 10/09/07

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 13th & 14th February 2007 10.45 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.V323645.R02.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.V323645.R02.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.V323645.R02.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. 4th July 2006 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 persons over the age of 65 years. It currently accommodates a small number of residents under the age of 65 years 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 £380.00 to £520.00 per week (current in January 2007). Services not included within the fees are hairdressing, chiropody (foot) care and newspapers. Public transport 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.V323645.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this unannounced inspection over two days. The first day was between 10.45am and 9.50pm and the second day was between 12.10pm and 7.15pm. 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. 25 resident and relative surveys were sent to the home for distribution prior to this inspection. The CSCI received 6 back, comments from which have been included within this report. As well as a selection of records relating to various aspects of care and the safe administration of medications, the care of five residents’ as well as their records were inspected in detail as part of a case tracking exercise. Arrangements for maintaining residents’ privacy and dignity were inspected and how these extend to allowing choices to be made and preferences to be met. Systems in place to ensure a varied and nutritional diet were inspected. Policies and procedures to ensure residents’ safety and protection from abuse were inspected, including how the home deals with complaints. The environment with records for maintenance and servicing of equipment, cleanliness and the arrangements to prevent infection were also inspected. All aspects relating to staffing were inspected, including staff recruitment records, staff training and arrangements for the supervision of staff. Various management systems were inspected along with how the views of the residents and other visitors are sought and how these influence in what way the home improves its services. What the service does well: The food provided is liked by the residents and is of a good standard. Good staff recruitment processes are in place and help to protect vulnerable residents. Residents’ personal monies are kept safe and the records kept are well organised and transparent. Euroclydon Nursing Home DS0000063477.V323645.R02.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: A copy of the Service User Guide and the complaints procedure needs to be given to each resident and /or their representative. Financial information regarding the Registered Nurse Care Contribution (RNCC) needs to be clearer for those who receive funding. The overall experience and qualifications of staff need to improve and relate to the needs of the residents within the home. Some aspects of the care planning documentation need to be more concise in order to give staff adequate direction. Residents need to be more actively involved in the devising of their care plans. Some shortfalls within the organisation and administration of the medication system need to be addressed and are clearly outlined within the appropriate outcome within this report. The home needs to be managed in such a way that recognises residents’ choices and which enhances their quality of life whilst in care. There needs to be some guidance for residents/visitors on how to seek advocacy. Improve arrangements that will ensure residents receive the support they require to eat/drink or receive the encouragement and monitoring they require to regain their appetite. Euroclydon Nursing Home DS0000063477.V323645.R02.S.doc Version 5.2 Page 7 The general profile of adult protection processes and elderly abuse needs to be raised. Some floor coverings still need to be made safe. Arrangements for acting upon identified maintenance work require improvement. Some adapted equipment in bathrooms and toilets requires changing in order to ensure cleanliness can be maintained. Arrangements to ensure staff are following infection control procedures and the training of staff in this needs improvement. The home needs to be staffed appropriately in number and skill mix. The Registered Person needs to ensure the home is running effectively and meeting the Care Home Regulations. The Registered Provider needs to support and allow the acting manager to facilitate the smooth running of the home. Provide new and inexperienced staff with adequate supervision. Provide all staff with adequate ongoing supervision and support. Provide staff with training in first aid, health and safety and the Control of Substances Hazardous to Health (COSHH) in order to help protect residents. Improve the standard of moving and handling practices. Organise and delegate health and safety checks that will help reduce the risk of harm or injury to residents and record these robustly. Thirteen requirements have not been complied with fully since the last inspection. On this occasion the timescales have been extended as indicated in the requirements made. Unmet requirements impact upon the welfare and safety of residents. Failure to comply by the revised timescale may lead to the CSCI considering enforcement to secure compliance. 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. Euroclydon Nursing Home DS0000063477.V323645.R02.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 Euroclydon Nursing Home DS0000063477.V323645.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The information available about the home is not accurate and therefore does not allow the prospective resident or their representative to make an informed decision regarding their care. Arrangements are in place for each resident to receive a contract, although recent new requirements under the Care Homes Regulations need to be met in order for complete transparency regarding entitlements. Residents’ needs are assessed prior to admission, however arrangements have not been in place to ensure these meet with the staffs’ skill mix or abilities. Arrangements are in place for prospective residents and other visitors to visit the home prior to admission. Euroclydon Nursing Home DS0000063477.V323645.R02.S.doc Version 5.2 Page 10 EVIDENCE: Both the home’s Statement of Purpose and Service User Guide were in the reception area. Although these documents had been updated since the last inspection in July 2006, the home was unable to demonstrate that it could meet all of the aims and objectives stated. There were some factual inaccuracies, which were also pointed out during this inspection. Neither the acting manager nor the home administrator was able to confirm that residents or their representatives are issued with a copy of the Service User Guide. Only one side of the home’s registration certificate was displayed. Both sides must be displayed for all the registration particulars to be viewed. Each resident funding their own care are issued with a copy of the home’s terms and conditions. These have been recently updated and a copy now needs to be issued to those who receive funding towards their care. Those funding their own care are made aware of the amount awarded to them for the Registered Nurse Care Contribution (RNCC). Those who receive funding towards their care, where the funded amount includes the RNCC were not being provided with a breakdown. The home has subsequently made arrangements for better transparency regarding this to comply with the Care Home Regulations 2001. A requirement from the last inspection has been met and all residents are assessed prior to admission and their needs are now recorded. Two examples of the new format were seen. If a resident is admitted as an emergency, the home endeavours to gather as much information as possible from involved individuals. Evidence gathered in this inspection demonstrated that not all the residents’ needs were being adequately met. Some are of specialist nature and very specific and many of the staff did not hold appropriate skills to meet these. Examples where residents’ needs were not being met were seen in two residents that have dementia, one resident with a catheter, one resident who’s mobility was poor, one resident who was dependant on staff to meet all of her needs, one particularly poorly resident and another resident who had a reduced appetite due to a recent illness. Euroclydon Nursing Home DS0000063477.V323645.R02.S.doc Version 5.2 Page 11 An immediate requirement was issued during this inspection for the Registered Provider to address this shortfall. Relatives and friends are free to visit at anytime and are made welcome. The home’s administrator was observed talking to regular visitors in a relaxed and welcoming manner. It was also obvious from a conversation witnessed between a carer and a relative that the lines of communication between them were relaxed and friendly. One relative confirmed that she visits on a regular basis and the staff are always friendly. One pre inspection survey returned by a relative did not feel that staff always listened to what they were saying; the other five were satisfied. Euroclydon Nursing Home DS0000063477.V323645.R02.S.doc Version 5.2 Page 12 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, 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Whilst arrangements are in place to plan and record the care needs of each resident, however their needs are not always met. The medication system is safe but there are some shortfalls that need addressing. In many cases residents’ privacy and dignity is upheld, however through a lack of staff training and supervision this at times is being compromised. Although caring and sensitive, staff are not provide with the skills they require to care for residents that are admitted for palliative care. EVIDENCE: The written care documentation, which includes care plans was read in detail for four residents and cross-referenced with the actual care being delivered. Several additional care files were inspected and observations made. Euroclydon Nursing Home DS0000063477.V323645.R02.S.doc Version 5.2 Page 13 Although the home has taken steps to meet a requirement from the previous inspection and has improved the content of the care plans and associated assessments, it became clear as the inspection progressed that there were several examples where staff were unable to deliver the care stated in the plan and which the resident required. This shortfall was confirmed in one survey form completed by a relative; the other five forms recorded that needs were usually met. There still needs to be more involvement with the resident and/or relatives when devising care plans. There was not a lot of evidence to suggest this happens although staff have informed the inspector otherwise. An immediate requirement was issued during this inspection to ensure that the health and care needs of residents are adequately met at all times. The recording of pressure ulcer/wound care and pressure relief care was inspected. One of the qualified nurses has recently taken on the lead for wound care within the home and has been slowly altering and improving how this area of care is assessed and recorded. As part of the tissue viability forum she is able to update herself adequately in this area of nursing. The home also regularly liaises with specialist nurses to ensure that correct dressings and equipment are used. Community Nurses attend to the needs of those who are not assessed as ‘nursing’ but who have some nursing needs. In one case a resident was admitted from home where a specialist mattress was already in place. Although arrangements were made by the home to source a pressure relief mattress, this took 4 days. Consideration should be given by the Registered Provider to purchase a high dependency mattress for such situations or the admission must only take place once the needs of the resident can be fully met i.e. that the necessary equipment is in place. Another resident is having her healthcare needs reviewed by specialist medical staff. However it was obvious that staff were struggling to meet these and that her needs had exceeded what the home could provide. The Registered Provider must make arrangements for her needs to be fully met. One resident and her relative had asked staff twice to ensure her catheter bag and tubing was placed correctly and comfortably, this was not done and was found by the Inspector on each occasion under her calf. An immediate requirement was issued during this inspection to ensure that the health and care needs of residents are adequately met at all times. A chiropodist attends the home on a regular basis and there was evidence to show that optical assessments have been arranged. Euroclydon Nursing Home DS0000063477.V323645.R02.S.doc Version 5.2 Page 14 Residents’ weights are reviewed and recorded. Requirements from a previous specialist inspection carried out by a CSCI Pharmacy Inspector were followed up. Some of these had been met but there were shortfalls on the day of this inspection both in the records and when medication was being administered. These were as follows: • Prescribed topical applications (creams/ointments) seen in bedrooms past their open date or with no opening date and dispensed a long time ago (in one case 2003). • An eye ointment not dated on opening. • Neither of the two trolleys were secured to the wall, despite the facility being there to do so. • The oxygen cylinder in the nurses’ office was not secured. The bracket to do this was broken. • In several examples hand written entries on the medication administration sheet lacked a second or any signature. • The symbol ‘o’ was seen used in several records by the times that medication should have been given, instead of the correct ‘key’ of reasons for this omission. • On two occasions the administering nurse was observed to sign the record before successfully giving the medication. The temperature of the fridge used for the storage of medications was recorded daily and this was within correct limits. A physical count of all controlled medication is usually carried out each day and sometimes after each shift. The stock of medication brought into the home by a resident admitted for respite care is counted on admission and discharge and recorded. A resident who self medicates inhalers had a care plan to this effect and her ability to do this successfully was being reviewed and recorded monthly. The medication policy had been reviewed which included guidance for staff action in the event of an error. The Inspector did observe some situations where the privacy and dignity of residents was being directly compromised. The Inspector observed one situation, which was poorly handled by the staff member and if allowed to become day-to-day practice would lead to the residents’ dignity being compromised. This was a request from a resident in the lounge to go to the toilet. Instead of being helped to the toilet the resident was politely asked to sit down several times and staff did not responded to that request. Staff were seen knocking on bedroom doors before entering and speaking to residents in a polite and respectful manner. One relative raised a concern during the inspection, which related to male staff washing female residents. Residents’ individual feelings on this subject should Euroclydon Nursing Home DS0000063477.V323645.R02.S.doc Version 5.2 Page 15 be explored, which had not been the case here, there was also concern about how little cover the resident had been given during the wash. During this inspection one resident was very poorly and died. This resident was being reviewed on a regular basis by specialist external nurses and was having pain control therapy. Senior staff supported the next of kin in a respectful and caring manner following the death. The home has been accepting admissions, which require palliative care. Although the trained staff have some appropriate related general nursing skills the care staff and qualified staff lack specific training/skills in this form of care. The Registered Provider must ensure staff are trained in and aware of ‘good practice’ as specified in the ‘End of Life Pathway’. Training and support for staff can be accessed, free of charge from the Care Homes Support Team starting with the Foundation in Palliative Care’. Euroclydon Nursing Home DS0000063477.V323645.R02.S.doc Version 5.2 Page 16 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. Arrangements have been made to improve the residents’ quality of life by introducing a person dedicated to activities. There is a willingness within the home to help support residents to make choices and satisfy their personal expectations but this is not always happening due to poor staffing levels and lack of guidance for staff. Residents enjoy the food provided which is wholesome and varied and which is served in pleasant surroundings, but they are not all given enough support to benefit from this. EVIDENCE: There were examples where residents were clearly making their own choices about how they spend their time on a day-to-day basis. Those requiring support to do this were unable to fully achieve this. This was evidenced in several ways. One resident waited all morning to be got out of bed, although food had been delivered and she had been washed and dressed, albeit by the night staff. Euroclydon Nursing Home DS0000063477.V323645.R02.S.doc Version 5.2 Page 17 Two further residents were unclear about the time of lunch and were worrying about what to do; no one had been to tell them by 1.30pm. One resident had specifically asked for a lock on her bedroom as she is disturbed by a resident that wanders. One confused resident sat twice on another resident’s legs that were elevated. This was due to a lack of staff supervision. A carer fed residents in the dining room and stood up throughout the process. Residents dependent on help to get to the dining room were late for their lunch. The Registered Provider has made steps to meet a requirement from the previous inspection and has introduced an activities co-ordinator for 3 days a week. A small group of more dependent residents were observed to be sitting around a table enjoying an activity. Some residents commented that since she has been in the home they have joined in some activities. An entertainer was arranged for one afternoon in February. A carer took one resident in a wheelchair around the grounds for some fresh air. One survey from a relative agreed that the activities in the home had improved, one resident said there are never any that they can join in and two said that there are “sometimes” activities are made available. Each month a multi denominational service is held in the home and a Roman Catholic Priest visits other individual residents Visitors were seen in the home and several residents confirmed that their loved ones visited regularly. The Registered Provider was asked to consider providing information on advocacy incase any resident feels they lack contacts that can represent them. Lunchtime was observed in the main house dining room. Food was served from a hot trolley by the chef. There was a main meal and an additional choice plus alternatives. The chef knew the residents’ likes and dislikes and who required extra calories in their food, either because their appetite was small or there was a specific health reason for this, such as excessive wandering and therefore a loss of weight. The food provided looked appetising and hot and was described by some residents as ‘good old fashion cooking’. Since the last inspection the chef has access to items of food that makes it easier to provide some variation in puddings for those that are diabetic. He has however confirmed that there is still a problem accessing enough fresh vegetables and fruit over a two-week period. The kitchen looked very clean and tidy. The staff are appropriately trained and wear protective clothing. The Food Safety Officer inspected the home in Euroclydon Nursing Home DS0000063477.V323645.R02.S.doc Version 5.2 Page 18 February of this year and awarded the kitchen 4 star rating in recognition of the high standards held. The shortfalls in this outcome are not related to the quality of cooking or in its presentation. There were unacceptable practices observed throughout the inspection, which the inspector links to shortage of staff and inadequate staff training/experience. These were; residents being helped to eat their food by a carer that stood up throughout the process. This carer was the only carer in the dining room where five of the several residents in there required help to eat. Plates were seen in one bedroom at 8pm left from teatime. One resident’s supper was put alongside a resident’s teatime food without the carer waking the resident up and ensuring that she ate something. One resident was served his lunch at 12.40pm and it was removed at 1.20pm untouched and without any intervention from staff despite his care plan saying he had been recently poorly and needed encouragement to eat. Other drinks were seen next to fairly dependent residents, which were left to go cold. Euroclydon Nursing Home DS0000063477.V323645.R02.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 have been made to ensure residents and representatives have access to the complaints procedure and improvements to the recording of these will ensure these are dealt with. Information and awareness relating to adult protection/elderly abuse issues remain weak and are not robust enough to offer residents adequate protection. EVIDENCE: The home has a complaints policy with written procedures, which is also contained in the Statement of Purpose in the reception area. A summary of this is also located on the back of each bedroom door. A requirement from the previous inspection has been met and 4 complaints were seen recorded in the home complaints file including any follow up and action taken. One complaint related to incorrect moving and handling practices, the second related to the discharge of a resident, the third was related to the lack of preparation on the admission of two residents and the fourth related to the provision of equipment and a change of flooring not being carried out. Two of the complaints were via the funding authority Gloucestershire County Council and altogether three had been substantiated. The Registered Provider was made aware of these at the time of this inspection. Euroclydon Nursing Home DS0000063477.V323645.R02.S.doc Version 5.2 Page 20 The resident/relative surveys received back by the CSCI indicate that the person would know what to do in the event of needing to make a complaint but two were not sure whom they should speak to if they were unhappy. The protection of vulnerable adults (POVA) and information on elderly abuse does not have a high profile within the home. Although the home has a policy there was no further information on this subject. A requirement from the previous inspection has been partially met. The current acting manager, who has attended training on the subject from the Gloucestershire County Council’s Adult Protection Team, has delivered POVA training to 21 of the 39 staff. Qualified staff have yet to receive the training and one nurse spoken to was unaware of how other agencies become involved. This training will need to be ongoing and the general profile of elderly abuse awareness raised in the home to offer robust protection. As previously mentioned in this report there is currently no information regarding advocacy. Euroclydon Nursing Home DS0000063477.V323645.R02.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. Arrangements are in place to improve the environment in order to make it a more pleasant place for residents to live. There are sufficient toilets and communal wash areas, however access is being made difficult due to the storage of equipment, which poses a risk to the resident. Arrangements have been made to improve the standard of some specialised equipment in order to make the older persons life easier or more comfortable, however some of the existing equipment could pose potential health risks. Residents live in a home where some arrangements have been put in place to reduce potential risks of accidents or harm. However other maintenance issues are not being addressed quickly enough to prevent residents from being harmed or having an accident. Euroclydon Nursing Home DS0000063477.V323645.R02.S.doc Version 5.2 Page 22 Although the home is cleaned procedures are not adequately in place to prevent the spread of infection and therefore residents are at risk. EVIDENCE: Although the improvements made in relation to the environment have been recognised, however there are too many shortfalls that still put residents’ at risk and it is on this basis that the outcome area that this has been assessed as poor. The current acting manager confirmed that when she started at the home in October 2006 she undertook a detailed audit of maintenance work needing to be done, which encompassed health and safety. She is currently unaware of a planned programme of works and explained that any access to monies for these works have to be accessed from the Registered Provider. Decoration of the ground floor corridors and bedrooms has taken place. More needs to be completed but this starts to meet a requirement made in the last inspection and the Registered Provider has subsequently reported that 47 of the bedrooms have been decorated. The last inspection report required one specific bedroom to be decorated in order to enable staff to clean the walls when needed. This room had been redecorated, but not in a washable paint and again the walls were stained. A requirement was made in the last report to replace one specific bedroom carpet and make safe or replace others. The one carpet has been changed as have several others (40 according to the Registered Provider’s report), but bedrooms 35 & 28 have carpets that are unsafe and these must be replaced as soon as possible. An entry in the maintenance book by staff dated 8/12/06 identifies the carpet in bedroom 39 as ‘coming away from door strip’. This was still the case during this visit and poses a potential risk. The floor covering in the centre ground floor toilet (one of three) must be made safe; it is extremely uneven and has been temporarily covered with linoleum. The Registered Provider confirmed that all requirements made by the Fire Officer have been met. One linen cupboard, noted in the last inspection not to have a smoke detector, now has one in place. The previous requirement to improve the environment has been removed from the report as the Registered Provider is reviewing the area under the new Smoking Regulations due to be enforced in July of this year. Euroclydon Nursing Home DS0000063477.V323645.R02.S.doc Version 5.2 Page 23 Several toilet and bathroom areas were seen to have problems. One bathroom and one toilet area had obstructed access to the toilet due to the storage of equipment. In the bathroom this equipment had been used at 8.30pm but not put back correctly. The base of a hoist in one bathroom is extremely rusty, as is a raised seat in a well used toilet area making it impossible to maintain good hygiene standards. The call bell cord was missing in one of the main toilets. Several commodes in bedrooms were seen in the afternoon with the remains of talcum powder on them. The commode in bedroom 36 needs replacing as it is torn. There were no risk assessments in place for the individual use of bedrails. There was however a generic risk assessment. Several en suite facilities were inspected. These were tidy and clean as were some communal toilets. A requirement in the last inspection has been met and 7 new profiling beds with additional mattresses have been purchased. A requirement from the last inspection has been partially met as lights up the stairs have been repaired. An external company has checked the emergency lighting system, but according to records additional checks by the home are irregular. Covers to radiators were seen to prevent burn injuries in the event of a fall and associated piping was also covered. The Registered Provider has reported that the home has a new heating system. Heating boilers were last serviced in August 2006. Windows that were not restricted during the last inspection were revisited on this occasion and were now restricted. One window (bedroom 33) had been recorded in the maintenance book in mid January as not being able to open or close properly. This was still the situation during this inspection and the bedroom was uncomfortably warm and humid. This needs rectifying as soon as possible for the comfort of the resident residing in this room. The home looked fairly clean and a requirement from the last report has been partially met, as there were odd areas of odour but an improvement from the previous inspection. The acting manager confirmed that some colour coded cleaning equipment had been purchased, however one domestic was seen still using a metal bucket and wooden mop. Colour coded plastic aprons are used, but on the day of this inspection there were both colours being worn in the dining area. Euroclydon Nursing Home DS0000063477.V323645.R02.S.doc Version 5.2 Page 24 One member of staff did not change the plastic apron he was wearing between changing a resident who had been incontinent and then re entering the dining room. He admitted he had not actually changed the apron all shift. In another situation however two members of staff did not commence their task before wearing the appropriate protective clothing. An alcohol based hand wash was available in some areas for staff to use inbetween washing hands. The home has a clinical waste contract in place. The majority of staff have not received infection control training and this may account for some of the shortfalls, this is also a failure to meet a requirement from the last inspection. One specialised piece of equipment used to feed a resident was covered in residue of the liquid feed. This places this resident at risk of infection. Euroclydon Nursing Home DS0000063477.V323645.R02.S.doc Version 5.2 Page 25 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. The home is not adequately staffed to meet the needs of the residents and therefore this puts them at risk. Insufficient arrangements for staff training put residents in the position of being cared for by staff that do not recognise their needs or understand their illness. Good recruitment checks help to protect the vulnerable residents. EVIDENCE: At the time of this inspection the number of staff, their experience and knowledge did not equate with the high dependency levels and needs of the residents. A requirement was made in the last inspection regarding inadequate staffing levels, this has not been met. As evidenced in this report residents’ care needs were not being met. A lack of resident supervision was also particularly evident during the handover from day staff to night staff in the period between 8.15pm and 9.30pm. The staff agreed it was difficult to help residents to undress and get ready for bed, do resident baths, help other residents to the toilet, administer medications, offer Euroclydon Nursing Home DS0000063477.V323645.R02.S.doc Version 5.2 Page 26 hot evening drinks and give help to some of those residents who cannot feed themselves. One very confused resident was redirected and reassured several times by the Inspector in this period of time as other staff were busy. Another resident came to find a member of staff to help another resident who had been calling for assistance to get off the toilet. An immediate requirement was therefore issued to increase the staffing levels and review and adjust the dependency levels to bring them in line with the capabilities of the staff. The Registered Provider responded to this immediately and a subsequent meeting has been held with the CSCI on this subject. This will continue to be monitored. A requirement from the last inspection required the Registered Provider to aim to have 50 of care staff trained to the National Vocational Qualification (NVQ) standard in care or equivalent. Currently 2 staff have NVQ Level 3, 1 has Level 2 and another has NVQ Level 2 in Learning Disabilities. There are several overseas staff who are qualified staff in their country of origin who have been assessed as holding a qualification that the Registered Provider considers an equivalent. This is however not recognised as an equivalent to the national standard of training required in the United Kingdom. In January 2007 the percentage of staff was 40 . The staff recruitment process in the last inspection was organised, well documented and all criteria was being met. During this inspection two new staff files were inspected and were evidenced as having all criteria met. The home has had a fairly large turn over of staff since the last inspection, which is partly contributory to the high levels of inexperienced staff. Staff records showed a shortfall in relevant trainings and over a sustained period of time. New staff attend an induction training, which is run externally and funded by the Skills for Care Council. Staff then continue basic mandatory training within the home. At the time of this inspection 19 staff had received moving and handling training/updates and 13 had not. Fire training had been given to 30 staff and 8 were still to receive basic training (some were new staff). As mentioned previously other basic trainings have been identified as needed by the acting manager but still need to commence such as Health & Safety, COSHH and Infection Control. The acting manager confirmed that she has been unable to obtain free training for overseas staff that have been in the country for under two years. As the Euroclydon Nursing Home DS0000063477.V323645.R02.S.doc Version 5.2 Page 27 Registered Provider has been reluctant to finance alternative training the only other option open to this group of staff has been to fund training independently or not receive valuable training at all. There is currently no identified budget for training. This has been identified, as being needed by two acting managers but to date the Registered Provider has not provided this. Euroclydon Nursing Home DS0000063477.V323645.R02.S.doc Version 5.2 Page 28 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. Arrangements have been made to employee individuals capable of managing the home, however indecision and a lack of support are preventing the successful smooth running of the home. Arrangements are in place to offer and improve the communication between staff and the management, however there are still no relative and resident meetings. There is no system in place that helps the home management collate and identify shortfalls and plan to improve these. The arrangements in place do not allow for health and safety problems/works to be initiated quickly enough to offer robust protection to residents. Euroclydon Nursing Home DS0000063477.V323645.R02.S.doc Version 5.2 Page 29 Staff are not being adequately supervised and therefore residents are not protected from poor practice. EVIDENCE: The present Registered Provider has owned the home since May 2005. Since the last inspection in September 2006 the home has had two acting managers and has not had a manager registered with the CSCI since the Provider’s purchase. The current and third acting manager commenced 31/10/06. She is a registered nurse with additional qualifications and has worked within care homes prior to this. Meetings have been held with the Registered Provider and the CSCI with reference to the requirement under the Care Homes Regulations 2001 for the home to have a manager who is registered with the CSCI. It is anticipated that an application will be received in the near future. On the day of this inspection a staff meeting was held and staff confirmed that regular staff meetings are beginning to take place. Minutes of a nurses meeting were seen in the nurses’ office. The acting manager also confirmed that she had held a meeting with the cleaning staff. There was no evidence of any resident/relative meetings. Staff confirmed that one has not been held for a long time. A requirement in the last inspection was made for the Registered Provider to devise and commence a quality assurance system. This has not been met, although the acting manager has commenced some simple audits. The Registered Provider, who is the nominated Responsible Individual (RI) for the CSCI, is not meeting a requirement within the Care Home Regulations 2001 under Regulation 26. This requires the RI or ‘another delegated person’ to carry out a monthly, unannounced visit and provide a written report on the conduct of the care home. These reports must be kept within the home for inspection, a copy sent to the Registered Manager and if requested, a copy sent to the CSCI. The financial viability of the home was questioned with the Registered Provider who gave reassurances that this was satisfactory. A request for the home’s accounts has not been made as part of this inspection. Euroclydon Nursing Home DS0000063477.V323645.R02.S.doc Version 5.2 Page 30 The system for recording any expenditure or balances of residents’ personal monies was extremely well organised. Monies counted corresponded with records kept as required in the last inspection. Receipts are kept for any expenditure also for services such as the hairdresser and chiropodist. A monthly statement is generated for residents or their representatives showing the above. The Registered Provider did provide the CSCI with an improvement plan/plan of action following the last inspection. The home’s accident book was inspected and monthly audits of these had been carried out for the months of January 2007, December 2006 and November 2006. The falls/accidents recorded were not excessive in number. Notification is being made to the CSCI via Regulation 37 following a death and of any event that leads to a resident requiring hospital treatment. A requirement for this to be done was made in the last inspection report. Safe practices and related health and safety checks were inspected. Poor moving and handling of residents was observed on three separate occasions and brought to the acting manager’s attention. In one resident’s case her environment (the fire door) was not safe due to her wandering and confusion. It was noted at the same time that no other fire doors are alarmed. Consideration should be given to doing this as this offers residents added protection should they attempt to exit a fire door. There were no individual risk assessments in place showing how these risks could be reduced. There were no risk assessments in place for the individual use of bedrails. A member of staff had placed a warning sign over a large spillage of liquid in the lift, but no one had mopped this up. The home currently has no one trained in first aid or anyone who has received any first aid awareness. Checks on hot water outlets had been carried out on the day of this inspection but on 3 outlets known to have individual regulators. There were no records available prior to this day. Consideration should be given to recording regular health and safety checks such as hot water outlets, particularly if these are not all individually regulated. Services on hoists are recorded as in June 2006. There was no available certificate of service for the lift, although the Registered Provider confirmed this had been carried out. A current disagreement with the lift firm needs to be sorted out. A copy of the certificate is to be forwarded to the CSCI when it has been issued. Euroclydon Nursing Home DS0000063477.V323645.R02.S.doc Version 5.2 Page 31 Because of the above shortfalls an inspection by the Health and Safety Officer has been requested. Checks to fire extinguishers, electrics (for the tower only), portable appliance testing and tests for Legionella were recorded. Fire alarm tests and staff response records were seen for Sept 2006, Oct 2006 and Jan 2007. The records for these were not well organised. Euroclydon Nursing Home DS0000063477.V323645.R02.S.doc Version 5.2 Page 32 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 1 2 3 1 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X 2 2 X 3 2 1 STAFFING Standard No Score 27 1 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 1 X 3 1 X 1 Euroclydon Nursing Home DS0000063477.V323645.R02.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5(1) Requirement The registered person shall supply a copy of the revised service users guide to each resident and their representative (timescale of 9/9/05, 17/1/06 and 28/03/06, 01/09/06 not met). The registered person shall prepare a written plan of care in consultation with the service user or their representative where possible and include them in any review of this plan. The Registered Person must only admit residents to the home who’s needs can be met by the services the home provides and which are within the capabilities of the staff group. The Registered Person must ensure the home is run in such a way as to meet all the health and care needs of the residents and offer adequate supervision where required. This also relates DS0000063477.V323645.R02.S.doc Timescale for action 16/04/07 2. OP7 15(1) 31/05/07 3. OP3 14(1)(d) 31/05/07 4. OP8 12(1) (a&b) 16/04/07 Euroclydon Nursing Home Version 5.2 Page 34 5. OP8 12(3) 6. OP9 13(2) to the care of those who are dying. The Registered Person must 16/04/07 ensure that residents’ feelings and wishes are acknowledged when meeting their health and welfare needs (this relates to requests from residents to go to the toilet). The Registered Person must 30/04/07 ensure that the Royal Pharmaceutical Society guidelines are met with relation to the administration and organisation of the medication system. (This is with particular reference to the following shortfalls: • Prescribed topical applications (creams/ointments) must be dated on opening and only used within the recommended time period. The same for eye ointments & drops. • The storage trolleys must be secured to a solid wall when not in use. • The oxygen cylinder in the nurses’ office must be secured and made safe. • Hand written entries on the medication administration sheet must be signed by two persons competent to do so to avoid mistakes in transcription. • The correct symbol (‘key’) must be used on the MAR sheet if a prescribed medication is not taken for whatever reason. • The administering nurse must only sign the MAR sheet when successful administration of the medication has taken DS0000063477.V323645.R02.S.doc Version 5.2 Page 35 Euroclydon Nursing Home place. 7. OP10 12(4)(a) The Registered Person must ensure the home runs in a manner that preserves the privacy and dignity of residents at all times. The Registered Provider must make proper provision for the health and welfare of the residents (this relates to residents who require help to eat and drink). The Registered Person must make arrangements by other means (as well as the continued training of all staff) to raise the profile within the home of the Protection of Vulnerable Adults. This must fall in line with the county’s protocol. 15/07/07 8. OP15 12(1) 30/04/07 9. OP18 13(6) 09/05/07 10. OP19 23(2)(d) The Registered Person must 30/06/07 ensure that all areas of the home are adequately decorated. The Registered Person must decorate bedroom 16 in such a way that allows the walls to be adequately cleaned. (Timescale of 01/09/06 partially met) The registered person must ensure that all floor coverings are secure and or replaced. This is with particular reference to bedrooms 28, 35 & 39 and the uneven floor in one of the ground floor toilets (Timescale of 01/09/06 not met) The Registered Provider must ensure that all areas that residents have access to are free from hazards. (This is with reference to toilet and bathroom areas being used for storage DS0000063477.V323645.R02.S.doc 11. OP19 23(2)(a) & 13(1) 01/05/07 12. OP19 13(4)(a) 01/05/07 13. OP21 13(4)(a) 16/04/07 Euroclydon Nursing Home Version 5.2 Page 36 14. OP22 16(2)(c) when still potentially used by residents). The Registered Person must ensure residents’ safety when specialised equipment is being used in this case bedrails used in conjunction with an appropriate risk assessment (Timescale of 9/7/05, 30/11/05 & 6/3/06 not met.) (Timescale of 21/08/07 partially met) The Registered Provider must ensure that all call bells are in good working order (this is with reference to the broken call bell in one of the ground floor toilets). The Registered Person must make arrangements for the window in bedroom 33 to be in good working order. The Registered Provider must ensure that any equipment used by the residents and staff is maintained in a satisfactory manner to avoid the spread of infection (This is with particular reference to the rust on the base of one hoist, also on a raised toilet seat and a torn commode in bedroom 36, making it impossible for good cleaning to take place). (Timescale of 01/09/06 not met). The Registered Provider must make arrangements through staff training and procedures to ensure good infection control is practised at all times. (Timescale of 01/09/06 not met). 16/04/07 15. OP22 23(2)(n) 30/04/07 16. OP25 23(2)(p) 01/05/07 17. OP26 13(3) 01/06/07 18. OP26 13(3) 31/07/07 19. OP27 18(1) The registered person must 10/04/07 provide enough staff on duty to meet the all the residents’ needs and facilitate the smooth running of the home and its upkeep. DS0000063477.V323645.R02.S.doc Version 5.2 Page 37 Euroclydon Nursing Home (Timescale of 01/09/06 not met) 20. OP30 18(1) (c)(i&ii) The Registered Provider must 31/07/07 provide adequate and relevant mandatory training to all staff in order for them to be able to work safely. The Registered Provider must also provide suitable assistance and time off to achieve this. (Timescale of the 01/07/06 not met) The Registered Provider must 31/07/07 ensure an application is made to the CSCI in relation to registering a ‘fit person’ as the Registered Manager. The registered person must 30/06/07 devise and initiate a system for evaluating the quality of care & services provided in the home and demonstrate how these will be improved. (Timescale of the 01/11/06 not met). The Registered Provider must 16/04/07 carry out a monthly, unannounced visit to the home. Produce a written report on the conduct of the home as laid down in this regulation. Keep a copy in the home, provide a copy for the Registered Manager and forward a copy to the Commission. The registered person must 31/07/07 ensure that all staff receive adequate supervision. (Timescale of 01/10/06 not met) The registered person must 28/06/07 demonstrate through adequate records that all areas/systems that the resident has access to are reasonably free from hazards to their safety. (Timescale not DS0000063477.V323645.R02.S.doc Version 5.2 Page 38 21. OP31 9 22. OP33 24(1) 23. OP33 26 (2, 3, 4 & 5) 24. OP36 18(2) 25. OP38 13(4)(a)& (c) Euroclydon Nursing Home met 09/07/05, 30/11/05 & 06/03/06, 28/07/06 not met) 26. OP38 13(5) The registered person must provide staff with adequate training and update training to ensure safe moving and handling is practiced. (Timescale of 01/09/07 partially met) The Registered Provider must make arrangements to provide staff with First Aid training. 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. (Timescale of 28/07/06 partially met) 02/05/07 27. 28. OP38 OP38 13(4)(c) 23(4)(a)( d) 01/06/07 16/04/07 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. 3. Refer to Standard OP8 OP14 OP38 Good Practice Recommendations Consideration should be given to the purchase of a highlevel pressure relief mattress. Consideration should be given to providing information/contact numbers for advocacy. Consideration should be given to robust documenting of health and safety checks within the home. Euroclydon Nursing Home DS0000063477.V323645.R02.S.doc Version 5.2 Page 39 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.V323645.R02.S.doc Version 5.2 Page 40 - 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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