Inspection on 22/07/08 for Euroclydon Nursing Home

This inspection was carried out on 22nd July 2008.

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

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 31/01/08

Euroclydon Nursing Home 10/09/07

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 26/11/2008.

CARE HOMES FOR OLDER PEOPLE Euroclydon Nursing Home Drybrook Gloucester GL17 9BW Lead Inspector Mrs Janice Patrick Unannounced Inspection 11:05 22 , 25 & 30th July 2008 nd 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.V366420.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.V366420.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Euroclydon Nursing Home Address Drybrook Gloucester 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 Mr Stephen John William Evans Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Euroclydon Nursing Home DS0000063477.V366420.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. 31st January 2008 2. Date of last inspection Brief Description of the Service: This registered care home predominantly cares for people over the age of 65 years, although there are a few people who are younger and 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. Access to the first floors is by passenger lift. The gardens are well maintained and accessible to all residents and include a summerhouse. There is a long drive to the property but in front of the house is ample car parking. The home has its own tail-lift mini-bus. Public transport to and from the home is limited and buses only go as far as the local village of Drybrook, which is half a mile away. In certain, individual circumstances, and when the home is able, a lift from the village can be organised. The fee range is determined on an individual basis and does not include hairdressing, chiropody (foot care) and newspapers. Information on the services provided along with the last inspection report, can be obtained from the home on request. Euroclydon Nursing Home DS0000063477.V366420.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. 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. During this inspection ‘we’ (The Commission for Social Care Inspection, CSCI) inspected the care that people were receiving. We also inspected the records maintained in relation to this. In doing this we looked at how the staff in the home work with external healthcare professionals to provide this care. We explored how peoples’ privacy and dignity is maintained and how they are able to make choices, and have a say in what happens to them. We inspected areas that give added quality to someone’s life, such as opportunities to socialise, recreational activities, the choice and standard of food and the cleanliness of the environment. We inspected the arrangements in place to safeguard vulnerable adults and, those in place to help people make a complaint or express a concern. We inspected the records held in relation to staff training and supervision. We looked at staff rosters to ensure that there are enough staff on duty to care for those living in the home. We inspected many of the systems that are designed to help organise and manage the home. We looked at how the management team identify shortfalls within the service and how they aim to improve these. The communication systems throughout the home were looked at and included how staff communicate with those living in the people home and with those who visit. We inspected records in relation to all areas of health and safety. We also revisited outstanding requirements made by us in a previous inspection, to see if these had been complied with. What the service does well: It has a zero tolerance of any form of abuse and staff act quickly and effectively to protect those living in the home. They also share information with external agencies, such as the police, the funding authority or us appropriately. It allows residents’ to make choices and supports them to lead their lives in a way they wish to. Euroclydon Nursing Home DS0000063477.V366420.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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.V366420.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Euroclydon Nursing Home DS0000063477.V366420.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents’ have at their disposal relevant information, although this may not be reaching everyone prior to admission. Residents’ admitted to the home can be reassured that their needs will be assessed prior to their admission. This is so that the home can be sure that they can meet the individual’s needs. EVIDENCE: Information about the home, in the form of the Statement of Purpose and Service User Guide, was not seen in the reception area as in past inspections. A summary of some of this information was seen on the back of each bedroom door, which included the complaint process. Other information, including the Employers Liability Insurance Certificate and the home’s Registration Certificate, were on display as is legally required. One resident commented in their returned questionnaire that they were very happy with the home, but when talking about their admission said: ‘it was Euroclydon Nursing Home DS0000063477.V366420.R01.S.doc Version 5.2 Page 9 arranged by Social Services with minimal information available to me or my family’. Other questionnaires implied that people had been satisfied with the level of information they had been given about the home. In June 2008 the home submitted its Annual Quality Assurance Assessment (AQQA), which told us that relevant information could be provided in large print and on audiotape (for the visually impaired). We discussed the home’s pre admission process with the Registered Manager and saw examples of some written pre admission assessments. The Registered Manager is far more selective in who he will accept for admission, being careful to ensure that the home can meet the potential resident’s needs before their admission. We discussed two people who had been referred to the home by the local funding authority. The Registered Manager had chosen to decline both. The first example was where he had considered the person’s needs too complex for the home to cope with at that particular time and in the second instance, the local Primary Healthcare Trust’s (PCT) Mental Health services could not guarantee the level of support he felt would be required. The home had recently taken a resident as an emergency admission. The person had fallen at home and was subsequently admitted to hospital, but was too frail to be discharged back to their own home. We saw a record of brief details that had been given to the home by the on call emergency social worker. The staff then completed a more comprehensive assessment once the person had arrived. We saw another pre admission assessment, which was more comprehensive. In this case, the Registered Manager had had time to visit the person in their home, complete an assessment of their care needs, which had identified the need for a suitable pressure relief mattress before the person arrived at the home. The home also completed the process by sending a letter to the prospective resident, confirming their admission. The Registered Manager explained that this procedure was being followed for all ‘planned’ admissions. One resident confirmed in their questionnaire that the Registered Manager had visited them in hospital before their admission, and that the Manager had been very friendly and helpful. This improved control over the admission process generally should help the home admit people where they are confident that they can meet their needs. Euroclydon Nursing Home DS0000063477.V366420.R01.S.doc Version 5.2 Page 10 Following admission residents’ care should be evaluated on a continual basis so that current health and social care needs are reflected and suitably met. This will also further ensure that residents’ living in the home remain suitably placed. During previous inspections we have had concerns that this had not been done. In January we were particularly concerned about one resident’s safety when not supervised by staff. Although the Manager has since sought medical assessments and reviews from various healthcare specialists, we are still unsure that the safety of this resident is being maintained. During the inspection we found the resident outside unsupervised and the care file indicated that the resident had been found outside of the home on two previous occasions. We told the Manager that whatever the outcome of these reviews were, it remains the responsibility of the Registered Manager and Registered Provider to be sure that they can provide this person with the appropriate level of care. Euroclydon Nursing Home DS0000063477.V366420.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although there remain shortfalls in some areas of residents’ care, other areas of care and documentation have greatly improved. As a direct result of some of these improvements, and the involvement of external healthcare professionals to help monitor and rectify these, the risks to those living in the home are reduced. EVIDENCE: We have aimed to be proportionate in the assessment of this outcome. Although there are still shortfalls in the monitoring and assessing of residents who are nutritionally at risk, we are reassured that appropriate steps are being taken to address this, through the support of external healthcare professionals. We have issued a separate Statutory Requirement Notice requiring the home to adequately assess residents’ needs and to ensure that this process is maintained. Euroclydon Nursing Home DS0000063477.V366420.R01.S.doc Version 5.2 Page 12 In this case, this specifically refers to the assessment, monitoring and meeting of individuals’ nutritional needs. The home had previously failed to maintain a record of individuals’ weights. Qualified nurses were not using the Malnutrition Universal Screening Tool (MUST) correctly or consistently and care staff were not correctly maintaining the food intake charts. There seemed to be a difference between what care staff, kitchen staff and qualified nurses all thought residents’ were eating. Daily entries of progress were being misinterpreted during monthly care plan reviews, giving the wrong impression of someone’s overall progress. The home could not therefore demonstrate consistent monitoring of those nutritionally at risk. In 2007 this resulted in a complaint from relatives who also had concerns about a resident’s progress in this area. Following our inspection of the home in October 2007 and a requirement by us to resolve this, the home enlisted the support of the Care Home Support Team. As a result of this the Malnutrition Universal Screening Tool (MUST) was introduced in order to bring some form of structure to the assessment process. The tool requires residents’ to be weighed and/or measured on a regular basis, according to their level of risk or loss of weight, which then ‘triggers’ further measures to be implemented if required. The idea being, if completed properly, a resident should not carry on losing weight without this being picked up at an early stage and some form of action being taken. Staff received training in its use and the senior management were auditing its use. We saw some of the audit statements during this inspection clearly picking up gaps in the use of the MUST and subsequent care planning. The way the food charts were being completed remains unhelpful. For example, entries such as ‘half of meal eaten’, ‘half a pudding taken’ does not tell us anything and it fails to say what was originally offered or precisely what was eaten. An example of a carer completing the food chart for one person at the end of her shift meant that the charts were open to mistakes being recorded. During this inspection there were three examples where a mixture of the above shortfalls meant that the individuals’ nutritional risk could not be adequately determined. We were impressed with the kitchen staffs’ knowledge of residents’ nutritional requirements. It was these observations in the case of one resident, which showed us that what was being recorded in the care plan summary was actually not what was happening in the dining room. This resident had been evaluated as ‘eating well’ in their care plan, however when we spoke with kitchen staff we were told that the resident had refused breakfast and at lunch time had spent moving the food around on the plate. The kitchen staff always assess the levels of wastage after each meal. Euroclydon Nursing Home DS0000063477.V366420.R01.S.doc Version 5.2 Page 13 A visitor commented in their questionnaire that in their opinion, their relative was still not given ample support at mealtimes. We explored this specific resident’s eating habits, which were complicated by the actual lack of acceptance of help from staff. We noted that the member of staff originally designated to ensure that certain residents’ receive the support they require in the dining room at breakfast time is still doing this. Previous inspections have identified serious shortfalls in care planning. We inspected several care files and then cross-referenced the written information with the care that was being delivered. We then asked staff about various needs to ascertain their knowledge of the written care plans. The care planning system and general documentation system has been changed, making it far more user friendly for staff to complete. When reviews are carried out or when health care needs change, previous assessments and care plans are now weeded out, therefore avoiding the original problem of conflicting information being in a resident’s file. Qualified nurses still need to ensure that completed assessments are dated and in some cases make sure their handwriting is legible. The style in which care plans are now being written is generally becoming more personalised and relevant to the resident’s actual problems. Some new records have been added to the system in order to try and address some of the new criteria required under the Mental Health Capacity Act 2005 and Equality and Diversity issues, but this requires further work. We inspected records for residents’ who require wound care. This was another area that had serious, shortfalls. We looked at one set of records, which related to pressure sores, developed on a resident’s heels. At our previous inspection we could not determine which record related to which heel and what care had been provided, when. However since our last visit one nurse had made a specific effort to ensure that it was ‘her’ who mainly dressed the wounds, in order to maintain continuity and consistency in practice. The records also demonstrated what care had been given and it was good to see that both heels had almost healed. In contrast to this, one resident’s legs were seen to have various open sores. The resident complained of it being an ongoing problem with one sore healing and another developing. One of these sores clearly required a dressing and the person told us that flies had been landing on it the previous day. We asked nurses why this had not been attended to if the sores were present the day before. They seemed unaware of the new development. On inspecting the wound care records; the last recording of a sore was in June of this year. We were concerned that no one had reported these changes. We were told that review dates for wound dressings are being put in the main diary so that they are not forgotten or missed. Euroclydon Nursing Home DS0000063477.V366420.R01.S.doc Version 5.2 Page 14 We read in one resident’s wound care records that the wound was due for review on the 24/07/08, having been reviewed previously on the 21/7/08. This had not taken place and it was not in the diary. This wound was reviewed during this inspection on the 25/7/08 after we had pointed this out. Returned questionnaires implied that residents’ were generally happy with the care they were getting and felt that staff listen and were usually available when they need them. As we arrived at the home the Registered Manager and Registered Nurse were administering the morning medications. We inspected the medication administration records (MAR) for several residents’. At 11.05am we noted that the MAR sheets for three residents’’ indicated that they had not yet had their medication. We were concerned that these medications were late, as on the MAR sheet the time for administration was 8am. We were told that two of these residents’ had been given their tablets but the MAR had not yet been signed. Medication must always be signed for directly after it has been successfully administered. By not doing this it puts the person at risk. This member of staff could have been waylaid or simply forget to sign the MAR, which means that another nurse may read the MAR and think that the medication has not yet been given and proceed to give this again. This is particularly dangerous when medication is not within a blister pack, where it is easy to see if an individual tablet for a set day, for a set time is still in the packaging or not. The medication trolley during this inspection contained a mixture of blistered medication and those that were in original boxes. On this occasion we witnessed these being signed for as soon as we pointed this out. It was also noted that these particular medications were being prepared individually into a medicine pot, in the nursing office and then being carried some distance to the person it was prescribed for (without the relevant MAR chart). This is considered poor practice and increases the risk of residents receiving wrong medication. Later in the day we observed one nurse dispense medication into a pot without reading the MAR sheet. The nurse was asked how she knew these to be the correct tablets; she said that she just knew. This is highly dangerous practice and goes against all guidance laid down by the Nursing and Midwifery Council (NMC). This practice appeared to be a ‘one off’ during this inspection. The Registered Manager also witnessed this and reassured us that an urgent supervision session would be held with this member of staff. This was subsequently confirmed as having taken place. Another person was prescribed a tablet during the daytime that is used as a relaxant. It had been prescribed for use at the resident’s or nurses’ discretion. It could be administered up to twice a day and between 30/06/08 and 25/07/08 had been used six times. There was no care plan that explained Euroclydon Nursing Home DS0000063477.V366420.R01.S.doc Version 5.2 Page 15 under what circumstances this should be used. Clear guidance is required as different nurses may use it for different reasons and its use could be abused. We saw that several MAR sheets were not attached to the main folder making it possible for records to get lost. We noted that a previous requirement made by us for all eye drops to have a date of opening put on them was being complied with. We witnessed two nurses checking the stock of a controlled medication and going together to give this to the person, but again this was done without the MAR chart in hand. Euroclydon Nursing Home DS0000063477.V366420.R01.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 good. This judgement has been made using available evidence including a visit to this service. There is a genuine desire to ensure that residents’ have opportunities for recreational activity. They are also supported to make their own choices on a daily basis, so that they can aim to lead a life where their individual expectations and preferences can be achieved EVIDENCE: During our inspection in January 2008 the home had just organised for twentytwo hours per week to be designated for activities. An existing carer had undertaken specific training in this and was due to commence in this role soon. During this inspection we saw this carer engaging with a small group of residents’’, who required a fair amount of support, to enjoy a game of bingo. Some residents’ during this inspection said they enjoyed the activities but that some are cancelled at short notice. Records showed that there had not been many activities provided in June. Reasons for this included annual leave and time spent on a one to one basis with residents’ who had needed this input. We noted that one person had been supported by the activities co-ordinator to go to a relative’s funeral. Records also showed that at other times, residents’ Euroclydon Nursing Home DS0000063477.V366420.R01.S.doc Version 5.2 Page 17 had taken part in painting, bowls, quizzes and music and movement. Several had enjoyed a trip around the Forest of Dean on the 18th July. A comment in one of the questionnaires returned by a relative said that their relative had enjoyed the trips out in the minibus. Another resident, who lives in the home, said they are always invited to take part in the activity taking place and that they enjoy these very much. One resident had commented that there needed to be more ‘one to one’ with those who suffer from poor memory or have lost the skills to participate in group activities. There are several residents’ like this in the home and although we are aware that some ‘one to one’ time is given, we would imagine that more activity hours are needed to be able to offer this. We have been told that it is the intention of the home to increase these hours once other expenses have been met. Residents’ were certainly observed making choices and many were seen to prefer their own set routine. Some like to remain predominantly in their bedrooms, some are going out independently with friends, relatives or support workers. If residents’ are able to look after their own finances then support is given by the administrator for them to continue doing this. A choice is given at mealtimes, including alternatives to the main dishes on offer at lunchtime. One relative said breakfast could be ‘mundane’ and said: ‘cereal seems to be the order of the day’. We spoke to the cook and looked at various records, which indicated that several residents’ were getting a variety of cooked breakfasts. For some, their choices will only be as good as those offered by the carer who gives time to do this. Residents’ are free to take a walk in the garden; one resident was seen enjoying their newspaper in the sun, seated at one of the garden tables. One resident who is not safe to do this alone is helped by staff to enjoy the garden. We spoke to several residents’ during lunchtime and they said the food was always good. One said: (referring to the cook) ‘she knows what I don’t like’. The cook serves lunch in the dining room from a hot trolley, so kitchen staff are interacting on a daily basis with those living in the home. They did seem to have a fairly good idea of what people like and do not like. These dislikes and preferences are all recorded on a board in the kitchen including specific diets. The cook is made aware of people’s weights, so is aware of who is losing weight and who needs to be kept an ‘eye on’. One resident had expressed a wish to lose weight having previously been overweight. The resident has been supported by kitchen staff to achieve this. The home is currently looking for a local community swimming pool, which has a hoist because the resident would like to use this as a form of exercise. Euroclydon Nursing Home DS0000063477.V366420.R01.S.doc Version 5.2 Page 18 Euroclydon Nursing Home DS0000063477.V366420.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 good. This judgement has been made using available evidence including a visit to this service. Residents’ living in the home and those visiting can be reassured that their complaints and concerns are taken seriously. They can also be reassured that there are clear policies and procedures in place to safeguard people from abuse and that appropriate action is taken when there is a suspected or alleged incident. EVIDENCE: We know that the home has received some complaints over the last year. These are recorded along with the letters sent and action taken in the home’s complaint file. As previously reported, the complaint process for people to follow is on the back of each bedroom door. It is also up on the notice board along one of the main corridors. The questionnaires received back indicate that people know how to make a complaint and do raise issues with the Registered Manager. The AQQA speaks of an ‘open door’ policy, which is aimed to help people raise concerns without the fear of reprisal. The home has a policy with procedures that relate to the safeguarding of vulnerable adults. We know that these procedures are followed in cases of alleged abuse because we are informed and through our communication with the local Safeguarding Team. Euroclydon Nursing Home DS0000063477.V366420.R01.S.doc Version 5.2 Page 20 Residents’ do report incidents that they feel unhappy about and the returned questionnaires tell us that people know who to talk to and that they feel staff listen. We know that staff have received training in safeguarding adults, some received this from the local Safeguarding Adult Team rather than ‘in house’. Senior staff and care staff tell us that they also discuss the subject in staff supervision and staff meetings. Euroclydon Nursing Home DS0000063477.V366420.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 adequate. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from living in an environment that is being constantly improved and which is kept clean. EVIDENCE: The home is a very spread out environment on two floors. As we saw in our inspection in January 2008, the communal area within the extension remains closed off. It is currently being used for storage. This does not affect the people within the home, as there is ample, alternative communal space. The closure of this area does mean that staff can monitor and observe those living in the home in a space that is more manageable with the current numbers of staff. Euroclydon Nursing Home DS0000063477.V366420.R01.S.doc Version 5.2 Page 22 The home continues to be upgraded with a rolling programme of improvements. We have been told that the next area for decoration will be the smaller bedrooms on the second floor. In relation to health and safety the hot water system in the main house could not be regulated and therefore risks of potential scalding had to be managed. The fitting of individual regulators on baths and sinks was due to start the week after this inspection. This is an important upgrade. The garden has a new large summerhouse, and it is planned that smaller groups will also use this, apart from individuals, for activities in the warmer months. We felt the home looked clean and tidier than our last visit, apart from the lounge in the extension. This seemed to be the consensus within the questionnaires returned. We could see that alterations made to the bathing facilities have included adaptations to make them easier for the elderly and physically disabled to use. An external contractor last checked the nurse call bell system in April of this year. All moving and handling hoists are also serviced appropriately. Staff have received training in effective hand washing techniques and now understand the colour coding of cleaning equipment, which is designed to help reduce the risk of cross infection. Care staff were seen wearing plastic aprons when either serving food or carrying out care tasks and disposable gloves were available. One particular member of staff has been given extra supervision in relation to shortfalls in good infection control practices, observed by us in January of this year. The Registered Manager also informed us that he has requested an infection control audit to be carried out by an external specialist. We will look at this on our next visit. The laundry was tidy and there are separate hand washing facilities. This room is now locked when staff are not present, as one person living in the home, liked to go in there and it was considered too high a risk. Euroclydon Nursing Home DS0000063477.V366420.R01.S.doc Version 5.2 Page 23 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 adequate. This judgement has been made using available evidence including a visit to this service. More input into staff training should improve staff awareness and will benefit those living in the home. Some basic competency issues within the qualified nurse team still require addressing to ensure people who use the service are not put at risk EVIDENCE: We were told that the home has under 35 residents’ currently living in it, so there are six carers in the morning and five in the afternoon (usually from 2pm), with two nurses on duty in the morning and one in the afternoon. The Registered Manager said he is usually extra to these numbers, carrying out management and teaching related tasks. The Deputy Manager also gets some time for office related work so that he can catch up on training staff, overseeing care systems and auditing. We checked the information we were given against the staffing roster and the agency staffs’ time sheets for the weeks commencing 14/07/08 & 21/07/08 and these numbers had been maintained. We also wanted to know if these numbers were adequate not only for the number of residents’ living in the home, but also appropriate for their level of need. Care staff continue to tell us that there is not enough of them to cope Euroclydon Nursing Home DS0000063477.V366420.R01.S.doc Version 5.2 Page 24 with the dependency needs of those living in the home. In some questionnaires a shortage of staff, particularly at weekends is commented on but equally so, most questionnaires tell us that people feel their needs are met and there is usually someone about when they need help. During this inspection the Registered Manager was seen helping the afternoon nurse with tasks that she still needed to do. At 4pm the home was contacted regarding a potential emergency admission and the monthly medication order arrived. The nurse had not at this point had a break. Although we were inspecting and the Registered Manager had been involved in this, the level of work at this point did necessitate him helping the nurse out. We have been concerned before about the home only having one nurse on duty in the afternoons, but the Registered Manager and Registered Provider maintain that this is manageable. During this inspection we saw an extra member of staff being organised for the next day because of the new admission, but by the time the night staff came on duty (8pm) this person had not arrived. The home were not informed any further of the progress of this admission by those arranging it. This does not help a care home plan its staffing. The home is low on care staff who hold the National Vocational Qualification (NVQ). This is due to problems the home has had in retaining staff over the past year, although this is slowly beginning to improve. A positive step towards achieving this is a more organised induction programme for new care staff, which is designed to lead onto the NVQ. Also, as part of a government funded initiative for care homes (Partnerships for Older People Project, POPPS) the home has taken delivery of a computer so that staff can work through some parts of the qualification electronically. Qualified staff are also receiving support to improve their competency in areas particularly around residents’ nutritional needs and wound care. As the administrator was away during this inspection and due back the following week, we requested the recruitment details of two people to be forwarded to us on her return. This information was subsequently received in September. It shows that all appropriate checks were carried out and that references were obtained. A gap in one person’s employment was explained but not in the other. All gaps in employment must be accounted for. Euroclydon Nursing Home DS0000063477.V366420.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ do benefit from living in a home that is generally run in their best interest and their views are taken into consideration when looking at ways of improving the service. However, the audits and checks that have improved the service so far, need to be maintained for this to continue. EVIDENCE: The home’s manager is registered with the Commission and is a Registered Nurse; a Deputy Manager, who is also a Registered Nurse, supports him. The Registered Provider is regularly on site and very involved in the running of the service. The home has now had stability in its senior management structure for nearly six months and improvements are now beginning to be noticeable. Euroclydon Nursing Home DS0000063477.V366420.R01.S.doc Version 5.2 Page 26 Systems that were completely disorganised have some structure to them and new initiatives are being introduced. There are still shortfalls occurring as have been described earlier in this report but there are now systems in place to identify these and address them in most cases. Several audits were a month behind during this inspection and we told the manager the importance of making sure that these are maintained, as it is through these, that slippages are identified before situations become a problem. This included the home’s health and safety audit for June. We were not clear why these had been missed, it seemed to be that senior staff had just been too busy, but we discussed the need for senior staff to be more organised and focused. There is certainly a need for more experienced qualified staff to be able to delegate to. We were told that an advert is currently out for a full time qualified nurse. Staff are receiving more training and supervision and the home has the support of the Care Home Support Team. We saw training records that demonstrate that staff have completed more fire training, specifically in evacuation. The Registered Manager also confirmed that he has spoken to the night staff about this separately. Fire fighting equipment is serviced and checked by a recognised contractor. On the morning of the 25/07/08 we saw a frail resident being moved, from a wheelchair to a dining room chair, by two care staff. It was clear from the start of the transfer that the person’s ability to stand was going to be unpredictable and that the resident was feeling weak. The staff chose to go ahead with the transfer, which resulted in them taking most of this person’s weight under her arms. The person ended up on the edge of the chair. When we spoke to one carer afterwards she confirmed that an earlier similar incident from the bed to the wheelchair had frightened them all because the resident’s legs had ‘buckled’ beneath them. We looked at this resident’s moving and handling assessment and care plan and found that the half, which gave staff the instructions on how to move the resident, was missing. The Registered Manager explained that it had existed but wondered if it had been missed when photocopying took place. He wrote out another instruction sheet and said that he would speak to the staff to find out what the resident’s current capabilities were in order to make the instructions more specific and safe. We noted in the records of the previous evening (24/07/08) that this resident had required the aid of an electronic hoist to safely transfer. We asked if all staff had received updated manual-handling training, as this had been a requirement made by us in the January inspection. The Registered Manager confirmed that eleven staff had been updated on the 21/07/08 and that the next session was due on the 14/08/08. Euroclydon Nursing Home DS0000063477.V366420.R01.S.doc Version 5.2 Page 27 Our concern is that staff did not use their initiative and assess the situation before they went ahead and moved the resident; this resulted in a decision being taken which put all three people at risk. We read some of the questionnaires that had been returned to the home as part of their quality assurance. These went out to those in the home and to those who visit. These were collected in during this month and have not yet been collated. Staff members had also been asked to give constructive feedback on the management of the home. Records show that some staff have received recent supervision and that some have not. We saw that new equipment trolleys have been purchased for the domestic staff, meaning that the cleaning staff can now wheel their cleaning products and equipment around with them, reducing the incidents of the odd product being unattended. The arrangements for the safe keeping of personal monies were not inspected during this inspection, but were last inspected in January of this year and this was all in order. We have made a recommendation that there is more frequent and organised filing of important documentation in the managers’ office. At times it was taking quite sometime to locate records needed for this inspection and did not help the Inspector feel reassured that work was being carried out in an organised fashion. Euroclydon Nursing Home DS0000063477.V366420.R01.S.doc Version 5.2 Page 28 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 3 X X 2 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 2 X 2 Euroclydon Nursing Home DS0000063477.V366420.R01.S.doc Version 5.2 Page 29 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 OP8 Regulation 14 (2) (a & b) Requirement The Registered Person shall ensure that the assessment of the service users’ needs are kept under review And: revised at any time when it is necessary to do so having regard to any change of circumstances. (In this report this relates to anyone who may be nutritionally at risk). A Statutory Requirement Notice has been issued in relation to this. The Registered Person must ensure that records pertaining to the treatment of pressure sores and any other wounds are accurate and appropriately completed. (This requirement is repeated timescale of 15/10/07 & 01/04/08 not fully met) The Registered Person must ensure that all staff adhere to safe practice when administering medication. This specifically relates to staff making an DS0000063477.V366420.R01.S.doc Timescale for action 15/10/08 2 OP8 17 Schedule 3 (3)(n) 15/10/08 3 OP9 13(2) 15/10/08 Euroclydon Nursing Home Version 5.2 Page 30 immediate record when they have seen service users swallow their medication and: making sure staff check the latest medication administration record (MAR) before they proceed to administer any medication and: ensure that medications are only dispensed when: the medication in its original packaging with directions on, the MAR and the person due the medication are all together at the same time. (This requirement is repeated timescale of 01/04/08 not fully met) 4 OP38 13(5) The Registered Manager must provide further up date training in safe moving and handling and ensure that all staff are competent on completion of this. (This requirement is repeated timescale of 01/04/08 not fully met) 15/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP7 OP28 OP30 OP31 Good Practice Recommendations That qualified staff continue to get support in the writing of care plans in order to improve these further. The home aims to have at least 50 of its care staff trained to NVQ or equivalent. That qualified staff are provided with training in their legal responsibilities of appropriate and good record keeping. Serious consideration should be given to establishing a DS0000063477.V366420.R01.S.doc Version 5.2 Page 31 Euroclydon Nursing Home filing system in the manager’s office so that documents etc can be easily found/referenced. 5 6 OP36 OP38 That all staff receive supervision at least six times a year, which can be a mixture of individual sessions and group supervision, where a record is kept. Consideration should be given to the robust and consistent documenting of health and safety checks (audits) within the home. Euroclydon Nursing Home DS0000063477.V366420.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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