Inspection on 31/01/08 for Euroclydon Nursing Home

This inspection was carried out on 31st January 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Euroclydon Nursing Home 11/06/09

Euroclydon Nursing Home 22/07/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Euroclydon Nursing Home Drybrook Glos GL17 9BW Lead Inspector Mrs Janice Patrick Key Unannounced Inspection 31st January 2008 07:30 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.V357507.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.V357507.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Euroclydon Nursing Home Address Drybrook Glos GL17 9BW Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01594 543982 01594 544352 Chantry Retirement Homes Ltd Stephen 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.V357507.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. 10th September 2007 2. Date of last inspection Brief Description of the Service: Euroclydon Care home is located in the Forest of Dean on the outskirts of Drybrook and is registered with the Commission for Social Care Inspection (CSCI) to provide both nursing and personal care to predominantly older people. It does however currently accommodate a small number of younger residents who have a physical disability. The home provides thirty-eight single and five double rooms. Twenty-eight rooms offer en suite facilities. In addition, there are a number of assisted bathrooms and toilets on each floor. There are several communal areas and a separate smoking room. One working shaft lift enables access to the first floor. The gardens are well maintained and accessible to all residents and include a summerhouse. There is ample car parking within the grounds of the home. The home has its own tail-lift mini-bus. The fees range from £400.00 to £595.00 per week (current at the time of this report). Services not included within the fees are hairdressing, chiropody (foot) care and newspapers. Public transport to and from the home is limited and buses only go as far as the local village, which is half a mile away. In certain individual circumstances and when the home is able, a lift from the village can be organised. Information regarding the home can be found in the main reception area. The Service User Guide, also in the reception area, states that the home’s previous inspection report can be made available on request. Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The 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. Two Inspectors carried out this unannounced inspection over three days. We (The Commission) sent questionnaires to people living in the home and to their relatives in order to seek their views of the services provided. 10 survey forms were returned. We also sent questionnaires to local General Practitioners who visit the home and one was received back. These views and comments contribute to this report. As part of the inspection process the care of five people was selected and relevant records were inspected in detail. In addition to this many other related care records were inspected. The homes ability to meet the needs of people who are confused was inspected. Inspectors particularly focused on the homes ability to assess and care for actual and potential risks relating to pressure sores and loss of weight. How peoples privacy and dignity is maintained and individuals’ ability to make choices and have their preferences met were inspected. The degree of involvement and control that people have over their care and their inclusion in decisions made in the home was also considered. Social and recreational needs were explored along with the arrangements to meet these. The choice and standard of food was inspected along with the support available to those who require help to maintain an adequate food and fluid intake. Arrangements for staff training were inspected. The general management of the home including all aspects of health and safety practice were explored and records inspected. The systems required to enable a home to identify shortfalls and improve on these were discussed. Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 6 Previous requirements made by us were reviewed for compliance. Unmet requirements impact upon the welfare and safety of residents. Failure to comply by the revised timescale may lead to the CSCI considering enforcement improvement to secure compliance. What the service does well: What has improved since the last inspection? Senior staff have started to address some of the shortfalls within the care planning system and are attempting to ensure that staff record additional information accurately. The Care Home Support Team from the Primary Healthcare Trust (PCT) are now offering support and guidance to staff in order to help fill some of the gaps in staff knowledge. This support has so far concentrated on nutritional care and skills in caring for those with dementia. The home is also participating in the Partnerships in Older Peoples Project (POPPS) a Department of Health initiative where Care Homes can access free training in many aspects of elderly care. Staff are now dating eye drops and other medicines on opening so products that are out of date are not used. Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 7 One member of staff has now completed an activity co-ordinator’s course and will be providing activities, 3 days a week, in the near future. Most staff have received basic training in the issues relating to elderly abuse and are aware of what they should do if they suspect or witness such a situation. Improvements have continued to the environment. All main bathrooms and toilet areas have been completely refurbished. General decorating plans continue and some carpets have been replaced. The designated smoking room has been decorated and the Fire Officer’s requirements pertaining to the environment are almost met. Main boilers have either been serviced or replaced, so the home is now able to provide more consistent heating. A review of some cleaning routines and the correct use of clinical waste bins is helping to improve the homes standard of infection control. Staff retention has improved meaning that the home now has the opportunity to develop staff skills. A Deputy Manager has been recruited. This has already brought additional practical support to the home manager as well as additional skills to the qualified nursing team. The manager has been in post for nearly one year and has recently been registered formally with us (Commission for Social Care Inspection (CSCI). A member of the staff team has now been trained as a Safe Moving and Handling Trainer which means that staff can be trained in this as required. What they could do better: The home must be careful when admitting people for short periods or as emergencies and consider carefully whether the staff are able to and have the capacity to meet their needs. Care planning must become more relevant to the person’s needs and offer staff clearer guidance. Additional records/assessments must be maintained accurately and consistently. Improvements in the general filing of care-related documents is required so that important information can be easily found. Hand written instructions on Medication Administration Records (MAR) sheets need to be avoided and where this is necessary the guidance set by the Royal Pharmaceutical Society must be adhered to. Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 8 Every person designated to administer medication must do this safely. Each person living in the home, irrespective of their needs or capabilities must be provided with the opportunity to participate in recreational and social activities. People who require the support of a member of staff to maintain an adequate nutritional intake must be provided with this at each mealtime or any other time that they are hungry. All staff must be aware of the issues surrounding elderly abuse and know what to do, at the beginning of starting work in the home. The home must consider how they are to reduce the potential risks of scalds from hot water outlets in areas of the home where people living there have access. Records should also be kept to demonstrate consistent checks on the emergency lighting system, vital in the event of a fire or electrical power cut. All staff must receive training in how to maintain good infection control and adhere to good practices. This is particularly relevant in homes that care for the elderly person. There must be enough staff on duty at any given time to meet the dependency levels of the people living in the home and to ensure their safety at all times. The home must be able to demonstrate that it is providing adequate induction training for all new staff before they are deemed competent to care for people on their own. The Registered Provider and Registered Manager collectively must be able to demonstrate that the home is being run in a manner that benefits the people living in it. Ensure that the audits being used are able to adequately evaluate the system it is being used on (such as the medication audit) and then ensure that other key areas such as health and safety are audited. Develop a user-friendly quality assurance system that enables the information from the audits to be collated. Any shortfalls can then be highlighted and acted upon and areas of improvement can be monitored and sustained or improved further. Improve staffs’ moving and handling practices to ensure the safety of the person being moved and that of the member of staff. Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 9 Provide the home with written evacuation procedures and ensure that each member of staff knows what to do in the event of a fire. Ensure that this guidance/training meets with current Fire Regulations. Ensure that requirements made by us are complied with. 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.V357507.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although people who are planning to live in the home on a permanent basis are being adequately assessed prior to moving in, the acceptance and management of those admitted as emergency and respite admissions is putting a strain on the staff and people are being put at risk as a result. EVIDENCE: This outcome has been assessed using the Key Lines of Regulatory Assessment (KLORA). All people moving into the home on a planned and permanent basis are assessed prior to their admission. We saw recorded pre admission assessments that demonstrate that all aspects of someone’s care are explored. We saw that additional information is gathered from the placing authorities own assessment called the ‘Care Needs Assessment’, although in some cases this was very brief. Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 12 Two people, via the questionnaire we sent out prior to inspecting this home, confirmed that they had been assessed prior to their admission and another person confirmed that they were able to look around the home before moving in. The home makes it clear in its Statement of Purpose that it will accept Emergency Admissions. The Registered Manager explained that these admissions are usually from the local authority where a contract has been drawn up with the home to have a fixed number of beds for their use. In the case of someone being admitted as an emergency, information is shared initially with the home over the telephone. In some cases the placing authority will fax to the home a ‘Care Needs Assessment’ prior to admission or just afterwards. If a short stay in the home is required (respite care) the same arrangements will apply unless it has been planned in advance. In this case the Registered Manager will visit the person and carry out an assessment. One person had stayed previously for respite care but before this current admission had been reassessed by the Registered Manager. We were concerned that the home was unable to adequately meet the needs of two people who had been admitted in the ways described above. One had been admitted into a local authority funded bed and the other was paying independently. Records showed that the safety of one of these people was being seriously compromised at times and that staff were aware of this. We suggested that the Registered Manager seek a reassessment/review of this person’s health and reconsider as to whether her needs could be met. The other person had specific needs that were not being met because staff lacked the time and skill to address these. We asked the Registered Manager if he had control over who was admitted into these beds, he said he did have. The home had been furnished with a ‘Care Needs Assessment’ for both the above people. One clearly stated that the person had needs that the home would find difficult to meet. Staff did not have the capacity to meet these individual needs or ensure the one person’s safety at the time of this inspection. We were further concerned about arrangements that had been made to admit three more people over the period of this inspection. At the time of this occurring there were no alterations on the duty rosters or plans to increase the staffing numbers to accommodate increased dependencies (see staffing outcome within this report). We therefore issued an Immediate Requirement to increase the staffing numbers. We stated a minimum number of staff to be on duty in order to ensure that the health and welfare of the people in the home was met. Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 13 We informed the Registered Provider that he had the option to increase the staffing numbers further if he considered it necessary. Information about the home is available in two documents kept in the reception area. These are called the Statement of Purpose and the Service User Guide. The Registered Manager has commented within the homes Annual Quality Assessment (AQQA) that they recognise the need to improve the availability of information for the prospective service user. It is planned that copies will be available in large print and on Compact Disc for those with visual impairment. Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although people are treated in a respectful manner staff are lacking some specific skills that would ensure people are not put at risk, however there is now support within the home that may improve this situation. EVIDENCE: This outcome has been assessed using the Key Lines of Regulatory Assessment (KLORA). The Registered Manager confirmed that since our last inspection in September 2007 the care plans had been reviewed. The home’s AQQA also states this. However on reading five care files it was apparent that these remained inadequate. Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 15 The Deputy Manager, who at the time of this inspection had only been working in the home just over a week, had audited 5 care files. We saw the audit reports and spoke to one of the qualified nurses responsible for writing some of the care plans. She said that the auditing process had identified shortfalls and she was getting guidance in how to improve the content of the care plans. Below is an example of some of the shortfalls found. In one person’s care file using ‘plain English’ would of helped. Sentences such as: ‘requires reality orientation for altered mood states’ and ‘discourage inappropriate behaviour’ do not give clear guidance to the care staff. In the same care file staff were reporting the person to be ‘regularly wandering’, ‘removing clothing’ and exhibiting challenging behaviour but there was no clear guidance in the care plan on how to deal with these issues. There was also a lack of risk management in relation to the challenging behaviour. Some additional problems that this person had were not considered and therefore there was no written guidance on how to deal with them. Comments in another care plan in relation to a person’s continence problems such as ‘use appropriate barrier cream’ (what cream?) and ‘use appropriate equipment’ in relation to potential pressure sores (what equipment?) all lacks guidance for staff. Another person was regularly leaving the building and therefore at risk. There were no care plans relating to this and no evidence that there was any risk management taking place. Staff were worried about this and when aware that she was not in the home were going out to look for her and bringing her back. There were also several examples of conflicting information across different records held for people. Examples of these are as follows: the records held regarding one person’s pressure sore were confusing. By reading the available records we could not ascertain whether this person had a pressure sore or not. Wound records dated 6/11/07 said ‘skin intact’, but personal care records completed by care staff for the same period mentioned a dressing in place. A later entry on 28/1/08 in a care plan said: ‘turn regularly’, ‘address any factors arising’, ‘regular evaluations’. This did not give specific guidance for care staff and did not indicate what the potential factors maybe. A wound progress chart was in use but did not have a date for follow up. When we asked the nurses present what the current condition of the person’s skin was, they were unclear. We therefore asked the person’s permission to view the area of skin in question. This revealed a dressing in place over a pressure sore the size of a two pence piece, which required attention. Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 16 In this case both the cushion on the person’s chair and mattress on the bed were not adequate for the current situation. It is however apparent that other people living in the home are getting access to a specialist healthcare professional who assesses and arranges provision of appropriate pressure relief equipment. Our concern is that staff were aware of other changes in this person’s health which should have triggered a more proactive response by staff. These included a substantial loss of weight and decreased mobility. So to have this degree of confusion over the status of this person’s skin when these factors were evident demonstrates poor practice and places the person at risk. One person’s file contained several different moving and handling assessments and assessments for pressure sores (Waterlow). Some had dates on and some did not so it was difficult to know which was the current guidance. Another person’s records completed by care staff indicated that she had been sore under her breasts for sometime. Neither nurse on duty was aware of this despite us being informed that the qualified staff read what care staff are writing each day and sign this off. We asked one of the nurses to follow this up. The Care Home Support Team has trained the nurses in the use of a nutritional assessment tool. We saw records that told us people were being weighed but again some weights had been transferred into the care files and some had not. In some cases there were weights recorded but no date. We viewed nineteen (19) people’s weight charts and ten (10) people had lost weight over the last 4 months. We acknowledge that in some cases there will be specific health reasons as to why some people are loosing weight, but the home has had previous requirements from us to ensure that everyone receives the support they require at mealtimes. The Registered Manager has assured us that people are having a nutritional diet and supplements are being given where required. One person who has lost weight was supposed to be having a record kept of what food he eats. Some were seen but these were not consistent and not fully completed for each day. We explained that it is difficult to be absolutely sure that people are maintaining adequate nutritional inputs if the records being kept are inconsistent. We again witnessed people requiring help, this time at breakfast in the main dining room and no staff being around to offer this. We watched several people sleep in front of their cereal or porridge. One person was observed to be asleep for 40 minutes with her cup of tea and cornflakes in front of her. She was not given any help to eat an alternative and her tea remained cold. Despite this people at lunchtime spoke highly of the food provided and many said how much they enjoy it. We observed staff sitting down and feeding some people and supervising others. One visitor said that staff give her relative help at mealtimes when she is not in the home. Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 17 We saw evidence that demonstrates that external healthcare professionals visit the home on a regular basis. This includes the General Practitioners, Community Nurses, Optician, Chiropodist and the Mental Health Team. One General Practitioner commented within a questionnaire that he is called out appropriately and that communication between the surgery and the home was good. All of the questionnaires returned said that the person living in the home ‘always’ gets or ‘usually’ gets the care and support they require. A couple of people commented that they have needed to complain when it has not been good enough but that the problem has been easily resolved. We did not observe any interaction or practice that caused us concern as to whether people’s dignity or privacy was being compromised. We listened to one conversation between staff and a person living in the home. This person was clearly confused and at no time did staff talk to this person in a manner that would belittle them or embarrass them. Another situation that was repeating itself during our inspection could have potentially compromised the person’s dignity but staff designated a lot of time to deal with each occurrence in order to maintain this person’s dignity (see link to staffing outcome). A comment within a relative’s questionnaire indicated that their relative had been denied help to change during the night and that a more recent request for the same help was dealt with by a different member of staff in a helpful manner. A previous requirement made by us was for nurses to make sure that each new packet of eye drops and ointment or cream was recorded with the date of opening. This was to ensure that none are used beyond their expiry date once opened. We saw that this was being complied with except for one barrier product for skin, which was in a bedroom with no date of opening. Despite the medication system being audited regularly (audits seen), which includes checking the Medication Administration Record (MAR) the variation in the standard of written instructions by nurses indicated that some nurses were aware of how to write these correctly and others were not. Some were completed poorly and posed a potential risk. Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 18 Examples of poorly completed MAR’s include: the handwriting and therefore the instruction was difficult to read due to the handwriting, three out of the six records seen only had one signature on the instruction instead of the two required in order to reduce the risk of mistakes in transcription (the other three had two signatures), one controlled medicine instruction only had one signature, several records showed no record of receipt of the medicine, two sedating medicines were prescribed as ‘to be given as required’ and were being given on a regular basis. One being given as much as three times a day with no recorded explanation as to why; although staff explained verbally why they gave it, one ointment prescribed for rectal use and to be given twice daily had only been recorded as used once since prescribed but no recorded explanation for the lack of use, although again staff verbally gave a reason. Two boxes of sedating medicine for rectal use were found in the trolley out of date by six months. The administration of medication was carried out safely by most staff except for the practices of one nurse who left decanted medicine on the top of the medication trolley during the time she left the communal lounge area. This was pointed out to the nurse at the time and to the Registered Manager. There were two examples of medicines running out the day before this inspection and two more were dependant on the pharmacy delivery being made that day. Although these had been ordered at the beginning of the week the Registered Manager has identified that nurses need to be identifying stocks that are due to run out, sooner. Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. Some people are able to make decisions on a daily basis and benefit from feeling that their expectations are generally satisfied, although people who are more dependants either physically or mentally are not having all their needs met. EVIDENCE: This outcome has been assessed using the Key Lines of Regulatory Assessment (KLORA). The home has been required by us to ensure that everyone in the home is given the opportunity to partake in social activities and recreational based activities if they wish and that these should suit individuals’ capabilities. We were informed that one member of the staff has recently completed an activities co-ordinators course and within two weeks will be co-ordinating and providing activities three days of the week. One relative commented in their questionnaire that the home had been without a designated activities coordinator since August 2007. Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 20 Despite this most other questionnaires indicated that people were happy with what the home provides. One comment said: “the home go to a lot of trouble to entertain the people there with music and religious occasions”. We did not observe any activities taking place during our inspection although the carer who is due to be the activities co-ordinator did ask someone if they wanted to watch a video. This person did not seem overly keen. There also appeared to be several people passing time on their own and several who were confused that clearly would benefit from constructive time spent with them, other than times when care is being delivered. The Registered Manager has commented within the home’s AQQA that it is an area that requires improvement. The home would also like to develop a ‘Friends of Euroclydon’. We did witness people making basic decisions on a day-to-day basis. Certainly at mealtimes a choice of food is provided with additional alternatives. People were asked where they would like to be pushed to, if in a wheelchair and people are free to smoke in the designated area if they wish. We were told by some people that they are able to choose when they go to bed. One person explained that she likes to have alternate days in bed. Although this was helping her pressure area care, she was clearly happy with the arrangement. A difficult situation requires urgent attention and involves a person leaving the building sometimes as late as 11pm. This person is thought to be at risk by staff when this happens. She is making a decision not to remain in the home and has voiced that she wishes to go home. The home must liaise with an appropriate healthcare specialist and representatives and explore issues relating to her mental capacity and the placement. The Registered Manager rightly said that people should not be locked in. This situation relates back to the appropriateness of some of the admissions to the home referred to at the beginning of this report and the home’s responsibility to ensure peoples’ safety whilst in their care. We observed mealtimes and have reported before in this report on shortfalls seen at breakfast time. The food provided looked appetising and was served from a hot trolley and there was very little wastage at lunchtime. Staff sat down and helped to feed people who could not do this themselves. One visitor who was spoken to at a previous inspection reported that her relative had improved and now comes down to the dining room (previously would not do this) and now eats well when down there. We observed one person receiving nutrition through a Percutanous Endoscopic Gastrostomy (PEG feed via a tube straight into the stomach). The machine that acts as the pump for this process required a clean in order to reduce the risks of infection. Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 21 People spoken to in the dining room said they really enjoyed the food provided. One comment in a questionnaire said that a person requires a soft diet but this does not always happen. Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 22 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. People living in this home can be confident that their complaints/concerns are taken seriously and that staff are aware of the issues relating to the safeguarding of adults and feel confident that any incidents of alleged abuse are dealt with in a robust manner. EVIDENCE: This outcome has been assessed using the Key Lines of Regulatory Assessment (KLORA). The home has a complaints policy and written procedures are displayed. The home confirms within their AQQA that they have improved accessibility to the complaints procedure by ensuring that each bedroom has a Service User Guide within it which contains this information. All the questionnaires received back indicated that either the person living in the home or a relative is aware of how to make a complaint. Two questionnaires included comments confirming quick action being taken by the Registered Manager to resolve issues. Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 23 We inspected the complaint file. Documentation relating to one complaint (seen at the previous inspection) was seen. Communication with this complainant remains open and various situations are monitored. We spoke with the Community Adult Care Directorate (CACD) formally Social Services who purchase care from this service on a continuous contractual basis. They have confirmed that they have not received a high volume of written complaints but have received comments of dissatisfaction in the last year from people who have stayed for short periods (respite care). CACD have renewed their contract with the service but continue to monitor people’s views on the service and care provided. The home’s arrangements for safeguarding adults against abuse are compatible with the home’s policy on this. The Registered Manager confirmed that this is ready for review. There are written procedures, which recognise the local authority’s wider protocol and include the involvement of external agencies such as CACD, the Police, the Safeguarding Adults Team and us. The training records told us that most staff received ‘in house’ training on this subject last year and some attended additional training provided by the county’s Safeguarding Adults Team. We are aware of two situations that required the Registered Manager to use the home’s procedures. During this time he kept us formally updated. The home’s administrator was also very aware of issues relating to potential financial abuse and gave one example of a person within the home not being sent the personal allowance element of their pension by the persons who manage her finances. She explained that if this continues the home will formally notify the Community Adult Care Directorate (formally Social Services). The subject of safeguarding adults has been discussed in staff meetings and the staff reminded of what they must do in the event of witnessing abuse (through the home’s ‘whistle blowing procedures) or on hearing an allegation. We spoke to one carer who has been employed since September 2007 and who told us she has not received this training. Safeguarding Adults training is not currently included in the group of trainings given at the beginning of someone’s employment. We would strongly suggest that the home consider this and provides further training relating to managing challenging behaviour and situations. The home’s AQQA says it intends to continue to improve staffs’ awareness on this subject. Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 24 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, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recent refurbishment and updating will benefit those living in the home, although peoples’ health and safety is not being monitored as effectively as it could be. EVIDENCE: This outcome has been assessed using the Key Lines of Regulatory Assessment (KLORA). We have been aware that the Registered Provider has been refurbishing several bathrooms and communal toilet areas over the last year. We saw these completed and they now offer clean and spacious areas to use. Comments expressed in the questionnaires indicate that this refurbishment has been appreciated. Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 25 The heating systems and hot water systems have also been serviced with two new boilers being installed. This now gives a more consistent level of heating and hot water throughout the home. We noticed that the communal area in the extension was cold. This area was not being used at the time of this inspection and the Registered Manager explained that the heating had been turned down for this reason, but that it does now work satisfactorily. We turned on hot water taps in some bedrooms and found that the temperature of the water coming out was very hot to the touch. We reported this to the Registered Manager and also saw records that were regularly recording the temperature of this water at 60 Celsius. This is considerably higher than the temperature recommended to avoid accidents involving scalding to elderly skin. We were reassured to see that full emersion areas such as bath outlets were regulated and therefore the water temperature was recorded at about 43 Celsius. We strongly suggest that the Registered Provider considers making arrangements to reduce the temperature of the hot water in areas where it is above 43 Celsius. A risk assessment could be carried out to show how the risk of scalding is being managed, but over the period of this inspection we were aware that many of the people living in the home are confused and therefore the risk of scalding is higher. All radiators were covered and the hot water pipes leading to them. This prevents burns if someone were to fall against a radiator or its feeder pipe. We could see that some carpets had been replaced and we were informed that various bedrooms have been decorated. The homes AQQA tells us that new commodes, new beds and mattresses have been bought. The Fire Officer visited the home following our request last year. Several areas of concern within the environment were identified. The Registered Manager confirmed that most of this physical work has been completed ready for the Fire Officer’s return in March this year. The home looked clean and there were no strong offensive odours. We saw two cleaning staff at work and they were able to confirm what colour coded equipment should be used where. Some simple alterations to household routines have been made to help promote good infection control such as the kitchen staff now clean the kitchen floor after their time at work instead of the general domestics who have been cleaning bedrooms and toilets. Special disposal bags for continence pads are now filled correctly and are not overflowing. The disposal of some old/rusty commodes will have also helped. The training records told us that some staff had received Infection Control training but not all. Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 26 The extremely poor infection control practice demonstrated by one member of staff in front of us could easily put everyone at risk and requires immediate supervision and improvement. This person had received relevant training according to the training records. A Senior Carer confirmed that all appropriate wipes, gloves and aprons are always available for use and most staff were seen using these appropriately. The home’s AQQA states that the home plans to employ a housekeeper in the future to co-ordinate cleaning staff and their routines. Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 27 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 needs of the people living in the home are not always met as well as they could be due to insufficient staff and at times a lack of staff skill and knowledge. EVIDENCE: This outcome has been assessed using the Key Lines of Regulatory Assessment (KLORA). We were again concerned to see that the numbers of staff on duty did not appear to match the dependency levels of those living in the home. Our concerns are that there are clear examples of increased needs and risk at times within the home but the staffing numbers do not alter to accommodate these. The Registered Provider’s view is that there is enough staff on duty so we gave specific examples of why we were concerned. These include: • One person was leaving the building and being retrieved by staff. Staff explained that they were unable to monitor her whereabouts at all times as other people require their attention. Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 28 Several people were again observed not receiving appropriate support to eat, this time at breakfast. • Two people in particular required a lot of one to one attention both in their personal care needs and mental health needs. This had been so for some time but there was no evidence to suggest that the staffing had been increased to accommodate this. • Reports indicated that staff were having to manage situations of challenging behaviour from one person but again there had been no alteration in the deployment of staff to help deal with this. • Despite the above the home considered it appropriate to admit three new people over the inspection period with no planned adjustment to the staffing numbers. It was because of this last point and the levels of risk present at the time of this inspection that we decided to issue the second Immediate Requirement in a year to increase the numbers of staff. This was to help ensure that peoples’ health care needs were met and that their safety could be maintained. The Registered Manager said that he aims to have on duty six (6) care staff in the mornings and five (5) in the afternoons. There are two qualified nurses on duty in the morning and one from 2pm. Night staff comprise of three care staff and one qualified nurse between 8pm and 8am. Duty rosters were not easy to follow, as totals at the bottom did not always indicate the actual numbers on duty. The rosters did show that the home has operated below numbers at times. The Registered Manager’s actual hours worked were not always recorded and we had to look at the home’s staff ‘signing in book’ to evidence his presence in the home on certain days. This was not always consistently recorded either. The home’s ability to retain staff has improved with five (5) staff employed in the Autumn of 2007 still in post. A Deputy Manager has been appointed and this person had been working in the home for just over a week at the time of this inspection. It is planned that he will take the lead on several of the care related systems. We inspected the recruitment files of two staff recruited since the last inspection. Both had been cleared against the Protection of Vulnerable Adults (POVA) list prior to commencing work. One had been cleared through the Criminal Record Bureau (CRB) prior to commencement the other approximately two weeks later. The Registered Manager informed us that this person had been supervised at all times prior to successful CRB clearance. Both have satisfactory references and no unexplained gaps in employment. We could see from records kept that each member of staff has basic training in some subjects such as fire awareness, safe moving and handling, first aid and food hygiene and staff confirmed that they had received these trainings. • Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 29 We were also told that senior care staff help supervise junior staff at the beginning of their time in the home. We made a requirement in the last inspection for the home to be able to demonstrate that they are providing staff with structured induction training and although the Registered Manager has been in contact with Skills for Care, formal induction training still has not been devised and implemented. Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 30 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 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although some areas of the home are beginning to improve and are running in the ‘best interests’ of those living there. There are still aspects in particular that relate to the management of peoples’ health and safety that require better attention by the Registered Manager. EVIDENCE: This outcome has been assessed using the Key Lines of Regulatory Assessment (KLORA). Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 31 The manager is now successfully registered with the Commission and a Deputy Manager has commenced at the home. The Registered Provider and Registered Manager must now concentrate on ensuring compliance with the requirements made by the Commission. We were surprised to find some of the requirements that have repeated themselves over the last 18 months still to be outstanding and discussed with the Registered Provider our concerns relating to this. This will continue to be monitored and if compliance is not achieved then enforcement action will be considered. We observed the Registered Manager making it clear to staff on many occasions what his expectations were in various situations. Informal discussions and formal meetings also take place. Comments within returned questionnaires included: ‘The manager is always receptive to any problem’. ‘There have been much needed improvements since the manager was appointed’. ‘The owners and manager are dedicated to the care of the people in their care’. The home still requires a structured Quality Assurance system to help them identify shortfalls, decide on a plan of action, set a date for when this is to be achieved and which then leads to regular evaluation. The home also needs to decide on how it will monitor sustaining improvements. Questionnaires are sent to people living in the home and their relatives by the Registered Provider to seek their views and feedback on the services provided. This was last carried out in January 2007. Staff were also sent questionnaires at this time. We did not see the results of these at this inspection. The home’s Annual Quality Assurance Assessment (AQAA) was returned to us as requested. It does acknowledge some of the shortfalls within this report relating to care planning and staff knowledge/training. The home does not keep personal money on behalf of people living there. In each bedroom there is a lockable drawer for keeping items or money safe. Hairdressing and Chiropody bills are sometimes paid by the home and an invoice then sent to the person that manages the person’s money. Some people prefer to manage their own money and are free to do so The home does have a Fire Risk assessment, which has been completed by an external specialist. However, there is still no evacuation procedure. This was a particular concern at the last inspection in September 2007 when it was clear after talking with night staff that they were not sure of what to do in the event of a fire. Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 32 The Fire Officer’s requirements need to be met by 6/3/08 and he is due to revisit the home. A written evacuation procedure is one of the things that need to be completed by then. The Registered Manager explained that he is due to commence evacuation training with staff in the near future. A different fire zone is tested regularly and we experienced the fire alarms being tested during our visit. All staff responded and met in the allocated area. We did however observe, on our return to the home on the second day of this inspection, a large table in front of one main fire exit and an armchair in front of another. These had been placed there on purpose to prevent a vulnerable person leaving the building. There was also an explanation by a member of staff explaining that a fire exit sign had been taken down because this person appeared to be reading this and locating the way to the exit. Although we could see why staff had taken this action, which relates to the specific risks discussed within the ‘health and personal care’ outcome of this report. It did however raise serious concerns about the staffs’ lack of understanding of fire safety and highlighted a need for further training. We also observed one of the cleaning staff leaving cleaning products out of her sight several times even after this had been pointed out by us. This again indicates a need for further training regarding this person’s lack of understanding of and adherence to certain health and safety practices. The evidence collected generally in this inspection relating to various practices shows that although staff are receiving training, it is still basic training in most subjects. Practices show that there is a need for further training so that staff understand the concept behind why they need to adhere to certain procedures/practices. One comment made in a returned questionnaire from a relative says: ‘ there is room for improvement with staff training’. Up to now the majority of training has been provided ‘in house’ but the home is one of many in the county that has signed up to the Department of Health’s funded initiative ‘Partnership for Older People Projects (POPPS) designed to help Care Homes access free relevant training. As discussed in the ‘environment’ outcome hot water temperatures were extremely high and were being recorded as such and emergency lighting had no records of being checked before November 2007. The Registered Manager is not currently carrying out a regular health and safety audit. An external contractor services the homes safe moving and handling equipment, once a year. Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 33 We spoke to the member of staff who has just completed training to become the home’s safe moving and handling trainer. We commented that despite staffs’ moving and handling training being up to date on the training records we had witnessed some poor practices. She was able to confirm that some staff did require further update training but she first wanted to ascertain what moving and handling equipment the home had. As the inspection progressed several pieces of equipment were found that staff should be using on a regular basis but which were probably not being used as effectively as they should be. Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 34 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 3 X X 2 2 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 3 3 1 X 3 X X 1 Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 35 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14(1) Requirement Timescale for action 01/04/08 2 OP7 15(1) The Registered Person must ensure that a robust pre admission process can be demonstrated and only admit service users who’s needs can be met by the services the home provides and who’s needs are within the capabilities of the staff group. (This requirement is repeated timescales of 31/05/07 & 15/10/07 not fully met) The Registered Person must 01/04/08 ensure that each service users’ needs have a written care plan. This must be devised following consultation with the service user and or their representative. This plan must clearly indicate how a particular need is to be met and it must be appropriately updated as required. (This requirement is repeated timescales of 31/05/07 & 15/10/07 not fully met) Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 36 2 OP8 12(1) 3 OP8 4 OP9 5 OP12 The Registered Person must make proper provision for the health and welfare of the service users by: Ensuring that adequate fluids are within reach. That support where required is given to each service user to drink and eat. And that consistent monitoring can be demonstrated for anyone who may be nutritionally at risk. (This requirement is repeated timescale of 31/04/07 & 15/10/07 not fully met) 17Schedul The Registered Person must e 3 (3)(n) 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 not fully met) 13(2) The Registered Person must ensure that the Royal Pharmaceutical Society guidelines are met with relation to the completion of handwritten instructions on Medication Administration Records (MAR’s) and that all staff adhere to safe practice when administering medication. 16(2)(n) The Registered Person must make arrangements for a programme of activities to be provided taking into account the residents individual needs, wishes and capabilities. (This requirement has been repeated as timescale of 31/10/07 not fully met). 01/04/08 01/04/08 01/04/08 01/04/08 Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 37 6 OP26 13(3) 7 OP27 10(1) 8 OP30 18(1)(c) (i) 9 OP33 24(1) The Registered Person must ensure that all staff are provided with adequate training and then adhere to good infection control practices, so as to reduce the risk of spreading infection. The Registered Provider & Registered Manager must take into consideration the size of the home, the statement of purpose, the number and needs of the service users and manage the home with competence and skill. This is with particular reference to dependency levels and the appropriate numbers of staff on duty to meet the needs of the service users. The Registered Person must make arrangements to provide staff with appropriate induction training. This training must be able to demonstrate that the member of staff has been considered as competent to carry out the task they were employed to perform, safely. (This requirement is repeated as timescale of 31/10/07 not met) The Registered Person must devise and initiate a system for evaluating the quality of care & services provided in the home and demonstrate how these will be improved. (This requirement is repeated timescale of the 01/11/06, 30/06/07 & 30/10/07 not met). 01/04/08 01/04/08 01/05/08 01/05/08 Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 38 10 OP38 23(4)(a)( d) 11 OP38 13(4)(a) 12 OP38 13(5) 13 OP38 13(4)(c) The Registered Person, through training and through the use of a fire risk assessment and evacuation procedure, ensure all staff working in the home are aware of safe fire prevention procedures and are competent in evacuation procedures in the event of a fire. (This requirement is repeated timescales of 28/07/06, 16/04/07 & 15/10/07 not fully met). The Registered Person must ensure that the home can demonstrate that practices are in place to ensure the health and safety of service users. This particularly relates to: • Specifically risk managing those who may leave the building and who are at risk of being harmed when they do so • Risk manage/reduce potential scalds from hot water being distributed above the recommended temperature. 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. The Registered Manager must through training or supervision ensure that staff understand why procedures relating to the Control of Substances Hazardous to Health must be adhered to. 01/04/08 01/04/08 01/05/08 01/04/08 Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 39 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 Refer to Standard OP7 Good Practice Recommendations The Registered Provider should consider arranging dedicated time in order for staff to transfer care-planning system over to new format, as opposed to qualified staff attempting to do this when they are responsible for the shift. Review the medication audit and ensure it is able to help identify shortfalls in the writing up of hand written instructions on MAR sheets Consideration should be given to phasing in regulators on all hot water outlets where service users have access. Consideration should be given to allocating a member of staff to specifically and regularly clean the PEG feed pump. Serious consideration should be given to ensuring that the registered manager is completely supernumerary and able to concentrate on managing the home and making necessary changes for compliance and improvement. Serious consideration should be given to establishing a filing system in the manager’s office so that documents etc can be easily found/referenced. Consideration should be given to robust documenting of health and safety checks (audits) within the home. 2 3 4 5 OP9 OP25 OP26 OP31 6 7 OP31 OP38 Euroclydon Nursing Home DS0000063477.V357507.R01.S.doc Version 5.2 Page 40 Commission for Social Care Inspection South West Regional Office 4th Floor, 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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