Inspection on 04/07/06 for Euroclydon Nursing Home

This inspection was carried out on 4th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Euroclydon Nursing Home 11/06/09

Euroclydon Nursing Home 22/07/08

Euroclydon Nursing Home 31/01/08

Euroclydon Nursing Home 10/09/07

Euroclydon Nursing Home 13/02/07

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 5th July 2006 09:30 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.V303250.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.V303250.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Euroclydon Nursing Home Address Drybrook Glos GL17 9BW Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01594 543982 01594 544352 Chantry Retirement Homes Ltd To be appointed Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Euroclydon Nursing Home DS0000063477.V303250.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. 17th November 2005 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 to provide both nursing and personal care to predominantly older persons over the age of 65 years. It does also accommodate a small number of residents under the age of 65 years who have a physical disability. Two shaft lifts allow access to the upper levels. The home offers 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. The gardens are well maintained and accessible to all residents and include a summerhouse. There is ample car parking within the grounds of the home. The home has its own tail-lift mini-bus. The fees range from £380.00 to £500.00 plus, for nursing care. Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this inspection over two days, between the hours of 09.30am and 6.30pm. The Registered Provider was available in the home during this time. The home was awaiting a newly appointed acting Manager to commence in post after a significant time without one, so staff were as helpful as they could be with the inspection process. 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. Care documentation and other health and care related records were inspected. Residents’ contracts, how they are informed of changes in payments and how information is passed onto them was inspected. Staff files and the home’s recruitment practice were inspected. The environment including its maintenance was inspected. Additional services such as laundry, cleaning and the catering services were inspected. Staff training records, the complaints record and the medication system were also inspected. How the home protects vulnerable adult was explored. Several relative and resident comment cards were forwarded to the home prior to this inspection. Several had not been given out by the time the Inspector arrived. Six relative cards were received back. Past requirements made by the Commission for Social Care Inspection (CSCI) were discussed and four of these had not been adequately met over an unacceptable time period. There has been a shortfall by the Registered Provider, in the absence of a Registered Manager, to uphold a number of National Minimum Standards (NMS), in particular staff training in basic subjects that help to offer residents protection such as fire awareness and safe manual handling, which has resulted in the home having an immediate requirement to address this. It has subsequently been confirmed that fire training has taken place. Several other services within the home such as the activity provision and general maintenance are not meeting with the residents’ or home’s needs. The Inspector has informed both the Registered Provider and the new acting Manager that the CSCI recognise that it will take time to meet all of the NMS. However, the CSCI will expect to see a significant improvement in these for the Registered Provider to avoid further action being taken. Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 6 It must also be reported that residents and relatives have said that the staff are very caring, well meaning, kind, and that they feel looked after. What the service does well: What has improved since the last inspection? What they could do better: Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 7 The areas identified below are a result of the home not having a competent Registered Manager in post for a significant period of time. Available information about the home needs to be updated and a service user guide distributed to all residents and/or their representatives. It is a good idea to have a copy in the reception area for reference, but it must contain all the required information. The pre-admission assessment process needs to be more informative, so that admitting staff are aware of all the residents needs by the time they arrive at the home. The knowledge within the staffing team needs to broaden and be fully updated in order to meet all the residents’ needs. Care documentation needs to be fully updated at all times and must have some resident and or representative involvement whenever possible. The medication system is in need of some alterations and updating to make it a robust and safe system. Communication on a day-to-day basis between staff and some residents must improve so that the less able person is receiving adequate interaction. All complaints need to be dealt with and the situation rectified. The recording of these could be more formalised to avoid misunderstandings in the future. All staff require awareness and updated knowledge in Adult Protection/Elderly Abuse issues, in particular those holding a senior position and who may well have to manage such a situation. The home must provide clear procedures for staff to follow. Resident safety and comfort would be improved with adequate and ongoing maintenance and refurbishment. The home needs to ensure adequate measures are being taken to make the home safe from fire or in the event of a fire. Improved maintenance is required in order for any cleaning and infection control practice to be effective. Any equipment that has to be purchased by the home must be done so without time delays and when it is required. All lighting, equipment and furnishings provided by the home must be in good working order at all times and ‘fit for purpose’. There must be adequate, trained and knowledgeable staff on duty at all times. Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 8 The home must provide enough stimulation, activities and social interaction to meet all the residents’ needs to enhance their quality of life. Arrangements must be put in place to improve how residents, relatives and staff communicate. The home must also devise a system that allows it to measure how good its services and care are and how and where improvements can be made. Safety practices within the home must improve and the reporting of incidents/accidents to the CSCI must be carried out. 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. Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 9 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.V303250.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents or their representatives have some information available to them but not all that is required to be given. All residents receive a contract with terms and conditions including additional information allowing them to be fully aware of any financial commitment or entitled payments. Residents’ needs are explored and documented prior to admission but this process needs to be recorded more fully to ensure all needs have been considered and the information is available for staff on the resident’s admission. Arrangements are in place for relatives and friends to remain in contact with the resident and remain part of their life. Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 11 EVIDENCE: The Homes Statement of Purpose and Service User Guide were seen in the reception area. The Service User Guide did not contain a copy of the homes terms and conditions although it did contain a copy of the homes complaints procedure and other required information. The Inspector understands that after the last main inspection in November 2005 copies were printed, but the office Manager confirmed that this document is not given out. Each resident and/or their representative must be given a copy of the Service User Guide. The office Manager explained that each enquirer is provided with a brochure This was seen and contains incorrect information about who the home is registered with. Another smaller Helpfull Information booklett is also given out. The majority of residents’ finance files were inspected and each contained a contract. These were either private contracts between the resident and the home or contracts between the home and funding authority that had also been signed by the resident or representative. In the latter case a copy of the homes terms and conditions had also been signed. The terms and conditions seen stipulated the bedroom to be occupied, the amount to be paid and what was not included in the fees. Additional correspondance was seen giving advice on fee increases. An example of how information pertaining to the Registered Nurse Care Contribution (RNCC) amount is highlighted on the invoice. Letters indicating changes in this following a review are also forwarded to residents or their representative. Residents have been assessed prior to their admission, by a senior nurse in the absense of a Manager. The assessments seen were very brief and offered only the basic information to the member of staff receiving the person on admission. During this inspection a new resident arrived and the receiving nurse had very little information about the individual or their needs. Two recent pre admission assessments were seen, the date of the assessment on both was absent and a history of previous falls needs to be included on the form. Relatives and residents confirmed that family and friends were always welcome and able to visit when they choose. Visitors were seen visiting across the hours the Inspector spent in the home. One relative confirmed that information on his loved one was always forthcoming from staff. This home does not provide designated rehabilitation services. Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 12 Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. 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. Care planning was generally well planned and informative, although it is unclear how much involvement the resident and or representative have. The residents’ health care needs are met. Some shortfalls in the medication system are not offering residents full protection. Residents’ privacy and dignity is being upheld for the majority of the time. EVIDENCE: The files of three residents were inspected and cross-referenced with the care being delivered. Several other care files were read but not in so much detail. Care plans were not in place as yet for the most recently admitted resident. Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 14 One care file requires the assessment to be updated as the residents needs have altered. The care plan was appropriate to the current needs of the resident, however it was important that the assessment be up to date in this case as the resident is no longer able to take nutrition orally. This could lead to confusing and ultimately dangerous information being available for staff. Additional assessments carried out after admission were seen and were current and updated on a monthly basis or as required. The documentation also took into consideration information or guidance from health care professionals such as the Community Dietician, Chiropodist, Speech Therapist, Continuing Health Care Nurse, Epileptic Specialist Nurse and Medical Consultants. Monthly weights are recorded. One care file demonstrated up to date care planning and recorded that the resident had gained weight. Pressure relief advice was also being sought from the Continuing Health Care Nurse for this person. Several pieces of pressure relief equipment were seen in the home. One relative who visits most days and two residents said they were not involved in their care planning. The medication system was inspected and some administration observed. The home is split into two units, each with its own medication trolley. The medication fridge was unlocked and the pad lock was not evident. Fridge temperatures were being recorded on a daily basis, on the day of inspection this was 8 Celsius. The general storage for medication does not meet with current pharmaceutical guidelines and advice from the CSCI Pharmacy Inspector will be taken and an inspection organised. Administration records (MAR sheets) were inspected and none of the hand written entries had signatures. A photograph of each resident was present to aid identification for any staff unfamiliar with the home. One residents record showed no indication as to whether her inhalers were being administered by staff or whether she self medicated. Stocks of controlled medications were checked and corresponded with the records kept. Records of stock being taken for disposal were seen and the home complies with the new arrangements for this. It was noted that the teatime medication round for one unit was completed by 4:40pm. There was only one qualified nurse on duty this particular afternoon; this may have been a reason for such early administration. Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 15 A relative had submitted a complaint regarding the administration of insulin by an Agency Nurse. This had been investigated and followed up with the Agency and a statement from the nurse in question obtained. The Registered Nurse on duty during the inspection explained that the use of agency staff had dropped and that the insulin is now always given by the home’s own staff, who are all familiar with the style of administration for this resident. Care staff were also heard reporting to the nurse to see if this resident’s insulin had been administered before they served her tea. The home also stores and uses oxygen and warning notices were in use. A copy of the British National Formulary dated March 2005 was seen. Eye drops were dated on opening, but it was noted that one bottle in use was one month out of date. The homes medication policy needs updating to include the new guidelines for medication disposal. At the time of this inspection a nurse was observed to leave several medications on the worktop in an unattended clinic. This practice was also seen in the Inspector’s visit in March of this year. The nurse was alerted to this and the medication secured. The residents privacy and dignity was upheld at all times, except the practice of cutting residents hair in the end of the main lounge, in full view of everyone is questionable. Euroclydon Nursing Home DS0000063477.V303250.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 at least once during a 12 month period. 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 were many examples of residents being able to make choices on a daily basis and in their lives generally. Some arrangements are in place for recreation, but for many on a daily basis, this is not adequate. Most residents enjoy the food but the home needs to ensure this is varied enough for those that are diabetic. EVIDENCE: Although the quality of these standards has been judged as good there is a large shortfall in activities and rereational opportunities on a daily basis for many residents. Several residents were spoken with over the course of both days. There are diverse ranges of abilities within the home and capabilities vary enormously. Several residents in one unit are suffering from dementia. When asked about their day answers were clearly confused, but many seemed in a state of well being. Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 17 Others probably require more one to one interaction and communication and this for some staff was a particular weakness. One resident has difficulty in communicating verbally although did well using a picture chart and other forms of expression. She is physically dependant but was able to say that she goes out in the garden and enjoys puzzles and colouring. She was able to explain that members of her family visit. Another resident said he had not visited any other homes before moving in but was very pleased with this one it couldn’t be better. He confirmed that he was free to spend his day as he chooses. He particularly enjoyed sitting in the garden room and had been an avid gardener in his past, although he commented that it would be nice to be able to do more. He said he would enjoy being able to take cuttings and grow these within the conservatory. Another resident had spent several periods of time in the home on respite care and now had been in the home permanatly for a short while. She commented that there was a period of fitting in, finding who you got on with and knowing who to steer clear of. She had made particular friends with another lady and they enjoyed eating and spending time together. This resident is a great reader and also enjoys the garden room. Her friend has been in the home for many years and was observed to be making a choice to have her after lunch drink of tea in her room before her afternoon sleep. This was to be arranged by one of the care staff who seemed to know her well. Within the home are younger residents with profound physical disabilities. One couple had become engaged a year ago and staff explained that this relationship is respected as it would be anywhere outside of the care home. Another older resident said ‘you have to take life as it comes, but I am very content here’. He was another example of someone leading his life as he chooses within the home. Choice was also given to those less able to verbally participate, in ways that were less obvious such as not being forced to move or eat when it was clear that this was not forthcoming. One resident has not been choosing to eat. A supplement drink was placed in front of her and several times during the meal she was encourgaed to eat by the nurse on duty. She was also offered alternatives. In the qualified nurses hand over concerns were highlighted about this for the afternoon nurse to be aware of. Other examples of encouragement were seen but again in places the skill of interaction from some care staff was very limited, although well meaning. Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 18 A gathering was held for Holy Communion during this inspection. One resident said it was very important to him to be able to attend and there was a good attendance. One of the senior care staff explained it was difficult to provide the daily activities needed. The activities person had left sometime ago and at present the home is not actively advertising. She confirmed that because of the size of the home and because of the diverse capabilities, a person in this position is really needed. The Registered Provider in response to this feels that the care staff could do more in the afternoons. Observation showed that many residents require interaction and one to one input across the day. One lady said Im OK but I get very lonely. It was obvious that there is not much time between care tasks in the day. This senior carer organises all sorts of outings and entertainment in her own time. She also raises money for this, as there is no designated budget. She was noted to be talking to a visitor in the evening about forthcoming events. Two of the younger residents have support workers who visit them and take them out on a regular basis. Most residents like the food. A choice is available each day and made by the resident or their care staff if they are unable in the morning. The kitchen staff serve the food from hot trolleys, in each unit. The use of an old examination couch in the new extension, as a sideboard should be discourage and a proper surface provided. This service was carried out with great care and residents were offered sauces or salt and pepper if they did not initiate this for themselves. Each resident had a drink nearby. Again interaction at the mealtime was limited from some care staff at a time where social intercourse could be encouraged. Again another lady who did not wish to eat was gently encouraged to do so but only drank her supplement drink. Another resident who receives her nutrition at night via a Percutaneous Endoscope Gastromy tube (PEG) was asked if she felt full. According to the nursing staff this resident has improved vastly since this was fitted. Prior to this staff considered her quality of life as being good apart from very distressing times of trying to physically eat, which are now a thing of the past commented one nurse clearly fond of the resident. The kitchen was inspected and found to have cleaning schedules and all other required records in place. The storeroom was relatively full; a comment was made by one of the staff that it can be a struggle providing alternatives for puddings for those residents that are diabetic. Ordering/shopping for fresh fruit and vegetables has reduced to fortnightly (used to be weekly) and in the recent heat it has been difficult to make fresh produce last for two weeks. Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 19 It was noted that residents in bed were receiving their main tea at 4pm. Staff explained that sandwiches are available later but many residents able to speak were unaware of this. This is a long period of time between teatime and breakfast the next day. Kitchen staffs’ knowledge on what the residents liked and how to make sure choice was being offered was good. Three care staff had completed a course on nutrition. Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 20 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to help visitors make a complaint, however, arrangements need improving to ensure each resident is also aware of these arrangements and that efforts are made to improve the service after a complaint has been raised and substantiated. There is a lack of staff knowledge on the subject of Adult Protection; this in turn is not affording residents the protection they should be getting. EVIDENCE: The home has a complaints policy/procedure, which gives the address of the Social Services (now the Adult and Community Care Services) and that of the CSCI. This document can be found in the Service Users Guide in reception, a copy of which needs to be given to each resident and or their representative. Six relative comment cards were received by the CSCI prior to this inspection and five of these indicated that the person was aware of the home’s complaints procedure. Several residents said they would go and speak to the office Manager if they were unhappy, but were unaware of a formal complaints procedure. A record of complaints is kept and of the action taken. Two verbal complaints were recorded and one written, since April 2006 and the home has reported in Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 21 its pre admission information that five have been received and substantiated in the last year. Consideration should be given to making this record more formal and organised. The home also has a policy for the Protection of Vulnerable Adults (POVA) dated June 2005. This does not have however, procedures for staff to follow in the event of an allegation or actual abuse towards a resident. Both registered nurses on duty had limited knowledge on the subject or what to do in the event of neither was able to comment on what other agencies maybe interested or involved in an allegation. Neither had received any training on this subject. The Senior Carer confirmed that she and one other senior carer had covered the subject of abuse in their NVQ Level 3 Award, but that they had not received any update training; no other staff have received training or supervision time on this very important subject. The home does have a Whistle Blowing policy. Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24, 25 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The environment requires further improvement to make it a pleasant and safe place for residents to live. Cleaning staff are employed to keep the home clean, however, good infection control is compromised by inadequate maintenance and refurbishment. EVIDENCE: The environment is large and in the last year there have been few changes to this. A new single bedroom has had a shower fitted and a bedroom has been created from an office so as to reduce the number of shared bedrooms. The Inspector did not see a rolling programme of maintenance and understands that the present maintenance hours are to be reduced. The provider has explained that arrangements are in place for the overall Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 23 maintenance hours to increase in August and that these will be shared with the home’s sister home in Gloucester City. The main communal lounge in the new extension is large and is part dining room. An effort has been made to break the area up by placing chairs in fairly large groups. A large examination couch used as a top for plates at lunchtime does not enhance this room and a corner was untidy with footplates to wheelchairs and various other items. Double doors allow access to the garden. There is a smaller sitting room off this, which was being used by the hairdresser to cut residents hair. The corridor off this, containing residents’ bedrooms, is looking tired with a peeling paper border. The bedrooms here were tidy and in reasonable decorative order, one had what looked like a fairly new carpet. Another bedroom requires a washable paint to the walls to cope with the needs of this particular resident, which should be done as a matter of urgency and a new floor covering to improve this room for the resident. Another bedroom along the main corridor into the extension must have its flooring changed as the state of the present flooring is totally unacceptable. These rooms were pointed out to the provider during this inspection. The dining room in the main house is very large and there are two smaller lounge areas off this. One very domesticated in appearance and another used as a garden room with access onto the lawn. There is a smaller lounge off one of the main corridors also with double doors leading onto the garden. Three residents were enjoying the tennis on the television in this room. There is a separate smoking room, which is extremely unwelcoming in appearance with very ‘old’ looking basic armchairs and a burnt linoleum floor. Several toilets and bathrooms were inspected and some have hoists to aid access into the bath. The base of the hoist in the ground floor bathroom has extensive rust, which would make cleaning difficult. There was a plastic basket in the corner of this room containing a hairbrush very full of hair, several loose used bars of soap and some old tubes of cream. The upstairs bathroom hoist chair requires cleaning underneath the seat and the chair in this room requires painting or replacing. This room had an overfull clinical waste bin, which was emitting a strong offensive smell. The airing cupboard next door had an ill-fitting door, which did not appear to be a fire door. A smoke detector could not be seen in this cupboard. Another separate toilet on this floor had no soap, a few paper towels and no waste bin. Several of the bedrooms on this floor were empty and although very spacious, contained tired looking furniture and threadbare or unsecured carpets at the door entrance. One bedroom has a whole square corner of carpet missing. Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 24 Several beds were inspected and many had extremely hard mattresses, which had been covered with the old style ‘spenco’ mattress, presumably in an attempt to make the surface softer for any occupant. One recorded complaint was from a previous resident who was having a respite stay at the home. This resident had complained that the mattress covering was lumpy and was causing him to loose his balance when sitting on the edge of his bed. According to the record it was not possible for staff to change this during his stay, as there was a lack of alternative mattresses. The bed in this room was inspected during this visit and still contained a very lumpy ‘spenco’ cover over the main mattress. The bed in room 40 was extremely unsteady. One wall light up the main staircase needs a shade. Two rooms had strong odours. Although the home is generally clean this was identified in the inspection in November 2005. Call bell leads were missing in some of the unoccupied bedrooms. Those that were occupied all had leads making access to the call bell manageable. One resident who has had frequent falls from her bed was seen on a specialised bed that lowers to the floor, accompanied by crash mats. The Continuing Health Care Nurse had supplied this equipment. Several height adjusting beds were seen and some residents required bedrails. In one example observed by the Inspector the resident’s leg was pressed up against the uncovered bedrail causing an indentation in her leg. This was pointed out to the nurse on duty, but it has been noted that a similar situation was observed in the previous inspection. Although the Inspector understands that after much requesting from the nursing staff additional equipment has been purchased by the Registered Provider, only one bedrail cover could be put on this bed. The laundry was tidy. The home has two shaft lifts. One was out of order for a considerable length of time due to problems obtaining the parts required, but is now working. The stair lift on the main stair case remains out of order. Radiators are covered to protect residents from service burns. Three care staff have completed infection control training and a distance study food hygiene course was completed by several staff some time ago. Plastic aprons were seen being worn when serving food. The home has a contract for clinical waste disposal. Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 25 Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 26 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 at least once during a 12 month period. 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 numbers of staff allow for basic care only to be delivered. The recruitment practices in the home help to protect residents. Present arrangements for staff training are inadequate if the home is to provide services for residents that are delivered by well-trained staff. EVIDENCE: Staff spoken to felt that the numbers of staff on duty were satisfactory at the present time to be able to deliver basic care (the home has several vacant rooms at present) but say it is only just manageable when it drops by one carer at 6pm. The Registered Provider feels that staff time could be deployed better and feels with a Manager in post this will improve. It was noted that one only one qualified nurse is on duty several afternoons in the week as opposed to the two in the past. The home has a full time office Manager who has been carrying out many tasks that will presumably be part of the new Manager’s role when she commences. Many residents referred to this person as the person they would talk to if they needed to speak to someone. Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 27 Five care staff hold the NVQ Award in care, this is well below the NMS. Some staff who are qualified nurses in their own countries are working at present as senior care staff. Half the care staff in this home are from overseas and it was observed that although very caring their communication skills and interactive skills are poor in many cases. Although the outcome judgement for this group is poor, staff recruitment practices have improved and appropriate documentation was seen in most cases. Gaps in employment were seen on one application and one reference was not from the staff member’s previous employer. The home must be careful in future to account for all gaps in employment and ensure that references are obtained from the previous employer if possible. There was evidence in the files of the office Manager chasing information up or filling in information on files as it has arrived. An external umbrella company send a letter confirming clearance against the Criminal Record Bureau CRB) list; this is then placed in the staff member’s file. One staff member explained that she had just completed her induction training and was able to show an example of the induction booklet used. She had not been given moving and handling or fire training and yet at times was in charge of the home. Another member of staff explained that she had been in the home for over a year and had received no manual handling training or fire training since her employment. She said she had kept asking but eventually gave up. She said ‘in the other home I worked in we were always training, here you get nothing’. Another member of staff confirmed they were in a similar situation. Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home would benefit from being managed by a competent person on a dayto-day basis and who is able to communicate to residents, relatives and staff their vision for taking the home forward. At the present time the home has limited ways of knowing whether the care and services they offer are of a good standard. Staff do not receive adequate supervision in order for the care that is delivered to be monitored or measured. The system for recording residents’ monies is not robust enough to offer protection. The home cannot demonstrate that sufficient arrangements are in place to maintain residents’ health and safety. Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 29 EVIDENCE: The home has not had a Registered Manager in post for 16 months. The previous acting Manager left at Christmas time, since then and up to recently, one of the registered nurses has been standing in as Deputy Manager. He did not feel he was getting adequate support to move the home forward and declined to stay in this role any longer. A new acting Manager is due to commence at the home next week. This person is a nurse. She does not hold specific management experience but will commence on an induction period; if this is successful the Registered Provider will need to apply for her to be registered with the CSCI. She will commence under full supervision, as her CRB has not yet been returned, although she was fully cleared in her last position. Due to a lack of management many systems are not in place. The staff confirmed that the Registered Provider is in the home 2 or 3 days a week and that he is approachable, albeit not always realistic about exactly what has to be done and what is always needed. Some staff spoken to confirmed that it had been a struggle at the beginning of the year to get basic equipment. Staff confirmed that they have also been constantly telling the Registered Provider of the lack of key trainings/updates. Minutes from a staff meeting were on the nurses’ notice board dated 15/11/05. Two staff confirmed that the Registered Provider used to have monthly staff meetings but there had not been any in the last couple of months. The Senior Carer confirmed there had been a recent nurses meeting. Two relatives spoken to were unaware of any relative meetings being held. Three residents were also unable to confirm any resident meetings but were aware of whom the Registered Provider was and confirmed they had met him. A quality assurance system has not been devised as yet. Resident surveys are carried out to obtain their views on the care and services provided. In the inspection report dated 6/3/06 it was identified that the home had had a good response but that several comments were made about the lack of stimulation and activity provision. This still remains a problem with no active recruiting taking place to address this. Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 30 The Registered Provider commented that the company is making arrangements to bring in another person who will act as the Care Services Manager for the company and that part of the remit will be to commence a quality assurance system along with responsibilities for health and safety practice. The personal monies held for six residents were inspected. Records are kept manually and on the computer and in three cases the amount held did not correspond with the record. The office Manager felt she could account for these shortfalls, knowing that the residents had received either Chiropody or hairdressing. A discussion was held about invoices being obtained from the hairdresser and Chiropodist. Several invoices were seen in residents’ files of these services that are arranged privately by the resident or their representative. Invoices are prepared on a monthly basis for those holding Power of Attorney. One set of arrangements in particular were discussed, where the office Manager helps a resident by cashing a cheque for them but does this through her own account for ease. This resident likes to have access to money when he wants it, but does not have family to help. This arrangement although well meaning, must change in order to protect both parties. Examples were seen where residents manage their own monies and organise payment of their own fees. Although the Senior Care staff are present in both units of the home and offer support and guidance to junior staff there is no formal supervision system in place at the present time. Records held by the office Manager are organised and secure. Care plans are held out of sight to promote confidentiality, although residents’ own access to their care files has not been explored. Records are kept of accidents in the home and since 4/3/06 there was 49 recorded incidents, 23 were in the day time hours and 18 were at night. 6 did not record a time of day at all and 4 could not be distinguished between night and daytime. A recent serious incident outside of the home but involving a resident, who later died, had not been reported to the CSCI, although a police enquiry is underway. Staff were aware that a death of a resident needed to be reported to the CSCI, but were unaware that anything else needed to be reported. Their knowledge regarding Regulation 37 under which various situations need reporting was sketchy. An up to date format for reporting under Regulation 37 was obtained from the CSCI’s web site during this inspection. No records were found of hot water temperature checks. Other health and safety records were sporadic. Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 31 Fire drills had been carried out according to the record on 5/5/06, 12/5/06, 19/5/06, 26/5/06, 16/6/06 and the 30/6/06. Fire panel checks, although headed weekly had been recorded as occurring on 16/6/06, 30/6/06 and nothing since July 2005. Weekly lighting tests were recorded as occurring with the Fire Officer on 3/3/05 and 10/11/05, nothing since. Certificates for hoist testing and maintenance by an approved company were seen dated December 2005. The office Manager confirmed that recent water samples were collected and sent for testing against Legionella. There were no records showing the recording of tank temperatures (at source) or other practices carried out to protect residents against this. There were no records demonstrating staff training in Fire Awareness or Manual Handling. Staff confirmed that this had not taken place for at least 13 months. Two windows on the top floor, which open below waist level, one in a room occupied by a resident who has dementia, were wide open with no restrictor. These rooms were on the first floor with a drop onto concrete below. This was pointed out to the office Manager immediately. Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 3 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 2 2 2 X 2 2 2 STAFFING Standard No Score 27 2 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 1 X 2 1 1 1 Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 6 Requirement The registered person shall supply a copy of the revised service users guide to each resident and their representative (timescale of 9/9/05, 17/1/06 and 28/03/06 not met). The registered person must ensure that a comprehensive assessment is carried out prior to a resident’s admission and that staff are aware of the resident’s needs before they are admitted. The registered person shall prepare a written plan of care in consultation with the service user or their representative where possible and include them in any review of this plan. The registered person must ensure that the medication storage and medication administration is to such a standard that protects residents and meets with the guidelines set by the Royal Pharmaceutical DS0000063477.V303250.R01.S.doc Timescale for action 01/09/06 2. OP3 14 21/08/06 2. OP7 15(1) 01/09/06 3. OP9 13(2) 01/09/06 Euroclydon Nursing Home Version 5.2 Page 34 4. OP12 16(2)(n) 5. OP16 22 6. OP18 13(6) 7. 8. OP19 OP19 23(2)(d) 23(2)(a) & 13(1) 9. OP19 23(4)(ae) 13(4)(a) 23(2)(a) & 13(1) 23(2)(b) 10 11. 12. OP19 OP19 OP19 13. OP22 16(2)(c) Society. The registered person must provide opportunities for activities and interaction to take place. These must meet with all the residents’ choices, capabilities and needs. The registered person must make sure that each complaint is dealt with and action taken to rectify the situation. The registered person must make arrangements for staff to be trained in the Protection of Vulnerable Adults and provide adequate procedures for staff to follow. These must fall in line with the county’s protocol. The registered person must ensure that the home is adequately decorated. The registered person must improve the state of the walls in room 16 and ensure that future cleaning of these is possible and carried out. The registered person must ensure that any requirements made by the Fire Officer are met and adhered to. The registered person must ensure that all floor coverings are secure and/ or replaced. The registered person must replace the carpet in room 20. The registered person must through refurbishment & decoration make the smoking room more habitable and pleasant for residents to use. The registered person must make available any equipment required for the care of a resident and to ensure their health and safety, in this case adequate bedrails used in conjunction with an appropriate risk assessment (timescale of DS0000063477.V303250.R01.S.doc 01/10/06 21/08/06 01/09/06 01/11/06 01/09/06 21/08/06 01/09/06 01/09/06 01/10/06 21/08/06 Euroclydon Nursing Home Version 5.2 Page 35 9/7/05, 30/11/05 & 6/3/06 not met.) 14. 15. OP22 OP24 16(2)(c) & The registered person must 23(2)(c) ensure the bed in room 40 is safe and ‘fit for purpose’. 16(2)(k) The registered person must ensure arrangements are in place to eliminate any odours in the home. 23(2)(p) The registered person must ensure that all lighting in the home is working adequately, to include emergency lighting. 22(2)(c) & The registered person must 13(3) provide adequate maintenance and refurbishment of equipment so as cleaning/infection control practices are effective. 18(1) The registered person must provide enough staff on duty to meet the all the residents’ needs and facilitate the smooth running of the home and its upkeep. 18(1)(c) (ii) The registered person must demonstrate that the home is aiming to have 50 of its care staff trained to NVQ Level 2 or an equivalent. The registered person must ensure all new staff receive adequate induction and mandatory training. The registered person must establish a system for evaluating the quality of care & services provided in the home and demonstrate how these will be improved. The registered person shall supply the Commission with an Improvement Plan. The registered person must ensure that any record of monies held on behalf of residents DS0000063477.V303250.R01.S.doc 21/08/06 21/08/06 16. OP25 21/08/06 17. OP26 01/09/06 18. OP27 01/09/06 19. OP28 01/10/06 20. OP30 18(1)(c) (i) 24(1) 28/07/06 21. OP33 01/11/06 22. 23. OP33 OP35 24A(2) 17 Schedule 9 11/09/06 28/07/06 Euroclydon Nursing Home Version 5.2 Page 36 24. 25. OP36 OP37 18(2) 37(1)(c) (e)(f)(2) 26. OP38 13(4)(a)& (c) 27. OP38 13(5) 28. OP38 23(4)(a) (d) corresponds with the amount being held. The registered person must ensure that all staff receive adequate supervision. The registered person must give notice to the Commission of any serious injury to a resident or of any event in the home that adversely affects the well-being or safety of the residents. The registered person must demonstrate through adequate records that all areas/systems that the resident has access to are reasonably free from hazards to their safety. (timescale not met 09/07/05, 30/11/05 & 06/03/06. The registered person must provide staff with adequate training and update training to ensure safe moving and handling is practiced The registered person, through training and through the use of a fire risk assessment, ensure all staff working in the home are aware of fire prevention and are competent in the event of a fire. 01/10/06 28/07/06 28/07/06 01/09/06 28/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Euroclydon Nursing Home DS0000063477.V303250.R01.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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