Inspection on 26/06/08 for Florence Nursing Home

This inspection was carried out on 26th June 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Townley Road, 2-3

Orchard House Nursing Home

St Josephs Rest Home

Foxley Lane (121a)

Tudor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Westmeria Nursing Home Westmeria 47 Park Avenue Bromley Kent BR1 4EG Lead Inspector Rosemary Blenkinsopp Key Unannounced Inspection 26th June 2008 08:30 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 Westmeria Nursing Home DS0000071180.V359940.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. Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westmeria Nursing Home Address Westmeria 47 Park Avenue Bromley Kent BR1 4EG 020 8460 5695 020 8466 0481 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) Safecare UK Ltd Mrs Susan Ann Clarke Care Home 36 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (1), Old age, of places not falling within any other category (36) Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP (maximum number of places: 36) Mental Disorder, excluding learning disability or dementia - Code MD(E) (maximum number of places: 1) The maximum number of service users who can be accommodated is: 36 21 November 2007. 2. Date of last inspection Brief Description of the Service: The ownership of the home has changed recently. The new owner has previous experience in the field of residential care homes and has previously managed nursing homes. He is a trained nurse. The name of the home has changed to Florence this needs to be officially processed through the Central Registration Team The home is a registered nursing home providing care for 36 residents. The category of residents is older people with one bed for a resident in the category mental disorder. This had been requested and approved under a variation of conditions. The home is an adapted building spread over four floors. The sitting and dining areas are located on the lower ground floor. Individual bedroom accommodation is located over the first and second floors. Bedrooms are a mix of single and shared facilities. A qualified nurse manages the home. Waking staff are provided throughout the 24-hour period. Qualified nursing staff are always on duty as this is a nursing Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 5 home. GP cover and other health provision are provided locally. The fees range between £ 590 - £850 a week. There is also the option to be accommodated in a double bedroom, which is now used as single accommodation for £ 900 per week. Fees vary between private and local authority placements. Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of the service is 1 star. This means the people who use this service experience adequate. The inspection was conducted over a one day period by two inspectors. The Head of Care, Gill Southwood, facilitated the site visit as the Manager was away. The new owner attended for the majority of the day. Periods of observation were undertaken on two floors. Prior to the inspection the Manager had completed the AQAA and forwarded this to the CSCI. Sixteen comment cards were returned to the CSCI including six from residents. During the visit the inspector met with two relatives and several residents. Staff were interviewed as part of the site visit. All of the information obtained from the sources identified above has been incorporated into this report. A selection of documents were inspected including care plans, staff personnel files as well as health and safety records. Feedback was provided to the owner and Gill Southwood, at the end of the inspection. Other information which has been considered when producing this report and rating, is the information supplied and obtained throughout the year including Regulation 37 reports and complaints. What the service does well: The home has retained a number of its staff including the qualified nurse team for a number of years. This provides residents with staff who understand the workings of the home and provides consistency in care. Generally the feedback obtained through comment cards and direct contact was positive regarding the services provided in the home, staff and the Manager. Gill Southwood is an experienced nurse who works as the clinical lead in the home. This is a valuable role as the Manager can often be busy with other managerial although non clinical issues. The two qualified nurses on each day Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 7 shift provide staff with a good level of direct supervision and clinical input into residents care. What has improved since the last inspection? What they could do better: Assessment procedures need to reflect that the resident has been involved in the process, has had an opportunity to sample the service, and that the home is suitable both in terms of the environment and the skills and knowledge of staff who work there. The home needs to further develop the current care plans, so that it incorporates comprehensive information about the residents, on which the staff can base their care, and includes that information obtained through the assessment process. Medications need to be improved upon both in terms of recording, storage and administration. The routines in the home need to reflect resident’s choice as this has been the subject of several comments including those from residents, staff and two relatives. The routines in the home need to be flexible to accommodate individual’s preferences. The complaints information needs to be fully reflective of all complaints received with supporting documentation. Staff need to be updated at the appropriate intervals for mandatory topics and receive training reflective of those resident’s conditions in the home. All records need to be available and accessible in the event that the Manager is not on duty. Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 8 Quality assurance systems must be in place to incorporate the views of all stake holders to establish a system for reviewing the services provided by the home. 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. Westmeria Nursing Home DS0000071180.V359940.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 Westmeria Nursing Home DS0000071180.V359940.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The pre-admissions procedures provide residents with limited information which they require in order to make any decision regarding placement at Florence Nursing Home and to establish whether the service is right for them. Staff have information on which they can base an initial care plan in order to address care required. EVIDENCE: The home is currently operating on 30 bedrooms as the majority of shared rooms are, or are due to be, converted to single bedrooms. At the time of the inspection there were 24 residents on site, of those residents two had pressure sores. Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 11 The Manager or a senior person assesses all prospective residents. In those care plans selected for inspection there was evidence of these assessments, which are recorded on a standard form. In addition there was the assessment received through the funding authority, these included some good information about the prospective residents and their needs. Initial enquiry forms are completed for all residents. Offer letters, confirming that following the assessment, the home is able to meet their needs, were on file. Terms and conditions of the placement were set out on a standard form. Some of the documents still had the previous name and owners included, all documents must accurately reflect the correct situation both in terms of owner ship and name of the home. Staff in the home conduct a “post admission assessment“, once the resident had been admitted. Not all records were fully completed with dates and staff signatures this needs to be addressed. Other admission information available in the files selected included a hospital discharge letter, a hospice discharge summary as well as multidisciplinary team member’s letters. The Statement of Purpose and Mission Statement were both available in the hall. There was little evidence of what information residents had been provided with prior to admission or whether trial visits had been undertaken either by the resident or their advocate. There was little evidence of how the resident had been supported or had had input into the decision regarding placement. It was evident that the skills of staff had not been considered when taking prospective residents conditions into account as staff were unaware of two resident’s conditions of those nursed in the home. When admitting residents with specific conditions, such as Huntington’s and Cerebral Ataxia, staff must be aware of the condition and any implications that this may have on providing care. Also the home should consider the existing level of resident’s dependency in the home and ensure that all equipment is available prior to admission. The home has changed it’s name to Florence, which the Central Registration Team (CRT), was advised of in writing. However the registration certificate still refers to the home as Westmeria, and this needs to be addressed. The new owner needs to again contact CRT to ensure that the home is correctly titles on the registration certificate and reflects the new owners. Please see requirement 1. Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents care needs are met by staff in the home supported by members of the multi disciplinary team. The emphasis on physical healthcare interventions and routines detracts for personalised and individual care. The information in care plans provided limited information for staff to deliver the care, particularly in respect of social needs. Without comprehensive information inconsistencies in care and approach, can occur with may negatively impact on resident’s health. The system for administration of medication is inadequate and potentially places residents at risk. EVIDENCE: In those care plans which were included as part of case tracking the residents photograph was included. Personal details including next of kin were also recorded. Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 13 Risk assessments were in place for the application of cot sides and manual handling. The manual handling risk assessment needs to detail the actual hoist and size of sling to use as this will vary between residents. Other records on risk assessments included those for falls and skin integrity, which was in one file in the very high risk band. In the event that high risk is identified then further action and specific interventions to reduce or eliminate the risk must be considered. The care plans are in two formats one a pre printed style the other a hand written one. The Head of Care stated that the pre printed formats had proved be of little assistance providing only limited information, therefore the handwritten ones were being re introduced. In those care plans inspected the problems identified were physical issues with nothing on social, psychological or spiritual needs. A night care plan and assessment were retained on file to provide an outline of the night care routines for that resident. The interventions and specific problems were not indicated on the typed care plan format. An example of this was the following; “____ is at risk of chest infection, pressure sores and DVT”. All of these would require a specific care plan and have specific and very different interventions to address the issues. One of the residents had wounds, individual wound care charts detailed the actual size and description of the wound as well as the dressing to be applied. The care plan of one resident who was observed during the tour to be very upset and distressed was inspected. In her care plan there was no evidence of her distress and measures to support her yet it was known by staff that she had been upset since her admission. Care plans were without the signature of the resident or their advocate as evidence of their input into developing the plan. Reviews of the care plans were short or simply a statement saying “ reviewed “ and a date, there was little documentation on how the care plan issues were progressing or otherwise. Daily events are recorded in two separate entries, one by the RGN the other by care staff. Some of these were limited and provided little reference to the actual care plan issues, particularly those written by care staff. Entries in daily events such as “bottom washed “were recorded in two care plans. More professional terms should be used when recording care. In relation to health care input there were in files referral forms from members of the multi disciplinary team. Visits by the GP, dietician and podiatry were also Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 14 evidenced. The records provided, gave the date of the visit and a short summary report. Fluid charts were incomplete without totals and entries such as “sips “gave little indication of intake. On totalling on of the charts the recorded intake was less than 200 millilitres, hence the resident would be dehydrated as this is significantly less and the recommended two litres a day. Without accurate records it would be difficult to know when residents are becoming dehydrated and may require further medical intervention. The medication administration records were audited. There were several instances where prescribed medication had been omitted or administered but not signed for. While it transpired that there were acceptable explanations for this, these explanations had not been recorded. In all cases where medication is not given as prescribed, staff must ensure that they record the reason for this. The administration/non-administration of all medication must be recorded accurately at all times to ensure that the residents are having/not having their medication for their health and wellbeing. This service is a care home (nursing), which employs registered nurses. The Nursing and Midwifery Council (NMC) Code of Professional Conduct requires each nurse to be individually accountable for making sure that all medicines are administered correctly. All staff are reminded that they must make an accurate record, immediately after observing a resident taking or refusing their medicines. Some items of medication were prescribed, “Use as directed”. No other directions were seen for administration. There must be clear direction for all items of medication to ensure that residents are receiving their medication accordingly and as prescribed by the General Practitioner. Again this will ensure the health and wellbeing of the residents as far as medication is concerned. There is a record for medication being received in the home however it was noted that one record stated that 56 Clomazepam tablets were received on 20/06/08 although none were received on that day. This came to light as the record for that medication on the Medicine administration records (MAR) sheet identified that it was out of stock. All medication being received in the home must be recorded accurately to ensure that there is no mishandling. The home has very recently changed their chemist and the staff are still getting use to the new system regarding receipt, administration and disposal of medication. The head of care stated that none of the people in the home administer their own medication. While touring the building at the start of the inspection, it was noted that the medicine trolley was left unattended and open. No staff member was around. Medicines in the custody of the home must be handled according to the Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 15 requirements of the Medicines Act 1968, guidelines from the Royal Pharmaceutical Society and the requirements of the Misuse of Drugs Act 1971. The Commission would continue to monitor the medication standard and if there is any further concern this might lead to enforcement action being taken against the home. Staff are aware of the need to treat residents with respect and to consider dignity when delivering personal care. The home arranges for residents to enjoy the privacy of their own rooms. Residents who were spoken to stated that they are happy with the way that the staff deliver their care and respect their dignity. One resident stated, “The staff look after me well”. Another resident stated, “The staff are good to me”. Observation of the staff team interacting with the residents showed that the carers were mindful how they addressed residents, and they were seen to be polite and friendly. In some bedrooms the call bells were unreachable and fluids not accessible. Residents should have both of these at hand to ensure that they can call assistance when they need and are able to drink when they choose. Records of accidents were retained and audits of wheelchair safety routinely carried out. The home employs male and female staff to address gender care issues. One resident although satisfied with the care, felt that he was not sufficiently empowered to make his own decisions. Please see requirements 2, 3 4 5 and 6. Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a varied selection of activities provided including external entertainers. Some choices are provided which means residents are enabled to input into their day. More flexibility is required in the daily routines to promote resident’s independence and enhance individuals’ well being. EVIDENCE: An activities coordinator is employed in the home five days a week. There is a weekly activity programme offering a variety of activities. During the site visit the activities person was outside sat on the patio with residents. It was a bright day and they were reading the papers, chatting and having a cup of tea. Visiting is open and the inspector met with some of those in the home. Comments in comment cards and received verbally were variable about activities. One comment was that “activities seem to be improving “.Whilst another stated that residents needed more activities and more stimulation. Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 17 Residents were observed to be either in communal areas or their own bedrooms indicating that they had choices. Individual newspapers and the TV were available in the lounge area. It was observed that those residents sat in the lounge were simply in front of the TV with no evidence that they had selected the programme to watch or were at all interested, in fact several had their eyes closed during the morning. There were several occasions when staff were not in the lounge area, although staff were in the vicinity. Residents need to be observed and supervised in case of accidents. The lunchtime meal was observed. Tables were laid in preparation. There were eleven out of fifteen residents sat in wheelchairs for the meal. It was unclear if this had been at the request of the resident. Residents must be provided with seating which is suitable to them and where possible of their choosing. The menu is produced on a four week cycle with two hot choices. The evening meal is usually soup and sandwiches. Twice a week residents are offered a cooked breakfast which some enjoyed. Staff were serving and assisting residents, and were seated to feed some residents. Portion size seemed good and second helpings were available should any one wish to request it. Juice was served with the meal. Trays were seen being taken to residents who stayed in their bedrooms for the meal. One comment received related the following “staff are friendly and caring and seem to do their best to make my mother comfortable”. Throughout the site visit it was evident that routines prevailed and were task led, particularly focusing on physical health needs. This should be reviewed. Please see recommendation 1. Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. Complaints information is available for residents to access. The records retained on site did not detail all complaints received and this does not provide an accurate picture of issues raised. Staff had a working knowledge and understanding of adult protection and whistle blowing, regular updating is required in these areas, to ensure that they are familiar with current guidance and contact points. EVIDENCE: Complaints information is available in the entrance hall on display as well as other documents issued to residents. The complaints file was inspected. It contained entries for November and December 2007, nil since. Following this site visit ,information was received regarding a complaint which had been raised with staff in the home and investigated ,however this was not in the complaints file. This had been received around April 2008 and should have been retained with the investigation, on file it was not in the file seen. The only information retained on the other two complaints was the actual complaint and the response letters. All complaints must be recorded with all investigation information and outcomes recorded. Complaints must be addressed within 28 days of receiving them. A log of all complaints should be retained which outlines the complaint Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 19 received the investigation and detail whether the complainant is satisfied with the outcome. Further information received by the CSCI, again following the site visit, regarding the handling of complaints was less than complimentary regarding the handling of concerns. In the opinion of the informant, the concerns had not been received well by staff in the home and action taken insufficient to address the issues. During staff interviews matters such as abuse ad whistle blowing were discussed. Staff were aware of the types of abuse and the action to take namely the reporting of such matters. They were less knowledgeable about the external bodies to contact and general terms such as Social Services and CSCI were cited as organisations for referral of abuse. Staff need to be familiar with the specific points of contact for referral to ensure that the information reaches the appropriate person. In respect of whist blowing staff demonstrated a variable level of understanding and knowledge. Some were fully conversant with the term, whilst others had a limited knowledge and one was unaware of the term or implications of such. Staff need to be updated regularly on dealing with abuse so that they are familiar with the current practices. The term whistle lowing and it’s implications should be included and revisited in this training. Please see requirement 7. Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 20 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 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are provided with satisfactory accommodation where health and safety issues are addressed although the layout of the building has limitations. The narrow corridors and access issues would limit the use of some equipment. EVIDENCE: The home is an adapted building over three floors. All areas are accessed either by stairs or a lift facility. It was noticeable that the hall area which had always had an odour present was on this visit, odour free. The hall itself had been reconfigured to allow better access for stretches used by ambulances, and wheelchairs. Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 21 All bedrooms have a sink and two rooms have en suite facilities. In the main those bedrooms inspected were personalised with the residents own items including photographs ornaments, TV’s, radios and small pieces of furniture. Bedrooms are individual shapes and sizes which provides choice to residents and prevents every room being to a set standard and design. Work was in progress to upgrade a bathroom to provide improved bathing facilities for those residents with mobility impairment. Hot water facilities are fitted with individual thermostatic control valves. Windows are restricted. Radiators are covered which affords protection from burns should a residents come into contact with them There is a ramp out to the lower ground floor patio to allow wheelchair access to this area. Comments in a comment card from a relative said the following “they don’t seem to keep up with minor repairs, general décor is just OK and could be better – the main lounge is particularly poor given the time residents spend there”. The handyman was said to be off work currently hence repairs were being addressed by the owner. Some system of ensuring that repairs are actioned needs to be put in to place an ongoing refurbishment continued. Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 22 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 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing is provided in sufficient numbers to meet the resident’s needs. Staff are subject to recruitment procedures although recruitment policies are not consistently followed resulting in residents receiving care from staff members who have not been properly vetted. This potentially leaves people who use the service at risk. Staff are provided with some training and induction to enable them to undertake the work they perform and provide residents with the support they need. Mandatory training for staff is not always up to date and this could have an impact on the care that residents are receiving. EVIDENCE: The home operates on two qualified nurses throughout the day period and five care staff. The Manager is supernumerary. In addition ancillary staff including cooks and house keepers are employed. From the staff training records, it was noted that they were not always up to date and there are gaps in mandatory training. It was very difficult to ascertain if the staff were up to date with their training. There must be a staff training and development programme in place, which meets Sector Skills Council Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 23 workforce training targets to ensure staff fulfil the aims of the home and meet the changing needs of residents. A training needs assessment must also be carried out for the staff team as a whole, and an impact assessment of all staff development must be undertaken to identify the benefits for residents and to inform future planning. The registered person must monitor staff competencies through regular supervision, as this will influence the need for updates with regards to training. Training and development must be linked to the homes’ service aims and to residents’ need and individual plans (for example training in Hutchinsons disease). The Head of Care is aware that there are some gaps in the training programme. These are being addressed and further training sessions have been arranged. All staff must be up to date with their mandatory training to ensure residents continue to receive care as is reasonable to meet their needs. It is advisable that mandatory training (Moving & Handling, First Aid & Fire training) are undertaken with care staff on an annual refresher basis or at the intervals recommended by the organisation that accredits the training. As part of the inspection process three staff personnel files were sampled for references, criminal record checks, application forms and copies of identification. It was noted that two of the staff had only one reference each. According to Schedule 2 of the Care Homes Regulations 2001, the provider/manager must have two written references relating to any person who is working in the home. Staff files must contain all relevant documentations as per Schedule 2 of the revised Care Homes Regulations 2001 for the delivery of good quality services and for the protection of residents. There was evidence in place stating that the person working in the home is physically and mentally fit for the purposes of the work which he is to perform at the care home however this was limited to the past five years only. It is recommended that a more comprehensive record be kept on each staff regarding their physical and mental status. None of the three files had a criminal record bureau check in their files. Gill Southwoood and the provider were unable to find them on the day of the inspection. Comments received by the CSCI were generally favourable about the staff. Those staff who were interviewed had a working knowledge about topics asked including infection control. On the topic of Clostridium Dificile the level of knowledge was variable with some staff having no knowledge on the subject. One chart which was included as part of the care plan package was an “Oral chart “the use of it was not fully understood by all staff. Staff must be familiar with all of the records and supporting documentation relating to residents so that they can deliver the care. Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 24 Of the current staff group nine have completed NVQ 2 or above whilst six are doing level 3. The home is part of the Bromley Consortium which provides regular training sessions to staff working in residential care settings. Resident’s conditions specifically cerebral ataxia and Huntington’s were little known or understood by staff. Staff must be fully conversant with not only the mandatory subjects but also those conditions for which they care. Without specific knowledge on resident’s conditions essential and important factors may be overlooked and put the residents at risk. Staff appeared to be very physically and task focused during the periods of observation. Please see requirements 8, 9 and 10. Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are shortfalls in the management the health and safety in the home and therefore the safety of residents and staff are not being promoted/protected and this potentially places them at risk. Staff supervision is inconsistent which could impact on the care the residents are receiving. Quality assurance measures are limited therefore give little information on how the service can be improved upon to benefit residents. EVIDENCE: Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 26 Three staff supervision records were sampled and it was noted the staff are not having regular supervision. Formal supervision sessions must be held with all care staff at least six times a year for the delivery of good quality services. During the inspection a number of records were not available or the staff/provider were not aware where they were kept. Records required by regulation for the protection of residents and for the effective and efficient running of the business must be available at all times for inspection in the care home by any person authorised by the Commission to enter and inspect the care home. Checks show that records are generally up to date however medication administration records are not being completed accurately and there were gaps in the record of the weekly fire alarm tests. All records in the home must be kept accurate and up to date at all times to ensure that residents’ rights and best interests are being safeguarded. Failure to comply with the aforementioned requirement represents serious breaches of the Regulations and urgent action must be taken by the registered person to address this to avoid the Commission taking further action to enforce compliance. With regards to health and safety records again some were not available at the times of inspection for example gas certificate, emergency lighting test and electrical wiring test. This was discussed in depth with the registered provider and head of care and the consequences of not having the records at hand were highlighted. It was identified at the last inspection that the home had a CHUBB reference manual, which could also be used for recording all fire safety checks although this was incomplete. At the time of this inspection, the manual is not being filled on a regular basis so it was very difficult to ascertain when fire safety checks are being carried out. The manual has very useful information on the frequency of checks foe example every six months for emergency lighting. A number of health and safety issues arose during this inspection and they are as follows: It was noted that there were gaps in weekly fire alarm test. Fire alarms test must be carried out and recorded on a weekly basis for the safety of residents as well as staff. COSHH materials were not kept locked. All COSHH materials must be kept locked in accordance to Control of Substances Hazardous to Health Regulations (COSHH) 1999 to ensure the safety of residents. Following the site visit the records which were unable to be located during the site visit were found. Photocopies of certificates were sent to the CSCI. Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 27 The records in relation to quality assurance measure were limited. There were minutes of meetings held with the qualified staff and the care staff. These were signed by the staff to indicate that individual staff members had seen them. A meeting with the house keepers had taken place April 08. Audits on care plans, wheelchairs and bedrooms were on file. . Gill Southwoood stated that a questionnaire had been sent out although the sample of the survey nor the results could be located. Up to date Regulation 26 reports were unavailable, the last one completed was January 2008. Regulation 26 visits must be conducted monthly unannounced and a report on the findings retained. The policies and procedures need to reflect the correct name of the home. Two resident’s monies were checked and found to be correct. Receipts were attached for expenditures and two staff signatures were in place to confirm the transaction. Money is safely stored in the safe. Please see requirements 11,12,13,14 and 15. Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 2 x 2 Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No 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 OP3 Standard Regulation 14 Requirement Assessment information must include details of the resident’s input into the process including trail visits and consultation on placement. Care plans must include all of the residents needs including social psychological. Detailed interventions must be recorded to direct the care provided. The administration/nonadministration of all medication must be recorded accurately at all times to ensure that the residents are having/not having their medication for their health and wellbeing There must be clear directions for all items of medication to ensure that residents are receiving their medication accordingly and as prescribed by the General Practitioner All medication being received in the home must be recorded accurately to ensure that there is no mishandling. Timescale for action 31/08/08 2 OP7 15 30/09/08 3 OP9 13 30/07/08 4 OP9 13 30/07/08 5 OP9 13 30/07/08 Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 30 6 OP9 13 Medicines in the custody of the home must be handled according to the requirements of the Medicines Act 1968, guidelines from the Royal Pharmaceutical Society and the requirements of the Misuse of Drugs Act 1971. A complaints log must be developed which is an accurate reflection of all complaints and contains evidence of the investigation and outcomes. There must be a staff training and development programme in place, which meets Sector Skills Council workforce training targets to ensure staff fulfil the aims of the home and meet the changing needs of residents. A training needs assessment must also be carried out for the staff team as a whole, and an impact assessment of all staff development must be undertaken to identify the benefits for residents and to inform future planning. Staff files must contain all relevant documentations as per Schedule 2 of the revised Care Homes Regulations 2001, for the delivery of good quality services and for the protection of residents. All staff must be up to date with their mandatory training to ensure residents continue to receive care as is reasonable to meet their needs Quality assurance measures must fully represent the opinions of all stakeholders and action plans developed for areas where shortfalls are identified. Regulation 26 visits must DS0000071180.V359940.R01.S.doc 30/07/08 7 OP16 22 30/07/08 8 OP28 18 30/09/08 9 OP29 19 30/08/08 10 OP30 18 30/09/08 11 OP33 24 30/09/08 12 Westmeria Nursing Home 26 30/07/08 Page 31 Version 5.2 OP33 13 OP37 25 14 OP38 23 conducted monthly unannounced Records required by regulation for the protection of residents and for the effective and efficient running of the business must be available at all times for inspection in the care home by any person authorised by the Commission to enter and inspect the care home Fire alarms test must be carried out and recorded on a weekly basis for the safety of residents as well as staff. All COSHH materials must be kept locked in accordance to Control of Substances Hazardous to Health Regulations (COSHH) 1999 to ensure the safety of residents 30/07/08 30/07/08 15 OP38 23 30/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 OP12 2 OP29 Refer to Standard Good Practice Recommendations A review of the daily routines should be undertaken to ensure that residents are provided with choice and independence promoted. It is recommended that a more comprehensive record be kept on each staff regarding their physical and mental status. Formal supervision sessions must be held with all care staff at least six times a year for the delivery of good quality services. 3 OP36 Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Westmeria Nursing Home DS0000071180.V359940.R01.S.doc Version 5.2 Page 33 - 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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