Inspection on 04/07/08 for Flowerdown Nursing Home

This inspection was carried out on 4th July 2008.

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

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

Other inspections for this house

Flowerdown Nursing Home 31/01/09

Flowerdown Nursing Home 05/06/07

Flowerdown Nursing Home 23/05/06

Flowerdown Nursing Home 19/01/06

Flowerdown Nursing Home 11/10/05

Flowerdown Nursing Home 11/04/05

Flowerdown Nursing Home 10/11/04

Flowerdown Nursing Home 16/04/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Flowerdown Nursing Home Harestock Road Winchester Hampshire SO22 6NT Lead Inspector Christine Walsh Unannounced Inspection 4th July 2008 10:00 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 Flowerdown Nursing Home DS0000011652.V365331.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. Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Flowerdown Nursing Home Address Harestock Road Winchester Hampshire SO22 6NT 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) 01962 881060 01962 881935 flowerdown@fshc.co.uk Tamhealth Limited (wholly owned subsidiary of Four Seasons Health Care Limited) To Be Confirmed Care Home 53 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - N to service users of the following gender: Either Whose primary needs on admission to the home are within the following category: Old age, not falling within any other category Code OP. The maximum number of service users who can be accommodated is 53. 5th June 2007 2. Date of last inspection Brief Description of the Service: Flowerdown Nursing Home is registered to provide care and accommodation for fifty three older persons who require nursing care. The home has been extended over the years and accommodation is provided in forty eight single rooms and one shared room, situated on two floors of the old house and the new extension. The home has completed an extensive programme of redecoration and refurbishment. The home has large well-maintained gardens and ample parking space. Flowerdown is owned and operated by Four Seasons Health Care, a large independent care provider in the UK. The home is situated in a semi rural area on the outskirts of Winchester, Hampshire. The home accepts residents funded by Social Services with top-up fees. The fees for self funded residents is £700. Per week Fees range from £460.40 - £850 . Service users pay extra for hairdressing, chiropody and personal toiletries etc. Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is “0 star ” This means the people who use this service experience Poor quality outcomes. This site visit formed part of the key inspection process and was carried out over one day by Mrs C Walsh, regulatory inspector, the newly appointed manager and deputy manager, assisted with the inspection visit. The Annual Quality Assurance Assessment (AQAA) document was completed jointly by the deputy manager and the previous manager. Since the new manager has been working in the home she has identified a number of areas in need of improvement, these were discussed with the inspector and are recorded and referred to in the body of this report. The AQAA informed us that the service ensures the race, gender identity, disability, sexual orientation, age, religion and beliefs of the residents are promoted by ensuring that each have an ongoing assessment to evaluate their care they require, their personal preferences and social requirements. It went on to tell us that the ethos of care is introduced to staff at the recruitment stage, and there are plans in place to support staff to receive diversity and equality training. The information obtained to inform this report was based on viewing the records of the people who use the service, of which two residents records were looked at in depth and of staff who work for the service. The day-to-day management of the home was observed, and discussions with residents and staff took place. In addition “Have Your Say” comment cards were completed at the time of the visit. The people who use this service are referred to as residents. What the service does well: The service does well to provide a comfortable and welcoming home where there is a range of activities to interest and stimulate the residents, these are planned and implemented by an activities coordinator. The residents and relatives had good things to say about the home and the staff. The majority said they liked the environment and their bedrooms, the food, entertainment and said good things about the staff. Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 6 What residents and relatives said about staff: “I was made to feel very welcome, I always find most staff helpful”. “The staff are very good and they work very hard”. “I always find the staff to be kind and helpful”. The home provides the residents and their relatives with information on how to raise concerns and make a complaint. The manager has an open door policy and will visit all residents on a daily basis to check if they are ok. The staff are encouraged to improve their knowledge and skills in the aspect of caring for the residents. They complete a through induction into care on starting in the home are supported to obtain a National Vocational Qualification and are provided with training that they must do and which is relevant to the needs of the residents. The home ensures it carries out a thorough recruitment process to ensure residents are not placed at risk of harm. The manager and the company regularly monitors the standard of care provided in the home and meetings take place with staff to ensure they are made aware of what their responsibilities are. Areas of health and safety, including fire safety are regularly monitored and all appliances in the home such as electrical equipment and moving and handling equipment are serviced to check they are in good working order. What has improved since the last inspection? Following the last visit to the home in May 2007 it was issued with three requirements and one recommendation. These included ensuring the assessment process is thorough so the home can ensure it can meet the needs of prospective residents, ensuring care plan are reviewed monthly and reflect the changing needs of the residents and the service must develop the staff training programme to ensure staff undertake appropriate training to enable them to be competent to do their job. Two of the requirements have been met, the third will be addressed in “What the service could do better”. The home has introduced a comprehensive assessment document and staff who carry out assessments receive training to complete the documentation correctly. This is to ensure they are gathering the right information to assess if they can appropriately meet prospective residents needs. Care plans viewed as part of the visit told us that the home is regularly reviewing care plans to reflect the changing needs of the residents. Issues in Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 7 respect of how the care plans are completed will be discussed in “what the home could do better”. Since the last visit to the home it has appointed an activities coordinator a deputy manager and more recently a manager. The activities coordinator is employed solely to plan and arrange activities of the resident’s choice. This appointment has proved to be valuable to the residents and the home. “I think activities with S……….. has greatly improved the activities department and trips out with service users has been very good over the last couple of months”. The activities coordinator has a good understanding of the physical and mental health needs of the residents and adjusts activites to meet their individual needs. The home has been without a registered manager since November 2007, however a new manager has recently been appointed to the post and provided evidence that she is aware of what the home could better and how she intends to improve the current standards in the in home. What they could do better: The third requirement referred to above was made in respect of staff training and required the home to ensure staff undertake appropriate training to enable them to be competent to do their job. Although there is evidence that staff are receiving training that is required by law and training relevant to the needs of the residents, there are areas of care practices that provide evidence that the staff are not applying what they have been taught. All nursing staff have received several training sessions on completing care plans, this is so the care plan can tell other staff including those who have not worked in the home before “how” to individually care for the residents. The care plans viewed during this visit did not tell us how the residents wished to be cared for. This places the residents at risk of not having their care carried out in the way needed and in the way the residents wish. This can compromise their dignity and continuity of care. All staff, as part of their induction process, receive information about respecting residents’ dignity and privacy, they are given a copy of the aims of the home and receive training on the basic principles of care. Evidence on the day of the visit showed us that basic care needs are not being appropriately met. The staff have received training in moving and handling but residents were observed to be inappropriately supported in chairs and beds, poorly positioned to eat their meals and pushed around in wheelchairs that did not have foot plates to rest their feet on. Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 8 Training records and discussions with the housekeeper tells us that staff receive training in infection control and health and safety, however the practice of carrying out nursing procedures without washing hands or wearing appropriate protection, and leaving harmful detergents unsupervised places the residents at potential risk. Comment cards received from residents, relatives and staff told us that the home lacks sufficient numbers of staff to meet the residents’ needs. The comment cards tell us that even basic care needs, such as supporting residents to bathe, clean their dentures, nails and glasses are not met. This is detrimental to the health and welfare of the residents and compromises their dignity. 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. Flowerdown Nursing Home DS0000011652.V365331.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 Flowerdown Nursing Home DS0000011652.V365331.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): 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures the people who have expressed an interest to move into the home are provided with information about its care practices and facilities. The Statement of Purpose and Service User Guide are currently under review. The home ensures the people who wish to move into the home have their needs assessed prior to admission to make sure it can meet their needs. The home does not provide intermediate care. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) informed us that the home does well to carry out a complex pre-admission assessment, residents and relatives are invited to visit the home to look around. It went on to tell us that it could do better to ensure all staff are confident to deal with enquiries Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 11 appropriately and to ensure all pre-admission assessments are signed in a timely manner. The newly appointed manager said she is in the process of making amendments to the Statement of Purpose and will be issuing each resident with an up to date Service User Guide. This was tested by viewing the assessment records of two residents, one who had recently moved in, and by speaking with the resident and the deputy manager who has recently attended an assessment-training day. Following the last visit to the home a requirement was made in respect of the assessment process. It asked that resident assessments are thorough to enable their care needs to be fully identified and person centred care plans to be formulated. Assessment documents were viewed for two residents one of whom had recently moved in. The assessment documentation is comprehensive and requests information about the person’s health, areas of need and other information relating the resident’s wellbeing, social interests, likes and dislikes and religious beliefs. The deputy manager provided information on the assessment process and said that she had recently attended a training day. This was to learn how to complete the assessment plans correctly. She went onto say since starting she has carried out an assessment with the support of the previous manager. The assessment plan completed by the deputy manager was completed in full. The other assessment plan viewed did not provide evidence that all areas of the residents needs had been assessed. This is an area where the home recognises it needs to improve and tells us in the AQAA that they plan to continue training their senior staff. If the prospective resident is able, they are invited to visit the home before moving in, at this visit they are shown the room they will occupy and will meet with other residents and staff. The home is not registered to provide intermediate care, but it does offer respite care, residents are welcome to stay for short breaks to support main carers or to prepare the resident for a future permanent place to stay. Flowerdown Nursing Home DS0000011652.V365331.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 poor. This judgement has been made using available evidence including a visit to this service. The people who use the service have care plans in place, however these do not describe how they wish to have their care carried out. This potentially places them at risk of not having their health and welfare needs met. The procedure for the administration of insulin to those who are diabetic was carried out inappropriately, potentially placing their health at risk. The home has safe systems in place for the storage, recording and disposal of medication, however incorrect procedures in administering medications, potentially places the people who use the service at risk. The home has an “ethos of care” statement, which informs the people who use the service that staff will respect their dignity and privacy, however evidence shows that this is not always followed. Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 13 EVIDENCE: The AQAA informed us that it does well to have comprehensive care plans in place for all residents. Medications are recorded, stored and administered as per guidelines and policies and procedures, and privacy, dignity and respect is maintained at all times. It recognises it could do better to ensure care plans are updated as a concern arises. This was tested by viewing the care plans of two residents and associated documentation, viewing medication records, observing practices and speaking with the newly appointed manager, deputy manager, residents and staff. Have Your Say” comment cards from residents, relatives and a general practitioner were also viewed. Two personal plans were viewed in depth, they provided evidence that information from the assessment process has been transferred into care plans where it has identified there is a need for support. Although from reading the care plans it could not be fully understood what the carer must do, it did not tell the carer how to provide the care and support or inform staff as to how the resident wished to have their care carried out. In particular the care plans for supporting the residents who are insulin dependent did not describe the procedure for testing blood sugars, and it did not say what dose or when the insulin should be administered. The manager said she plans to improve the use of all documentation, which includes, where it is kept and the layout, so staff know where and what to record on specific records. This is to ensure fuller detail of what care has been carried out is recorded and to ensure that appropriate entries are made. The manager spoke of implementing a named nurse and keyworker system that she feels will also improve how residents receive their care. A member of staff said in a comment card “When I started my post as a care assistant I felt I lacked a lot of important information about the people I was supposed to be looking after, for example, any allergies, diabetes, how they transfer etc. Fortunately I had already worked in care and have my NVQ2”. (National Vocational Qualification). Seven “Have Your Say” comment cards were received from the residents, two residents reported that they “always” receive the care they need when they need it, four said usually and one said sometimes. Whilst speaking with a resident over a mealtime who requires support to maintain blood sugar levels with diet and insulin, the practice of checking and the administration of the insulin was observed. The practice was carried out but did not take into account the resident’s personal health care needs, the Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 14 risk of cross infection, or show respect to their dignity and privacy. The resident had been eating for approximately half an hour before a nurse entered the room without knocking and proceeded to take a sample of blood to test. This was done without wearing disposable gloves or washing her hands. The insulin was then administered, again gloves were not worn, hands not washed and the inspector was not asked to leave the room. The inspector asked the resident if they were happy with their presence. This practice was immediately brought to the attention of the manager who said she would investigate and review the practice with her nursing staff. Each resident has access to a general practitioner and other health care professionals such as chiropodists, opticians, dentists and psychiatric teams when needed. The manager spoke of how she is working with her team of nurses to be proactive in calling health care professionals as required and not in the way as quoted by a general practitioner: “We are often called at short notice, and very often this is at a weekend when there is a locum on duty who may not know the resident”. The manager said she is asking her team of nurses to be continually assessing and reviewing the health of residents, and on a daily basis assess if a resident requires a visit from the GP. The administration of resident’s medication was not observed on this occasion, excepting the administration of insulin. The storage, recording, receipt and disposal was seen to be as recommended by the Royal Pharmaceutical Guidelines. The home uses a monitored dosage system (MDS) supplied by a recognised high street pharmacy. The home currently does not have guidelines in place for the administration of “As required” medications. It is considered important to have these plans in place to ensure residents are receiving the correct additional medications when they need them such as painkillers, laxatives and medications for managing anxiety. Whilst viewing the home with the manager and meeting with residents it was observed that many of the residents had not been made comfortable from being moved from their beds. At least four residents were observed sitting in armchairs without appropriate support to make them comfortable, or without footrests and support to assist them to sit appropriately to eat their breakfast. Some were without slippers and covers to keep them warm. Two of these residents were sitting next to open windows. Another resident was seen to have slipped down her bed, and this appeared to be because the backrest of the bed had been raised too high and no additional support had been provided to maintain a good sitting position. This lack of attention to provide basic care is potentially detrimental to the health and welfare of the residents. Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 15 The manager said she is aware of some of these practices and provided evidence that she has it on her plan to meet with her nursing and care staff to improve basic care and nursing practices. She went onto say she is looking at day and night care practices and will allocate staff to ensure resident’s needs are met. Staff were observed on occasions to respect the dignity and privacy of the residents, knocking on doors before entering and engaging with residents respectfully. In comment cards that we received they told us that staff understand the values of caring for people, this was not demonstrated during the process of administering insulin and moving the residents from their beds. The staff must also consider when residents ask to listen to the radio or watch television that these pieces of equipments are tuned in, placed on a station of their liking and in good working order. It was observed at the time of the visit that this was not the case, as radios and televisions were turned on but not tuned in, so residents were not able to enjoy this facility. Whilst there appeared to be sufficient numbers of staff on duty it was noted that responses to call bells were taking a long time to answer. On one occasion it was timed at more than five minutes before it was answered and on a separate occasion staff were observed chatting amongst themselves without checking the indicator board or responding to the call. “Have Your Say” comment cards received from residents and completed by relatives on their behalf, told us that they were concerned that call bells appear to take a long time to be answered. This on occasions compromises the dignity of residents as they are requiring to use the bathroom and then are left for long periods until a member of staff can assist them back to their chair or bed. A relative said: “The staff are always available in an emergency, because of a lack of staff however, “routine” matters such as changing incontinence pads can be delayed for extended periods, leading to an undignified period of discomfort”. The manager said she plans to randomly audit call bell responses and take appropriate action where required. A resident said: “It can take sometime to get a response, short staffed perhaps?” Another resident said: “I have been told I have to wait for assistance from staff to use the bathroom, but sometimes I have to wait so long I do it myself. There have been times I have waited forever for assistance to return to my chair”. Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 16 Residents with limited mobility are placed at potential risk of harm if they are attempting to move without the appropriate support and mobility aids. The manager again informed us that she plans to put a system in place to monitoring staff responses to call bells, and will ensure staff are regularly recording contact time with residents. Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. The appointment of an activities coordinator has improved the quality and range of activities for the people who use the service. The home provides a welcoming and comfortable home where residents can meet and are supported to maintain contact with family and friends. There is little evidence to demonstrate that the home provides a person centred approach and empowers the resident to have a say about their lives. The people who use the service receive three meals a day of their choice, however the home must ensure they are provided with the appropriate support and eating aids to eat their meals. EVIDENCE: The AQAA informed us that it does well to provide a fully inclusive activity programme. It encourages residents to personalise their rooms and provides a quiet and separate communal room for resident to entertain their visitors and Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 18 a fully accessible garden. It recognises it could do better to provide outings and plan to do this when the better weather comes. This was tested by speaking at length with the activity coordinator, the cook and residents. Observing activities and viewing “Have Your Say” comment cards. The home has recently employed an activites co coordinator who works eighteen hours a week in the home and is responsible for planning and carrying out activites, including in house and external activities. The activities coordinator was spoken with at the time of the visits and found to be enthusiastic and appear to have a good understanding of the needs and abilities of the residents, including residents with dementia and those who have sensory and cognitive disabilities. The activites coordinator spoke of her day-to-day responsibilities and how she plans an activity. For example the home was holding a fete the day following the visit, prior to this residents had been involved in making saleable items for it, including decorating picture frames, making potpourri bags and bookmarks. The coordinator spoke of the benefits of making items from scratch such as the potpourri bags and how she encouraged the residents to use their senses such as smell and touch whilst making the bags. Another resident was observed making bead necklaces and keyrings for the fete. This resident was confined to her bed but was very keen to be involved in the preparation for the fete. Contact with the local community had also been made to make donations for raffle prizes and other staff had been involved in producing a pamphlet describing what activites and events will be taking place. Comments received from residents, staff and relatives were positive and informed us that improvements had been made since the activities coordinator had been in post, which includes excursions in the homes minibus to garden centres. A relative said: “I recently went out with my mother in the min bus for an outing”. A member of staff said: “I think S……… has greatly improved the activities department and trips out with the residents have been very good over the last couple of months”. The coordinator carries out group activities and will meet with residents in their own rooms on a one to one basis. In order to identify what the residents are interested in the coordinator has developed a questionnaire that asks the Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 19 residents about their history, occupation, hobbies and interests. She said she plans to use this information so personalised activities can take place. At the time of the visit to the home it was busy with visitors, it was observed that visitors were made to feel welcome and it was observed that staff are sensitive to families who are preparing for the loss of a dear one. A visitor’s notice is displayed and all visitors are asked to sign in and out of the home. Residents have access to a phone, but can have a phone of their own installed. Some residents have their own mobiles. The home has a quiet room that has been tastefully decorated and furnished, where residents can meet their visitors in private, although they can meet them in their own rooms if they wish. Comments received from staff and relatives included: Relative: “We are always made to feel very welcome, we visit at different times and always find the staff to be most helpful” Staff member: “We are a friendly and welcoming home, we always strive to make everyone comfortable”. Another staff member said: “ The nursing home has a good atmosphere and the patients are happy which, is important!” There was little evidence to show us that the home ensures the residents are helped to exercise choice and control over their lives. The two personal plans looked at did not provide information on how the residents would like to spend their day, and the failure to check what residents would like to watch or listen to on the television or radio shows us that the resident wasn’t asked. The home has a fulltime cook and kitchen assistant, the home is in the process of appointing another assistant. The cook was met with at the time of the visit and provided evidence that she has an understanding of the nutritional needs of the elderly and specific diets, for example diabetes. The cook said she will meet when possible with residents on admission to the home to find out their likes and dislikes and if there is any specific dietary needs. Residents have an option of three cooked meals a day including a cooked breakfast. A light tea is provided with a hot and cold option and supper is later Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 20 provided for residents who may still be feeling hungry. The four weekly menu plans appeared well balanced and wholesome. The menu is not displayed but residents are asked what they would like to eat at the beginning of the day, if they change their mind an alternative is provided. The two personal plans seen had a completed nutritional assessment in them and there was evidence that a record of what each resident is eating and drinking is kept. Although these records showed long periods of time where it appeared the residents hadn’t received anything to eat or drink. The manager said residents receive regular drinks and snacks, although staff do not appear to be recording this as they should be. Whilst visiting residents in their rooms earlier in the day, a number of residents were seen to have fallen asleep whilst their breakfast was left in front of them. The manager dealt with this immediately. Staff must also consider the posture of residents to ensure this is such to aid eating and digestion. The home should also ensure that residents have the appropriate eating utensils, to assist eating their meal independently and provide them with support to eat when required. Comments received from residents and relatives provided differing opinions about the quality of the food. The majority of the residents said they either usually or sometimes liked the meals and one said: “I think they could be better”. A relative said: “There is always enough food, but it can sometimes be a bit stodgy, or institutional in nature”. Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 21 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 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is information that tells the people who use the service how they can raise concerns or make a complaint. The manager is planning to make the complaints procedure more accessible for them. The home must ensure that the people who use the service are safeguarded from the risk of abuse. Current practices observed in the home places them at potential risk. EVIDENCE: The AQAA informed us it does well to record all complaints and reply to them as per company policy. It told us it does well to have an open policy for visitors and residents to raise concerns, and it ensures all its staff have a criminal record bureau (CRB) check before starting work in the home. The AQAA tells us they have received forty-five complaints of which 95 have been resolved within 28 days and 10 safeguarding investigations have taken place. They recognise they could do better to ensure all staff raise concerns as they arise and intend in the next twelve months to have a member of staff attend a “Trainer the trainer” course in protecting vulnerable people from abuse. Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 22 This was tested by viewing the complaints log, speaking with the manager and deputy manager and viewing “Have Your Say” comments cards from residents and staff. The complaints procedure is displayed on the wall in the entrance to the home and provides information on how residents or their representatives can make a complaint. The manager is planning to ensure each resident has the complaints procedure at easy reach. The complaints procedure will be placed in an information pack that will be in each resident’s room. The home keeps a record of all complaints and the action they have taken to resolve it. Every three months an audit of all complaints is viewed and a summary with actions is given to the home. The number and nature of complaints for May 2008 was viewed at the time of the visit and provided evidence that the standard of personal care is a concern. The majority of comment cards received from residents and relatives said they were aware of who to speak to if they were unhappy and how to make a complaint. But some said they didn’t know how to make a complaint and staff were not always available. A resident said: “They eventually listen to me” A relative said: “ I feel that management are not always available to speak to, e.g. at weekends”. Comment cards received from staff provided evidence that staff know what to do if a resident or relative raises a concern. A staff member of staff said: “I would ask if I could help first, if not, I would ask them to speak to the manager”. Since June 2007 there have been five complaints that have been investigated under the Local Authorities Safeguarding Protocol. The home has worked jointly with social services to investigate and provide evidence of how they are going to address the concerns. A number of these concerns raised were by relatives who had observed first hand, the poor care practices and a delay in answering call bells. Care practices observed during this visit to the home tell us that these practices continue to occur. Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 23 The service provides training for staff in abuse awareness and safeguarding the residents from the potential risk of harm. A member of staff has now been trained to train staff in abuse awareness and in addition the staff complete a workbook. Due to the limited time the manager has been in post she was unable to provide verbal evidence that all staff had received the training, but said as far as she was aware staff had. The training certificates viewed for four members of staff provided evidence that they had received abuse awareness training. The manager must ensure all staff have received the training and ensure they are aware of what they must do if they suspect or witness an abusive act. The home has a copy of the Department of Health’s “No Secrets” and the joint authorities (Social Services) safeguarding protocol. The manager plans to ensure these documents are accessible for all staff. Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22,23,24, and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who use the service live in a spacious, clean and welcoming home, however attention to eradicating unpleasant odours and the potential risk of cross infection must be addressed. EVIDENCE: The AQAA informed us that the home has a welcoming and friendly atmosphere, all areas are accessible to residents and their families including the well maintained garden. It recognises it could do better to encourage the residents into the garden more in the better weather. This was tested by touring the home, speaking with residents, the housekeeper and viewing “Have Your Say” comment cards received from residents and staff. Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 25 Flowerdown Nursing Home is a large home accommodating up to fifty-three residents. The home is built over two levels and over a number of years has been extended to accommodate the current number and needs of residents. A tour of the building provided evidence that care has been taken to provide a homely and welcoming home, which has been tastefully decorated and furnished to a high standard. Communal areas are bright, airy and spacious. The garden has been landscaped and includes raised flowerbeds, a water feature and patio area. There is access to the garden from some of the ground floor bedrooms. Residents who were spoken with at the time of the visit said they were happy with the home’s environment and their own rooms. Bedrooms were observed to be homely, clean, well maintained and personalised reflecting the residents individuality. A resident who was spoken with at the time of the visit said she was happy with her room. The home has adequate numbers of toilet and bathroom facilities and most bedrooms have en suite facilities. Moving and handling equipment is in place to support residents who have mobility difficulties such as electrically operated beds, hoists, bath hoists and handrails. Time was spent with the housekeeper who heads a team of domestic staff. The housekeeper was observed throughout the day supporting her team, working hands on and advising her team what areas of the home need attending to. The housekeeper went through the cleaning rota, which includes daily, weekly and monthly tasks. The home was clean and tidy but a number of areas had unpleasant odours. The housekeeper spoke of how they are working with a number of residents to gain entry to their bedrooms, as they refuse to let them into their rooms to clean. Comment cards received from residents and some completed by visiting relatives told us that the home is usually fresh and clean, but there unpleasant odours present. A relative said: There is always a strong smell of stale urine”. Another said: “It does smell a lot sometimes”. Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 26 The housekeeper and manager must take steps to prevent and promptly eradicate unpleasant odours to ensure the residents have a pleasant environment to live in and visitors to visit. The training records viewed for four staff confirmed that they have received infection control training and the housekeeper confirmed that she is aware that the majority of staff have had this training. Staff are provided with equipment such as hand gels, disposable gloves, aprons and colour coded linen bags to reduce the risk of cross infection. The practice of taking a sample of blood without washing hands and/or wearing gloves places the residents at risk of cross infection and must be addressed. Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home appears to provide sufficient numbers of staff to support the people who use the service, however the current routines and deployment of staff is not meeting all their needs. Staff are provided with the appropriate training and skills to meet the needs of the people who use the service, however the quality and standard of training requires assessing. The home carries out appropriate recruitment checks on staff, which minimises the risk of harm to the people who use the service. EVIDENCE: The AQAA informed us that the home does well to maintain staff levels as per the guidelines, improving recruitment and ensuring all staff receive a full comprehensive induction programme. It recognises they could do better to encourage more staff to access the companies National Vocational Qualification (NVQ) programme. This was tested by viewing staffs training and recruitment records, observing their practice. Viewing “Have Your” Say comment cards from staff and residents and speaking with the manager and deputy manager. Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 28 At the time of this visit there were 48 residents living permanently in the home and someone receiving respite care. We were informed that there were ten care staff, two nurses, ancillary staff, the manager and an administrator on duty in the morning. Although there appear to be sufficient numbers of staff to meet the needs of the residents, the care practices identified throughout the body of this report indicate that that there may not be enough staff on duty or that they are not being deployed efficiently. Delays in answering call bells, residents being assisted out of bed and then left inappropriately dressed and the comments received from residents and relatives support this. Comments recieved from staff centre on the need for more staff, these include: “There is not enough staff for what we have to get through in a day”. “Although we are told we have enough staff, I don’t think a “quick wash” just in the morning is sufficient. Clients nails are never cleaned, dentures are rarely cleaned, do we have enough staff??” “I don’t work with the carers, but I get the impression that they often need more staff”. This was brought to the attention of the manager who provided evidence that she is in the process of appointing new staff, including nursing staff and will be addressing the ineffective way in which they appear to be working. Comment cards from staff provided us with information that generally the staff work well as a team, pulling together when they are busy. A few comment cards told us that some have concerns that they are not always receiving the information they need to support the residents, and when they pass on concerns about residents the nursing staff do not appear to listen or do anything with the information. A relative said: “There are very few staff around when you need them, sometimes the lounge has no cover for sometime and there is a lack of communication between staff”. The AQAA tells us that 48 of staff have a national vocational qualification (NVQ) of level two or above, this includes bank staff. Viewing training information for four staff and comments received from staff tells us that they are encouraged to undertake a NVQ, but the home knows it could do better to improve this area of training for staff. Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 29 Recruitment records for four staff, which, have been appointed since the last visit to the home, and the records of two staff who are currently going through the recruitment process were viewed. The records demonstrate that the home carries out a thorough recruitment process. It requests an application to be completed, obtains appropriate checks, for example, Criminal Record Bureau (CRB) and Protection of Vulnerable People (POVA), two references and asks them to attend an interview. The manager keeps a record of questions and answer asked at interview. Comment cards received from staff told us that their employer carried out checks before they started working in the home. A member of staff said: “The CRB/POVA checks were carried out promptly”. The home provides an induction for its staff when they start working in the home. Staff receive an internal induction which introduces them to the routines, the needs of the residents, and health and safety. In addition they undertake a “Skills for Care” induction package, (a nationally recognised body for ensuring staff are supported to develop skills in care). This requires them to complete the induction during the first few months of employment and includes them receiving specific areas of training for example fire safety, food hygiene and moving and handling. A workbook seen for a member of staff currently doing their induction was seen and provided evidence that they are being completed and checked. The staff receive training that is mandatory (training required by law) and training specific to the work they do. Records seen for four staff provided evidence that they had received training in first aid, fire safety, moving & handling, food hygiene, bereavement and introduction to dignity and privacy. Comment cards received from staff provide mixed views on the type and standard of training. A member of staff said: “The training is very good and up to date”. Another said: “ I think we could definitely be offered more training that is relevant to our work and the people we look after. When I did my manual handling course (in house) all my instructor did was read me a book, I was appalled”. Following the last visit to the home is was required to develop a training matrix, which would enable the manager to have a quick reference guide to Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 30 what training staff have received, require or need updating on. The manager provided evidence that she is in the process of developing the training matrix and feels it will be helpful for her to establish what training staff are and have recieved. Minutes of a meeting held in January 2008 told us care and nursing staff were reminded of the importance of completing and signing care plans and reminded them that they had received training in this area. The deputy manager said nursing staff had recently received further training in care planning, however from the care plans seen there did not appear to have been an improvement. The manager must consider if the quality and standard of training meets the needs of the staff. Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 31 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. The home has recently appointed a new manager who appears to have a good understanding of the needs of the people who use the service and the operation of the home. The people who use the service are living in a home that is not currently run in their best interests, but the recruitment of a experienced manager and regular monitoring of care practices should address this. The people who use the service have their financial interests safeguarded. The home has systems in place to provide a safe place for the people who use the service to live, however care must be taken to ensure residents are not exposed to potential risks, such as unsupervised cleaning products. Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 32 EVIDENCE: The AQAA informed us that the home does well to have an open door policy where people can see the manager as they wish. It tells us the regional manager visits on a monthly basis and every three months will carry out full review of the home. The home recognises it needs stability in the management position. This was tested by speaking with and observing the practice of the newly appointed manager and deputy manager. The administrator provided information about the management of resident’s personal monies, and health and safety documents which included fire records. The home has been without a registered manager since October 2007 A temporary manager was placed in post until the recent appointment of the current manager. The newly appointed manager had been in post for two weeks at the time of this visit and the deputy manager two months. Through observation it was evidenced that the managers have established a positive working relationship with one another and staff. The manager said she is still finding her feet but has already identified a number of areas of concern that she is in the process of addressing, these include the day to day running of the home and care of the residents. Both the manager and deputy manager have a registered manager’s award (RMA), and the manager has been registered with the Commission for Social Care Inspection in a previous employment. It was observed that the manager is developing relationships with residents and staff and appeared aware of the majority of the residents’ personal and health care needs. A comment received from a member of staff told us: “ Even though the manager is new to Flowerdown, I find her very approachable and she is interested in what we are doing”. It is one of the responsibilities of the manager is to ensure the home is providing a quality service and that all elements of the management of the home are regularly monitored and reviewed. The manager provided evidence that she is aware of the systems used by the company that must be completed to monitor the homes quality. An annual quality review is undertaken. A monthly unannounced visit is carried out to monitor the service, (regulation 26). Regulation 26 reports held in the home tell us that all areas of the home’s Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 33 day to day activity is audited and actions are recorded where concerns have been identified. Although there are areas of good outcomes for residents as assessed at this inspection, such as Choice of Home and Activities, other areas were only adequate or poor. The manager told us she plans to meet with her heads of department to think about how to make improvements, share information, and move forward to enhance the service they are providing. There was evidence that the manager has already held a meeting with her nursing staff and discussed issues such as care planning, accountability, medication and good practice. The home will support residents with their personal monies and has systems in place to monitor the expenditure, payment of bills such as hairdressers and the current balance. This is a computerised system which the administrator has received training on. At the time of the visit the fire alarm system was tested and a fault was found. This was dealt with efficiently and an engineer visited the home the same day to make the repairs. The fire systems are checked by the handyman who is an ex fire officer, and the housekeeper, who between them share the responsibility of testing the equipment and training the staff. Fire records and staff training records provided evidence that regular checks of fire safety equipment and training takes place. Other documents and certificates provide evidence that gas and electric appliances and moving aids are regularly serviced. At the time of the visit it was observed that not all cleaning materials were stored safely, as these were left exposed and unsupervised on trolleys, within reach of residents. Some of the residents who live at Flowerdowns have dementia and may be at risk from these substances. The risks were brought to the attention of a member of staff and reported to the housekeeper. Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 34 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X 3 3 3 3 X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 35 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Care plans must describe how the people who use the service require and wish to have their care needs carried out. Timescale for action 31/08/09 2. OP8 12(1)(b) The home must ensure the 15/08/09 people who use the service who have specific health care needs, for example diabetes receive the correct treatment, to ensure they maintain a good standard of health. The home must ensure the people who use the service have their dignity and privacy respected at all times. The home must ensure it provides opportunities for the people who use the service to have a say and make decisions about how they wish to receive their care, and their health and welfare. DS0000011652.V365331.R01.S.doc 3. OP10 12(4)(a) 15/08/09 4. OP14 12(2) 31/08/09 Flowerdown Nursing Home Version 5.2 Page 36 5. OP18 13(6) The home must ensure that all staff have received training in abuse awareness and know what to do to protect the people who use the service. The home must keep the environment free from offensive odours so the people who use the service can live in a pleasant environment. The home must ensure that the people who use the service are protected from the potential risk of cross infection. Procedures for administering insulin must include correct infection control procedures. 30/09/08 6. OP19 16(2)(k) 15/08/09 7. OP26 13(3) 15/08/09 8. OP27 18(1)(a) The home must ensure that at all 15/08/09 times there are suitably qualified, competent and experienced staff working in the home to meet the current care, health and welfare needs of the people who use the service. 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 Flowerdown Nursing Home DS0000011652.V365331.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Flowerdown Nursing Home DS0000011652.V365331.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. 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