Inspection on 29/01/08 for Fosse House Nursing Home

This inspection was carried out on 29th January 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

Fosse House Nursing Home 29/08/07

Fosse House Nursing Home 03/01/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Fosse House Nursing Home South Street Stratton on the Fosse Radstock Somerset BA3 4RA Lead Inspector Judith McGregor-Harper Key Unannounced Inspection 29th January 2008 11:00 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 Fosse House Nursing Home DS0000067689.V358392.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. Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fosse House Nursing Home Address South Street Stratton on the Fosse Radstock Somerset BA3 4RA 01761 233018 01761 233632 fossehouse01@btconnect.com 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) TC Carehome Ltd Post vacant Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Elderly persons of either sex, not less than 60 years, who require general nursing care. Up to 3 places for personal care. Date of last inspection 29th August 2007 Brief Description of the Service: Fosse House Nursing Home is set in the village of Stratton-on-the-Fosse approximately 5 miles from Shepton Mallett and the City of Bath respectively. Fosse House is a registered care home that provides nursing and personal care to elderly persons of either sex, not less than 60 years, who require general nursing care. The home is registered to accommodate up to thirty seven service users. Fosse House was developed from the conversion of a large character house with an additional newer accommodation extension. The accommodation is on two floors and bedrooms are spacious. The home comprises 31 single rooms and three double rooms, plus communal space. The upper floors are serviced by a passenger lift. There are communal rooms on both floors. The large rooms are both lounge / diners. All services are provided in the home and the home is surrounded by gardens. The house looks out onto open fields and has very pleasant and well kept gardens that are accessible and have seating. Registered nurses and carers staff the home 24 hours a day. The current fees charged are £550.00 - £725.00 per week. The home also has some rooms identified for a block contract with Social Services. Fosse House Nursing Home DS0000067689.V358392.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 no star. This means that people who use this service experience poor quality outcomes. This inspection took place over one day in January 2008. Two inspector carried out the inspection between the hours of 11am – 5.30pm. The inspection was unannounced. Twenty nine people were living at the home on the day of the inspection. All people living at the service were at least 65 years of age. Both women and men live at the home. There have been several admissions to the home since the last key inspection in August 2007. We were able to see and observe staff interactions with people and talk to people about how they view living at Fosse House. We also received two survey responses from people living at the home. We spoke with duty staff. We received feedback about the service in surveys from five relatives. We sent out surveys to health professionals linked to the service but to date no replies have been received. The acting manager Mrs. Haskins was on duty and available during the inspection process. Mrs. Haskins had been in post for three weeks and has previous experience of managing care homes. We would like to thank the duty staff for their time and hospitality shown to the inspectors. Care services are judged against outcome groups. They allow us to judge how well a provider delivers outcomes for the people using the service, rating them as Excellent, Good, Adequate or Poor. This judgement is based on the standards looked at during the inspection process. Records examined during the inspection were nine care and support plans, written risk assessments, staff recruitment and supervision records, staffing rosters, staff training records, complaints/compliments, medication administration records and maintenance records. After the inspection, at our request, the home provided and forwarded copies of the staff training matrix, revised Statement of Purpose, risk assessment for free standing heaters, Regulation 26 reports of monitoring visits by the provider and contact addresses of community health and social care professionals linked to the service, so that surveys could be sent to them. We did not ask the service to complete an Annual Quality Assurance Assessment (AQAA); the service completed and submitted one for the last key inspection in August 2007. What the service does well: Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 6 Fosse House has a settled and stable staff team who have a positive attitude toward working at the home. This means that people who live there are supported by staff who enjoy their work. The staff want to continue to improve standards at the home and over the last year the service has worked hard to implement requirements made by the Commission at key and random inspections to improve the quality of the service. Nursing care is competent and records of nursing care delivered are maintained well. Palliative care is sensitive and attentive. What has improved since the last inspection? What they could do better: Seventeen requirements and fifteen recommendations are made to the home. This seems like a lot but overall we were pleased with how the home is progressing to improve standards of personal and nursing care. There is a staff confidence in the home of united team work. Requirements and recommendations are listed at the end of this report. Requirements are made in relation to oral hygiene, medicine handling, protocols in managing adult protection, health and safety, infection control, staff recruitment and management of the home. Care staff need to ensure that people get their daily dental hygiene needs met. Ointments and creams must be labelled to when they were opened and must not be used after the expected expiry time. Policies in the home devised to inform staff how to report adult protection issues must be updated with current local authority contacts. The inadequacy of hand washing facilities in the laundry needs to be discussed with the local Health Protection Unit. Hoists and stand aids in the home must be deep cleaned. The Commission must be notified if the heating system fails. Staff must be employed safely not putting people in the home at risk. Internal quality assurance processes must ensure that people are not put at risk by unsafe staff recruitment practices. Staff must refer to people who live in the home in a manner that shows appropriate respect. It is because of poor staff recruitment practice, failure to ensure via quality audits that recruitment is safe and failure to have policies on adult protection Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 7 that reflect current local practice that the overall judgement of the service has been deemed poor. Most of the recommendations are made regarding the physical appearance of the building. Bathrooms and corridors would benefit from redecoration. Other recommendations are made about medicine management, infection control, adult protection and health and safety. 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. Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 8 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 Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 9 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, 2 and 3. Standard 6 is not applicable; the home does not offer intermediate care services. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an informative service users guide and a statement of purpose to help the prospective resident make an informed decision about moving into the home. Contracts are issued and are clearly written. Senior nurses carry out pre-admission assessment and gather information from health professionals to ensure that the service and the home can meet the person’s needs. EVIDENCE: The new home manager has revised the home’s statement of purpose and service user guide. Copies of these documents were forwarded to us on request after the inspection. A large print version is available. Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 10 A sample contract was inspected and contained clear information within it to protect the rights of person moving into the service and service provider. The administrator confirmed that contracts had been issued. Admission assessments were available to read in the care plans inspected. Either the manager or senior nursing staff in the home had carried out an assessment and acquired the Single Assessment documentation (SAP) from the community health care professionals pre admission. This gives the home sufficient information to judge whether or not the service would be able to meet the needs of the prospective person. The template used for recording the information includes mental health, as well as physical health care needs. Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are receiving responsive personal health care at the home although staff are not giving attention to peoples’ daily dental care needs. Records maintained about people’s health needs are detailed and care given for people in the last weeks of their life is sensitive and attentive. Medication is managed safely but attention needs to be paid to the correct storage of medicines. EVIDENCE: We examined care plans for nine people. These were a mixture of people who currently live at Fosse House and some people who have died at the home since the last inspection visit. Care plans inspected contained clear guidelines for wound care management. There was a full history of people’s medical histories and current health care needs. In one care file there was not a rationale written for daily monitoring of a person’s pulse when they take a pulse monitoring medicine. A written rationale for pulse monitoring with Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 12 expected normal ranges and action to be taken should the pulse fall outside the normal range is recommended. The home has started producing some very useful and full life history documents. This will help with developing more individualised care at the home and help focusing social activity programmes for people. We spoke to people about the care they receive. People said that the staff were caring, one person who was being nursed in their room said they wished the staff could give more time to staying to talk after coming to administer care to them as they valued the social contact with staff. In the two survey responses received both respondents stated that they ‘always’ receive the care and support they need. On the day of the inspection a tour of the bedrooms was completed. During this tour it was noted that some people did not have toothbrushes and toothpaste. For a number of other people, who did have this equipment, the paste and brush were dry. It is difficult to ascertain therefore if people living at the home had been supported to maintain their oral hygiene needs. This is a basic care need and must be addressed. Medications management was assessed and written records for medicines administered were thoroughly completed and clearly managed. There was a record of staff signatures and list of homely remedies from all four doctors surgeries that have residents registered with them. Medicines storage was suitably large with two trolleys, one for each floor. A lockable treatment storeroom houses the medications fridge and there is staff hand washing facility. There was an unpleasant malodour in the treatment storeroom, probably coming from the sink. The source of this should be identified and malodour eliminated. The temperature in this room on the record sheet showed that at times the temperature inside the storeroom exceeds 25 degrees Celsius. It is not recommended to store medicines above this temperature. In some people’s bedroom they had topical creams for personal use. The opening date of creams and recommended use by date for topical creams should be recorded on the container, as this was not evident. There should also be a rationale for the cream’s use in a care plan if a cream is being used as a treatment or barrier cream. Controlled medication was safely stored and fully recorded. Oxygen cylinders not in use were securely stored. Chronic ill health conditions such as diabetes was well managed. Insulin was stored appropriately and blood sugar monitoring was recorded. Staff were working safely. Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 13 Care records of people recently deceased demonstrated that the home had action plans for terminal and palliative care that were reviewed and updated throughout a person’s last illness. Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 14 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. People have the choice of attending in-house activities. Visitors are welcomed to the home and may stay for a meal. There is a choice of meals that are nutritionally balanced. EVIDENCE: One member of care staff was allocated to undertake activities. Two care staff have received activities training, it would be beneficial to the service if more care staff attend activity courses if a dedicated activities post is not created. In survey responses two relatives noted how the frequency of in-house activities had increased over the last few months. One person stated they wished that people got to use the home’s pleasing gardens more used in good weather. Relatives and friends are made welcome and residents spoken with commented on their relatives being welcome and visiting regularly and being Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 15 offered a meal. In one surveys response by a relative, a comment stated. “The staff fulfil all of my mother’s needs with gentleness and compassion.” Another person wrote. “The staff are exceptionally helpful and welcoming.” Mealtimes are social and well organised. People were seen as they were assisted to the meal tables to sit together. The tables were attractively presented. People were satisfied with the menu commented on having a choice at each meal. We observed the lunch being served. It appeared plentiful and nutritious. No complaints were heard about the food or the service. Drinks served late morning and assistance was given where needed. Cold drinks of fruit squash were available in jugs in the communal rooms. Staff said they were aware of the service users who needed to be prompted or assisted with drinking. We saw staff assisting people with lunch in a sensitive manner although we did bring to the attention to the manager that we overheard one staff member referring to people who need assistance as ‘the feeders’. This is neither an appropriately dignified nor respectful expression. People are offered a menu choice of by the kitchen assistant each day who checks to see what people would like to eat on that day. An environmental health visit was on the 24/08/07 and was satisfactory. We identified some areas in the kitchen that need deep cleaning; these areas were relayed to the chef on duty. The kitchen grill is due to be replaced. The home maintains suitable daily records for cold and frozen food storage. We saw plenty of food supplies in the home, including fresh and frozen vegetables and fruit. We discussed with the managers simple ways that people who have a low body weight could increase their calorific intake. People can purchase toiletries from a small stock held at the home. The hairdresser visits the home once a week and people can have their own hairdresser visiting if they wish. Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 16 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 adequate. This judgement has been made using available evidence including a visit to this service. The home has policies for adult protection and restraint. Both need revising to ensure that appropriate contact details are recorded and that the policies are relevant to the home. The complaints policy is clearly written and provided for residents and their families. A concern that was raised was not recorded in detail but is being addressed by the home. EVIDENCE: The home has a written complaint’s policy, which is displayed in the home. We looked at the home’s complaint log. There had been one complaint raised to the home since the last inspection. The complaint was investigated and some of the complainant’s concerns were upheld. Action was taken to address the cause of the complaint. There was not evidence of complete record keeping regarding the complaint process. This was brought to the attention of the new manager who had already started putting together a system to ensure that complaint records are collated for tracking. Following the inspection copies of documents investigating the complaint were forwarded to the Commission. The home has policies on adult protection. The home did have a copy of the local adult protection strategy for Bath and North East Somerset. This Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 17 document related to 2005 however and is not the most recent copy of this guidance. There was no copy of the Somerset guidance made available to inspectors. These must be obtained in order to inform the home’s adult protection policy. The home has a policy on restraining people. This needs to be reviewed to the appropriateness of such a policy and staff training needs. Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 18 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, 20, 21, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home offers attractive communal space but bath and shower rooms are austere and uninviting. The heating systems are not working and need sorting out. There is a risk of spreading germs around the home from unsuitable facilities. EVIDENCE: We toured the premises. Domestic staff were on duty and were seen cleaning bedrooms. In survey responses two people who live at the home noted that the home is ‘usually’ fresh and clean but also that staff sickness can sometimes affect domestic staffing levels and mean that one cleaner rather than two is on duty. Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 19 Bedrooms can be personalised and this was evident with lots of homely bedrooms with photos, pictures, and small pieces of furniture, Televisions, radios and personal ornaments. Beds seem comfortable and were nicely made with clean and attractive bed linen. The amount of natural light around the home is good but in one or two bedrooms it was less good. Not all the bedrooms seen had bedside lighting or furniture that was in a good standard of repair. We recommended to the manager that an audit of bedroom furniture supplied by the home be carried out. Communal areas were clean, tidy and spacious. Armchairs looked comfortable, and specially adapted chairs were seen in use. There were hoists and stand aids stored out of the way when not in use so that they did not present obstacles in the home. These hoists and stand aids were all in need of deep cleaning, especially around handles and area to stand on. There have been some environmental improvements within the last year with redecoration and some new carpets. A shower ‘wet room’ has been installed which is practical and is well used. A new dishwasher has been purchased and a sluice room was installed by the new owner. The wet room, like all the bathrooms is austere in decoration and would benefit from being made more inviting through decoration. One bathroom had a split wooden bath panel, which should be replaced. The home has a nurse call system in place, which is quite loud and may be intrusive. At the last inspection the previous manager said that the volume of this is reduced at night. The home was a pleasant temperature but there have been on-going problems with the central heating at the home. The home is using freestanding electric heaters. This must be risk assessed and recorded. In one bedroom we saw an unguarded radiator. This should be risk assessed to reduce the risk of scalding to people. There is a laundry that is managed well. There are commercial machines for managing the home’s laundry. There is no sink in the laundry for laundry staff to wash their hands. This must be discussed with the local Health Protection Unit, as it may not provide adequate infection control protection to staff. We also recommend that the Health Protection Unit be consulted regarding the routine usage of toilet brushes in the home that are left in toilet areas and more appropriate alternatives to this practice. Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 20 A staff member working in laundry confirmed the storage of chemicals and use of alginate bags for contaminated laundry. When staff change linen they put the linen waiting to be taken to the laundry into colour coded skips, which sit in corridors. There are no lids for the skips. These must be covered as the laundry poses a cross contamination risk. There was an area of frayed carpet outside of the shower wet room. We discussed with the acting manager that there were a lot of posters in the home displayed for staff to read. We felt that this detracted from the homeliness of the house and recommended that the manager consider whether there are more appropriate staff only areas that the posters be displayed. Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 21 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 poor. This judgement has been made using available evidence including a visit to this service. There is a settled skill mixed staff team. The registered nurses on duty were professional and knowledgeable. Staff training is planned and offered so that the staff team is skilled. Recruitment processes are not safe, putting people who live at the home at risk. EVIDENCE: On the day of the unannounced inspection the home was fully staffed. The manager and deputy were both on duty. The manager reported no staffing vacancies at the home. Staff spoken with had positive attitudes toward working at the home. People spoken with living at the home praised carers. There is a skill mixed staff team with catering, care, administration and cleaning. Staff hours were variable, geared to suit the individual. Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 22 The duty rotas seen for the week of the inspection and the week before the inspection were acceptable with staffing levels at a minimum of six staff each morning. Induction for new staff is carried out over their first three months in post. A contract of employment is issued after three months. There had been one staff appointment since the inspection five months ago. We inspected two staff files. One file was in order containing all the information required. One other file, of the most recently appointed person had neither CV nor application form present in the home. We asked for a copy of this documentation to be sent to the Commission. This information was received by the CSCI on the 01/05/08 following an additional request by us. The information received was reviewed. This demonstrated that not all checks had been completed to the necessary standard. The individual had commenced employment at the home without a Criminal Record Bureau check and two written references being received. The references, which were received, were found to be a poor quality and had both been written by friends. There was no reference from the individual’s last employer. There was no evidence in the staff file of the supervision arrangements which should have been put into place until a satisfactory Criminal Record Bureau check had been received. It could not be confirmed if a gap in the individuals work history had discussed, as the individual interview notes are not kept. The individual is a registered nurse. There was no evidence in the staff file to demonstrate that these professional qualifications had been checked with the Nursing and Midwifery Council. The application did not comply with good recruitment and equal opportunities guidance as it asked for information relating to the individuals age, gender, marital status and number of children. There was no evidence of the person identify including a recent photograph and identification. Poor recruitment practise may put people living at the home at risk. The home has a training matrix, forwarded to the CSCI following the inspection. This contains a record of mandatory training. The home has not yet met the 50 target of care staff achieving a minimum level qualification of NVQ 2 in care, but staff are supported to undertake this training award. Staff supervision is currently undertaken by the manager for all staff. We examined staffing supervision records for three staff. They had all received supervision on a two monthly basis. Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 23 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): 33, 35 37 and 38. Standard 31 is not assessed, as there is no registered manager at the home. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is an acting manager at the home who needs to submit an application to register with the CSCI. People who live at the home are asked how things can improve for them but quality assurance processes do not ensure the safety of people living at the home. There are some areas of health and safety that must be addressed to make the home safer. EVIDENCE: Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 24 Mrs. Haskins in the new manager designate. She is a registered nurse and has experience of managing similar nursing homes. As she is new in post she is not yet registered as the home manager with the CSCI. It is of concern that the acting manager commenced employment before personal background checks had been received and this put people at the home at risk. At the time of the last inspection quality assurance questionnaires to professionals, relatives and groups of residents had been completed and were seen. Changes were planned from the feedback to increase the amount of weekend cleaning. The home completed an annual quality assurance assessment as required by the Commission for the last inspection. It was not required to be repeated for this inspection visit. The home has an in-house policy on abuse prevention, however current local authority policy does not inform this document. The home forwarded to us copies of monthly audits of the home carried out by a senior manager for the company that owns Fosse House. The audits provided overviews of the following management areas in the home: maintenance, fixtures & fittings, health & safety, staffing, role of home manager, staff training, activities, medicine administration, quality assurance, diet, complaints, records, views of service users, views of staff, care planning and staff supervision. Storage of records was secure and the home has been notifying the Commission of deaths or injuries at the home. We reminded the manager that the Commission also needs to be notified of events that pose a health and safety risk to people living at the home, such as the problems that have been on-going with a failing heating system. We saw tick list records indicating that a number or regular health and safety checks are carried out on equipment used in the home. However, we recommend that a work sheet be devised detailing what has been checked in monthly showerhead cleaning and wheelchair safety checks. We did a random spot checked of monies that the home holds for three people. These all added up correctly and written records were accurate. The home has an administrator who has many years of experience at the home, assisting with the accounting, management of residents’ finances and the safe storage of all records. Maintenance records were sampled for fire safety and servicing, hoist and lift servicing, gas servicing, portable appliance testing and mains installation work. The manager was not able to produce neither a current certificate for electrical hardwiring nor gas safety landlord’s certificate. Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 25 We received verbal confirmation from the manager that staff had received fire safety training in the last two weeks. However, this was not evident on the home’s written training records. An immediate requirement was left that the home to provide written evidence of up to date staff fire training. (This was complied with by forwarding to the CSCI a staff training matrix with the required information following the inspection visit). The manager was not able to produce the fire risk assessment for the home. The manager is advised to ensure this is compliant with the latest fire service regulation guidance, which now requires emergency evacuation management planning. The home tests fire door closure hardwired into the main system weekly. This does not include the weekly testing of battery operated door closures. This should be tested and recorded weekly. We examined accident records. There had been 25 accidents to people in the home since the last inspection. There is not a meaningful monthly audit of accidents performed. This is of concern as there was a pattern within the accidents of bed rail injuries and repeated falls by one person over their bedrails. In one person’s care plan was no evidence of the use of bedrails being re-assessed following the falls. In bedrooms we noticed that where people have dentures that the denture cleaning tablets were not stored securely. These tablets are harmful if swallowed and must be risk assessed if left accessible in bedrooms of people who have confusion or dementia. A suitable lock must be fitted for the sluice so that the sluice can be locked when not being used by staff. Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 26 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 3 2 X X 2 2 2 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X 3 3 2 1 Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 27 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 Standard OP8 Regulation 12 (1) (b) Requirement Measures must be put in place to ensure that people’s daily dental hygiene needs are being met. People’s personal topical creams must have recorded an opening/expiry date and rationale for use included in a person’s care plan. Staff must be made aware of the importance of addressing people who live in the home via language that show appropriate respect. The home must obtain a current copy of both the Bath and Somerset local authority safeguarding vulnerable adults policies, in order to inform inhouse policies and protocols in adult protection. The use of free standing electric heaters must be risk assessed. Timescale for action 01/04/08 2 OP9 12 (1) (a) 01/04/08 3 OP15 12 (5) (b) 01/04/08 4 OP18 13 (6) 01/04/08 5 OP25 13 (4) (c) 21/04/08 Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 28 6 OP26 16 (2) (j) The home must consult the local Health Protection Unit regarding there currently being no hand washing facilities in the laundry. To demonstrate infection control practices, laundry skips in corridors must be covered. 01/04/08 7 OP26 13 (3) 07/04/08 8 OP26 16 (2) (j) Patient hoists and stand aids 21/04/08 must be deep cleaned to manage cross infection. Staff recruitment must meet the requirements of Schedule 2 of the Care Homes regulations 2001. Staff must not commence employment until two satisfactory references have been received. The manager must apply to the CSCI to be registered. Quality assurance processes must be in place to ensure that staff are not employed until satisfactory background checks have been received. Vulnerable adults policies and procedures in the home must be revised to include current local protocols. 21/04/08 9 OP29 19 (5) (d) 10 11 OP31 OP33 8 (2) 19 (5) 30/04/08 30/04/08 12 OP33 13 (6) 30/04/08 13 OP37 37 (10 (e) The Commission must be notified 30/04/08 in writing of any event in the home which adversely affects the well-being or safety of any service user. The home must obtain a 01/05/08 certificate of electrical hardwiring and a gas safety landlord’s certificate. 14 OP38 23 (2) (c) Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 29 15 OP38 13 (4) (c) Denture cleaning tablets stored in people’s rooms must be risk assessed under COSHH. A suitable lock must be provided for the sluice. The home must demonstrate that all staff have received fire safety training. 21/04/08 16 17 OP38 OP38 13 94) (a) 23 (4) (d) 01/04/08 31/01/08 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 Refer to Standard OP7 Good Practice Recommendations It is recommended that when a person is prescribed Digoxin, that a rationale for daily pulse recording with expected normal ranges be recorded in an individual’s care plan. It is recommended that ventilation be provided for the medicines store room to ensure that the inside temperature does not exceed 25 degrees Celsius. The source of the malodour in the medicines store room should be identified and eliminated. 3 OP15 Areas of the kitchen identified at the inspection should be deep cleaned. The kitchen grill should be replaced. It is recommended that the home’s restraint policy be reviewed. It is recommended that information for staff posted in communal areas be reviewed with regard to enhancing the homely appearance of the building. It is recommended that the frayed carpet outside the first floor wet room be replaced. It is recommended that bathrooms and shower rooms be DS0000067689.V358392.R01.S.doc Version 5.2 Page 30 2 OP9 4 5 OP18 OP19 6 7 OP19 OP21 Fosse House Nursing Home upgraded or redecorated in order to improve the experience of bathing and showering at the home. 8 9 OP21 OP24 It is recommended that the first floor wooden bath panel be replaced as it potentially poses an infection control hazard. It is recommended that the home conduct an audit bedroom furniture to ensure that people are provided with adequate and suitable bedroom facilities. It is recommended that the uncovered radiator in Room 23 be risk assessed. It is recommended that the home consult the Health Protection Unit for advice regarding the use of toilet brushes in the home. It is recommended that written staff interview records be maintained. It is recommended that a work sheet be devised detailing what has been checked in monthly showerhead cleaning, wheelchair safety checks and why. It is recommended that the home’s monthly accident audit be meaningful in identifying trends for future accident prevention planning. It is recommended that Dorgard fire detection devises be tested weekly and tests recorded. 10 11 12 13 OP25 OP26 OP29 OP37 14 15 OP38 OP38 Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Region Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Fosse House Nursing Home DS0000067689.V358392.R01.S.doc Version 5.2 Page 32 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!