Inspection on 13/07/06 for Frenchay Park Nursing Home

This inspection was carried out on 13th July 2006.

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

Other inspections for this house

Frenchay Park Nursing Home 24/02/09

Frenchay Park Nursing Home 13/06/08

Frenchay Park Nursing Home 14/08/07

Frenchay Park Nursing Home 27/02/07

Frenchay Park Nursing Home 10/02/06

Frenchay Park Nursing Home 10/06/05

Frenchay Park Nursing Home 03/11/04

Frenchay Park Nursing Home 11/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Frenchay Park Nursing Home 140 Frenchay Park Road Frenchay Bristol BS16 1HB Lead Inspector Wendy Kirby Key Unannounced Inspection 09:30 13 , 18th, 21st July 2006 th 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 Frenchay Park Nursing Home DS0000034485.V302464.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. Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Frenchay Park Nursing Home Address 140 Frenchay Park Road Frenchay Bristol BS16 1HB 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) 0117 9659957 0117 399300 Ms June Marilyn Phillips Mr Gordon Norman Brooking, Mr Derek Marsh Mrs Leanne Williams Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Staffing notice dated 25/02/2002 applies. Manager must be a RN on parts 1 or 12 of the NMC register Date of last inspection 10th February 2006 Brief Description of the Service: Frenchay Park is registered as a Care Home for a maximum of 30 residents requiring nursing care. The Home is situated in an urban position, and sits on the main Frenchay Park Road. It is a short journey away from the Fishponds High Street. It is within easy access to local community facilities and is less than 4 miles to Bristol city centre. It can be accessed by car or bus, being on a main bus route. The home is a converted older property offering single and shared bedrooms on two floors. There are two lounges and a separate dining room. There is a passenger lift providing access to all service user areas. All parts of the home are accessible to the able-bodied as well as wheelchair users. The cost per week to reside at Frenchay Park Nursing Home will cost from £480.00. Fees are reviewed annually and if care needs increase. This weekly fee does not include provision for items such as hairdressing, chiropody, dental, ophthalmic, or audiology services. Prospective residents can be provided with information about the home by accessing the Service Users Guide, which will detail the services and facilities available at the home. Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection conducted as part of the annual inspection process. The inspection lasted three days. Prior to the visit the inspector spent some time examining documentation accumulated since the previous inspection, including the pre-inspection questionnaire, notified incidences in the home, (Regulation 37’s) and the unannounced reports conducted by the Registered Providers (Regulation 26’s). The inspector sent questionnaires “Have your say” to thirty residents in the home prior to the inspection and fourteen were completed and returned. Relatives and visitors “Comment Cards” were also sent and nineteen of these were completed and returned. Six relatives asked to be contacted prior to the inspectors visit to discuss concerns and any issues they wished to share. Information from these discussions and the questionnaires have been collated and are detailed throughout the report. The inspector spent time throughout the course of three days in discussions with the group manager and registered manager. A number of records and files relating to the day-to-day running and management of the home were examined. Six residents were case tracked. Their care plans and care files were examined. The inspector had discussions with the residents and observed indirectly going about their daily routines. The inspector toured the premises accompanied by the group manager. Time was spent observing residents in the home throughout the course of the visits and many were spoken with at length. Several visitors were spoken with during the visit. Members of staff were observed on duty and six were consulted individually. On the second day of the inspection the inspector met with the Fire Safety Officer to ascertain the safety of the laundry room, which is, situated under one of the staircases. On inspection it was confirmed that the laundry room with regards to fire safety is acceptable where it is. Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 6 A cursory tour was also conducted by the fire safety officer will who be writing to inform the home of any other issues raised. Some of these issues are detailed in the report and subsequent requirements have been made. Feedback was given to the group manager on the outcome of the inspection. What the service does well: What has improved since the last inspection? In order to promote the health and safety of residents, risk assessments have been developed for the use of bed rails and consent has been obtained for its use. Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 7 What they could do better: Residents must have an up to date contract/terms and conditions so that they and their families are aware if their rights. Care plans need further development to demonstrate that all needs are recognised and met. Residents and representatives need to be involved in the development and review of care plans wherever possible. Care Files must be reviewed regularly on a monthly basis and updated accordingly and six-monthly reviews of all care files must be arranged for residents and/or their representatives, wherever possible. A representative from social services must be involved with six monthly reviews when they fund residents. The home must ensure that food and fluid intake records are consistently maintained. Residents identified health care needs must be identified and be clearly documented in their care files. The home must continue to seek resident’s wishes concerning palliative care so that the residents, and where appropriate their families wishes, are accommodated at the end of their life. These wishes need to be recorded in their care plan. The residents must be given opportunities for stimulation through leisure and social activities, which suit individual needs and preferences and detail about individual daily preferred routines must be improved. Mealtimes must be unhurried and assistance given sensitively to ensure that adequate nutritional and fluid intake is maintained. Policies and procedures for complaints must be reviewed to ensure that residents feel that their concerns are listened to and acted upon effectively and that any issues are recorded with the outcomes. To further ensure the resident’s safety and wellbeing a number of requirements have been made regarding the environment and the beds in the home. These are detailed at the end of the report. The home must implement a planned programme of introducing bedroom door locks. Ensure that residents’ clothes are pressed and that residents have access to their individual garments at all times. Domestic hours must be made available to bring the home up to an acceptable standard of hygiene and cleanliness and to ensure that this level is maintained. To ensure the residents continued safety there must be a robust recruitment procedure whereby new staff have interviews and if needs are identified the appropriate support, induction and supervision can be given. Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 8 Staffing levels are not adequate. The manager must work full time supernumerary to ensure effective management of the home and additional trained staff will need to be deployed. Additional care staff must be deployed on all shifts to ensure levels are maintained to reflect the dependency levels of the residents currently residing at the home. Residents and their advocates must be given the opportunity to discuss any issues, views or satisfaction about the service they are receiving through resident and relative meetings. Induction for some members of staff must be more comprehensive to support them when meeting the needs of residents. Where appropriate and when the need has been identified staff must receive regular assessments of their skills, particularly their communication skills and receive additional supervision until they are able to work alone unsupervised. Residents, visitors and staff would be better protected if records can clearly identify those members of staff who have been present and those who have not been present during fire drills as recommended by the Avon Fire Brigade. All night staff should undertake this on a three-monthly basis, and day staff six-monthly. 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. Frenchay Park Nursing Home DS0000034485.V302464.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 Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 Quality in this outcome area is adequate. Prospective residents or their families receive relevant information to make a decision about the nature of the home. Prospective residents’ needs are assessed prior to admission to determine the suitability of placement. Contracts and/or terms and conditions must be issued to all residents so that they are aware of their rights. Trial visits give prospective residents an opportunity to assess the home. EVIDENCE: A statement of purpose and service user guide is made available at the initial stage of enquiry to prospective residents/families. Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 11 Thirteen residents stated in their surveys that they had received enough information to assist them in deciding if the home was the right place for them to live. The service user guide includes valuable information on the facilities and services available to them within the home. During the case tracking process for six residents it was noted that none of the residents had a contract or written terms and conditions. Some residents who were funded by social services had a contract with regards to an arrangement of fees only. Nine residents surveys confirmed that they had not received a contract. This shortfall was noted at the previous inspection. A requirement will be made for all residents to receive a contract with written terms and conditions. Consideration is being given to enforcement action, as this requirement remains outstanding. Pre-admission assessments are comprehensive covering all activities of daily living, a full health screen and personal history background. The prospective resident, family and carers are involved in the pre-assessment and all information is used to determine the suitability of the placement. The manager through her assessments was able to demonstrate knowledge of the current residents, their medical history, personal background and their subsequent needs. The inspector looked at six pre-admission assessments and the information gathered should provide a sound benchmark of the resident’s ability and state of health prior to admission. Prospective residents are encouraged to visit the home either for the day or perhaps for lunch dependent on their wishes. A month’s trial period on both sides is usually undertaken to ensure that everyone is happy with the arrangements and to ensure that the placement is suitable. Frenchay Park Nursing Home DS0000034485.V302464.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. There was insufficient individualised planned care detailed in each residents file. Some health needs were identified in residents care files. Resident’s social needs were not fully assessed and recorded. Residents do not receive the care and support they need. Residents can expect to receive care and support in a sensitive way. Medication systems are safe. Plans are being developed with regards to resident’s wishes when dealing with acute illness and making plans for end of life. Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 13 EVIDENCE: Six residents care files were looked at in detail, including pre-admission assessments, care plans, personal history profiles and risk assessments. All records evidenced lack of consistency in assessing, planning, implementing and evaluating the resident’s care. Information was out of date, limited in detail and did not reflect residents’ needs. These care files and discussions held with residents and relatives evidenced that initial care plans had not been developed and written in their presence. Care plans should wherever possible be signed by the resident or their representative. Several residents and relatives commented that they had not received six monthly reviews to discuss and evaluate the residents’ care plans, which also would give them the opportunity to raise any issues or concerns they may have. Intermittent care plans were not available when short-term needs had been identified. The inspector had noted when reading the outcome following a GP visit that one resident had oedematous legs. A care plan should have been developed to clearly identify how this was affecting the resident and how the staff would support the resident, for example, by elevation and applying support stockings as prescribed by the GP. As a result of these findings the inspector requested that the six residents case tracked had a complete review of all the information contained in their care files and that new care plans were developed. These were examined on the third day of the inspection. The results were positive and encouraging, however the home will be required to up date all residents care files with the residents and families wherever possible which will be closely monitored by the inspector. Health Care needs were evidenced in the care files, which included nutritional, wound and pain assessments, however the assessments were not accurate and had not been reviewed consistently. Several residents’ assessments had identified the need for intervention and close monitoring in nutritional and fluid intake. Fluid and nutritional intake charts were not completed fully for individual residents and did not include enough detail of quantities taken over a twenty-four hour period. This was noted at the previous inspection. The inspector had received various comments from relatives who had grave concerns that some residents were not receiving adequate fluids or nutrition. More evidence of this is detailed later in the report under Standard 15. Records of the General Practitioner (GP) visits with residents and the outcomes were documented. Specialist referrals and visits from other professionals Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 14 including, Physiotherapists, Chiropractors, Dentists and Opticians were also seen. Seven residents surveys stated that in general they felt they received the care and support they needed, however the majority felt that they did not. Comments included “Staff are expected to do too many things” and “There doesn’t seem to be enough staff to cope with the workload”. The inspector had many discussions with relatives prior to the inspection and all comments were similar in content. One relative said that because staff are so busy she found it quicker and easier to visit the home on a daily basis and wash and dress her mother herself. Many relatives had made repeated requests for basic care needs such as shaving, putting in dentures and making sure residents were wearing their glasses. Staff spoken with during the inspection stressed how they were unable to cope with the workload within certain timescales due to the high levels of residents’ dependency. From discussions it was evident that the residents in the home had become frailer over time and that all twenty-eight residents required input from staff for many activities of daily living. The pre-inspection questionnaire stated that eighteen residents had some degree of dementia, twenty-seven required help with toileting and twenty-eight residents required help with washing and dressing. Monthly reviews to re-evaluate care plans and residents needs would have indicated that the staffing levels were not sufficient to meet the needs of the residents in the home but this had not been done. Following the inspection and collation of further evidence detailed throughout the report a requirement has been made to increase the staffing levels. Policies and procedures for receiving, storing, administering and disposing of medications were examined and correct. There were photographs of each resident on their medication charts to help ensure that medication was dispensed to the correct person. The administration charts were legible and continuity of administration was shown with a signature from the person dispensing. Staff were witnessed knocking on residents doors before entering confirming respect for the residents individual privacy and dignity and staff responded to residents in a sensitive and professional manner. Although this was not looked at in great detail during the inspection, the manager and her staff are currently making every effort to establish resident’s wishes concerning palliative care. Also any wishes the residents and if appropriate their families would wish for at the end of life. This will be looked at in more detail during future visits to the home. Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents do not benefit from a varied activities programme, which is both enjoyable, stimulating and meets individual preferences and expectations. Records need to be more detailed to evidence residents are enabled to dictate their own daily routines. Menus provide a nutritional balanced diet for residents. At times assistance with meals was not dignified and given at their own pace. EVIDENCE: There was information about residents past histories on file, although the detail in these varied considerably. As noted at the previous inspection they contained information about daily routines, however these were not detailed enough to give a good picture of individual preferred routines and examples of how these could be improved were discussed with the manager. Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 16 On examining the files it was evident that this had not improved. It is particularly important that these are completed for people with dementia who may not be able to directly say what they would prefer. The home is in the process of developing a new initiative to complete a social assessment of each resident. It is a comprehensive document and should enable the staff in the home to relate to residents in a personalised way. It should also create topics of conversation, encouraging life review and reminiscence, which will have meaning to that individual resident. The inspector looks forward to looking at the progress of this initiative and its effectiveness at the next inspection. There are some formal activities planned for the forthcoming months and these were listed on the home’s notice board. One relative stated that she attends a musical sing a long in the home once a month and that her mother enjoys it. The home does not have an activities co-ordinator at present and the residents have little stimulation on a daily basis. The inspector witnessed the same routine for residents throughout the three-day inspection whereby residents come down stairs in the morning and sit in the lounge until it is time to go to bed. The television was on but only one resident was paying any attention to the daytime programme. The sun was shining on all three days yet it was only on the last day of the inspection that four residents were encouraged to sit out and enjoy the gardens and pretty courtyard. Comments received from relatives included, “Residents are left in the lounge for long periods of time with no staff contact”, “Most of the time the residents sleep because they are so bored” and “There is no stimulation offered to residents, my mother is lucky because she has visitors every day”. One relative told the inspector that she rarely witnessed residents out in the gardens and felt that this was because staff could keep an eye on all residents if they were all in one room. The lack of stimulation for all residents in the home was discussed with the group manager and it was agreed that an activities coordinator must be recruited. New initiatives were discussed such as one to one sessions with residents who stay in their rooms, and a more active role for key workers to identify residents’ individual preferences and needs. The group manager has trained the staff in a comprehensive course in dementia, however the home has not looked at ways in which residents with dementia can receive stimulation. In one of the sister homes a “rummage box” has been provided which contains various items that residents can relate to. These items provide memories and topics of conversation for residents where they are able to reminisce. This has been a very popular resource; it is Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 17 unfortunate that Frenchay Park residents have not benefited from such innovative practice. Due to the size and layout of the dining room it is not possible for all residents to enjoy the social advantages of dining together. Staff had used their expertise and knowledge of the residents, personalities, preferences and ability to eat independently, when seating them for lunch. Residents that required assistance with eating their meals were not all supported by staff members in a respectful, sensitive way, for example without rushing the residents and staff were not sat at the same level as the resident, some staff were seen standing above the resident. As mentioned previously in the report several relatives were concerned that residents were not receiving adequate fluids and nutrition and were not receiving adequate support from staff. One relative told the inspector that she had witnessed meals being left in front of residents who require assistance with feeding. The staff have then returned to find the food untouched and then thrown it away. Several other families had made similar comments. One relatives comment card informed the inspector that during one of her visits she had found drinks placed out of reach of her relative and when she offered her a drink she drank three glasses of water consecutively. Another relative stated that when she has visited her frail relative several fortisip drinks were lined up but staff had not opened them for her so she had been unable to drink them. The pre-inspection questionnaire stated that all twenty-eight residents required help, supervision or prompting when eating meals. One staff member explained that one resident she cares for requires all food to be fed to her and the food is pureed. The staff member stated that the resident will eat all of her breakfast but requires plenty of time and patience; breakfast for this particular resident can therefore take up to forty minutes. Consequently some residents are frequently not washed and dressed before midday. Both relatives and staff at the home had stressed their concerns and frustrations at this. It is evident that the shortfall in maintaining adequate fluid and nutrition for residents is due to the high dependency levels of residents, the lack of staff resources and subsequently the time allocated for these tasks. The inspector looked at the kitchen and store area and spent time with the chef and his assistant. They were able to demonstrate an awareness of individual needs of the residents, including special dietary requirements and personal preferences. The menus consist of a varied, well-balanced choice of Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 18 traditional home cooked meals. The kitchen was very clean and organised. Stores exhibited a wide range of foods. Food hygiene training was up to date. Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Some residents and relatives do not feel that their concerns are dealt with effectively. There are procedures in place to protect vulnerable adults from abuse. EVIDENCE: The home has a complaints procedure, which is clearly displayed and forms part of the residents’ guide. The pre-inspection questionnaire stated that there had been no complaints received since the last inspection. Eight residents stated they knew who to speak to if there were not happy. One relative stated “I would always talk to the matron, who is always on top of every situation”. Due to their frailty many residents rely on their relatives to represent them when dealing with any concerns. Many relatives were not happy with how concerns were dealt with and statements included, “Although my worries or concerns are listened to, they are not acted on”, “I do not feel the matron is as helpful as she could be” and “When I make a complaint I am made to feel a waste of time”. Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 20 Prior to the inspection a family of one resident contacted the inspector with concerns over the care the resident was receiving. As a result of this the manager invited the family to the home for a meeting. The meeting was held on the first day of the inspection and the inspector attended. The family had valid reasons for their concerns with regards to care planning, staff shortages and lack of stimulation for their relative. The meeting was open and enabled the family to discuss their feelings and frustrations. It was apparent from the meeting that there were shortfalls in the service provided and the manager and family spent time devising care plans to assist in alleviating some of their concerns and to ensure that adequate provision was made to prevent these problems reoccurring. One residents survey stated that, “If we complain a meeting is usually set up so we can air our views”. Unfortunately the inspector could not share the comments and information she received about how concerns and complaints were dealt with, with the manager due to her absence on the second and third day of the inspection. However it was discussed with the group manager who will be required to feedback this information to the manager to ensure that processes of dealing with concerns are dealt with appropriately and effectively in the future. This should ensure that residents and relatives anxieties and frustrations are relieved. There are procedures as well as a range of guidance information on the topic of protection of vulnerable adults from abuse’ including the Local Authority “No Secrets” document. The staff handbook and induction training provides education on topics for whistle blowing, management of aggression and bullying. The availability of this information should increase staff awareness and understanding of their role in protecting vulnerable adults who live at the home. The inspector was informed by the manager that the organisation actively promotes staff training and education in these areas, all staff are encouraged to attend training in dealing with difficult behaviours and protection of vulnerable adults. Staff training records evidenced this commitment. A number of staff are undertaking the National Vocational Qualification in care award, and a component of the award addresses issues around the topic of the protection of vulnerable adults from abuse. Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,24,26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents do not live in a safe and well-maintained environment and are at risk in some areas of the environment. Adequate laundry facilities would enhance the service provided to the residents. EVIDENCE: The home is an older property converted and adapted to care for elderly people. There is a passenger lift to access all floors. There are two lounge areas, one of which incorporates a dining area. These were found to be comfortably furnished and homely in appearance. Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 22 The home has a small pretty garden area, which was well stocked with planters displaying colourful bedding plants. There is also a small courtyard with adequate seating for four residents and sun screening. On the third day of the inspection four residents were seen enjoying their lunch in this area. A tour of the residents’ bedrooms was taken with the group manager. Some bedrooms were bright, airy and personalised and some residents had brought in their own furniture and personal effects to make it more homely. Some of the rooms were in need of redecoration, required new bedroom furniture/repairs to broken handles, new carpets and new vanity units. An audit was completed of all bedrooms and an action plan will be required to address these and other areas identified during the tour. As mentioned previously in the report all twenty-eight residents have varying dependency levels. Twenty-three residents require the use of a wheelchair and require assistance with manual handling equipment. It was noted that most of the residents had divan beds, which are not suitable for the safe use of this equipment or manual handling procedures. A large quantity of residents had bed rails, which were not fitted properly. This was brought to the attention of the maintenance man who dealt with this immediately. The home is required to carry out a risk assessment of all beds to ascertain who requires profiling beds with integral bed rails. Three beds were identified during the inspection requiring immediate replacement and these were ordered. Further evidence will be required to inform the inspector how many new beds are required and timescales in which this will be achieved. The home is able to provide specialist pressure relieving equipment which was evident for many residents living in the home, however many of these mattresses are not suitable for divan beds and causes the mattress to overhand. Safe adequate provision must be made to ensure that appropriate beds are obtained to accommodate the size of the pressure relieving mattresses. At the previous inspection it was noted that bedroom doors did not have locked door facilities for residents privacy and security and a requirement was made that the home begin a planned programme of installing these. This requirement has not been fully met and although the home has given new residents to the home the choice of having a lock provided a further requirement is made to fit a lock to the door of each room as it becomes vacant. Laundry facilities are limited and the main laundry room on the ground floor is small. The inspector requested a visit from the Avon and Somerset Fire Safety Officer to ascertain the safety of the location of the laundry room situated Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 23 underneath one of the staircases in the home. The inspector accompanied the Fire Officer during his visit and although the laundry room is not conducive to working practice it does meet with fire safety regulations. There is limited space for sorting or storing the residents’ laundry prior to taking it to their rooms. All ironing is carried out in a resident’s room if it is vacant. Several relatives informed the inspector that they iron the residents’ clothes themselves because often they do not get ironed and are very creased. At one stage during the inspection the inspector had told the group manager that she felt the residents looked unkempt. It was agreed that some residents were seen to be wearing clothes that had not been pressed. Relatives stated that clothes went missing and that items went missing and were found on other residents who for example had the same Christian name, relatives felt that this was undignified. It was recommended at the last inspection that alternative space be sought to ensure that residents received adequate laundry facilities. The group manager explained to the inspector that alternative plans had been discussed to utilise other parts of the home in order to make adequate provision for laundry facilities. This will require some minor building work but has not yet been addressed. In the interim the home must explore alternatives to ensure safe working practice and that residents laundry is washed and pressed to an adequate standard. All residents and relatives surveys made positive comments about the domestic duties carried out in the home. The inspector spent some time talking to the domestic who had worked alone for six weeks whilst her colleague was absent from duty. The domestic had worked hard to maintain the cleanliness of the home single handily, however this was proving a mammoth task and the deep cleaning rota for residents’ rooms and carpet shampooing had lapsed. The area manger explained that the second domestic was due back to work the following week. The inspector required that extra domestic staffing hours be deployed if the domestic did not return to work. Since the inspection the inspector was notified that the domestic staff member had returned to work. Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents’ needs are not fully met by staffing levels and the skill mix of staff. Residents would be further protected if the home followed their recruitment policy and procedure by interviewing all staff prior to employment. Staff receive training to help provide the skills needed to meet the residents needs. EVIDENCE: At present staffing levels are not sufficient to meet the dependency levels of the residents. Although the home follows the staffing notice issued by the Department of Health this is a minimum recommendation, when levels of dependence increase the staffing levels also need to be increased. This judgement is based upon observation and discussion with residents, relatives and staff. Recruitment policies and procedures are in place, the files inspected showed all the appropriate documents and checks are done. However two staff members had been recently employed through an agency and had not had an interview Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 25 with the manager prior to commencement of employment. This is poor practice and does not reflect the recruitment policy and procedure in the home. Relatives had raised various concerns with the inspector about some staff members whose first language is not English and had limited communication skills in the English language. Comments received stated that although the staff members were very kind it was difficult to communicate needs and that when delivering care they were not talking to the resident. The inspector witnessed on several occasions during the inspection that tasks were being carried out with the residents with little or no verbal interaction/explanation. It was also apparent that these staff members were working in pairs, which exacerbated the problem. Had the staff been interviewed the manager would have had an early indication that these staff members would require a comprehensive induction, supervision, extra support from experienced members of staff and possibly access to external English classes. The inspector had discussions with the area manager about these issues and the need for further induction and supervision to support some staff members in order that they can deliver care to the residents more effectively. The inspector spent some time talking and observing staff members who were experienced, committed, caring members. Staff stated that the workload was too great for the amount of staff on duty and that they went home feeling frustrated at the end of their shift. One relative stated that, “Some staff are so helpful, but I think they are required to do too much and some staff require more training”. There is an induction programme, which covers all mandatory training, including Fire, Manual Handling, and Health and Safety. All staff are given a copy of the General Social Care Councils Code of Conduct. The home continues to support their staff with NVQ training and the enrolling programme continues. The manager and her staff are conscientious in attending training relevant to the care needs of the residents, including updates on infection control; wound care/skin care management and dementia care. A training matrix had been developed and the inspector was able to see that all mandatory training including manual handling was undertaken and course dates had been organised for the future. However it is difficult to be confident that staff who have little understanding of English would benefit Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Although the residents’ needs and best interests are central to the management approach in the home, the manager’s supernumerary hours must be reviewed to ensure that she can fulfil her managerial duties. Good accounting methods are adopted and policies and procedures are followed correctly when handling residents’ personal money. Staff are not adequately supervised. The health and safety of residents, staff, and visitors is protected, however, records must identify which staff members require fire drill training. Residents, visitors and staff will be further protected when the home complies with certain provisions identified by the Fire Safety Officer. Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 27 EVIDENCE: Unfortunately the manager was only in attendance for one day of the three day inspection, however discussions that were held, although limited were useful. Otherwise discussions were held with the group manager and will be fed back to the manager to ensure that all relevant information collated as a result of the inspection is passed on. Through observation and discussion the inspector had concerns with regards to the manager not working supernumerary on a full time basis and having to work as the trained nurse on the staffing rota. It was evident in discussion with the manager that she also had concerns regarding her workload. The home does not have a receptionist or administrator and as the staffing notice states these duties should be excluded from the manager’s role. When the manager is working as the trained nurse in charge of the shift she also has to work as a receptionist answering the phone deviating from her shift responsibilities to deal with management issues e.g. liaising with residents’, relatives and visiting health care professionals. Relatives’ comments in general did reflect that they did not feel an overall confidence in the managers’ ability. Relatives said that although there were resident meetings arranged they were unable to attend because meetings were arranged during a weekday when they had work commitments. Residents/relatives meetings are poorly attended and copies of the minutes are not circulated to individual families who cannot attend. All discussions held with the group manager over these issues were received positively and suggestions by the group manager were made about how these problems could be alleviated for example, deploying additional managerial hours and recruiting an administrator or a receptionist. The policy and procedure for holding residents personal money was examined and four individual accounts were looked at. It was evident that good accounting methods are adopted which account for all transactions documented and receipts for sundries were available to see. A plan has been developed to ensure staff receive supervision once every six to eight weeks. Arrangements in place confirm that individual supervision is based on an agreement between the manager and staff member. A plan is devised for discussion relating to key residents, work issues, staff issues, personal development and training. Although this standard was not looked at in great depth it was apparent that the manager did not have sufficient time allocated to fulfil supervision adequately, particularly for the new recruits mentioned previously in the report. Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 28 Some of the Health and safety records in the home were examined. Documentation showed that all relevant checks were maintained correctly and at the required intervals including all fire alarms and equipment, emergency lighting and the water temperatures. The homes records showed all necessary service contracts were up to date including, gas and electrical services, manual handling equipment and lift servicing. The fire logbook evidenced compliance to the weekly, monthly and annual checks alongside records of staff training and drills completed. Records need to clearly identify that all members of staff have been present during fire drills as recommended by the Fire Prevention Officer and that all night staff undertake this on a three-monthly basis, and day staff six-monthly. The area manager is conducting a monthly visit to the home and copies of the reports are being sent to the Commission for Social Care Inspection. Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 29 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 1 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 3 2 X X 1 X 1 X 2 STAFFING Standard No Score 27 1 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 2 X 1 Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 30 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 OP2 Regulation 5(1)(b) Requirement Ensure that all residents have an up to date contract/terms and conditions. Repeated requirement. The home must continue to: 1 Develop Care plans with the residents and/or their representatives, wherever possible. 2 Ensure all residents have care plans, which accurately reflect their needs and how those needs will be met. 1 Care Files must be reviewed regularly on a monthly basis and updated accordingly. 2 Six-monthly reviews of all care files must be arranged for residents and/or their representatives, wherever possible. A representative from social services must be involved with six monthly reviews when they fund residents. Ensure that food and fluid intake records are consistently maintained. Repeated requirement Timescale for action 13/10/06 2. OP7 OP8 15(2)(b) 25/09/06 3. OP7 12(2) 15(1) 25/08/06 4. OP8 12(1)(a) 31/07/06 Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 31 5. OP12 16(2)(n) 6. 9. OP14 OP15 12(2)(3) 12(1)(a) (b) 10. OP16 22(1-6) 17(2) sch4 11. OP19 23(2)(b) (c) Ensure that residents are given opportunities for stimulation through leisure and social activities, which suit individual needs and preferences and improve detail about individual preferred daily routines. Ensure residents are consulted and supported to develop plans for their daily routine. Mealtimes must be unhurried and assistance given sensitively to ensure that adequate nutritional and fluid intake is maintained. Policies and procedures for complaints must be reviewed to ensure that residents feel that their concerns are listened to and acted upon effectively and that any issues are recorded with the outcomes. An action plan must be sent to CSCI detailing the timescales and priority areas; 1. Refurbish and redecorate all bedrooms identified during the environmental audit carried out. 2. Replace carpets in all rooms identified. 3. Secure any trailing cables to the skirting. 22/09/06 25/08/06 25/09/06 25/09/06 22/09/06 11. OP22 16(2) c All beds must be risk assessed 28/08/06 ensuring that they are of suitable height, safe to use and comfortable for individual residents. Overhang of any pressure relieving mattresses must cease by providing suitable beds to accommodate them. Privacy locks to be fitted to each bedroom door as it becomes vacant. Repeated requirement. DS0000034485.V302464.R01.S.doc 12. OP22 16(2) c 08/09/06 12. OP24 12(1)(a), 12(4)(a) 25/08/06 Frenchay Park Nursing Home Version 5.2 Page 32 13. OP26 12(4)(a) 16(2)(f) 14. OP27 18(1) a 15. OP29 19(1)(a) 16. OP30 12(1)(a) (b) Ensure that residents’ clothes are pressed and that their dignity is maintained by ensuring that residents have access to their own clothes at all times. Care staffing levels to be assessed and staff must be deployed in sufficient numbers on every shift in order to meet the dependency levels of all residents in the home. Robust recruitment policies and procedures must be applied to ensure that staff have the skills, communication and experience necessary for their role. Induction for some members of staff must be more comprehensive to support them to meet the needs of residents. The Nurse Manager supernumerary hours must be reviewed to enable her to fulfil her duties. A system to be put in place so that residents and their advocates have the opportunity to discuss any issues, views and level of satisfaction about the service they are receiving. Staff to be given adequate, appropriate and effective formal supervision Arrangements to be made for staff to attend a drill every three months for those on night duty and every six months for day staff. 25/08/06 25/08/06 28/08/06 28/08/06 17. OP31 18 (1) a 21/07/06 18. OP33 24(1) 08/09/06 19. OP36 18(1)(a) (c) 23(4)(e) 28/08/06 20. OP38 08/09/06 Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 33 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 OP26 Good Practice Recommendations Find a more appropriate site for the laundry room to enable laundry staff adequate room to iron and distribute residents’ clothes. Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Frenchay Park Nursing Home DS0000034485.V302464.R01.S.doc Version 5.2 Page 35 - 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. 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