Inspection on 27/02/07 for Frenchay Park Nursing Home

This inspection was carried out on 27th February 2007.

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 13/07/06

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 27 , 28 February 2nd, 7th March 2007 th 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.V331270.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.V331270.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 9659957 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.V331270.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 13th July 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.V331270.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 was conducted over a period of three days and one evening; the purpose of the evening visit was to investigate concerns that had been raised by residents and relatives over staffing levels on the evenings and at night. In particular concerns had been raised about the lack of supervision to the residents who were situated in the lounge, the inability to be able to find a member of staff and residents not going to bed at their preferred times. Prior to the visit the inspector spent 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 fourteen of these were completed and returned. The inspector spent time throughout the course of three days in discussions with the group manager, registered manager and support 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 them indirectly going about their daily routines. The inspector toured the premises accompanied by the maintenance operative and the 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. Feedback was given to the registered provider Mrs Philips, group manager, registered manager and support manager on the outcome of the inspection. Frenchay Park Nursing Home DS0000034485.V331270.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Residents are protected by the homes recruitment policy and procedures. Relatives/residents meetings have been arranged in order to discuss various issues within the home, levels of satisfaction and address any concerns people may have. The benefit of these will be greater if more people were encouraged to attend. The home has worked hard in improving parts of the home that residents use, including the bathrooms and lounge areas. They have been tastefully redecorated and refurbished to a high standard. Frenchay Park Nursing Home DS0000034485.V331270.R01.S.doc Version 5.2 Page 7 What they could do better: There are various requirements outstanding from the previous inspection and some new requirements have been made as a result of this inspection. How this service can improve is detailed throughout the report and in the requirements made at the end, the list below is only an example of how the service can be improved. 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 to ensure that they accurately reflect current needs and sixmonthly 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 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. The procedures for dealing with complaints must be reviewed to ensure that residents feel that their complaints/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 suitability of the beds in the home. Staffing levels are not adequate. Additional care staff must be deployed to ensure levels are maintained to reflect the dependency levels of the residents currently residing at the home. An immediate requirement was made about this. Although residents and their advocates are given the opportunity to discuss any issues, views or satisfaction about the service they are receiving through resident and relative meetings it is apparent particularly from surveys that people remain unhappy. Other initiatives must be sought to ensure that people are encouraged to discuss how they are feeling and how these can be resolved. Frenchay Park Nursing Home DS0000034485.V331270.R01.S.doc Version 5.2 Page 8 As a result of this inspection and the repeated failure for the service to comply with the previous requirements made, a service of concern meeting has been arranged to discuss the findings of our inspection and the subsequent action to be taken. CSCI will continue to monitor the home closely and carry out further timely inspections to ensure that requirements detailed in the improvement plan are resolved and that progress is being made. This will ensure the home complies with both the Care Home Regulations and National Minimum Standards. 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. Frenchay Park Nursing Home DS0000034485.V331270.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.V331270.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents’ needs are assessed prior to admission to determine the suitability of placement. EVIDENCE: 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. Where possible the manager had obtained assessments and care plans from other professionals involved for example, social workers and hospital staff. Frenchay Park Nursing Home DS0000034485.V331270.R01.S.doc Version 5.2 Page 11 The inspector looked at six pre-admission assessments and the information gathered provides a sound benchmark of the resident’s ability and state of health prior to admission. Frenchay Park Nursing Home DS0000034485.V331270.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although there have been some improvements not all residents have been consulted about their health and personal care needs and cannot be assured their views and expectations will be considered. Residents care plans don’t accurately reflect the care that is being delivered. Residents do not always receive the care and support they need. Safe systems help to protect residents from the risk of medication errors. Staff members on duty respected residents’ privacy and dignity throughout the inspection. EVIDENCE: Frenchay Park Nursing Home DS0000034485.V331270.R01.S.doc Version 5.2 Page 13 At the inspection in July 2006 it was evident that care plans were not person centred, did not accurately reflect residents needs and were not developed with the residents and /or their representative. The following requirements were made. 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. 3 Care Files must be reviewed regularly on a monthly basis and updated accordingly. 4 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. 5 Ensure that food and fluid intake records are consistently maintained. During this inspection the inspector examined six residents care files including pre-admission assessments, care plans, personal history profiles, preferred daily routines and risk assessments to find evidence of any progress the home had made. Although some records had improved some continued to lack 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 and wishes. One resident’s file had a catalogue of weaknesses. Numerous written entries were found in the daily record from night staff about the resident being found on the floor however incident/accident forms had not been completed on all occasions. The resident had recently returned to the home following a hospital admission yet their care plans had not been reviewed until the fifth day of their arrival back into the home. The dependency level chart did not reflect the correct levels and the score was documented at 27, the inspector checked the scores and made the level of dependency high with a score of 42. Bed rails were in place but the consent form had not been signed. There was a risk assessment in place but the record was sparse in detail, it was not dated or signed and there was no way of knowing how up to date the risk assessment was. Three wound care plans were in place for skin tears and one for a swollen finger but these had not been reviewed for up to eleven days. Since the last inspection the manager has made some efforts to conduct a six monthly review of residents care files with the residents and/or families. Frenchay Park Nursing Home DS0000034485.V331270.R01.S.doc Version 5.2 Page 14 However eight reviews remain outstanding, following this inspection the manager has sent a letter to the inspector detailing appointments she has since made with the remaining residents and their families. Health Care needs were evidenced in the care files, which included nutritional, wound and pain assessments. Several residents’ living at the home are very frail and require intervention and close monitoring in nutritional and fluid intake. Fluid and nutritional intake charts have improved and include more detail of quantities taken over a twenty-four hour period, but the inspector saw two charts at 10pm that had not had an entry since 6pm. Several residents have bed rest during the day. This is good practice particularly around risks such as development of pressure sores. Unfortunately there are grave errors in this intended good practice as turn charts had not been completed since 4pm. Records of the General Practitioner (GP) visits with residents and the outcomes were documented. Specialist referrals and visits from other professionals including, Physiotherapists, Chiropractors, Dentists and Opticians were also seen. Ten residents surveys stated that in general they felt they received the medical support they needed comments included “I have a low blood count which needs monitoring and I receive blood transfusions when necessary” and “I always get my tablets as I get a lot of pain”. Residents were asked in their surveys “Do you receive the care and support you need?” comments included, “Its not perfect but its close”, “It depends on how busy the staff are but most times support is given when I ask”, “Not very good at all, I am always waiting” and “I’m mostly happy with the support I get”. 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 twenty-six required help with toileting and washing and dressing, sixteen residents require help/supervision/prompting to eat and drink and twenty-six residents have restricted mobility and require the use of a wheelchair. 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. Frenchay Park Nursing Home DS0000034485.V331270.R01.S.doc Version 5.2 Page 15 During the inspection 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. One carer was seen explaining what was going to happen as she transferred the resident from the chair to a wheelchair using a hoist. Her tone was reassuring and she gave simple clear instructions to the resident to ensure that that they were aware of the procedure about to take place. Frenchay Park Nursing Home DS0000034485.V331270.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although there have been some improvements residents do not benefit from a varied activities programme, which is both enjoyable, stimulating and meets individual preferences and expectations. Residents are encouraged and supported to maintain family/friend contact, however the home needs to reassure and support the family when they wish to be involved with their loved ones care. 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 but sometimes the meals are cold. EVIDENCE: Frenchay Park Nursing Home DS0000034485.V331270.R01.S.doc Version 5.2 Page 17 At the last inspection it was evident that there was a lack of stimulation for residents in the home and the following requirement was made: 1 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. 2 Ensure residents are consulted and supported to develop plans for their daily routine. The home has recently recruited an activities coordinator and although she is relatively new to the post the manager discussed new initiatives to be developed such as one to one sessions with residents who choose to stay in their rooms, and a more active role for key workers to identify residents’ individual preferences and needs. The coordinator has worked hard in developing an individual activity assessment for all residents, which gives a comprehensive overview of their personality, physical ability and preferences. All activities are recorded including who took part and feedback on how successful the session was and whether it was enjoyed. There are some formal activities planned for the forthcoming months and these are listed on the home’s notice board. Musical entertainers also visit the home on a regular basis. Only four residents surveys conveyed that the activities in the home were adequate, comments included, “I have met the activities lady and she seems a very nice person” and “I cant think of anything else I would like to do that isn’t already being done”. The coordinator only works fifteen hours per week and during discussions with the manager and residents it is possible that this may not be sufficient to keep people stimulated throughout the day. Other comments from residents included, “I get bored sometimes”, “I would like to do more activities but sometimes I don’t get downstairs until lunch time and I feel that I miss out”, “ I would like to write letters or cards to people” and “Nobody asks or tells me when something is going on which I think is poor”. This information was fed back at the outcome meeting at the end of the inspection and will need to be reviewed by the home. Over the past two inspections requirements were made to ensure that residents were empowered to make choices about how they wish to live their lives. Preferred daily routines and preferences are now recorded, however these are not detailed enough to give a good picture of individual preferred routines and comments received from residents support this. Two residents stated, “Staff are always friendly and polite but I would prefer a female carer as I feel out of place sometimes” and “I would prefer a woman to dress me wherever possible, I don’t like wearing trousers but they sometimes put them on me”. Frenchay Park Nursing Home DS0000034485.V331270.R01.S.doc Version 5.2 Page 18 During the evening inspection the inspector spent some more time looking at preferred daily routines for residents, which did not always specify times that residents would like to get up or go to bed. Several residents told the inspector their preferred bedtimes, but these were not documented. The chef continues 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 traditional home cooked meals. The kitchen was very clean and organised. Stores exhibited a wide range of foods. Residents commented positively on the food in their surveys, which included, “I enjoy the food prepared”, “Good variety”, “There’s always an alternative” and “The food is very good”. The only negative comments about the food were that sometimes the food was cold by the time the meal was served to them. On the second day of the inspection the inspector and Mrs Philips observed lunch being served. The lunch was leaving the kitchen hot on a trolley but the food was cooling down all the time whilst up to thirty meals were being served. Mrs Philips informed the inspector that this would be resolved by purchasing a heated trolley whereby meals would be served in the lounge by the chef directly to the residents. Frenchay Park Nursing Home DS0000034485.V331270.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are not empowered to make complaints or raise concerns and those that are raised are not dealt with effectively. There homes procedures 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. Residents are asked in their surveys if they knew who to speak to if they were not happy. Comments received were mixed and included, “ You can trust the staff to speak up for you if you are not happy”, “There is a nurse I trust and like very much”, “I don’t know who I would speak to”, “If I try to tell someone I get told to shut up, it puts you off, I wouldn’t know who to trust or who to talk to”. Frenchay Park Nursing Home DS0000034485.V331270.R01.S.doc Version 5.2 Page 20 Unfortunately the surveys were mostly written anonymously so it was impossible to follow up comments made. However the comments were discussed with the manager and Mrs Philips, who both were deeply concerned and disappointed that residents living in the home were feeling this way. Residents were also asked if they knew how to make a complaint. Six residents said did not know how to make a complaint and one stated, “ I have not been told about the complaints procedure”. Again the overall response was mixed but generally negative in content including, “Yes I would go straight to the matron”, “I have no complaints”, I know how to complain but it never makes any difference” and “I wouldn’t trust anyone, I have made complaints but nothing ever happens”. As detailed in the previous inspection report there does seem to be an area of weakness around effective communications and dealing with peoples concerns. It also raises questions about what the manager/resident qualifies as a complaint. The manager stated in her Pre inspection questionnaire that there had been no complaints received and yet residents’ surveys indicate that complaints have been raised and not resolved adequately. Following on from the last inspection it was hoped that the six-monthly reviews held with residents would also give them the opportunity to raise any issues, anxieties or concerns they may have. As required at the previous inspection the manager will be required to ensure that complaints and concerns are dealt with appropriately and effectively in the future. This should help ensure that residents and relatives anxieties and frustrations are relieved. It was also agreed that the whole staff team must address the seriousness of the concerns and comments mentioned above in order to determine why residents are feeling the way they are and how this can be resolved. 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.V331270.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is comfortable, tastefully decorated and furnished. It provides a safe, peaceful and well-maintained environment for the residents. Some bedrooms, toilets and bathrooms require refurbishment and redecoration. Residents’ beds do not ensure safe working practice when staff are following manual handling procedures and do not maximise residents independence. All people who use the service fell that the home is clean, pleasant and hygienic. EVIDENCE: At the previous inspection previous requirements were made to: Frenchay Park Nursing Home DS0000034485.V331270.R01.S.doc Version 5.2 Page 22 1 Refurbish and redecorate all bedrooms identified during the environmental audit carried out. 2 Replace carpets in all rooms identified. 3 Risk assessed and replace where necessary all beds ensuring that they are of suitable height, safe to use and comfortable for individual residents. The home has made improvements within the environment that residents live in. Discussions were held with the maintenance man who confirmed that he had received an action plan to address refurbishment and redecoration in all bedrooms identified, replace carpets in all rooms identified and that the work continues. The inspector had a look at the work achieved so far, which was of a high standard, and tastefully done. Further refurbishment has also been commenced to upgrade the bathrooms and toilets and again the work completed so far is very good. Some of the toilets require redecorating and the flooring needs replacing. The purchase of additional commodes, bedside tables and profiling beds was evident, new carpets and curtains have also been ordered. Many of the vanity units have been replaced and the ongoing replacement programme is to continue. Some of the residents bedroom furniture is unsuitable to hold their possessions adequately and are broken in places, the inspector was informed that furniture was being ordered for each room when it was being redecorated. The residents lounge areas have been redecorated and all lounge furniture has been replaced. These areas were bright, clean and spacious and residents were taking advantage of all these areas throughout the inspection. Mrs Philips told the inspector about possible future plans to build a conservatory, which would extend the dining area, allowing more residents to enjoy the social advantages of dining together. At the last inspection a requirement was made to risk assess all beds for residents who require hoisting and/or assistance of two nurse’s and to replace with profiling beds. The inspector had seen evidence of this provision and was assured that this was an ongoing programme. However during the recent evening inspection some beds were identified that remain unsuitable and were in need of urgent replacement. One lady was watching the television when the inspector went in her room. She had a small portable TV at the far side of her room; two thin pillows supported her head so that in effect she was lying down, straining to see to the programme, her bed was not profiling nor did it have a back rest. Frenchay Park Nursing Home DS0000034485.V331270.R01.S.doc Version 5.2 Page 23 Another resident who the inspector had met during other visits to the home requires transfers via the stand aid hoist. Her bed was far too high for her to sit on with her feet remaining on the floor, which meant that the manualhandling practise was not followed correctly and did not ensure the safety of the resident or the staff. All residents and relatives surveys made positive comments about the domestic duties carried out in the home including, “Very happy with the cleaners no complaints there” and “It always looks clean and smells fresh”. Frenchay Park Nursing Home DS0000034485.V331270.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents’ needs are not fully met by staffing levels, which compromise their health safety and welfare at risk. Residents are protected by the homes recruitment policy and procedures. Staff receive training to help provide the skills needed to meet the residents needs. EVIDENCE: Following the key inspection in July 2006 a requirement was made to assess the care staffing levels and deploy staff in sufficient numbers on every shift in order to meet the dependency levels of all residents in the home. The requirement was made primarily because evidence confirmed that residents were being left in the lounge unsupervised for long periods of time from 9am to noon. During the random inspection conducted in October 2006 it was noted that an additional care staff member has been deployed to work from 8am-12pm to Frenchay Park Nursing Home DS0000034485.V331270.R01.S.doc Version 5.2 Page 25 supervise residents in the lounge. Discussions were held with visitors in the home and staff members on duty who all expressed positive outcomes for this provision. The extra member of staff was assisting with all transfers from wheelchair to lounge chair, helping residents to the toilet when required and ensuring that residents received regular drinks including morning coffee. The extra member of staff had improved daily routines and provided other care staff with realistic timescales to get remaining residents up, washed and dressed. Visitors felt more reassured that their relative was safe and under regular supervision. At this inspection evidence gathered through observation and discussion with residents, visitors and staff confirmed that standards had dropped and the lounge assistant hours had ceased and yet the high dependency levels remained the same as before. The manager explained that at one stage the homes resident occupancy had decreased at one stage and that the additional staff member was not required. When the occupancy increased the staffing levels were not reassessed and residents were placed at risk yet again. As mentioned previously in the report the purpose of an evening visit to the home was to investigate concerns that had been raised over staffing levels on the evenings and at night. In particular concerns had been raised about the lack of supervision to the residents who are situated in the lounge, the inability to be able to find a member of staff and residents not going to bed at their preferred times. These were just some of the inspectors’ findings that evening: The inspector arrived at 6.30pm. One RGN and two carers were on duty. Three residents were in the small lounge and twelve residents were in the main lounge. The inspector spoke with two ladies in the smaller lounge, who said that they liked to go to bed around 9pm, but that they often had to wait. The previous night they had not gone to bed until after 10pm. The inspector spent time throughout the four-hour visit talking and observing the two residents. One of these residents was still not in bed when the inspector left the home at 10.30pm. In the lounge residents were falling asleep and some looked very uncomfortable with their heads resting on their tables or on the arms of the chair. Three residents in particular were very agitated and confused. They were quite unhappy, vocal, fidgeting and not peaceful at all. Two of these residents tried on numerous occasions to get up, some times one succeeded and was very unsafe, and the other one was perched precariously in her chair throughout the evening. Frenchay Park Nursing Home DS0000034485.V331270.R01.S.doc Version 5.2 Page 26 When the care staff came in to the lounge to take a resident to bed they would settle these residents and make them safe, but within minutes of them leaving the lounge the residents would start to get up again. One resident had a large black eye and bruising to her forehead, several areas on her legs and arms were bruised and had dressing to protect skin tears. The bruising to the face was caused by a fall on 3rd march 2007 at 6.40pm in the lounge, where as mentioned above the residents are not supervised for long periods of time. The inspector spoke with all staff members and observed them caring for the residents. They were empathetic about the residents not going to bed at their preferred times and were obviously concerned that residents were not supervised in the lounge. It was obvious that no sooner had the staff collected a resident to take them to bed that the call bells would start ringing and they would have to leave the resident to answer the bells. Residents who had rang their bells, requested cups of tea, the commode and to change a television programmes. Other contributing factors in delays included visitors, answering the front door and the telephone. The inspector could not fault any of the staff on duty they were respectful and helpful throughout the inspectors visit. It was also evident that they did not “cut corners” in any way in order to just get residents into beds. The inspector left the home at 10.30pm and there were five residents still up and requiring assistance to enable them to go to bed. It was anticipated that they would all be settled by 11.30pm at the earliest. The inspector spent time throughout the inspection 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. Many comments received from residents and visitors to the home verified that there are serious staffing issues and that person centred care is compromised due to staff shortages. Comments included, “It is a long wait for anything”, “ I am not happy here”, “I would like more staff at the home”, “Staff can be rude, abrupt and sometimes not very friendly”, “You can ask for help but they go away and don’t come back again, mornings and evenings are the worst and sometimes I have an accident because I have to wait”. It was apparent that many residents and visitors spoken with understood that staff resources had a major impact on morale and effective working practice. An immediate requirement was made for the home to provide adequate staffing levels to meet the dependency levels of the residents and that when levels of dependence increase the staffing levels will reflect this. Frenchay Park Nursing Home DS0000034485.V331270.R01.S.doc Version 5.2 Page 27 At the July 2006 inspection the following requirement were made: 1 Robust recruitment policies and procedures must be applied to ensure that staff have the skills, communication and experience necessary for their role. 2 Induction for some members of staff must be more comprehensive to support them to meet the needs of residents. Recruitment policies and procedures are in place; the files inspected showed that all the appropriate documents and checks are carried out. Shortfalls in staff induction have improved and the length of induction depends on individual abilities and experience. 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. 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. Frenchay Park Nursing Home DS0000034485.V331270.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are some areas of management that have major weaknesses, which compromise running the home in the best interests of the residents. Good accounting methods are adopted and policies and procedures are followed correctly when handling residents’ personal money. Staff receive supervision, however the sessions are not up to date. The health and safety of people in the home is compromised and they are potentially at risk due to lack of specialist equipment. Frenchay Park Nursing Home DS0000034485.V331270.R01.S.doc Version 5.2 Page 29 EVIDENCE: Although there are some good systems in place to help ensure that the home is run in the best interests of the residents there is cause for concern around unsafe staffing levels, the lack of person centred care and choice to residents. Serious concerns are raised when the service continually fails to comply with the repeated statutory requirements that have been made following each inspection. Since the inspection in July 2006 the manager is now working supernumerary to assist her to fulfil her duties. Since the last inspection the manager has had relatives/residents meeting to discuss various issues within the home, levels of satisfaction and address any concerns people may have. Unfortunately the attendance has been poor and the manager is now looking at ways in which advertising the meetings could be more effective and allowing plenty of notice for people to attend. The effectiveness of future meetings arranged will be monitored during future visits and comments will be obtained from residents and their families. The policy and procedure for holding residents personal money was examined and three 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. There is an annual appraisal process, which ties in with the supervision arrangements. The manager has established a formal recorded supervision procedure for all staff. A plan is devised for discussion relating to the residents, work issues, staff issues, personal development and training. However supervision with staff was not up to date. 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. As mentioned previously in the report staff are sometimes unable to carry out safe manual handling techniques due to inadequate beds. Frenchay Park Nursing Home DS0000034485.V331270.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 3 3 2 1 X X X X 3 STAFFING Standard No Score 27 1 28 1 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 1 X 2 Frenchay Park Nursing Home DS0000034485.V331270.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Timescale for action 06/07/07 2. OP7 15(2)(b) 3. OP8 Sch3 3(m) Prepare written care plans detailing how residents’ needs are to be met. Wherever possible this must be compiled with the residents and/or their representatives. Third repeated requirement Keep residents plans under 06/04/07 review so that they accurately their current needs. Third repeated requirement Properly maintain records of 06/04/07 specialist healthcare to evidence that fluid input and output charts and turning of residents at risk of pressure wounds is properly carried out. Second repeated requirement Residents must be given opportunities for stimulation through leisure and social activities, which suit individual needs and preferences. Second repeated requirement Ascertain and take into account residents wishes and feelings regarding their health and DS0000034485.V331270.R01.S.doc 4. OP12 16(2)(n) 06/06/07 5. OP14 12(3) 13/04/07 Frenchay Park Nursing Home Version 5.2 Page 32 6. OP16 22(1-6) 17(2) sch4 7. OP21 23(2)(d) 8. OP22 16(2) c 9. OP27 OP28 18(1) a welfare so that their preferences regarding daily routines are respected. Second repeated requirement Procedures for complaints must be reviewed to ensure that residents’ concerns/complaints are listened to and acted upon effectively and that any issues are recorded with the outcomes. Third repeated requirement The toilets identified during the inspection must be redecorated and the flooring must be replaced. Provide suitable equipment so that beds used by the residents are of suitable height, safe to use and comfortable. Second repeated requirement. Care staff must be deployed in sufficient numbers on every shift at all times in order to meet the dependency levels of all residents in the home. Immediate requirement was made at this inspection. 23/04/07 06/05/07 23/04/07 07/03/07 10. OP31 12(1)(2) (3) 11. OP33 12. OP36 13. OP38 The management must make provision for the health and welfare of people who use the service. 24(1) An effective system must 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. Second repeated requirement 18(1)(a)(c Staff must be given adequate, ) appropriate and effective formal supervision. Second repeated requirement 13(5) The manager must ensure safe working practices in moving and handling to avoid injury to DS0000034485.V331270.R01.S.doc 06/04/07 06/07/07 06/07/07 06/06/07 Frenchay Park Nursing Home Version 5.2 Page 33 14 OP38 12(2) residents and staff Enable residents to make 06/04/07 decisions regarding the care they receive so that they can consent or decline the use of bed rails. 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 OP15 Good Practice Recommendations The home must continue to monitor the temperature of the meals being served. Frenchay Park Nursing Home DS0000034485.V331270.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: 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 Frenchay Park Nursing Home DS0000034485.V331270.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. 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