Inspection on 11/12/07 for Glenmoor House Nursing Home

This inspection was carried out on 11th December 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

Glenmoor House Nursing Home 26/11/08

Glenmoor House Nursing Home 14/12/06

Glenmoor House Nursing Home 07/02/06

Glenmoor House Nursing Home 27/10/04

Glenmoor House Nursing Home 16/06/04

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

CARE HOMES FOR OLDER PEOPLE Glenmoor House Nursing Home Rockingham Road Corby Northants NN17 1AD Lead Inspector Kathy Jones Unannounced Inspection 11th December 2007 09:10 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 Glenmoor House Nursing Home DS0000012617.V354351.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. Glenmoor House Nursing Home DS0000012617.V354351.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Glenmoor House Nursing Home Address Rockingham Road Corby Northants NN17 1AD 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) 01536 205255 01536 262662 Southern Cross Healthcare Services Limited Judith Milburn Care Home 59 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (22), Old age, not falling within any other of places category (37), Physical disability (20) Glenmoor House Nursing Home DS0000012617.V354351.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Dementia - Code DE(E) Physical Disability - Code PD The maximum number of service users who can be accommodated is 59. 14th December 2006 2. Date of last inspection Brief Description of the Service: Southern Cross Healthcare owns Glenmoor House Nursing Home. It is a 59bedded care home with a registration for 48 nursing care beds. It provides care to elderly people (over 65 years of age) and has a further registration category for caring for elderly people with dementia related illnesses and younger adults with a physical disability. The home is a purpose built building and is situated on a main route within Corby. It is well situated to access local facilities and amenities with a complex of shops close by and it is on a local bus route. The accommodation offers a range of communal areas including lounges and dining areas on both floors. All bedrooms are single and the majority have ensuite facilities. Level access to the home is via the main entrance and there are stairs and a passenger lift for access to the first floor. Information about fees was not available within the service user guide at the time of the inspection and a requirement has been made to include this information. The following fees were provided by the manager as being current at the time of the inspection in December 2006: Glenmoor House Nursing Home DS0000012617.V354351.R01.S.doc Version 5.2 Page 5 Fees range between £331 and £696 dependent on assessed needs. The fees include personal care, accommodation, meals and laundry. Chiropody and hairdressing services can be arranged and are charged separately. Other costs would include personal expenditure such as newspapers, clothing and toiletries. Glenmoor House Nursing Home DS0000012617.V354351.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Standards identified as ‘key’ standards and highlighted through the report were inspected. The key standards are those considered by the Commission to have a particular impact on outcomes for residents. Inspection of the standards was achieved through review of existing evidence, pre-inspection planning, an unannounced inspection visit to the home and drawing together all of the evidence gathered. The pre-inspection planning was carried out over the period of a day and involved reviewing the service history, which details all contact with the home including notifications of events reported by the home, telephone calls and any complaints received. The report of the last inspection carried out in December 2006 was also reviewed and taken into account when planning the inspection. The unannounced inspection visit covered the morning and afternoon of a weekday. The inspection was carried out by ‘case tracking’, which involves selecting samples of residents’ records and tracking their care and experiences. Observations of the homes routines and care provided were made and the inspector spoke with some residents and their relatives about the support that they received. Staff were also spoken with to ascertain their views on the service provided. In addition information received following the inspection in surveys completed by two residents, three relatives, two health professionals and one staff member has been taken into account. The management of a sample of residents’ medication was checked. And a sample of staff files was reviewed to check the adequacy of the recruitment procedures in safeguarding residents’. Communal areas were viewed and a sample of residents rooms. Verbal feedback was given to the Senior Nurse who was in charge of the home on the day of the inspection and some feedback was given to the Operations Manager during a telephone call after the inspection. What the service does well: There are some very caring staff at Glenmoor House who have a strong commitment towards providing residents with a good standard of care. Staff spoken with and observed were caring and respectful in their approach to residents. Glenmoor House Nursing Home DS0000012617.V354351.R01.S.doc Version 5.2 Page 7 The management of residents’ medication on the nursing floor was good with appropriate safeguards in place. Residents spoken with who were able to express a view were happy with the meals that are provided and said that they are given a choice of meals and if these are not suitable alternatives are offered. There are procedures for making complaints, which residents and their relatives are aware of and there is a process for investigating any concerns raised. What has improved since the last inspection? What they could do better: It is important that the service user guide is updated to include information about the fees, which helps people to make informed decisions about their care. The assessment process also needs to be more thorough in ascertaining peoples’ needs and expectations to ensure that these can be met or a compromise agreed. Better communication systems are needed between care staff and also with other departments to ensure that residents’ needs are properly met. Care plans, which provide information for staff about residents care needs, were in place, however they needed to be more detailed to help staff meet the needs of residents with more complex needs. Some improvement is needed in the recording of medication on the first floor to ensure that there is a clear audit trail to enable any discrepancies to be quickly identified. Staff practice in relation to the administration of medication to people with dementia also needs to be monitored to ensure residents are properly safeguarded. Staff training in the Mental Capacity Act 2005 is needed to give them a better understanding of their responsibilities under the legislation. This will help to Glenmoor House Nursing Home DS0000012617.V354351.R01.S.doc Version 5.2 Page 8 ensure that residents’ rights are protected and everyone works together in the residents best interests in a planned way. The condition of some bedding and carpets and the cleanliness in some parts of the home occupied by residents was poor. The findings of the inspection indicate that Glenmoor House needs strong leadership and consistent management to ensure that they are able to meet the needs and protect the health and safety of the residents who live there. 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. Glenmoor House Nursing Home DS0000012617.V354351.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 Glenmoor House Nursing Home DS0000012617.V354351.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, standard 6 is not applicable as intermediate care is not provided. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The assessment process does not provide sufficient assurances that residents needs and expectations can be fully met. The lack of information about fees and fee structures reduces people’s ability to make informed decisions about their care. EVIDENCE: Information for residents, relatives and any other interested parties about the services, is provided in a statement of purpose and a service user guide. This includes information about the organisation, the home, the philosophy of care and the criteria for admission. Copies of the documents and a copy of the most recent inspection report are available in the foyer. A sample check of information within the statement of purpose identified that some of the information was out of date. For example two senior managers Glenmoor House Nursing Home DS0000012617.V354351.R01.S.doc Version 5.2 Page 11 named as contacts in the case of a complaint have left Southern Cross and the contact details for the Commission for Social Care Inspection were given as the Northampton office, which closed in March 2007. In addition the service user guide did not include all of the required information. It is now required that information about the fees is included to ensure that prospective and existing residents and their relatives have clear information about the costs and the reasons for any differences in charges. This information was not in the document, making it difficult for people to compare the costs of care, plan their finances and make informed decisions. Review of a recently admitted residents care file identified that a pre-admission assessment had been carried out. The assessment reviewed was not dated or signed and some sections had not been completed. Discussion with the resident identified that they were having difficulty accessing their en-suite toilet, which was limiting their independence. They said that this had not been a problem in their previous home. A thorough pre-admission assessment should have identified these needs and expectations, which may have helped to reduce the risk of the residents’ needs and expectations not being fully met on admission. Glenmoor House Nursing Home DS0000012617.V354351.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 adequate. This judgement has been made using available evidence including a visit to this service. The level of care and support received by residents appears to be variable with some residents receiving very good care, while the needs and expectations of others are not being fully met. EVIDENCE: Information received in surveys received from two residents, three relatives and discussion with some residents and relatives during the inspection identified that some were very happy with the care. Positive comments included “Show patience and understanding towards my mother --- they know her really well so are able to give her good care”. However others indicated that residents did not always get the care that they needed and standards varied in different parts of the home. One relative commented “Now moved downstairs to the nursing unit it is far better care than the residential unit” Glenmoor House Nursing Home DS0000012617.V354351.R01.S.doc Version 5.2 Page 13 Health professionals raised poor communication among the staff team as a problem and said that advice they have given has not always been passed on to other staff. This makes it difficult to ensure that residents’ needs are properly met. A relative also commented on the poor communication between staff. Information received in surveys from health professionals identified that there had been some concerns about staff understanding of the needs of a resident with a specific health condition. Staff acknowledged that prior to some recent training on this health condition they had not fully understood the specific needs of the resident making it difficult to understand and fully meet their needs. Care plans and risk assessments to identify risks such as pressure ulcers; falls and nutritional risk were also in place on residents care files. The assessments were reviewed regularly helping to identify any change to the level of risk and care required. Care plans reviewed contained information required for staff to meet the residents basic care needs. However discussion with staff and review of the care plans for a resident with complex needs identified that more detailed care planning and record keeping were needed to guide staff in meeting the residents needs in full. Advice was also given to include more specific information in relation to a resident’s nutritional plan. It contained very general statements such as “offer appetising meals” rather than identifying particular meals that would be likely to tempt the resident. Discussion with staff identified that they were aware of the residents food preferences and that food supplements were being added to drinks and sometimes meals, however this was not included in the plan. It is important that information within the care plans is accurate to help ensure that all staff are providing the required care. It is also important that this is linked with an effective method of evaluating the effectiveness of the care provided. There was evidence within the residents daily records that staff were in some cases recording whether the resident had eaten or not, however this was not consistent and information about whether food supplements had been added or not was not included. The limited information makes it difficult for staff to demonstrate the care and support given and to evaluate the effectiveness of the care in meeting the resident’s needs. A pharmacist from the pharmacy company who supply the drugs was carrying out an audit of the medication management systems on the ground floor on the day of the inspection. The pharmacist confirmed that no concerns had been identified, that medication was being well managed and that there were good recording systems in place. Glenmoor House Nursing Home DS0000012617.V354351.R01.S.doc Version 5.2 Page 14 During a sample check of residents bedrooms on the dementia unit a medicine pot and an unidentified white tablet were found on a bedroom floor. Failure to monitor medication for people with dementia creates a risk of them not getting the medication they need and a resident taking someone else’s medication. It is of concern that a similar issue was identified at the last inspection. A sample check of medication on the first floor identified that records of medication received and administered to residents’ are kept. However there is no record of medication carried forward from one cycle to the next making it difficult to carry out an accurate audit of residents’ medication. All staff were very respectful in the way they approached and interacted with residents. All personal care was provided in the privacy of residents’ rooms and residents spoken with confirmed that staff treated them with dignity. Comments from health professionals also confirmed that staff respect the privacy and dignity of residents’. Review of one resident’s care records identified that a member of staff had entered some comments, which were inappropriate and this was going to be addressed by the nurse in charge at the time of the inspection. Glenmoor House Nursing Home DS0000012617.V354351.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Visitors are encouraged and welcomed into the home and residents’ are happy with the food provided. However better communication and understanding of the Mental Capacity Act may help staff to ensure that residents’ rights and choices are supported. EVIDENCE: Observations and discussion with residents’ and staff throughout the inspection identified that the routines are flexible. Residents’ spoken with who were able to express a view were generally satisfied with their lifestyle in the home. One resident who completed a survey stated that there were always activities that they were able to take part in and another said that there were sometimes. A relative confirmed that activities are provided and staff interact with residents is confirmed by a relatives comments “They talk to her frequently, include her in activities and have fun with her on mum’s good days. There is a lot of laughter, which mum loves.” Glenmoor House Nursing Home DS0000012617.V354351.R01.S.doc Version 5.2 Page 16 Relatives and a resident spoken with confirmed that the visiting arrangements are flexible and that they are able to visit in private. The level of choice and control residents have over their life varies. One resident spoken with is relatively independent and confirmed that they are able to make choices and decisions about their care. However, for other residents this is much more difficult. Information received in surveys and discussion with staff identified that staff would benefit from training on the Mental Capacity Act 2005 to enable them to understand more fully their responsibilities for ensuring that residents rights are fully protected. The annual quality assurance self assessment identifies that Southern Cross have introduced a system whereby the nutritional values of foods are identified for each food product to help ensure that residents’ nutritional needs are met. However it was identified that this tool is not in operation yet at Glenmoor. Positive comments were received from residents about the meals. Discussion with the cook identified that she is aware of those residents who require specific diets to meet religious, cultural and health requirements, she was also aware of individual preferences. It was therefore dissapointing to find that poor communciation between kitchen and care staff resulted on the day of inspection in two residents not having the meal that had been planned for them. Glenmoor House Nursing Home DS0000012617.V354351.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. There are procedures for dealing with concerns and complaints which residents, relatives and staff are aware of. EVIDENCE: Two residents who forwarded surveys confirmed that they knew how to make a complaint and had someone to talk to if they were not happy. It was however identified that two senior managers named as contacts in the service user guide have left Southern Cross. It is important that care is taken to keep this information up to date to ensure that any concerns can be addressed promptly. The Commission for Social Care Inspection have received two complaints since the last inspection in December 2006; one has been referred to Southern Cross Healthcare for investigation and the other to Social services. Information received in the annual quality assurance assessment indicates that complaints are investigated and shortfalls acknowledged. Staff spoken with were aware of their responsibilities in reporting any concerns and protecting the vulnerable people in their care. Glenmoor House Nursing Home DS0000012617.V354351.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The condition of some bedding and carpets and the cleanliness in some parts of the home occupied by residents was poor. EVIDENCE: A sample of shared lounges and dining rooms and residents’ bedrooms on both floors were seen during the inspection. Some carpets were noted to be in a poor condition and some areas were in need of re-decoration. Staff advised that they expected the carpets in the corridors which were quite stained to improve with cleaning, however some of the bedroom carpets appeared to have lost their ‘pile’ making it difficult to remove the stains. It was of particular concern that a carpet in a bedroom, which a new resident was due to occupy three days following the inspection, Glenmoor House Nursing Home DS0000012617.V354351.R01.S.doc Version 5.2 Page 19 was very heavily stained and in poor condition. Cleaning staff said that they had been unable to remove the stains and were not aware of any plans to replace the carpet prior to the resident taking up occupancy. One survey from a resident said that the home is always fresh and clean while another said it is sometimes. A sample check during the inspection confirmed that the standard of cleanliness in residents’ rooms varies. One resident’s bedroom was found to be clean and relatives said that someone from the family visits each day and they have no concerns about the cleanliness. However two other residents’ bedrooms in the same area were not maintained to the same good standard and the pillows were hard and lumpy and the mattress stained. As part of the investigation of a recent complaint the Responsible Individual has identified that there had been a decline in general housekeeping across many parts of the home. The Responsible Individual has confirmed that she has made arrangements for cleaning standards to be monitored. Glenmoor House Nursing Home DS0000012617.V354351.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels and staff training needs are not adequately based on meeting residents’ needs. EVIDENCE: The annual quality assurance self assessment submitted to the Commission for Social Care Inspection states “we employ sufficient staff to meet residents needs”. These comments do not appear to be supported by those received in surveys from relatives, residents, staff and discussion with staff. Comments include “They are under resourced staff wise”, “ appear to be very short staffed at times so if they are tied up with a client the remainder are left to their own devices and with dementia are very vulnerable”. Discussion with staff during the inspection, observations and review of a resident’s dependency assessment identified that the staffing problems are likely to be due to a number of issues and need a thorough review to ensure that residents’ needs are adequately met. For example a residents dependency assessment tool, which is used by the company to calculate staffing requirements was reviewed. This identified that a resident described by staff as being one of the more dependent residents due to their psychological needs had been assessed as low dependency. The tool did not Glenmoor House Nursing Home DS0000012617.V354351.R01.S.doc Version 5.2 Page 21 take account of their psychological needs and accurately reflect the staff support required. If the staffing levels are based on an inaccurate dependency scoring then the sufficiency of staffing to meet residents needs, will be directly affected. It is of concern that a similar issue was raised at the last inspection in December 2006. Staff identified a problem with a small number of staff taking sick leave at the last minute making it difficult to arrange cover, this then left them short of staff and finding it difficult to meet residents needs. Comments received from relatives, residents, and health professionals and staff, indicate that the majority of staff do their best and work hard for the residents but that better communication and closer monitoring of some staff is needed. Comments include “The attitude of staff ---very supportive and caring”, “they do have caring skills and interact well with people”, another identifies the fact that one group of employees appear to be more empathetic and caring than another. The annual quality assurance self assessment identifies that over half of the staff team have undertaken a National Vocational Qualification at level 2 which provides them with a basic understanding of the care needs of older people. Discussion with staff and comments received in the surveys including those from health professionals confirmed that all staff do receive training, however more consideration needs to be given to any staff training needs prior to admitting residents with specific health care conditions or needs. To date staff have not received any training on the Mental Capacity Act 2005 and discussion with them indicated that they are not fully aware of their responsibilities and the requirements of this legislation. Given the needs of residents, consideration should be given to providing staff with this training to help them meet their responsibilities and protect residents’ interests. Two staff files were reviewed to check the adequacy of the recruitment process. This confirmed that criminal record bureau checks are carried out as part of consideration of the applicants’ suitability for working with vulnerable people. There was also evidence that references were taken up, however the second page of the employment references for both staff members were missing and in one case it could not be verified that a reference had been requested from the most recent employer. Advice was given to ensure that complete records are kept to confirm that a thorough recruitment process, which protects residents, has been followed. Glenmoor House Nursing Home DS0000012617.V354351.R01.S.doc Version 5.2 Page 22 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 adequate. This judgement has been made using available evidence including a visit to this service. The home needs strong leadership and consistent management to ensure the home is able to meet the needs and protect the health and safety of the residents who live there. EVIDENCE: Standard 31 has not been assessed as this specifically applies to a registered manager. There has recently been a manager registered in respect of Glenmoor House, who had worked there in a management capacity for two years. However at the time of this inspection she was working in another large nursing home owned by the organisation in the area with a view to transferring Glenmoor House Nursing Home DS0000012617.V354351.R01.S.doc Version 5.2 Page 23 there permanently. Since the inspection visit and prior to completion of the report she has confirmed that she has moved permanently to the other home. Although standard 31 has not been assessed as such, as the management of any service is key to residents well being, the arrangements have been taken into account as part of this inspection. An experienced senior nurse was ‘acting up’ as manager at the time of the inspection and also carrying out the role of a nurse. Comments from health professionals and staff confirm that the senior nurse is very competent and has a strong commitment to the well being of residents. Discussion identified that it had not been possible for the Acting Manager to remain in a supernumerary capacity all of the time to enable her to carry out the management role due to the need to cover the rota. The findings of this inspection identify the need for strong and full time management of the home and this is supported by the following comments from relatives received in surveys “staff appear to be doing there own thing and the lack of communication internally is poor”, “No manager in place currently so the home has a lack of direction and I believe its not being run that well”. Small amounts of money are held on behalf of some residents to assist with the payment of items such as hairdressing and chiropody treatment. A sample check of the management of residents’ monies identified that the practice of keeping receipts for hairdressing had ceased, meaning that there was no evidence to support the transactions and protect residents. It was also identified that there had been delays in paying the chiropodist for treatment and debts had been allowed to build up. The administrator was in the process of trying to resolve these problems at the time of the inspection. While there was no evidence from the small sample check of dishonesty, it is recommended that the organisation carry out an audit of monies managed on behalf of residents. The organisation has audit systems in place to check specific aspects of the service provided and an operations manager from the organisation conducts monthly unannounced visits to review and report on the quality of care provided. These records were not reviewed during the inspection, however the findings of the inspection confirm the need for increased review and monitoring of the quality of the service provided. Discussion with staff confirm that there is an ongoing programme for staff to receive training in safe working practices such as movement and handling and food hygiene. Advice was given during the inspection about the importance of keeping chemicals and tools secure, particularly where there are residents with dementia. Glenmoor House Nursing Home DS0000012617.V354351.R01.S.doc Version 5.2 Page 24 A sample check of the servicing of hoists confirmed that these are now serviced regularly and a requirement placed at the last inspection has been met. Oxygen was found to be securely stored, however advice was given regarding the need for signage on the door of rooms where this is stored. Glenmoor House Nursing Home DS0000012617.V354351.R01.S.doc Version 5.2 Page 25 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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 1 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 2 X X 2 Glenmoor House Nursing Home DS0000012617.V354351.R01.S.doc Version 5.2 Page 26 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 OP1 Regulation 5 Requirement A Service User Guide must contain all information detailed in Regulation 5, including clear information about all charges. This would help prospective and current residents and their families make informed decisions. Prior to admission a full assessment must be carried out to identify peoples needs and expectations to ensure that they can be met. Care plans must be specific about the actions required of staff to ensure that residents care and support needs can be consistently met. (A similar requirement with a timescale of compliance of 28/02/07 has not been met) Quantities of medication carried forward from the previous month must be recorded as part of an audit trail. This is to assist in monitoring safe practice in relation to the management of residents’ medication. Timescale for action 15/02/08 2. OP3 14 15/02/08 3. OP7 12 (1) (a, b), 15 28/02/08 4. OP9 13 (2) 28/02/08 Glenmoor House Nursing Home DS0000012617.V354351.R01.S.doc Version 5.2 Page 27 5. OP9 12 (1) (a, b), 13 (2) Staff practice must be reviewed to ensure that residents receive medication as prescribed. (A previous requirement with a timescale of compliance of 15/01/07 has not been met) Carpets and bedding which are in good condition must be provided and replaced as and when necessary. This is to ensure that residents are comfortable and live in a pleasant environment. All parts of the home must be kept clean to provide a pleasant and hygienic environment for residents. There must be sufficient staff to meet residents’ needs at all times. Where staffing levels are based on a calculation of residents dependency this must be an accurate reflection of their needs and staffing requirements, and kept under review. The Commission for Social Care Inspection must be notified as to who is in full time day to day charge of Glenmoor and kept informed of any changes. Where financial transactions are made on behalf of residents’ evidence of these transactions must be kept to protect residents and staff. 15/02/08 6. OP19 16 (2) (c) 15/03/08 7. OP26 23 (2) (d) 15/02/08 8. OP27 18 (1) (a) 15/02/08 9. OP31 8 (1) (2) 30/01/08 10. OP35 13 (6) 30/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Glenmoor House Nursing Home DS0000012617.V354351.R01.S.doc Version 5.2 Page 28 1. 2. OP14 OP15 OP8 3. OP30 4. OP35 Staff should receive training on the Mental Capacity Act 2005 to help them protect residents’ rights. Better communication systems between care staff and also with kitchen staff should be implemented to help ensure that residents’ health care needs and dietary needs and preferences are fully met. Staff training needs should be considered prior to the admission of residents’ with specific health care conditions to help ensure that their needs can be fully understood and met from admission. An audit of residents’ monies should be carried out to ensure that residents are properly protected. Glenmoor House Nursing Home DS0000012617.V354351.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection East Midland Regional Office Unit 7 Interchange 25 Business Park Bostocks Lane Nottingham NG10 5QG 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 Glenmoor House Nursing Home DS0000012617.V354351.R01.S.doc Version 5.2 Page 30 - 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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