Inspection on 14/12/06 for Glenmoor House Nursing Home

This inspection was carried out on 14th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Glenmoor House Nursing Home 26/11/08

Glenmoor House Nursing Home 11/12/07

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 Mrs Kathy Jones Unannounced Inspection 14th December 2006 09:40 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.V321589.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.V321589.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 Vacant Care Home 59 Category(ies) of Dementia - over 65 years of age (22), Old age, registration, with number not falling within any other category (37), of places Physical disability (20) Glenmoor House Nursing Home DS0000012617.V321589.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. To limit service user numbers: The total number of service users accommodated in Glenmoor House Nursing Home must not exceed 59. To limit service user numbers: No one falling within the category of OP may be admitted into Glenmoor House Nursing Home where there are 37 persons of category OP already accommodated in the home. To limit service user numbers: No one falling within the category of PD may be admitted into Glenmoor House Nursing Home where there are 20 persons of category PD already accommodated in the home. To limit service user numbers: No one falling within the category of DE(E) may be admitted into Glenmoor House Nursing Home where there are 22 persons of category DE(E)already accommodated in the home. To limit service user numbers: No one requiring nursing care may be admitted into Glenmoor House Nursing Home where there are 48 persons requiring nursing care already accommodated in the home. To restrict the service user`s accommodation to the first floor: The service users admitted to Glenmoor House Nursing Home who fall within the category of DE(E) may only be accommodated on the first floor. To admit the one named service user: To be able to admit into Glenmoor House Nursing Home one named service user who is 64 years of age as outlined in variation application number V000021343 dated 08/06/05 To admit one named service user: To be able to admit into Glenmoor House Nursing Home the one named service user who is 64 years of age as outlined in variation application number V000023824 dated 16/08/05 To admit one named service user: To be able to admit the additional named service user to Glenmoor Nursing Home who is within the dementia category (DE(E) to the ground floor as outlined in variation application number dated V31156 dated 29/03/06. To admit one named service user: To be able to admit the named person of category DE named in variation application number V35292 dated 19th September 2006. 5. 6. 7. 8. 9. 10. Glenmoor House Nursing Home DS0000012617.V321589.R01.S.doc Version 5.2 Page 5 Date of last inspection 7th February 2006 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. The following fees were provided by the manager as being current at the time of the inspection: • 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.V321589.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 half 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. A pre-inspection questionnaire submitted by manager, two comment cards from residents five from health professionals were received and taken into account. On this occasion no comment cards were received from relatives however the inspector noticed that these were available for relatives in reception to take if they wished. The report of the last inspection carried out on the 7th February 2006 was also reviewed. The information gathered assisted with planning the particular areas to be inspected during the visit. 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 residents’, staff and visitors. The management of residents’ medication was checked. A sample of staff files were also reviewed to check the adequacy of the recruitment procedures. Communal areas and a sample of residents’ bedrooms were viewed and observations were made of residents’ general well being, daily routines and interactions between staff and residents. Verbal feedback was given to the manager on the inspection findings at the end of the inspection. What the service does well: Glenmoor House Nursing Home DS0000012617.V321589.R01.S.doc Version 5.2 Page 7 There is a thorough assessment process in place, which identifies prospective residents needs to ascertain if their needs can be met at Glenmoor House. Staff presented as caring and committed to meeting residents’ needs. On the dementia unit staff were chatting and singing with residents and on the nursing floor the activities organiser was observed to spend some time chatting with individual residents. Residents’ spoken with were happy with the staff and sad that their privacy and dignity is respected. Residents confirmed that the visiting arrangements are flexible and their relatives are made welcome. Residents were happy with the meals provided, special diets are catered for and staff were observed to encourage and offer alternatives to a resident who hadn’t been eating well. Concerns and complaints are taken seriously and residents said they knew how to, and felt able to raise any concerns. What has improved since the last inspection? What they could do better: More detailed information in the statement of purpose would assist prospective residents and their families in deciding if Glenmoor House was the right place for them. Residents’ care plans did not in all cases contain sufficient information about residents needs to ensure that staff are fully informed about the current care needs and the care they are required to give. Medication was another area where some shortfalls were identified, the management of medication was generally good however some medication for a resident had not been recorded creating a risk that this would not be given when required. Some tablets had also been found by domestic staff indicating that staff had not checked that residents had taken the medication. Glenmoor House Nursing Home DS0000012617.V321589.R01.S.doc Version 5.2 Page 8 It was of concern that a member of staff caring for a resident using oxygen had not received any training in its use and had no care plan to provide guidance. Correct procedures for storage and signage relating to the storage had not been followed which could put people at risk in the event of a fire. Procedures for recruiting staff were variable with evidence of good procedures in some cases, however action needs to be taken to ensure that thorough checks are made for all new staff in order to protect residents. Management arrangements and accountability need to be formalised to provide some reassurances to residents and their families. Although the current manager has been in post for a year, the commission for social care inspection has not yet received an application for registration. Although the majority of equipment is serviced regularly there had been a problem with servicing the hoists which the inspector was informed was due to a change of contractor. Although the servicing was carried out on the day of inspection care should be taken when changing contracts to ensure that servicing continues within recommended timescales to avoid putting residents at risk. 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.V321589.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.V321589.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 was not inspected, as the home does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a thorough assessment process in place, which provides reassurances that the needs of people entering the home can be met. However more information about the range of needs the home intends to meet would assist prospective residents and their relatives in making a choice. EVIDENCE: There is a statement of purpose, which provides prospective residents’ and their relatives’ with information, which includes information about the organisation, the home, the philosophy of care and the criteria for admission. Review of the information within the statement of purpose identifies the need to review and revise the information. Some recent changes in senior personnel within the organisation have recently changed and the document needs updating to reflect this. It is also important to ensure accurate Glenmoor House Nursing Home DS0000012617.V321589.R01.S.doc Version 5.2 Page 11 information is provided, as at present the statement of purpose names the manager as a registered manager. The term, registered manager is used to identify someone who has been registered by the Commission for Social Care Inspection. An application for registration has not yet been submitted by the organisation for registration of the manager. Glenmoor House currently provides care for people with a wide range of needs; this is not reflected in the statement of purpose. For example it states that the category is for “Both male and female older people with nursing over 65 years of age”. There is no mention of the separate dementia unit or of the care provided to people under the age of sixty five who have a physical disability. A younger resident told the inspector that they saw Glenmoor as a home for older people. The inspector would advise that the admission criteria is reviewed and that details of how the various needs and different ages will be met within the home are clearly detailed within the statement of purpose. This would assist prospective residents and their relatives in deciding if it is the right home for them and also clearly identify to them arrangements for meeting the varying needs. Comments from two residents received in questionnaires indicated that they didn’t have much choice about the home that they were going to, one because of limited places in the area and the other because it was an emergency situation. However one states, “I choose to live here now because I like it”. A resident spoken to during the inspection recalls receiving some written information but was not well enough to absorb it but remembers that the manager visited her in hospital to do the assessment and gave verbal information about the home which she felt was sufficient for her needs. Records for three recently admitted residents were reviewed during the inspection to check the adequacy of the assessment process. The assessments carried out prior to admission contained detailed information about the resident’s care needs and included information about preferred routines. For example times for getting up and going to bed. Where applicable additional information had been gathered to support the assessment carried out by staff at Glenmoor such as assessments of need carried out by social services and/or health professionals. The information gathered provided sufficient information to enable a decision to be made about whether the prospective residents needs could be met at Glenmoor. Glenmoor House Nursing Home DS0000012617.V321589.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 care and support received by residents is in the main good however the shortfalls in care planning and guidance for staff puts residents at risk of their health care needs not being met. EVIDENCE: Just two completed questionnaires were received from residents’ before the inspection. One of these confirmed that the resident always got the care and support including medical support that they needed, while the other stated they “sometimes” get the care and support and usually get the medical support that they need. Five questionnaires were received from General Practitioners. Three were satisfied with the overall care provided while two stated they were not, four of Glenmoor House Nursing Home DS0000012617.V321589.R01.S.doc Version 5.2 Page 13 the five felt that the home communicated clearly with them and worked in partnership with them. Of the five responses two felt that staff do not have a clear understanding of residents needs and three that there was not always a senior member of staff to confer with. However one member of staff was particularly named as “knowing what was going on”. Care plans, which are in place to guide staff as to how to meet residents’ needs, were reviewed to check that they were reflective of residents needs and that the instructions to guide staff were sufficient to meet their needs. This identified that the care plans in place are not fully reflective of residents needs, for example a night care plan identified that a resident does not go to sleep until between 3am and 6am but there was no information about arrangements for meals during this period. Staff advised that the resident was given a hot main meal around 11pm however this was not identified in the plan therefore any new or agency staff would not be made aware of the arrangements. There is a comprehensive set of records, which are designed to identify residents’ needs and guide staff in meeting them; however advice has been given regarding the organisation of the records. Records relating to pressure area assessment, care planning and treatment were contained within different parts of the file with some records mixed in with blank forms making it difficult for staff to locate the relevant information. Records for a recently admitted resident who staff had told the inspector had pressure ulcers on admission to Glenmoor from hospital were reviewed. These identified that there was a body mapping record, which referred to the condition of the pressure ulcers on admission however it was dated fourteen days after admission. Information about required treatment was included in the body mapping record however this had not been transferred to the wound care plan which would be the document used to guide staff in the care required. This care plan, which should prescribe the care, just stated, “dress wounds daily or more often if needed” and “use prescribed dressings”. The inspector was satisfied from discussion with staff and a resident that pressure sores were being treated which was confirmed by entries in the daily records however the lack of an adequate care plan detailing the prescribed treatment puts residents at risk. A member of staff was observed to be sensitive and caring to a resident in the latter stages of life. However observations and discussion with the staff member identified that although the resident was on oxygen there was no care plan for this and staff had received no guidance or training in the use of oxygen. Oxygen cylinders stored in the treatment room were not stored safely, for example they were not chained to the wall and there was no warning notices on the door to highlight the risk in the event of a fire. The management of residents’ medication was reviewed on the first floor. There are procedures in place for checking and recording medication received, Glenmoor House Nursing Home DS0000012617.V321589.R01.S.doc Version 5.2 Page 14 administered and returned to the pharmacist, however a sample check identified some shortfalls in staff practice. For example some medication was found in the trolley prescribed for a resident, which had not been recorded on the medication administration sheet. It transpired that the medication had been prescribed, to be taken prior to medical treatment; however there was a risk the medication would not be given, as there was no record to prompt staff. Several tablets had been found by domestic staff in residents’ rooms indicating that staff were not checking medication was actually being taken. The registered manager confirmed that she would investigate this matter and review staff practice. Residents spoken to were satisfied that their privacy and dignity was respected and during the inspection the inspector observed staff to speak with and about residents respectfully. Personal care was provided in privacy however the inspector observed that the majority of bedroom doors where residents were nursed in bed were open unless staff were assisting with personal care. Two residents were specifically asked by the inspector for their views on this, neither recalled being asked about preferences but both were happy with their doors open as they liked to see people come and go and did not see this as a breach of their privacy. The inspector would recommend that residents’ individual preferences in relation to having bedroom doors open or closed are checked with them to ensure that a proper choice is made and privacy protected. Glenmoor House Nursing Home DS0000012617.V321589.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 good. 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 and efforts are made to accommodate different needs in relation to mealtimes. EVIDENCE: Observations and discussion with residents’ and staff throughout the inspection identified that the routines are flexible. There was a delay in residents on the nursing floor receiving assistance with washing and dressing on the morning of the inspection with some residents waiting for assistance until late morning. The inspector was informed that this was because some of the hoists used for movement and handling were not in use (This issue is covered in the management section of the report). Residents spoken with were understanding of the reasons and did not have any concerns about the impact on their routines and there was no indication of this being a regular occurrence. Glenmoor House Nursing Home DS0000012617.V321589.R01.S.doc Version 5.2 Page 16 An activity organiser is employed in the home and at the time of the inspection a volunteer was also assisting with activities. Activities are rotated between the two floors of the home to enable more people to be involved. In addition to the organised activities the activity organiser was observed to spend some individual time with residents chatting to them in their rooms, which is particularly important for residents who are being nursed in bed. Comments received in a questionnaire from a resident identified that activities are not provided as often as they would like. The activity organiser advised that she plans to identify activities for each individual, which may then assist with having a programme, which matches the expectations of the individual. There was a relaxed atmosphere on the dementia unit and staff were observed to be chatting and singing with residents. The inspector spoke with a resident and his visitors who confirmed that the visiting arrangements were flexible and that they are able to visit in private. Discussion with a relative identified that a resident felt that they had more control over their lives since admission to the home and that they were able to come and go as they pleased and had the support that they needed. Discussion with staff identified that meal times can be flexible. For example staff said a main meal is provided late at night for one resident due to her current sleeping pattern and that she is encouraged to have snacks at regular intervals. However as identified in the previous section this needs to be identified within her care plan to ensure that any new or agency staff are aware of this routine. The cook was aware of those residents’ who required a special diet. Residents’ preferences including cultural or health related are respected in relation to meals provided. Residents spoken with during the inspection were happy with the standard of meals provided and confirmed that they had a choice. The two residents who sent in questionnaires were also happy with the meals. The cook confirmed that she liaises with nursing and care staff and residents regarding special diets either for cultural reasons or medical. The cook has attended some training on nutrition and advised that she is using food supplements where prescribed as part of the meal rather than separately to make the food more tempting to residents. Glenmoor House Nursing Home DS0000012617.V321589.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a positive approach to the management of complaints with people being encouraged to raise any concerns. Complaints are taken seriously and appropriate action is taken to address the concerns. EVIDENCE: Two complaints were received by the Commission for Social Care Inspection since the last inspection. One complaint was about cleanliness in the home and was forwarded to the registered provider for investigation. The other related to care planning for a particular resident, this complainant was referred to social services who were purchasing the care. Review of the complaints record indicated a thorough approach to the management of complaints with records kept of any actions taken as a result of a concern or complaint. A sample check of these confirmed that appropriate action had been taken to address the concerns identified, which ranged from spills on the carpet to shortfalls in care. The relatively high number of recorded concerns and complaints since the last inspection in February 2006 (17) indicated the registered manager encourages people to raise all concerns, including relatively minor ones, which are taken seriously. The two residents who forwarded questionnaires confirmed that they knew how to make a complaint and had someone to talk to if they were not happy. Glenmoor House Nursing Home DS0000012617.V321589.R01.S.doc Version 5.2 Page 18 Residents spoken with during the inspection confirmed that they felt able to raise any concerns that they may have and were satisfied that they would be dealt with appropriately. Staff spoken with were aware of their responsibilities in protecting the vulnerable people in their care. Glenmoor House Nursing Home DS0000012617.V321589.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. The home was clean, comfortable and in good decorative order providing a pleasant environment for Residents. EVIDENCE: Communal lounges and dining rooms and a sample of residents bedrooms were viewed during the inspection. Residents on the ground floor are those who require nursing care or have a physical disability. The first floor is divided into two areas with a separate dementia care unit and another area for residents requiring some assistance through old age. One of the residents who sent in a questionnaire indicated that their room was not always clean though the day rooms were. No name was given therefore it was not possible to check the specific concerns however residents spoken with Glenmoor House Nursing Home DS0000012617.V321589.R01.S.doc Version 5.2 Page 20 during the inspection were happy with the standard of cleanliness in the home. All areas of the home seen during the inspection were clean and there were no offensive odours. The carpets in the corridors on the ground floor were noted to be stained which staff advised had recently been cleaned however were stained again due to the wheelchairs. The inspector was informed that the carpet cleaner had broken and that they were waiting for a replacement to be delivered. Residents’ bedrooms were comfortably furnished and those who were able to express a view said that they were happy with the facilities. Residents’ and their families are encouraged to take in personal items such as photographs, pictures and ornaments to enable the resident to have familiar items around them. Communal areas of the home had been decorated for Christmas providing a festive atmosphere. The dining room in the dementia unit was noted to be poorly lit, one of the bulbs required replacing however it was felt that even with existing lights all operational the lighting levels might still be quite dim. Glenmoor House Nursing Home DS0000012617.V321589.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some shortfalls were identified in relation to staff recruitment procedures, which do not provide adequate care and protection for residents. EVIDENCE: Of the two questionnaires received from residents’, one said that they could do with more staff and the other said that staff are sometimes available but “they are always just seeing to someone else”. Previous requirements have been made in relation to the need to review staffing levels. An assessment of the dependency level of each resident is held on his or her files, and the manager advised that this is used to calculate staffing levels. However it was of concern that the completed assessment for a resident who according to their care plan is unable to mobilise independently, requires two or three carers for movement and handling and is nursed in bed identified that they had been assessed as low dependency. It was difficult to ascertain on the day of inspection how much the delays in assisting residents was due to the problems caused by the maintenance issues with the hoists and how much was due to the staffing calculations. In view of this and the findings in relation to the dependency tool the manager was advised to review staffing levels with these points in mind taking account of Glenmoor House Nursing Home DS0000012617.V321589.R01.S.doc Version 5.2 Page 22 the practical outcomes for residents i.e. the length of time they are having to wait for assistance. The pre-inspection questionnaire submitted by the manager identified an ongoing programme of staff training, which was supported by discussion with staff during the inspection. Approximately seventeen percent of staff had completed a National Vocational Qualification (NVQ) at least level 2 or held an equivalent qualification which is a relatively low percentage however additional staff were undertaking the qualification. The NVQ provides staff with a basic understanding of care practices and the needs of older people, which is considered important in helping ensure that their needs are met. The activities organiser advised that she has undertaken some training to train other staff in dementia care since the last inspection and plans in the New Year to train other staff. While there was evidence that there is a programme of training in place consideration needs to be given to ensure that staff have the necessary training to meet the needs of individual residents. For example as detailed in the health and personal care section of this report a member of staff had received no training in the use of oxygen, which a resident was receiving, and she was required to monitor. Two staff files were reviewed to check the adequacy of the recruitment process. One of the files indicated that a thorough recruitment process had been followed which included obtaining appropriate references and undertaking a criminal record bureau check prior to the staff member started working in the home with vulnerable people. Review of a second file identified that the criminal record bureau application had been returned as the information provided was incomplete and there was no evidence on file that a new application had been submitted. The two references that had been obtained looked as though they were from colleagues rather than being from an employer and there was no evidence that this or the reasons had been checked. The manager advised that this second member of staff was on the ‘bank’ list and used to cover staff absences, however would not be used until the queries about the recruitment process had been resolved satisfactorily. Advice was given to check the recruitment process for other staff to protect residents. Glenmoor House Nursing Home DS0000012617.V321589.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management systems are in place to protect the health, safety and welfare of residents’ however some shortfalls such as delays in servicing equipment could put residents’ at risk. EVIDENCE: Standard 31 has not been assessed as this specifically applies to a registered manager. Although the manager had been in post for a year at the time of the inspection, no application for registration has yet been submitted to the commission for social care inspection (CSCI) by the organisation. It is the expectation of CSCI that part of the organisations recruitment process for managers is a determination of their ‘fitness’ for registration and that a timely Glenmoor House Nursing Home DS0000012617.V321589.R01.S.doc Version 5.2 Page 24 application for registration is made. This issue was raised in a meeting with a senior representative of the organisation and the manager has advised that she is in the process of completing an application. While appropriate management systems are in place and the findings of the inspection indicated that the current manager has worked with staff, residents and their relatives to improve standards of care within the home some shortfalls still remain. The inspector would advise that consideration is given to the need for any additional management support in order to ensure that continued improvements are made and maintained. 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 two residents’ monies identified that records of all transactions are kept and the money held corresponded with the record. The organisation has audit systems in place to check areas such as the management of medication and the manager also advised that she sample checks residents care plans. Comment cards are available in the home and the manager advised that she intends to establish a more formalised quality assurance process whereby views on the quality of care are sought on a regular basis. However review of the complaints/concerns record indicated that the manager seeks relatives’ views and acts on them. An operations manager from the organisation conducts monthly unannounced visits to review and report on the quality of care provided. The inspector has noted from reports of the visits that some of these visits have been undertaken outside of normal office hours, which is considered important for a service providing twenty four hour care. Records and 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. The pre-inspection questionnaire identifies that equipment such as fire and electrical equipment and the central heating system are serviced regularly. However at the time of the inspection it was apparent that there had been concerns about the frequency of servicing for the hoists, which a large number of residents are reliant on for movement and handling. The inspector was advised that the organisation had changed the service contractor and Glenmoor had put in a request for their hoists to be serviced on 21 June 2006. On the day of the inspection the engineer was servicing the hoists however it was of concern that this visit had only been prioritised as a result of staff refusing to use them. Following the service engineer’s visit some of the hoists were put out of action until parts could be obtained and repairs made. Failure to maintain such crucial equipment could put residents’ and staff at risk. Glenmoor House Nursing Home DS0000012617.V321589.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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 2 Glenmoor House Nursing Home DS0000012617.V321589.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 OP8 2. OP9 Regulation 12 (1) (a, b), 15 Requirement Timescale for action 28/02/07 3. OP8 OP9 4. 5. OP9 OP29 6. OP38 Care plans must be reflective of residents’ current health and welfare needs and sufficiently detailed to guide staff in meeting needs. 12 (1) (a, All prescribed medication b), 13 (2) received for residents’ must be entered on the administration record. 13 (2), 13 Where residents’ are prescribed (4) (c), 18 oxygen, staff must receive (1) (c) (i) training regarding administration and storage. 12 (1) (a, Staff practice must be reviewed b), 13 (2) to ensure that residents receive medication as prescribed. 19 (1) (a, Staff must not commence work b, c) in the home until satisfactory information has been obtained to confirm their suitability to include criminal record bureau clearances and appropriate references. 13 (4) ( Equipment provided for c), 23 (2) residents, including hoists must (c ) be serviced regularly and kept in good repair. 15/01/07 15/01/07 15/01/07 15/01/07 15/01/07 Glenmoor House Nursing Home DS0000012617.V321589.R01.S.doc Version 5.2 Page 27 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 OP1 Good Practice Recommendations The statement of purpose should include clear information about the needs of the people Glenmoor is able to provide care for and how their needs will be met. Glenmoor House Nursing Home DS0000012617.V321589.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB 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.V321589.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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