Inspection on 21/08/07 for Glentworth House Nursing Home

This inspection was carried out on 21st August 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

Glentworth House Nursing Home 21/01/09

Glentworth House Nursing Home 25/07/08

Glentworth House Nursing Home 19/06/06

Glentworth House Nursing Home 23/11/05

Glentworth House Nursing Home 31/05/05

Glentworth House Nursing Home 14/01/05

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

CARE HOMES FOR OLDER PEOPLE Glentworth House Nursing Home 40-42 Pembroke Avenue Hove East Sussex BN3 5DB Lead Inspector Niki Palmer Key unannounced Inspection 21 August 2007 10:45 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 Glentworth House Nursing Home DS0000062476.V345601.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. Glentworth House Nursing Home DS0000062476.V345601.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Glentworth House Nursing Home Address 40-42 Pembroke Avenue Hove East Sussex BN3 5DB 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) 01273 720044 01273 723660 manager@glentworth-house.co.uk Whytecliffe Limited Vacant Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33), Physical disability (33) of places Glentworth House Nursing Home DS0000062476.V345601.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service Users should be sixty-five (65) years or over on admission. The service can provide up to thirty-three (33) nursing places and thirty-three (33) social care places. The maximum number of service users to be accommodated is thirtythree (33). 19th June 2006 Date of last inspection Brief Description of the Service: Glentworth House is a large detached nursing home with a purpose built extension. It is situated in a quiet residential area of Hove, close to local shops and public transport. Restricted on street parking is available at a cost of 50 pence per hour. Parking time is restricted to a maximum of two hours, although residents and visitors are entitled to visitor parking permits, which are available on request from the home. The home is located over three floors and consists of six double and 21 single rooms. All parts of the home can be accessed by a lift. The home has a wellmaintained rear garden, which is easily accessed from the ground floor lounge. Communal areas throughout the home are limited. The home was purchased by the current Providers approximately two and a half years ago. Since this time they have undertaken extensive refurbishment of the home, which is of a high standard. The home provides nursing care and support to residents who are both privately funded and those who are funded by Social Services. The local authority have contracted five beds for Transitional and Interim Care. The purpose of this is to offer nursing support and rehabilitation to residents for up to a maximum of eight weeks (usually following discharge from hospital prior to returning home). The local authority provides specialist support such as physiotherapy. Specific rooms have been designated for this care. The fees currently charged range from £445 - £650 per person per week. Additional costs are charged for hairdressing, chiropody and newspapers. The Provider also owns one other home in Saltdean, East Sussex. Glentworth House Nursing Home DS0000062476.V345601.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at Glentworth House will be referred to as ‘residents’. This unannounced inspection took place on Tuesday 21 August 2007 and lasted seven hours. 31 residents were accommodated on the day of the inspection. In order to gather evidence on how the home is performing, individual discussions took place with six residents, four visiting relatives / friends and five members of staff. The acting Manager was available for the duration of the inspection, whilst one of the Providers was present for the latter part of the day. Following the inspection, telephone contact was made with the Older People’s Specialist Nursing Team who work closely with the home. Their comments about the overall care provided at the home were very positive and have been reflected throughout this report. Three care records were examined on the day of the inspection in some detail for the purpose of monitoring care. Other records and documentation inspected included: the home’s preadmission assessment and care planning procedures, medication practices and procedures, the provision of activities and food, quality assurance systems, complaints procedure and the systems in place to safeguard residents from harm, the recruitment of staff and the provision of relevant training. Most areas of the home were seen. A detailed Annual Quality Assurance Assessment (AQAA) was completed and returned by the acting Manager of the home prior to the inspection. This gave the service the opportunity to tell the CSCI about how they are performing including: how they ensure that people using the service views are upheld and incorporated into what they do, what the service does well, identify any barriers to improvements that have been faced over the past 12 months and how the service plans to make improvements within the next 12 months. Glentworth House Nursing Home DS0000062476.V345601.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Improved medication procedures ensure that all medication administration records are signed. In addition, individual photographs have been placed on the medication administration forms. This helps to ensure that all prescribed medicines are administered at the correct time to the correct person. Call bells are left within easy reach of all residents. This enables residents to call for staff for help and support when they need it. Following the last inspection, in which some residents expressed some dissatisfaction with the choice, variety and standard of food, the cook asked all residents to complete a satisfaction survey and encouraged residents to put forward a number of comments and suggestions about how things could be improved. Since this time the cook asks each person on a daily basis whether Glentworth House Nursing Home DS0000062476.V345601.R01.S.doc Version 5.2 Page 7 they would prefer the cooked lunch as per the menu, or an alternative such as jacket potatoes, omelettes or a salad. The numbers of staff on duty in the daytime have been increased. This ensures that residents’ assessed needs are met, particularly during the busiest times of the day. The Manager has organised a separate file for all complaints and concerns. This helps to ensure confidentiality both to the complainant and to any persons mentioned in the complaint. Additional chairs have been purchased for residents to have in their rooms for guests. What they could do better: Two requirements are outstanding from the last inspection report: The home provides a high standard of nursing care to residents, but this is not being reflected in individual care plans. Residents’ personal care needs are at risk of not being met due to care plans and risk assessments not being completed and reflecting actual current practice. A concern was raised at the previous inspection in respect of how the home manages residents’ personal laundry. It was disappointing to note that during this inspection residents and relatives again expressed some dissatisfaction with this. They explained that some items of clothing had gone missing, whilst other items had not been cared for properly, which had caused them to shrink and be ruined. Five requirements have made been made as a direct result of this inspection: The home’s systems for ensuring that all residents have an assessment of need undertaken prior to moving in to the home need to be improved. The Manager is required to undertake individual risk assessments for the use of bed rails for all residents in order to determine whether or not they are required in order to maintain residents’ personal safety. A number of residents are prescribed medicines on an as and when required basis (PRN). The medication administration records (MARS) do not currently provide nursing staff with any guidance as to when they should be offered / administered, or what they are for. Some mandatory training is outstanding for a high proportion of the staff team including: fire safety, infection control, health and safety, First Aid and Safeguarding Adults from Abuse. Glentworth House Nursing Home DS0000062476.V345601.R01.S.doc Version 5.2 Page 8 The Manager is required to implement a formal supervision structure. This will help to ensure that all staff are appropriately supervised and allow employees and the Manager to discuss all aspects of practice and help to identify any training needs. 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. Glentworth House Nursing Home DS0000062476.V345601.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 Glentworth House Nursing Home DS0000062476.V345601.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 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s systems for ensuring that all residents have an assessment of need undertaken prior to moving in to the home need to be improved in order to determine all residents’ health and personal care needs. EVIDENCE: Most residents spoken with said that they had been informed about the home prior to admission from their relatives and / or Adult Social care Worker. A number of relatives said that they had had the opportunity to visit the home informally prior to their relative moving in, although most residents said they had not. Residents, their representatives and the acting Manager of the home confirmed that all prospective residents have an assessment of need undertaken prior to admission. The purpose of this is to determine what the person’s health and personal care needs are and whether or not the home can meet them. Glentworth House Nursing Home DS0000062476.V345601.R01.S.doc Version 5.2 Page 11 Three care records were viewed on the day of inspection, however only two pre-admission assessments could be found in individual care records. The two that were seen were found to be quite brief with little attention being paid towards residents’ personal and social care needs. In addition, it was not clear in one person’s records what their primary nursing needs were, nor had the assessment been signed and dated by the person completing the assessment. It was therefore not possible for the Inspector to determine on what basis this person had been accepted by the home. These concerns were discussed with the acting Manager of the home on the day of inspection who said that in line with the home’s revised person centred care planning procedures, the home’s pre-admission assessment procedures will be reviewed. The home is required to ensure that detailed assessments are undertaken for all prospective residents prior to admission. These must clearly identify what the person’s primary nursing needs are, what their personal and social care needs are and be signed and dated by the person undertaking the assessment. These must be made available for inspection. The local authority have contracted five beds for Transitional and Interim Care. The purpose of this is to offer nursing support and rehabilitation to residents for up to a maximum of eight weeks (usually following discharge from hospital prior to returning home). The local authority provides specialist support such as physiotherapy. Specific rooms have been designated for this care. The Inspector spoke with a number of residents and their relatives who were using the home on a short-term basis only and it was pleasing to note that all feedback was very positive. A high number said that they would most definitely recommend it to others. Intermediate care is not provided. Glentworth House Nursing Home DS0000062476.V345601.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 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a high standard of nursing care to residents, but this is not being reflected in individual care plans. Residents’ personal care needs are at risk of not being met due to care plans and risk assessments not being completed and reflecting actual current practice. EVIDENCE: Three individual plans of care were seen on the day of inspection. Whilst there was evidence to show that a number of healthcare assessments had been undertaken including: manual handling, nutritional screening and pressure area care, all were noted to be focused on outcome scores and fail to provide nursing and care staff with detailed information in respect of what they need to do to meet individuals’ needs. For example where it had been determined that a person is at high risk of developing pressure area care damage (pressure sores), there was no information recorded about what staff need to do to minimise the risks; albeit that pressure area turning charts were seen in individual bedrooms. Glentworth House Nursing Home DS0000062476.V345601.R01.S.doc Version 5.2 Page 13 Although manual handling assessments had been completed there was no clear information in respect of how that person needs to be supported safely e.g. with a hoist, wheelchair or with one or two carers / nursing staff. Therefore there was not sufficient detail in the care plan to allow a nurse or carer that was unfamiliar with the resident to give all the care required. This is outstanding from the previous inspection. Most residents residing at the home are provided with bedrails. The purpose of this is to reduce the risk of falls from bed. In response to a requirement made at the previous inspection, nursing staff are now seeking the consent of residents and their representatives for the use of these, however through discussions with staff it emerged that not all residents actually require them. As the unnecessary use of bed rails can increase the level of risk to residents e.g. should someone attempt to climb over them to get out of bed, the Manager is required to undertake individual risk assessments for the use of bed rails for all residents in order to determine whether or not they are required in order to maintain residents’ personal safety. It must be noted that all plans of care seen were noted to be heavily focused on meeting the healthcare needs of residents, with little or no attention being paid on meeting their personal or social care needs. The acting Manager spoke in detail with the Inspector about how she is keen to change the current care planning format. She explained that she will be implementing person centred planning, which will focus on the holistic needs of residents in addition to their physical nursing needs. A training day for RGN’s had been planned for the day after the inspection. The home’s progress with this will be followed up at the next inspection. All residents appeared well cared for and evidence was seen that advice is sought from other healthcare professionals, including General Practitioners, Older Persons Nurse Specialists and a Community Psychiatric Nurse. This was confirmed by a member of the Older People’s Specialist Nursing Team: “They do manage the care of residents very well and identify and seek support if there are problems from outside specialist agencies”. Since the last inspection a ‘clinic room’ has been completed. This is kept locked at all times and is used for the storage of controlled drugs and other nursing equipment such as needles, syringes, dressings and oxygen. A sample of controlled drugs were randomly checked and found to be in order. Individual prescribed medicines are stored in residents’ own bedrooms. Most regular medicines are dispensed from blister packs that have been prepared and delivered by a local pharmacist on a monthly basis. Registered Nurses only hold responsibility for administering these. One of the Senior Nurses is responsible for the reordering of medicines. All unused / omitted medicines are appropriately disposed of through a licensed waste disposal company. Glentworth House Nursing Home DS0000062476.V345601.R01.S.doc Version 5.2 Page 14 Whilst all medicines were found to be appropriately stored with clear and accurate records maintained including individual photos being present on all MARS, two minor shortfalls were noted on the day of inspection: A number of residents are prescribed medicines on an as and when required basis (PRN). The medication administration records (MARS) do not currently provide nursing staff with any guidance as to when they should be offered / administered, or what they are for. The home is required to ensure that clear guidance is recorded on the MARS for all medicines that are prescribed on an as and when required basis. On some occasions e.g. when residents are prescribed short-term prescriptions such as antibiotics or topical creams, nursing staff handwrite these onto the MARS. In order to reduce the risk of human error, it is recommended that all handwritten entries are countersigned. This will help to ensure that the correct medication, time and dose are recorded. Each of the residents spoken with said that staff treat them at all times with dignity and respect. This was evident on the day of the inspection. Each of the residents are addressed by their preferred term and have access to private areas within the home (usually their own bedrooms). It was pleasing to note that all call bells were within easy reach of all residents seen on the day of inspection and all feedback received from residents in respect of the amount of time it takes for staff to attend to them was generally very positive. This is improved since the last inspection. A concern was raised at the previous inspection in respect of how the home manages residents’ personal laundry. It was disappointing to note that during this inspection residents and relatives again expressed some dissatisfaction with this. They explained that some items of clothing had gone missing, whilst other items had not been cared for properly, which had caused them to shrink and be ruined. This requirement is outstanding. The acting Manager and Older People’s Nurse Specialist informed the Inspector that the home have recently entered into the Gold Standard Framework Awards. This is a three stage Quality Assurance programme, which aims to build on a step-by-step approach to improve the supportive and palliative care of people in nursing homes as they near the end of their lives. It focuses on optimising communication, planning ahead, continuity of care, team working and symptom management. The home’s progress with this will be followed up at the next inspection. Glentworth House Nursing Home DS0000062476.V345601.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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A variety of appropriate activities are planned, residents have the choice of participating or not. Relatives and visitors are made to feel welcome at the home. The provision of food is improved. EVIDENCE: As already mentioned, the home’s current care planning format does not allow for individuals’ personal preferences in respect of social activities to be recorded, although it must be noted that all feedback received on the day of inspection in relation to this was positive from both residents and their relatives. All activities are planned on a monthly basis by a member of care staff. The Inspector was informed that these are written up and given out to each resident on an individual basis and that is their choice as to whether or not they join in. Different activities include: bingo, painting / arts and crafts, cake making and reminiscence. Once a month an external person is bought in by the home such as a live music entertainer. Some of the residents commented that they are also taken out by relatives. It must be noted that no activities were observed on the day of inspection. Glentworth House Nursing Home DS0000062476.V345601.R01.S.doc Version 5.2 Page 16 All visitors spoken with confirmed that that they are always made to feel welcome by the home and that they are encouraged to visit at anytime. Most said that they often arrive unannounced and are usually offered a hot drink and somewhere quiet to meet with their relative / friend, which is usually in individual bedrooms due to the limited communal areas. All feedback received in respect of this was positive. Residents, the Manager and other staff spoken with confirmed that residents are offered choice whenever this is possible. For example, the clothes they would like to wear each day, the food they would like to eat and the activities that they participate in (or not). Following the last inspection, in which some residents expressed some dissatisfaction with the choice, variety and standard of food, the cook asked all residents to complete a satisfaction survey and encouraged residents to put forward a number of comments and suggestions about how things could be improved. Residents confirmed that since this time the cook asks each person on a daily basis whether they would prefer the cooked lunch as per the menu, or an alternative such as jacket potatoes, omelettes or a salad. Evidence of alternatives being provided was seen on the day of the inspection. It was pleasing to note that all feedback received from residents and their relatives was exceptionally positive on this occasion with one person saying “That’s what the home does best, feed us with good food” The home was awarded with a Clean Food Award by Brighton and Hove City Council in September 2006. Glentworth House Nursing Home DS0000062476.V345601.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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and others can be assured that the home will deal with any concerns or complaints that arise. Residents will be better protected from potential harm, neglect and abuse once all staff have received specific training in this area. EVIDENCE: The home has a detailed complaints procedure, which is on display at the main entrance to the home. It gives clear guidance with regards to how a complaint can be made and how the complainant can expect it to be dealt with. Residents and relatives spoken with said that they would feel confident in raising concerns directly with the Manager or Provider of the home. No formal complaints have been received by either the home or the CSCI since the last inspection, however the Manager did explain that on occasions she does receive minor verbal concerns by residents and their relatives, which she said are always dealt with immediately and rectified. This was confirmed by residents and others. In response to a recommendation made at the last inspection, the Manager has organised a separate file for all complaints and concerns. This helps to ensure confidentiality both to the complainant and to any persons mentioned in the complaint. Glentworth House Nursing Home DS0000062476.V345601.R01.S.doc Version 5.2 Page 18 The home has a detailed Safeguarding Adults from Abuse policy and procedure in place in line with revised local multi-agency guidelines. Whilst some staff said they had received the appropriate adult protection training, only nine out of the 24 nursing and care staff have. The home is required to ensure that all nursing and care staff receive up to date Safeguarding Adults from Abuse training. Residents are protected by the home’s robust recruitment policies and procedures. Glentworth House Nursing Home DS0000062476.V345601.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, 20, 23, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Extensive refurbishment of most areas of the home has been undertaken. Glentworth House now present as a well-maintained, homely and comfortable place to live. EVIDENCE: The home is located over three floors and consists of six double and 21 single rooms. All parts of the home can be accessed by a shaft lift. The home has been under new ownership for two and a half years. Since this time a tremendous amount of refurbishment has taken place, which is to a very high standard. All residents, relatives, others and staff commented that this has made a vast improvement to the overall ‘feel’ of the place. Most rooms have en-suite bathrooms consisting of washbasin and WC. Those that do not, have washbasins in the rooms. Glentworth House Nursing Home DS0000062476.V345601.R01.S.doc Version 5.2 Page 20 As bedrooms have become vacant they have been totally refurbished. Those seen had been personalised to individuals’ preferences. Following a recommendation made at the previous inspection, the Provider has recently purchased new chairs for residents to have in their rooms for guests, however on the day of the inspection they were all being stored in one of the vacant rooms. Two of the shared bedrooms were noted to be in a poor decorative state of repair, although the Provider assured the Inspector that these will be prioritised in due course. A maintenance person was present during the course of the inspection. He was noted to be re-hanging curtains in two of the ground floor bedrooms and making general repairs throughout the home. Hallways, bathrooms and the sluice area have been redecorated since the last inspection. The gardens to the front and rear of the home are well maintained with all residents able to access the secluded rear garden, which includes a patio and seating. Residents were observed to make good use of the rear garden on the day of inspection. There is one main lounge on the ground floor and two very small lounge areas on the first floor. It must be noted that there is insufficient space in the main lounge to accommodate all residents at any one time. At present, there is no separate dining area, therefore those residents who choose to do so, eat their food in the lounge. Due to the limited space available, staff were observed to support residents with their meals, whilst kneeling on the floor. The Manager confirmed that planning permission has recently been granted to add a conservatory area to the rear of the property. It is anticipated that this additional space will offer residents more choice in respect of where they take part in activities and mealtimes. All areas of the home were noted to be clean on the day of inspection. Glentworth House Nursing Home DS0000062476.V345601.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers of staff deployed to work in the home are greatly improved. This ensures that residents’ needs are met by sufficient numbers of staff on duty. Residents are safeguarded by the home’s robust recruitment procedures. The home’s systems for ensuring that all staff receive regular mandatory training need to be improved. EVIDENCE: Evidence provided within the home’s AQAA confirmed that the home employs a total of eight Registered Nurses, 17 care staff and eight others including a maintenance person, kitchen staff and domestic staff. The vast majority of staff are female, although two male carers are employed. Staffing rotas confirmed that there is always one Registered Nurse on duty at all times (in addition to the Manager) and a minimum of eight care staff in the mornings, five in the afternoons and two at night. This is greatly improved since the last inspection. All feedback received from residents and others confirmed that staffing levels within the home are improved. The Manager confirmed that all job advertisements are placed in local newspapers. All interested applicants are required to complete an application Glentworth House Nursing Home DS0000062476.V345601.R01.S.doc Version 5.2 Page 22 form, alongside the required Criminal Record Bureau (CRB) and Protection of Vulnerable Adults First (PoVA) (police checks), health declaration and Equal Opportunities Monitoring Form. Three recently appointed staff members’ recruitment files were examined. It was pleasing to note that there was clear documentary evidence available for inspection including two written references, CRB and PoVA First checks. A new induction pack for all new staff was introduced by the home in April 2007. This is based on meeting the outcomes of Skills for Care and equips newly appointed staff to understand and meet the health and personal care of residents. Of the 17 care staff employed, seven have achieved at least NVQ Level 2 in Care, whilst a further 10 are currently working towards this qualification. 17 staff completed a training course in April 2007, which was aimed at working with people with dementia, whilst a further two are due to commence this in September 2007. The Provider also confirmed that a number of staff have been identified to undertake equality and diversity training and nutrition in older people in due course. Whilst staff commented that the level of training provided by the home is good, it was of concern to note that some mandatory training is outstanding for a high proportion of the staff team including: fire safety, infection control, health and safety, First Aid and Safeguarding Adults from Abuse. This was discussed with the Registered Provider and Manager on the day of inspection and a requirement made. Glentworth House Nursing Home DS0000062476.V345601.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): 31, 32, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The overall management of the home is improved. The health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: The home has been without a Registered Manager in post for over one year. A new acting Manager was appointed in March 2007 who was available for the duration of this inspection. She is a Registered General Nurse who has been practising mostly in hospital settings since 1991. This is her first experience of working in a care home setting. She has recently started to work towards her Registered Manager’s Award (RMA) and is currently in the process of applying to the CSCI to become the Registered Manager of the home. Glentworth House Nursing Home DS0000062476.V345601.R01.S.doc Version 5.2 Page 24 All of the residents, relatives, staff and others spoke highly of her leadership and management skills. Indeed, many commented that the overall management of the home has improved since she has been in charge. They commented that she is approachable, honest and knowledgeable. The acting Manager spoke in detail with the Inspector about how she intends to implement a clear quality assurance system in order to determine what the home is doing well and where there are areas for improvement. She explained that she is still relatively new to the role and that she hopes to implement formal methods of feedback from residents, their relatives and others. This has not been reflected as a requirement at this time but will be followed up at the next inspection. The home has no involvement in residents’ finances. The Provider explained that any additional requests for money such as toiletries, hairdressing and chiropody are invoiced to relatives or appointed others on a monthly basis. The acting Manager of the home commented that there is currently no formal supervision structure in place within the home, although she has recently been undertaking staff appraisals. The Manager is required to implement a formal supervision structure. This will help to ensure that all staff are appropriately supervised and allow employees and the Manager to discuss all aspects of practice, the philosophy of care in the home and help to identify any training needs. Concerns were raised during the home’s last three inspection reports in respect of how the home ensures the safety of residents from fire. Despite a fire risk assessment being in place and the home having a ‘closed door policy’ for residents, it was of serious concern to note that a number of fire doors were continuing to be wedged open with door wedges and furniture on the day of this inspection. One resident also commented that she has her door wedged open at night (with a dining trolley). Whilst some fire doors have been fitted with self-closing devices that release on the fire alarm being activated, not all have. Due to the serious concerns in which the Providers have repeated to fail to comply with this requirement, the Providers were required to resolve this matter with some sense of urgency. The Providers confirmed in writing to the CSCI within one month of the inspection that all remaining fire doors had been fitted with self-closing devices and that all staff have been notified in writing of the home’s safe fire procedures. As the appropriate action was taken within the given timescale, this has not been reflected as a requirement within this report. Glentworth House Nursing Home DS0000062476.V345601.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 X 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 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X X 3 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 X 3 Glentworth House Nursing Home DS0000062476.V345601.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 OP3 Regulation 14(1)(2) Requirement Timescale for action 31/12/07 2. OP7 OP8 3. OP7 OP8 That detailed assessments are undertaken for all prospective residents prior to admission. These must clearly identify what the person’s primary nursing needs are, what their personal and social care needs are and be signed and dated by the person undertaking the assessment. These must be made available for inspection. 15(1)(2) That all care plans provide (a-d) nursing and care staff with clear details of the action that is to be taken to meet the personal, healthcare and social needs of residents. These must be regularly reviewed in consultation with residents. [Outstanding from last inspection report]. 13(4)(a-c) That individual risk assessments for the use of bed rails are undertaken for all residents in order to determine whether or not they are required. The appropriate action must be taken. DS0000062476.V345601.R01.S.doc 31/12/07 31/12/07 Glentworth House Nursing Home Version 5.2 Page 27 4. OP9 13(2) 17(1)(a) 5. OP10 12 (4)(a) 16(e) 6. OP18 OP30 18(1)(a) 18(c) (i)(ii) 18(1)(2) 7. OP36 That clear guidance is recorded on the medication administration records (MARS) for all medicines that are prescribed on an as and when required basis (PRN). That the standard of personal laundry and ironing within the home is of a good standard [Outstanding from the last inspection report]. That outstanding mandatory training is provided to all staff including: fire safety, infection control, health and safety, First Aid and Safeguarding Adults from Abuse. That a formal supervision structure be introduced. Supervision must take place at least six times a year. 31/12/07 31/12/07 28/02/08 31/12/07 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 OP9 Good Practice Recommendations That all handwritten medication entries are countersigned. This will help to reduce the risk of human error and ensure that the correct medication, time and dose are recorded. Glentworth House Nursing Home DS0000062476.V345601.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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