Inspection on 25/07/08 for Glentworth House Nursing Home

This inspection was carried out on 25th July 2008.

CSCI found this care home to be providing an Poor service.

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 21/08/07

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 23/11/2008.

CARE HOMES FOR OLDER PEOPLE Glentworth House Nursing Home 40-42 Pembroke Avenue Hove East Sussex BN3 5DB Lead Inspector Jennie Williams Unannounced Inspection 25th July 2008 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.V367460.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.V367460.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.V367460.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service Users should be sixty-five (65) years or over on admission. The maximum number of service users to be accommodated is thirtythree (33). 21st August 2007 Date of last inspection Brief Description of the Service: Glentworth House is a large detached nursing home with a purpose built extension, registered with the above listed conditions of registration. It is situated in a quiet residential area of Hove, close to local shops and public transport. There is no parking available at the home and restricted paid parking in adjacent streets. 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. Residents accommodation is located over two floors. The third floor is used for management and administration duties. There is a passenger shaft lift at the home that assists residents to access all residential areas of the home. There are twenty-one (21) rooms for single occupancy and six (6) shared rooms. All bedrooms, except one, are provided with en suite facilities. The local authority has contracted seven 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. There is a lounge/dining room for use and the home has recently added on a conservatory to add to the communal area for residents use. There are suitable numbers of toilet and bathing facilities located throughout the home to meet the needs of residents. The home has a well-maintained rear garden, which is easily accessed from the ground floor lounge. Fees are £675 per week. Additional fees are: hairdressing, chiropody, toiletries and newspapers/magazines (at cost). This information was provided to the CSCI on the 25 July 2008. Glentworth House Nursing Home DS0000062476.V367460.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. It should be noted that following recent CSCI consultation, it was identified that service users prefer to be called people who use services. It was confirmed that the home uses the term residents. For the purpose of this report, people who use the service will be referred to as residents. The home has been without a Registered Manager since approximately April 2005. A person appointed by the registered providers to manage the service has been in post since January 2008. For the purpose of this report this person will be referred to as the appointed manager. This unannounced site visit took place over seven and a half hours on the 25th July 2008. Feedback was provided to one of the owners on the 01 August 2008. Evidence obtained at this site visit, previous information regarding this service and information that the CSCI have received since the last inspection forms this key inspection report. Information shared with the CSCI through Safeguarding Adults investigations have been incorporated into this report. Twelve residents were spoken with throughout the site visit. The Inspector had limited communication with some residents. Ten surveys for residents to complete were sent to the home, of which one was returned. It was identified that this was completed with support from a representative. One visitor was spoken with throughout the site visit. Care plans were not viewed in detail as a Quality Review Nurse from the local purchasing authority had undertaken a review of information on the 7th July 2008 and the home was happy to share this report with the Inspector. Specific areas of care were viewed in eight care plans. Ten surveys for staff to complete were sent to the home prior to the site visit, of which none were returned. The Inspector spoke with three staff and the appointed manager. Three staff files were viewed. A tour of the environment was undertaken and some individual rooms were viewed. Medication procedures were inspected. The quality assurance system was discussed and complaint records were viewed/discussed. An Annual Quality Assurance Assessment (AQAA) was received from the home prior to the site visit. This was to obtain information about the establishment to assist CSCI in the inspection process. The AQAA also provided the Commission with numerical information. Glentworth House Nursing Home DS0000062476.V367460.R01.S.doc Version 5.2 Page 6 There were thirty residents residing at the home on the day of the site visit. What the service does well: What has improved since the last inspection? Work has been done to comply with the requirements made at the last inspection. The home ensures pre assessments are undertaken on all prospective residents prior to admission, ensuring all needs can be met at the home. One was not available for inspection, despite this being part of the requirement in the previous inspection report. Procedures have been changed to ensure the standard of personal laundry and ironing has improved and is of a good standard. The appointed manager confirmed that all staff are now up to date with all mandatory training, ensuring residents are safeguarded. Staff have had appraisals undertaken and the appointed manager is taking action to ensure that supervision is provided to staff on a regular basis. Glentworth House Nursing Home DS0000062476.V367460.R01.S.doc Version 5.2 Page 7 What they could do better: The documentation in place for some people does not fully reflect the level of care provided and there is a risk that care may not be consistently provided. Clear and up to date information pertaining to individuals must be maintained to evidence that the home is meeting the needs of residents. Bed rails risk assessments need to provide consistent information and clearly identify if bed rail covers are required or not to ensure residents and staff are safeguarded. Medication procedures need to be more robust to ensure residents and staff are safeguarded. It is an outstanding requirement that clear guidance be provided on the use of as needed (PRN) prescribed medicines. Clear information must be in place to identify if a prescribed medicine is in use or not. Staffing levels must be regularly reviewed to ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. Priority must be given to ensure that an application is sent to the Commission to process in respect of the person managing the service. An effective quality assurance and quality monitoring system needs to be developed and implemented to ensure that the home is run in the best interest of service users and that the aims and objectives of the home are met. Shortfalls identified through Safeguarding Adults investigations and CSCI inspections would be identified earlier if there was an effective system in place. That clear records, as required by regulation, be maintained, kept up to date and be available for inspection to ensure compliance and to ensure the home is managed effectively and residents are safeguarded. Urgent action is required to ensure that information required under legislation is provided to the CSCI within the given timescales to ensure compliance. It is recommended that a copy of the CSCI inspection report be kept displayed within the home to ensure people have easy access to this. Management of the service must ensure that improvements are made and all sections thoroughly completed when the CSCI next require them to submit their AQAA. Any minor shortfalls noted at the site visit, of which no requirement or recommendation has been made, have been highlighted throughout the report. These areas will continue to be monitored throughout the inspection process. Glentworth House Nursing Home DS0000062476.V367460.R01.S.doc Version 5.2 Page 8 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.V367460.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.V367460.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, 4, 5 & 6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has information available for prospective residents/representatives on the facilities and services provided to make an informed decision if their needs can be met at the home. The pre admission process ensures that only residents whose needs can be met at the home are admitted. EVIDENCE: The home has a Statement of Purpose and Service Users Guide that is available at the home and provides prospective residents/representatives with information about the services and facilities provided at the home. The Statement of Purpose advises that the home has five transitional beds, however it was confirmed at inspection that there are seven beds identified for transitional care. This information needs to be updated. Glentworth House Nursing Home DS0000062476.V367460.R01.S.doc Version 5.2 Page 11 There is no information in the Statement of Purpose/Service Users Guide on the arrangements made for consultation with residents about the operation of the care home. This has not been reflected as a requirement or recommendation, however this information must be included when the home has implemented a clear quality assurance system. The home is registered to accommodate 33 residents. Nursing care is provided at the home. The AQAA identified that there are some residents residing at the home with a dementia type illness and some with mental health needs. The appointed manager confirmed that the nursing needs of these residents are the predominant needs. The AQAA identified that management make a copy of the latest CSCI inspection report about the home available to all new and existing people who use their service. On discussion with the appointed manager, it was confirmed that this is currently kept in the manager’s office. It was recommended that a copy of it be kept displayed within the home to ensure people have easy access to this. The appointed manager undertakes an assessment of all prospective residents. Copies of social services care plans are obtained wherever possible. It was confirmed that residents admitted for transitional care stay for a maximum of six to eight weeks. There was documentation in place to evidence that a pre admission assessment had been undertaken for one resident prior to being admitted to the home. A pre admission assessment could not be located for another recent admission, however the appointed manager confirmed that one had been undertaken. This has not been reflected as an outstanding requirement. However, it remains a requirement that management must ensure that all paperwork pertaining to an individual is available for inspection at the home. Staff spoken with felt that all residents were appropriately placed at the service and feel that management will take appropriate action if the needs of an individual could no longer be met at the home. The appointed manager confirmed that there was no one residing at the home from any minor ethnic community, social/cultural or religious groups with any specific needs or preferences. There is one resident residing at the home whose first language is not English and there are communication aids in place to assist staff in communicating with the resident. Arrangements are made with the family/representative when medical appointments are needed. Some residents spoken with confirmed that they came to visit the home prior to moving in. Others could not remember or confirmed that their family/representative had visited the home. A resident who shares a room confirmed that they are happy with this arrangement and were asked prior to being allocated the room. The survey received identified that they received Glentworth House Nursing Home DS0000062476.V367460.R01.S.doc Version 5.2 Page 12 enough information about the home prior to moving in to decide if it was the right place for them. It was confirmed that it is in the contract/terms and conditions that the first four weeks is a trial period, to ensure that the individuals needs can be met at the home and the home meets the individual’s expectation. There is no dedicated accommodation to provide intermediate care, however there are seven allocated rooms for transitional care residents. Respite care is available if there is a spare room. Glentworth House Nursing Home DS0000062476.V367460.R01.S.doc Version 5.2 Page 13 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 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Previous intervention, monitoring and input from other health professionals ensure healthcare needs are being met, however care plans in place need to be consistent in information and address all needs of the individual. Residents are not fully safeguarded by the medication procedures in place. EVIDENCE: Safeguarding Adults alerts and concerns raised by other health professionals regarding care practices within the home resulted in health professionals from social services and the Older People Nurse Specialist team visiting the home and undertaking a review of a random selection of care plans. The home has been monitored by other professionals, through Safeguarding Adults procedures, to ensure residents needs are identified and met. Staff must ensure that care provided is pro active and not reactive. Glentworth House Nursing Home DS0000062476.V367460.R01.S.doc Version 5.2 Page 14 Care plans were not viewed in detail as a Quality Review Nurse from the local purchasing authority had recently undertaken an audit of the home, of which the home was happy to share with the Inspector. These reports advise the home on areas for improvement and provide them with an action plan and timescales within which to comply. The Quality Review Nurse monitors the home to ensure action plans are complied with. The last review undertaken by the Quality Review Nurse identified that improvements are being made with the information within the care plans and these will be reviewed at the next visit to ensure improvements are maintained. Improvements are slowly being made, due mainly to interventions from other professionals, but not at the speed that is expected of a service committed to providing good quality care. The Inspector viewed specific areas of care within eight care plans. It was observed that most needs were identified and guidance was provided to staff on how to meet the needs of individuals. One resident may at times display aggressive behaviour. The Inspector was informed that there is a care plan in place for this, however on viewing the individuals file there was no guidelines in place for staff on what may trigger this behaviour, nor any information on how best to deal with this behaviour. The appointed manager confirmed that advanced care plans for the end of life are still being implemented. A staff member spoken with confirmed that ‘there have been big changes in the care plans and they are much better now and gives clear guidance on what to do for individuals’. The care plans viewed identified that they have pre-populated information on them and staff at the home must ensure these are personalised to the individual, to ensure a person centred approach to care is promoted. Information documented in turning charts and fluid balance charts used for monitoring care must be improved and consistent. (Turning charts - used for people who have limited movement and are at risk of developing pressure areas. Fluid balance chart – used to monitor the intake and/or output of an individual). One chart inspected demonstrated that a resident had not been assisted in changing position for a period of 10 hours, nor been offered any food/fluids. On viewing daily notes, it was observed that some staff were writing ‘all care given’ and ‘care given as required’. Daily records are a good source of evidence to show that care is being provided, as detailed in the care plan, however the term All care given is not helpful or adequate, especially when care plans do not reflect accurately all needs. Daily records when well written, help ensure a consistent approach and good quality of care for residents. It is in the homes interests to be able to show what they have done, along with providing the evidence on which to base the monthly review and to record that they are following the assessment of needs. Glentworth House Nursing Home DS0000062476.V367460.R01.S.doc Version 5.2 Page 15 Risk assessments were observed to be in place, however it was noted that there are different formats being used within different files for the use of bed rails and information was not consistent. Where bed rail covers were noted not to be in use, the appointed manager confirmed that an individual becomes agitated when covers are used. Risk assessments in place must identify why it has been decided not to use covers. Covers can protect residents from further injury. Work has been undertaken to address the previous requirement in relation to bed rails, however further work is required and a new timescale has been set in which the home must ensure compliance. Management must iterate to staff the importance of clear recording and good documentation. Following a Safeguarding Adults investigation there were shortfalls noted within the documentation of care plans and daily recording. The home does not appear to have learnt from these issues. Information shared with the CSCI identifies that there are concerns about the clinical care provided at the service. There was evidence that residents have access to visits from health professionals. A resident observed to be wearing glasses confirmed that they recently had an eye check and other residents confirmed that most residents had their eyes tested recently. There was evidence of a swallowing assessment having been undertaken. A resident commented that ‘staff speak with the GP when needed, a dentist is arranged if needed and most residents had eye checks done.’ Pressure relieving equipment is available at the home. Information shared with the CSCI identify that there have previously been concerns that this equipment has not been used effectively. It was confirmed that there are policies and procedures in place for all aspects of dealing with medications. The content of these were not viewed. Medicines are kept in locked cupboards within the individuals room. Some hand written orders on the MAR charts had not been signed at all to identify who wrote the information. It is recommended that handwritten prescriptions are double signed by two staff that are trained in medication procedures. This is to further safeguard colleagues and residents from the risk of errors occurring. Where a PRN, ‘as needed’, prescription is being used regularly, staff need to ensure a GP reviews this and if necessary changed to a prescription for regular use. Where medicines/creams as prescribed as when required (PRN), there was no clear guidance to identify when staff should administer the medicine or what indications to look for. This remains an outstanding requirement. There was no clear guidance in place for the use of prescribed creams/lotions. One MAR chart identified that one individual had four different creams Glentworth House Nursing Home DS0000062476.V367460.R01.S.doc Version 5.2 Page 16 prescribed with the order ‘apply as directed by GP’. There was no information available to identify if these creams were still required, when they need to be applied or where they should be applied. Where a cream has been prescribed for regular use, this was not being signed for. The registered nurse confirmed that this was no longer in use, however there was no information available on the MAR chart to reflect this. The registered nurse confirmed that the use of creams were not reflected in the care plans. Photos were observed to be on some MAR charts to assist the staff in identifying residents. It was confirmed to the Inspector when providing feedback that a digital camera has been purchased to ensure all MAR charts will have photos on them. It was confirmed that unused medicines are disposed of through a licensed company. Records viewed evidenced that accurate records are being maintained of controlled drugs and these were seen to be stored appropriately. There was oxygen stored in a resident’s bedroom without warning signs in place. The appointed manager confirmed that they were being collected that day from the suppliers. Residents spoken to felt that staff respect their privacy and dignity. Staff were heard to be calling residents by their preferred term of address and were observed to knock on bedroom doors prior to entering. Glentworth House Nursing Home DS0000062476.V367460.R01.S.doc Version 5.2 Page 17 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ lifestyle within the home is generally their own choice and residents are provided with sufficient stimulation to fulfil their interests and needs. Residents are provided with varied nutritional meals and are provided with choice to ensure their preferences are catered for. EVIDENCE: Residents spoken with confirmed that their routines of daily living are to their own choice and preference. Residents were observed to move freely within and out of the home throughout the site visit. Bed times are to the individuals’ preference, as well as choosing to have a bath or shower. Residents confirmed that staff encourage their independence and they choose their own clothes to wear etc. One resident identified that staff tell them when they are due for a shower, however this suits the individual and they have not felt the need to request an additional one. Some residents and staff spoken with felt that there could be more activities provided, whilst others felt that there were enough provided if they choose to Glentworth House Nursing Home DS0000062476.V367460.R01.S.doc Version 5.2 Page 18 be involved. The staff that identified that they felt more could be provided were not concerned about this as they stated that the provision of activities had improved since employment of the appointed manager and feel that this issue will be addressed. For those residents who felt that there were not enough activities could not identify what else they would like offered. One comment from a resident was ‘sometimes a long afternoon’. No requirement or recommendation has been made in respect of this, however management must ascertain the wishes of residents and take action if it is identified as being needed. The AQAA identifies that they are currently trying reminiscence therapy as an activity and they have had a lot of positive feedback from this. Residents confirmed that they are able to receive visitors at anytime. One resident was observed to be taken out by a visitor on the day of the site visit. Carers provide activities for residents on a day-to-day basis and outside entertainment also visits the home. This includes a poetry man and a musician visiting every four weeks. Staff may take residents out into the community or to the sea front, dependent on weather and if they have some spare time. They are currently looking into hiring a mini van bus to have group outings. It was confirmed that there is an allocated budget for the provision of activities. The appointed manager confirmed that there is allocated time for staff to spend with those residents who may remain in their rooms due to their health needs/choice. Most residents spoken with were complimentary about the food provided at the home and confirmed that they are provided with a choice. The menus provided to the Inspector identified that there is a choice available. Comments received from residents ranged from ‘sometimes choice’, ‘very nice’ to ‘no problems with anything not being liked’. It was confirmed that the cook visits individuals on a daily basis to ensure choice is provided. The appointed manager is currently looking at providing a dining table and chairs in the conservatory for those residents who wish to eat here. Residents currently eat in the lounge room off individual tray tables or in their rooms if they prefer. Some residents did not know what they were having for lunch that day. One comment was ‘don’t know what’s for dinner until it’s in front of you’. The appointed manager confirmed that they did have a notice board advertising what was being provided for the day, however this was taken down, as the majority of residents did not want this in their home. Staff are available for those residents who may require assistance with eating their food. For those residents where it was identified that a special diet/soft diet was required, there were guidelines in place for this within the individuals’ care plans. The home has confirmed that they received four scores on the door from the last environmental health inspection. Glentworth House Nursing Home DS0000062476.V367460.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Complaints are dealt with by the home and action taken where necessary, ensuring those who raise complaints that they are listened to. Safeguarding Adults alerts are not shared with the CSCI, however the home co-operates with the leading authority in these investigations, assisting to ensure residents become better safeguarded. EVIDENCE: The home has a complaints procedure available to all people and a copy of this is on display at the entrance to the home. Three out of the five residents asked confirmed that they knew who to speak to and felt comfortable to raise any concerns within the home. Two would not feel comfortable to raise any concerns unless ‘it was really bad’. The AQAA identifies that there have been three complaints made within the last 12 months. One of these was referred to the home from the CSCI. It was recommended to the appointed manager that a central log of complaints be maintained. Information regarding complaints is currently stored within individual resident files. Other records of the complaints dealt with via head office of the company were not available at the home for viewing. Action needs to be taken to ensure that all records are available at the home for inspection. Discussions were had with the appointed manager on ways to Glentworth House Nursing Home DS0000062476.V367460.R01.S.doc Version 5.2 Page 20 ensure good record keeping is maintained in relation to complaints and the outcome for each complaint is identified. The AQAA identifies that there have been one Safeguarding Adults referral made and two Safeguarding Adults investigations. One of the complaints was dealt with through the Safeguarding Adults procedures of which the outcome was inconclusive. The AQAA identified that there had been one referral to the Protection of Vulnerable Adults (POVA) List. This incident was prior to the appointed manager commencing work and no further information was available in relation to this. further information received following the inspection identifies that the registered provider is also unaware of this referral. Social services have advised the CSCI that a further two allegations have been made in relation to two separate transitional residents. These occurred within the week prior to giving feedback. These are currently still being investigated, however preliminary findings on one investigation has found the recording at the home poor to be able to substantiate any of the information. The CSCI have not received any notification regarding these allegations at the time of writing the report. Further information has been shared from the Safeguarding Adults team that identified there had been a Safeguarding Adults investigation earlier this year of which the CSCI has received no information. This was found to be substantiated and identified there were concerns around nursing care practices. It was concluded that the Safeguarding Adults alert was substantiated and there was negligence but this was not wilful negligence. This was confirmed as neglect by omission. This investigation identified many areas of improvement required within the home. Due to one alert being made, the local authority undertook a review of a selection of residents. Shortfalls noted during their investigations in relation to documentation were continuing to be observed at this inspection. This identifies that the outcomes from any referrals are adequately managed, with the issues resolved but not learnt from. This investigation resulted in the local purchasing authority temporarily suspending further placements at the home. Serious issues were identified throughout this investigation and the Safeguarding Adults team implemented a protection plan. Action must be taken to ensure that the CSCI is advised of all allegations raised and be kept informed of action taken and outcomes. There is a flow chart available at the home for staff to follow in the event an allegation is made. The appointed manager and staff spoken with confirmed that they have received Safeguarding Adults training, which included whistle Glentworth House Nursing Home DS0000062476.V367460.R01.S.doc Version 5.2 Page 21 blowing. A staff member confirmed that they would feel comfortable whistle blowing within the service. Glentworth House Nursing Home DS0000062476.V367460.R01.S.doc Version 5.2 Page 22 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Work has been done to improve standards within the home, ensuring residents live in a comfortable and suitable environment. EVIDENCE: Residents’ accommodation is provided over three floors and there is a passenger shaft lift that provides access to all areas. The Statement of Purpose identifies that there are 21 single rooms and six double rooms. On tour of the environment, it was observed that the home is generally well maintained and residents live in a homely environment. Some areas require additional attention. This includes ensuring extractor fans are working and ensuring toilet roll holders are fixed so toilet rolls are easily accessible to residents, promoting their independence. Glentworth House Nursing Home DS0000062476.V367460.R01.S.doc Version 5.2 Page 23 Some of the areas that the Inspector was informed that has improved since the last inspection is a conservatory being added onto the lounge room and the garden has been made more accessible to residents. Work has been done and is continuing to be done to improve the standards within the homes environment. It was confirmed that all beds are adjustable, ensuring these meet the needs of those residents who require nursing care. Residents spoken with were happy with their rooms. A random selection of rooms viewed identified that residents are able to personalise their own space to their choice and preference. The appointed manager confirmed that the provision of personal laundry services has improved. One member of staff is now responsible for the washing and ironing of residents’ personal clothing. The residents spoken with expressed no concerns about the laundry service. A visitor spoken with confirmed that they always found the home fresh and clean. There were no offensive odours noted on the day of the site visit. There is a sluice machine available at the home to assist with infection control procedures. The home has adapted good infection control practices by providing alcohol gel at the entrance of the home that they encourage all visitors to use on arrival and when leaving the service. Staff spoken with confirmed that they have undertaken infection control training. Gloves were observed to be available for use by staff. It has been confirmed that the home has an appointed Infection Control Champion to ensure that they are fully compliant with new regulations and recommendations. Glentworth House Nursing Home DS0000062476.V367460.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are generally safeguarded by the recruitment procedures. Staffing levels are not consistent in ensuring that at all times there are suitably qualified and competent persons working at the care home to meet the needs of residents. EVIDENCE: Residents spoken with were generally complimentary about the staff working at the home. Comments ranged from ‘OK’, ‘quite good, some good, some not’, ‘very kind’ to ‘99 excellent’. Staff and residents spoken with felt that there were sometimes not enough staff on duty. Some residents confirmed that there was always someone around to assist them when needed and some felt that they had to wait for a long time for their call bell to be answered. The Inspector was with one resident who required assistance, so the call bell was rung. It took seven to eight minutes for staff to answer this call. Staff stated that there appeared to be a high level of sickness within the team, which left them short staffed when a person rings in sick at the last minute. The AQAA identifies that three full time and three part time staff have left employment in the last 12 months. The appointed manager confirmed that Glentworth House Nursing Home DS0000062476.V367460.R01.S.doc Version 5.2 Page 25 they are currently in the process of recruiting new staff, which will address the shortfall in staffing numbers. Staff confirmed that agency staff are used. The appointed manager confirmed that she works during weekdays and that there is always a registered nurse on duty. She confirmed that there are usually two nurses and six carers in the morning, one nurse and four carers in the afternoons and one nurse and two carers that work a waking night. Staff spoken with were confident that the appointed manager will take appropriate action to address staffing numbers and they were aware that staff were currently being recruited. Management must ensure that staffing numbers are regularly reviewed and action taken if needed to ensure that all needs of residents are met. The AQAA did not contain clear information on the numbers of care staff employed and how many have National Vocation Qualification (NVQ) level 2 or above. The home is taking action to ensure 50 of care staff are NVQ trained and some care workers are currently working towards NVQ level 3 qualifications. Three staff files viewed identified that some improvements need to be made in the recruitment procedure. Ensuring application forms are fully completed will assist in addressing some of the shortfalls, such as gaps in employment, reasons for leaving etc. No requirement or recommendation has been made in relation to this, however the appointed manager must take action to address the shortfall in information. The home ensures references; Protection of Vulnerable Adults (POVA) first check and a full Criminal Record Bureau (CRB) check are obtained. The appointed manager confirmed that where a staff member commences work with just a POVA first check in place, this person is supervised until a full CRB check is received. It is recommended that the health questionnaire ask for information regarding current illnesses and not just illnesses that they have suffered from in the past. There was evidence in the staff files that two of the new staff members have undertaken induction training. The appointed manager confirmed that staff undertake an in house induction that complies with the Common Induction Standards as set by the Skill for Care. Staff spoken with felt that they are provided with enough training opportunities that are relevant to their roles. One commented about training, ‘plenty of training, it is coming out my ears’. Staff confirmed that they are kept up to date with mandatory training. Staff spoken with and records viewed identified that some recent training undertaken was: Manual Handling, Adult Abuse, Infection control and equality and diversity. Glentworth House Nursing Home DS0000062476.V367460.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 38. People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst most residents express satisfaction of living in the service, the homes record keeping does not safeguard residents. Implementing a clear quality assurance system will assist management in ensuring that the home is run in the best interest of residents and ensure that the aims and objectives of the home are met. EVIDENCE: The home has been without a Registered Manager since April 2005. The current appointed manager has been in post at the home since January 2008. Previous appointed manager has been in post, however did not complete the registration with CSCI. Priority must be given to ensure that an application for Glentworth House Nursing Home DS0000062476.V367460.R01.S.doc Version 5.2 Page 27 Registered Manager is forwarded to the CSCI to begin the registration process. The appointed manager is a nurse with current registration with the Nursing and Midwifery Council (NMC) and has just completed the Registered Manager Award course. The certificate for this arrived on the day of the site visit. The appointed manager has worked in a variety of settings within the health field in a variety of positions. She confirmed that she has previous experience at management level. Staff spoken with spoke positively about the appointed manager and confirmed that she is approachable and supportive. Comments received were ‘ good’, ‘if there are any issues, something will be done about it’ and ‘brilliant’. Staff and the appointed manager confirmed that there are clear roles and responsibilities within the home and with external management. There is currently no structured quality assurance system in place to obtain feedback from residents, staff, health professionals or other stakeholders with an interest in the service. The appointed manager confirmed that they have obtained a quality assurance checklist that is a break down of the National Minimum Standards that she is currently working through. An audit has recently been undertaken on the meals and she has just commenced doing an audit on social activities. The appointed manager confirmed that she is thinking about implementing a suggestion box. Discussions were had with the appointed manager on ways to ensure a structured quality assurance system is in place, results analysed and shared with all people who have an interest in the home. The previous inspection report identifies that there was no clear quality assurance system in place. The appointed manager at that time informed the Inspector of their proposals and no requirement made. Due to changes in management, there continues to be no clear system in place. This has now been made a requirement to ensure the home is run in the best interest of residents. As mentioned previously, there is no information in the Statement of Purpose/Service Users Guide on the arrangements made for consultation with residents about the operation of the care home. There were some Regulation 26 reports available for viewing at the home. The appointed manager confirmed that the responsible individual visits the home and provides a report every month. Action is needed to ensure that these reports are available for inspection at the service. Monthly and weekly checks are undertaken on areas relating the health, safety and welfare of residents. This includes fire alarms, emergency lightings, hot water and audits on care plans. The AQAA provided was poorly completed and gives very little information about the service. The questions relating to the views of residents provide very limited information. Areas of the data section were left blank. The AQAA does Glentworth House Nursing Home DS0000062476.V367460.R01.S.doc Version 5.2 Page 28 not give a reliable picture of the service. The evidence provided to what they do well was poorly completed. The AQAA provided limited information on their plans for improvements in the next 12 months. The AQAA did not identify any action that had been taken in relation to previous requirements or recommendations. It is concerning to note that the AQAA was completed on the 27 May 2008 and the appointed manager confirmed to the Inspector at the site visit that she saw the last CSCI report after completing the AQAA, despite being in post since January 2008. Management of the service must ensure that improvements are made and all sections thoroughly completed when the CSCI next require them to submit their AQAA. The home does not hold any personal allowances. Residents either manage their own money or have representatives that assist them to manage their finances. Invoices are sent to relatives/representatives where needed for toiletries, hairdressing and chiropody etc. The appointed manager confirmed that she has undertaken appraisals for staff and proposes to undertake supervision with all staff every three months. This has not been reflected as an outstanding requirement as action is being taken to address this. As highlighted throughout the report, the homes record keeping does not safeguard residents. Clear records, as required by regulation, must be maintained, kept up to date and be available for inspection. The appointed manager confirmed that she was not aware of Regulation 37, notifications that are required by law to be sent to the CSCI. This information was shared with her on the day of the site visit. Action must be taken to ensure that all information required to be notified to the CSCI is done so within the required timescales. The appointed manager confirmed that staff are kept up to date with mandatory training. The appointed manager confirmed that staff participate in fire training and fire drills, which include night staff. It was confirmed that another fire risk assessment was due to be undertaken in another month’s time. The AQAA identifies that all equipment, as applicable, has been serviced or tested as recommended by the manufacturer or other regulatory body. Glentworth House Nursing Home DS0000062476.V367460.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X 1 2 Glentworth House Nursing Home DS0000062476.V367460.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 17 Requirement Timescale for action 30/09/08 2. OP8 3. OP9 4. OP9 5. OP27 That clear and up to date information pertaining to individuals are maintained, up to date and all care provided be accurately recorded to evidence that the home is meeting the needs of residents. 13(4)(a-c) That bed rails risk assessments provide consistent information and clearly identifies if bed rail covers are required or not to ensure residents and staff are safeguarded. 13(2) That clear guidance is recorded 17(1)(a) on the Medication Administration Records (MAR) charts for all medicines that are prescribed on an as and when required basis (PRN), to ensure medicines are used appropriately. Timescale 31.12.07 not met. 13(2) That clear accurate records are maintained for all medicines that are prescribed and MAR charts to clearly identify if a medicine is in use or not. This is to ensure residents are safeguarded and health needs are met. 18(1)(a) That staffing levels are regularly DS0000062476.V367460.R01.S.doc 15/09/08 15/09/08 15/09/08 15/09/08 Page 31 Glentworth House Nursing Home Version 5.2 6. OP31 7. OP33 Care Standards Act, 12 (1) 24 8. OP37 17 9. OP38 37 reviewed to ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. That an application is sent to the Commission to process in respect of the person managing the service. That an effective quality assurance and quality monitoring system is developed and implemented to ensure that the home is run in the best interest of service users and that the aims and objectives of the home are met. That clear records, as required by regulation, be maintained, kept up to date and be available for inspection to ensure compliance and to ensure the home is managed effectively and residents are safeguarded. That information required under legislation is provided to the CSCI within the given timescales to ensure compliance. 30/09/08 30/09/08 30/09/08 15/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP29 Good Practice Recommendations That a copy of the CSCI inspection report be kept displayed within the home to ensure people have easy access to this. That the health questionnaire for prospective employees asks for information regarding current illnesses and not just illnesses that they have suffered from in the past. DS0000062476.V367460.R01.S.doc Version 5.2 Page 32 Glentworth House Nursing Home Commission for Social Care Inspection Maidstone 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. Extracts may not be used or reproduced without the express permission of CSCI Glentworth House Nursing Home DS0000062476.V367460.R01.S.doc Version 5.2 Page 33 - 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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