Inspection on 18/12/07 for Gorton Parks Nursing Home

This inspection was carried out on 18th December 2007.

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

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

Other inspections for this house

Gorton Parks Nursing Home 21/04/08

Gorton Parks Nursing Home 03/10/07

Gorton Parks Nursing Home 20/06/06

Gorton Parks Nursing Home 02/03/06

Gorton Parks Nursing Home 07/06/05

Gorton Parks Nursing Home 11/11/04

Gorton Parks Nursing Home 01/06/04

Gorton Parks Nursing Home 23/02/04

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

CARE HOMES FOR OLDER PEOPLE Gorton Parks Nursing Home 121 Taylor Street Gorton Manchester M18 8DF Lead Inspector Sue Jennings Unannounced Inspection 18th & 19th December 2007 & 3rd January 03:00 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 Gorton Parks Nursing Home DS0000021678.V357232.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. Gorton Parks Nursing Home DS0000021678.V357232.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gorton Parks Nursing Home Address 121 Taylor Street Gorton Manchester M18 8DF 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) 0161 220 9243 0161 230 7439 www.bupa.com BUPA Care Homes (CFHCare) Ltd Jason Paul Axford Care Home 148 Category(ies) of Dementia - over 65 years of age (90), Old age, registration, with number not falling within any other category (43), of places Physical disability (15) Gorton Parks Nursing Home DS0000021678.V357232.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The number of older people requiring nursing care at any one time shall not exceed 43 patients of either sex aged 60 years or over. There are three named service users requiring care by reason of physical disability. Should these service users no longer require the accommodation offered the places will revert to the category of old age (OP). This accommodation is in Sunny Brow and Debdale Houses. In addition a maximum of 12 places are designated for use as intermediate care beds for service users aged 55 and over requiring intensive rehabilitation by reason of physical disability following discharge from hospital care. The rooms are located in Debdale House and equipped with appropriate specialist facilities, equipment and staffing. The length of stay should not normally exceed 6 weeks. A maximum of 60 places in Delamere House and Melland House are registered for older people with dementia who require personal care only. A maximum number of 30 places in Abbey Hey House are registered for either sex aged 60 years or over for people with dementia assessed as requiring nursing care. Minimum nursing staffing levels as specified in the Staffing Notice issued under Section 13 of the Care Standards Act 2000 on 15 February 2006, will be maintained for Sunny Brow and Debdale Houses. The service provider will keep the needs of all service users living in Debdale House under continuing review and ensure that the numbers and skills of staff deployed in that unit are adequate to meet their differing assessed needs. All staff employed in Debdale House will be trained in techniques for rehabilitation as detailed in National Minimum Standard 6.3 (National Minimum Standards, Care Homes for Older People) and this training will be maintained on an ongoing basis. Minimum nursing staffing levels as specified in the Staffing Notice issued under Section 13 of The Care Standards Act 2000 on 15 February 2006, will be maintained in Abbey Hey House. All staff employed in Abbey Hey House must receive accredited training in dementia care by 31st March 2006 and this level of training will be maintained on an ongoing basis. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care DS0000021678.V357232.R01.S.doc Version 5.2 Page 5 2. 3. 4. 5. 6. 7. 8. 9. 10. Gorton Parks Nursing Home Inspection. Date of last inspection 3rd October 2007 Brief Description of the Service: Gorton Parks Nursing Home is owned by BUPA Care Homes. The home is a purpose built building and consists of 5, 30 bedded units. The home can provide accommodation for residents assessed as requiring intermediate care, nursing and personal care and Dementia care. Each unit is a single storey building with a lounge, dining area, a conservatory, a smoke room and a kitchenette. All bedrooms are single and all rooms provide a wash hand basin and a mirror. There are no en-suite facilities available. Accessible toilets and bathrooms, with aids and adaptations for those residents who are wheelchair users or with poor mobility are located near to bedrooms and living rooms. The home is located in the residential area of West Gorton in the North of Manchester. Local amenities, including a market, banks and shops are all within easy walking distance. Public transport is accessible. There are ample parking facilities at the front of the building. An administration building houses the main kitchen, hairdressing salon, laundry and offices. The charges for fees range from £373.54 to £639.73 per week. Additional charges are made for hairdressing, trips and newspapers. Gorton Parks Nursing Home DS0000021678.V357232.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0. This means the people who use this service experience poor quality outcomes. This report is based on information gathered by the Commission for Social Care Inspection (CSCI) since the last inspection on 03 October 2007 and any other information received prior to this visit. Residents, relatives and staff were sent survey forms. CSCI survey forms were issued to 30 residents 25 relatives and 140 staff. At the time of writing this report 6 completed resident survey forms, 4 completed relative survey forms and 22 completed staff forms had been received by CSCI. Many of the residents have varying forms of dementia and were therefore not able to give their personal views of the home. This unannounced visit forms part of the overall inspection process and took place on Tuesday the 18th and Wednesday the 19th December 2007 and Thursday 3rd January 2008. This inspection was carried out in response to a number of serious concerns received by CSCI regarding poor care practice at the home. As part of the visit time was spent examining relevant documents and files, talking with the home’s manager, 2 unit managers, several residents living at the home, two visitors and 9 members of staff. All units were visited during the inspection process. The visit on the 3rd January started at 03:00am to enable us to speak to night staff and observe practice. What the service does well: There was a well planned menu and some residents told us that there is a choice of meals at each mealtime. Staff told us that the chef would make an alternative to the menu; drinks are provided on request. They told us that there is an open visiting policy, which was confirmed by the visitors spoken to. A visitor told us that she visited every day at different times and staff were always welcoming and cheerful. Gorton Parks Nursing Home DS0000021678.V357232.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Care plans did not fully identify residents’ needs or the action required to meet needs. They could improve the information in care plans to make it more person centred. Care plans for social and emotional needs must be put in place for everybody living at the home. Care staff need to see the provision of social care and emotional care as a very important part of their role. The manager must develop a system of auditing care plans to ensure they are fully completed, reviewed and where necessary amended. Staff need to make sure that residents are made aware of the meal choices. They should research appropriate activities specifically designed for people with dementia. A number of accident reports identified injuries sustained during assaults by other residents however these incidents had not been referred using the adult safeguarding procedures. Any suspected abuse of a resident must be referred using the safeguarding procedures. The medication systems were not well managed and had the potential to place residents at risk of harm. To ensure the safety of residents living at the home a robust recruitment procedure must be adhered to at all times and there must be evidence that Criminal Records Bureau (CRB) or Protection of Vulnerable Adults (POVA) checks have been undertaken before anybody is offered work. Not all staff were receiving regular formal supervision in line with the home’s policy. There was evidence that staff had attended safeguarding training, however referrals were not always being made appropriately to the local safeguarding team. Please contact the provider for advice of actions taken in response to this Gorton Parks Nursing Home DS0000021678.V357232.R01.S.doc Version 5.2 Page 8 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. Gorton Parks Nursing Home DS0000021678.V357232.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 Gorton Parks Nursing Home DS0000021678.V357232.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 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient information is provided for prospective residents to make an informed choice about admission to the home. Peoples needs were assessed prior to admission. EVIDENCE: A service user guide and statement of purpose are available and provide good information on the services provided. At the last inspection they told us that a pre-admission assessment took place for all prospective residents. We saw the ‘Quest’ individual assessment booklet in the care plans. This is completed by a unit manager and consists of a tick box system. Depending on the scores, the assessment document guides staff to which parts of the care plan/risk assessments need to be completed. This is carried out to make sure that they are able to meet people’s needs. Gorton Parks Nursing Home DS0000021678.V357232.R01.S.doc Version 5.2 Page 11 They told us during the last inspection that those residents who are referred through Care Management arrangements a copy of the Care Management Assessment is obtained before admission is arranged. The home provides intermediate care for 12 people aged 55 and over that require intensive rehabilitation following discharge from hospital care and prior to returning home. Appropriate facilities were in place for people receiving intermediate care to enable them to maximise their independence. Gorton Parks Nursing Home DS0000021678.V357232.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 poor. This judgement has been made using available evidence including a visit to this service. Care plans were not sufficiently detailed and medication practices had the potential to place residents at risk of harm. EVIDENCE: It was disappointing that the good progress in care planning identified at the last inspection had not been maintained. Care plans did not fully reflect residents’ complex needs or the actions required to meet needs. It is important that person centred information is gathered within assessments. We looked at assessments and care plans completed for nine people and saw that the information recorded did not fully reflect the resident’s care needs. Information in the care plans was conflicting. One resident’s care plan dated 20/9/07, stated ‘fractured hip at the moment transfers with hoist’. Gorton Parks Nursing Home DS0000021678.V357232.R01.S.doc Version 5.2 Page 13 They told us that the resident’s hip had healed but the care plan had not been reviewed or altered. One care plan contained no details but had been reviewed three times. It was clear that the manager did not have a system of auditing care plans to make sure residents changing care needs were being assessed and reviewed. We had concerns that one resident on Delamere unit could have been inappropriately placed. We saw they were quite agitated when other residents were around and some residents were seen to turn and walk away. We saw them shouting at another resident and prodding another resident in the arm to get them to move out of the office. They were also observed shouting loudly at another to “get out” when she tried to enter the office this resident was very distressed and observed to back away. They told us on the second day of our site visit 19th December 2007 that a reassessment and review of the resident would take place. However on the final day of the site visit 3rd January 2008 no action had been taken. We spoke to a resident at 07:15 who said they had been “up for a while”. They told us that they had “had a cup of tea and come in to the office to read the paper before breakfast”. It was of concern that on Delamere unit the dignity of residents was not always respected. This unit had a stale unpleasant smell and one bedroom door was still missing a door handle despite this being raised at the last inspection. We saw that although staff had assisted residents to dress some were unshaven and others were wearing dirty glasses and a number of the ladies had facial hair. All of these things demonstrated a lack of attention to residents’ basic care needs. We saw that some areas of resident’s health care needs were not being met. For example a number of residents did not have any dentures. This could have an adverse effect on resident’s nutritional intake causing weight loss. When we discussed this with the unit manager on the 19/12/07 they told us “the dentist came to take an impression about two months ago but we have not heard anything from them since”. They told us that the dentist had come from Birmingham because they could not access this service locally. They were advised to contact the North Manchester PCT (Primary Care Trust) for advice about local dentists. It was of serious concern that at the time of our last site visit for this inspection on 3/1/08 no action had been taken to contact the dentist or the PCT. Gorton Parks Nursing Home DS0000021678.V357232.R01.S.doc Version 5.2 Page 14 We asked residents what it was like living at the home and one told us “it’s OK here” another said “I don’t like it”. We asked what the food was like one replied “I can’t enjoy it without my teeth, they are supposed to be getting me some new ones but they have not come”. They told us “it would make my day if you could sort my teeth out for me”. Staff commented on survey forms about the lack of communication. For example, “on the Delamere unit I found a lack of communication and team work with the day staff and night staff” and “all night care staff should have report for safety of residents”. Records available including up to date night records were brief and contained repeated similar phrases such as “good night,” “slept well” and “care as planned.” It is important to be more descriptive and record what the resident actually did. This will enable staff to build a picture of the resident and to be able to demonstrate changes in condition to others such as G Ps and social workers. One relative commented, “when my mother was restricted to her bed I was concerned about the amount of times she was checked. Perhaps it would be a good idea if they signed for the times residents have been checked” and “the domestic staff do a lot for the residents”. One relative commented “Sunnybrow House has only 3 residents that need one carer putting them to bed and toileting the rest needs 2 carers and one is doing the medications”. One care plan stated that the resident was to be “put in the smoke room at times of high activity”. There were serious concerns that this practice restricts the movements of residents and is perceived as a method of restraint, which is inappropriate. There were a number of serious issues highlighted regarding medication storage and administration. On Delamere unit they told us that medications were being given at 10.00am, 2.00pm. 6.00pm. and 10.00pm. The morning round also took a long time and it was almost 11:40am when it was completed. Residents’ medicines were not well managed. We saw that people sometimes missed their medication because there was none available to give. We also found that two people had not had their pain-reliving patches changed at the right times, possibly resulting in poor pain control. They had stopped doing regular checks to make sure that medicines are handled in accordance with their procedures. To try and address these concerns further medicines training was planned and the service was bringing in its own quality assessors to look at medicines Gorton Parks Nursing Home DS0000021678.V357232.R01.S.doc Version 5.2 Page 15 handling. The manager was planning to restart a regular medicines audit to monitor the handling of medicines to help ensure any needed improvements are made. Administration of medicines was observed. In one house no one had had any morning medicines by 11am. This meant there was a risk that when doses of a medicine were repeated later in the day, the time between doses may be too short. Residents’ health could be at risk if medicines are given too close together. Some residents with dementia type illnesses were prescribed medicines “when required” for agitation. Records mostly showed why the medicines were given but on occasion the reasons were not recorded. Staff should take care to record why these medicines are administered to show that residents receive them appropriately. They did not have protocols in place for giving “when required” medicines, which would provide guidance for staff, to help ensure they are used in a consistent way. They told us that discussions were held with doctors and families if a resident needed to take their medicines in food or drink, but some of the records about this had not been regularly updated. The records should be kept up to date and could give clearer instructions to care staff about the way the medicines are given. We saw that records for the administration of medication were generally up-todate but should have been more clearly completed. For example, if ‘1 or 2 tablets’ was prescribed the actual number administered was not always shown. There were sometimes gaps in the record keeping, particularly for creams, so it was not always clear whether residents had received their medication or not. We saw that records for the receipt of medicines and disposal of unwanted medicines were mostly up-to-date. But, when medicines were taken away for administration outside the home the quantities leaving and returned to the home were not recorded. These records need to be made to account for all medicines handled by the home. The medicines storage was good and controlled drugs were safely locked away. Some of the fridges needed defrosting to make sure they keep the right temperature to protect the quality of medicines stored there. We saw there was incorrect storage of non-medication items in the controlled drug cupboard. Gorton Parks Nursing Home DS0000021678.V357232.R01.S.doc Version 5.2 Page 16 We saw that on Delamere special instructions for example ‘before food’ were not being followed. One resident’s medication prescribed to be taken 20 minutes before food’ was not given until after the resident had eaten breakfast at 11:15. One issue of more serious concern was found where quantities of one medication did not tally with the record kept. This suggested that staff had signed the administration record for a controlled medication as not required but the medication had actually been given to the person. We saw a box of paracetamol, which appeared to have been prescribed, with the top cut off, filled with different types of paracetamol and labeled staff only. Gorton Parks Nursing Home DS0000021678.V357232.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 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is scope to further improve and individualise the activities provided. There was a varied menu but improvements need to be made to make sure that residents are offered choice. . EVIDENCE: They gave us a copy of the menus; these offered a good variety of meals. It is recommended that the menu on the Dementia care units have photographs of the meals rather than the written version. Two residents told us that they enjoyed the food offered, with comments including “good” and “not bad at all”. One resident said “the meals used to be very good but they are not very good now”. Another resident told us that the meals “could be improved” and another told us “I don’t think much of it now I have to watch what I eat and buy my own bread and cooked meats”. Another resident told us that “the food is mediocre I don’t like it, it’s not for me”. Gorton Parks Nursing Home DS0000021678.V357232.R01.S.doc Version 5.2 Page 18 We looked at lunch being served on Melland unit. Staff on Melland assisted those less able residents with their meals and encouraged people to talk and interact to make mealtimes a more positive experience. The meal served was tomato soup, poached salmon in hollandaise sauce, new potatoes and vegetables. The alternatives were cheese and onion pie or sandwiches. The sweet was stewed rhubarb and custard. We saw that residents were offered a choice of tea/coffee or fruit juice with their meal. We saw a number of incidents on this unit during the lunchtime meal which were dealt with very well by staff. Staff were observed to defuse situations between residents quietly and quickly. Surveys received from relatives or friends of residents said that “I feel some of the time meals could be more choice than she gets, she has allergies to some foods”. One resident said “no one ever comes and asks us about the meals or anything else”. One resident commented that “the kitchen season food too much and could take care in food preparation for example taking the ends off sprouts”. Another said “there could be a better selection of meals” When asked about activities one resident said “there’s enough going on”. Another resident said “I’d like to get out more”. We heard music playing on one unit however this was popular music and not really appropriate for the residents in the lounge. One resident told us “it is not my type of music”. It is recommended that a record is kept of consultations/discussion with residents and relatives regarding the programme of activities. It is recommended that the photographs on display on Delamere are updated as some date back to 1999. They told us that the home had adopted a donkey and that the donkey was brought to the home and taken around the units. We saw some residents playing dominoes with the activity coordinator and a relative. They should research appropriate activities specifically designed for people with dementia so that all residents have the opportunity to take part in recreational activities. One member of staff commented in a survey form they should “provide more activities for residents as don’t have enough outings”. Gorton Parks Nursing Home DS0000021678.V357232.R01.S.doc Version 5.2 Page 19 Gorton Parks Nursing Home DS0000021678.V357232.R01.S.doc Version 5.2 Page 20 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 poor. This judgement has been made using available evidence including a visit to this service. Not everyone knew how to make a complaint. The safeguarding procedures were not always followed so residents are not fully protected from harm. EVIDENCE: They had a complaint procedure and a copy of the Manchester Multi-Agency policy on the protection of adults from abuse. We spoke to one visitor who was unaware that the home had a complaint procedure and could not recall this being discussed at the time of their relative’s admission to the home. One relative or friend of a person living at the home commented in a survey form, that, “I am not sure how to make a complaint. If I had a complaint my first call would be sister in charge”. Two residents said they did know how to make a complaint and another said “I would usually speak to the sister who does all she can”. One member of staff commented on a survey form “confidential information is being freely discussed this means I don’t have the confidence in the admin and management staff to report serious concerns I have about residents and other staff members behaviour”. Gorton Parks Nursing Home DS0000021678.V357232.R01.S.doc Version 5.2 Page 21 They provided a training matrix that showed 83 staff had attended POVA training, however, the staff were not fully aware of the procedure to be followed. We saw that staff including unit managers were not aware of the correct safeguarding procedures. A number of accident reports relating to residents identified injuries sustained during assaults by other residents, however these incidents had not been referred using the local adult safeguarding procedures. Any suspected abuse of a resident must be referred using these safeguarding procedures. Gorton Parks Nursing Home DS0000021678.V357232.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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards of cleanliness needed to be improved to provide an odour free environment for the benefit of residents. EVIDENCE: We saw that some of the resident’s bedrooms were personalised with photographs and ornaments. A number of the units had an unpleasant odour and did not provide a comfortable and clean living environment. One relative or friend of a person living at the service said “the smell of urine can be very strong on occasions, it would provide a more pleasant Gorton Parks Nursing Home DS0000021678.V357232.R01.S.doc Version 5.2 Page 23 environment if this was corrected for both residents and visitors”. On entry to Delamere unit we noted that there was a stale and unpleasant odour. Residents on Delamere unit were seen walking around and it was obvious they were used to coming in and out of the office to sit with the staff. One of the resident’s bedroom doors had a broken lock – this was identified at the last inspection on 3/10/07 and had not been repaired. This was of particular concern because there was a ‘crash mat’ (mattress) placed on the floor beside the bed. This was used in case the resident fell out of bed. The door opened onto the mattress and posed a risk of falls to other residents who might wander into the room. It was noted on Melland unit that the communal rooms did not have any curtains at the windows affording the residents no privacy or dignity particularly in the evenings when it was dark outside. Gorton Parks Nursing Home DS0000021678.V357232.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 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels do not always allow resident’s needs to be appropriately met. The recruitment procedures do not fully protect the residents and poor care practices in some areas placed residents at risk. EVIDENCE: We saw a member of agency staff (male) and a female member of staff were walking a male resident down the corridor on Abbey Hey unit. The resident stopped abruptly and said “hey where are we going”. The female member of staff ran off, leaving the male agency worker to explain to the resident where they were going. The agency worker managed the situation appropriately. However, it was of concern that a member of staff had run away from the situation. This raises the question of the staff member’s ability to carry out her role. We heard a resident screaming throughout the visit. We asked them if the resident screamed all the time and the nurse responded by saying “that’s why she’s on promazine.” Gorton Parks Nursing Home DS0000021678.V357232.R01.S.doc Version 5.2 Page 25 During the visit to Abbey Hey unit an agency member of staff approached us with a female resident and asked us what the resident’s room number was. The staff member did not know the name of the resident nor the bedroom number. This was cause for concern as it demonstrated that staff did not know the residents on this unit. Between 7.20 and 10.30 we saw no interactions between staff and residents other than the task of staff supporting residents to have their breakfast. Even at this time there was very little communication between staff and residents whilst at the table. One relative or friend said that they thought that moving and handling practices could be improved. They commented that they had witnessed staff using the poor practice of “dragging residents from a sitting position by their wrists and arms”. Staff must be trained in safe moving and handling practices to make sure that they support residents using the appropriate techniques. Staff files did not clearly show what training staff had received. It is recommended that staff training records are kept up to date to evidence that all staff have received training appropriate to the job they are doing and have been assessed as competent following the training. We saw fifteen staff files on the 18.12.07. All files contained proof of ID, medical checklists, dates of starting, job descriptions, terms and conditions and application forms. Not all staff files contained a relevant CRB (3 files without). There was evidence that POVA 1st checks had been carried out for newly recruited staff. They were reminded that staff working only on a POVA 1st check must be supervised at all times. It was of serious concern that one member of staff who was being investigated under adult safeguarding was not entitled to seek employment in the UK. They employed this person even though the documents provided as proof of ID clearly stated ‘Employment Prohibited’. They told us that in the week prior to the inspection starting the service had used approximately 200hrs of agency staffing. A few weeks previously the service had used approximately 500 hrs of agency staff in one week. This resulted in no continuity of care for residents. One resident told us “there are always different staff on”. Comments from relatives who completed surveys included, “the home had a lot of agency staff at one time this required the regular staff to tell them what to do ”, “Sometimes residents were not getting their breakfast until 11:30 and lunch is at 12:00 – 12:30”. One relative commented, “we have nothing but high regard for the staff that we see”. Gorton Parks Nursing Home DS0000021678.V357232.R01.S.doc Version 5.2 Page 26 To ensure the safety of residents living at the home a robust recruitment procedure must be adhered to at all times. There must be evidence that thorough safety checks have been undertaken before anybody is offered work. They told us that there was a high turnover of staff. In the week prior to the inspection starting the service had used approximately 200hrs of agency staffing. A few weeks previously the service had used approximately 500 hrs of agency staff in one week. The inspectors were informed that there was a high turnover of staff and that BUPA were “looking into it”. We asked if exit interviews were taking place for the staff who were leaving, they said that they had not been done so far but were planned for staff leaving in the future. There was an acting manager on duty during the site visits. They told us that the previous manager of the service had been transferred to another BUPA home as there were problems there. There was mixed feedback from residents about the availability of staff. Three residents who filled in surveys said that staff were ‘usually’ available when needed. One other individual responded ‘sometimes’. Comments from residents included “I don’t like having to wait coming off the toilet”. One commented, “there are a large number of staff changes, some of the care assistants do not interact with residents and do not seem able to cope with the more challenging residents. Some people are ignored”. Concerns told to us by a number of residents about the availability of care staff must be taken seriously. Staffing numbers and how they are deployed needs to be kept under constant review. One member of staff commented in a survey form that, “there is never enough staff for all the residents, plus nurses have enough care plans, appointments, meetings and medication to do, they should not be counted in the numbers”. Another commented “appropriate information is not given unless requested by ourselves”. Other staff comments included “my supervisor trained me in areas I would be working in and not others”, “had no training since the first 3 days which were the induction” and “It is a regular occurrence that we are understaffed and have to work without enough staff. The management are aware of this situation on most occasions”. One relative commented, “My Aunt is currently experiencing great stability than in previous placements, I do appreciate this and I think my aunt does too”. Another commented “There are a few very caring staff”. Another commented, “If there is any criticism it is that they don’t have enough staff at times to cope”. Gorton Parks Nursing Home DS0000021678.V357232.R01.S.doc Version 5.2 Page 27 Gorton Parks Nursing Home DS0000021678.V357232.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Day to day management arrangements fail to make sure that care staff receive the leadership and support they need. EVIDENCE: Staff surveyed commented, “last time I had an evaluation was about 7yrs ago”, “ I feel that night staff carers are not trained enough” and “communication between day and night staff is a constant battle”. Another commented “I only ever meet the manager to discuss absences I’ve had” The frequency and quality of supervision for all care staff must be improved. Gorton Parks Nursing Home DS0000021678.V357232.R01.S.doc Version 5.2 Page 29 They told us that the unit managers should carry out the role of supervising staff, however, it had become apparent to the management of the service that not all staff were receiving regular formal supervision. They told us that some dates had been arranged for supervisions to take place. The homes policy on staff supervision was that staff received formal supervision 6 times a year. The manager must develop a system of auditing staff supervision on each unit to make sure all staff receive supervision in line with the organisation’s policies and procedures. We saw that the management and recording of accidents was not well managed. It was difficult to cross-reference the accident reports to the resident/staff and therefore impossible to fully audit them. It is the manager’s responsibility to make sure accident records are audited on a regular basis. This would enable them to identify any residents having recurring accidents and to produce a plan of action to minimise any risks to the resident. A number of completed accident reports had been left in the book. To meet the requirements of the DATA Protection Act 1998 completed reports should be filed in the resident/staff file. This also showed that regular audits of incidents and accidents were not taking place. This could result in the deterioration of resident’s conditions not being identified. We saw that a number of residents were waiting for a dentist to carryout a second visit. They told us that a dentist visited in August 2007. No attempts had been made by managers to follow up on this visit resulting in resident’s health care needs not being met. As previously stated it was of serious concern that at the time of our last site visit on 3/1/08 managers had taken action to contact the dentist or the PCT. The management of residents finances had not changed since the last inspection. The glass bolts on the fire doors on Delamere unit were missing and must be replaced. This was identified by the police officer investigating the safeguarding allegation who requested an inspection by the fire safety officer. It was of concern that this had not been identified by staff at the home. There were no management systems in place to audit care plans and make sure residents needs were assessed, reviewed and met or that staff were being appropriately supervised. Gorton Parks Nursing Home DS0000021678.V357232.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 X X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X x 2 Gorton Parks Nursing Home DS0000021678.V357232.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? 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 12(1) Requirement Care plans must contain sufficient information to enable staff to appropriately meet resident’s individual needs and must be regularly reviewed. Daily records contained in care plans must accurately detail the care delivered to residents to show that assessed needs are being met. There must be a complete, clear and accurate list of currently prescribed medication and, the time and date of administration for each person to help ensure that medicines are administered correctly. Medicines must be available and offered for administration as prescribed to ensure the health and well being of people at the service. The timings of the medicines rounds must be audited to ensure medicines are offered at the right and best times for residents. Timescale for action 28/02/08 2. OP9 17(1)(a) 31/12/07 3. OP9 13(2) 31/12/07 4. OP9 13(2) 28/01/08 Gorton Parks Nursing Home DS0000021678.V357232.R01.S.doc Version 5.2 Page 32 5. OP10 12 (4) (a) Residents’ dignity must be maintained at all times. To ensure the safety of residents all suspected abusive situations must be referred to Adult Safeguarding. 28/02/08 6. OP18 13 (6) 28/02/08 8. OP26 13 (4)(a) (c) 9. OP27 10. OP29 The home must be kept clean and satisfactory standards of hygiene maintained. Where 23 (2)(d) carpets have an odour these must be cleaned to improve the living environment for residents. 18(1)(a) There must be suitably qualified, competent and experienced staff working in the home in such numbers appropriate to the health and welfare of residents. 19 (1) (a) To ensure the safety of residents (b) (i) (c) living at the home a robust (4) (a) (b) recruitment procedure must be (i) adhered to at all times and all safety checks must be undertaken prior to any work being undertaken. 12 (1) Management systems must be in place to ensure that the needs of residents are met by competent and trained staff who receive regular supervision. All staff must be trained in safe moving and handling techniques. 28/02/08 28/02/08 28/02/08 11. OP31 28/02/08 12. 13. OP30 OP36 13 (5) 18(2) 28/02/08 All staff must receive appropriate 28/02/08 supervision. Gorton Parks Nursing Home DS0000021678.V357232.R01.S.doc Version 5.2 Page 33 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 OP7 Good Practice Recommendations 1. It is recommended that the ‘Daily life’ recordings include sufficient information to evidence the care delivered over a 24-hour period. 2. It is recommended that the care files on Delamere are reviewed and updated to contain accurate and consistent information. 2. OP9 1. It is recommended that individual staff members sign for all thickened drinks/soups given to a resident. 2. It is recommended that the MAR should clearly cross reference to where there is a signed accurate recording of thickened fluids. 3. OP9 There should be individual written guidance for people prescribed ‘when required’ medicines to help ensure consistency in their use. Records should be made detailing why the ‘when required’ medicine was given and the outcome. 1. It is recommended that a record is kept of consultations/discussion with residents and relatives regarding the programme of activities. 2. It is recommended that the photographs on display on Delamere are updated as some date back to 1999. 5. OP15 It is recommended that the menu on the Dementia care units have photographs of the meals rather than the written version. It is recommended that staff training records are kept up to date to evidence that all staff have received training appropriate to the job they are doing and have been assessed as competent following the training. 4. OP12 6. OP30 Gorton Parks Nursing Home DS0000021678.V357232.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Manchester Local Office 11th Floor, West Point 501 Chester Road Old Trafford Manchester M16 9HU 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 Gorton Parks Nursing Home DS0000021678.V357232.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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