Inspection on 05/07/06 for Grey Ferrers Nursing Home

This inspection was carried out on 5th July 2006.

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

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

Other inspections for this house

Grey Ferrers Nursing Home 17/05/09

Grey Ferrers Nursing Home 22/05/08

Grey Ferrers Nursing Home 11/12/07

Grey Ferrers Nursing Home 02/07/07

Grey Ferrers Nursing Home 20/09/05

Grey Ferrers Nursing Home 28/04/05

Grey Ferrers Nursing Home 02/08/04

Grey Ferrers Nursing Home 06/05/04

Grey Ferrers Nursing Home 03/03/04

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

CARE HOMES FOR OLDER PEOPLE Grey Ferrers Nursing Home Priestly Road Blackmore Drive Leicester Leicestershire LE3 1LQ Lead Inspector Mrs Gillian Adkin Unannounced Inspection 5th July 2006 10:00 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 DS0000001907.V301978.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. DS0000001907.V301978.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grey Ferrers Nursing Home Address Priestly Road Blackmore Drive Leicester Leicestershire LE3 1LQ 0116 2470999 0116 2558364 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) www.bupa.com BUPA Care Homes (CFH Care) Limited Vacant Care Home 120 Category(ies) of Dementia - over 65 years of age (60), Old age, registration, with number not falling within any other category (30), of places Physical disability over 65 years of age (30) DS0000001907.V301978.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Persons who fall within category DE(E) may only be admitted into Stewarts Hey & Woodville House Unit. Bradgate Unit may accommodate a total of 30 persons who fall within categories/combined categories OP and PD(E). Brandon House may accommodate a total of 30 persons who fall within categories/combined categories OP and PD(E). Service User Categories No person falling within either category OP or PD(E) may be admitted to the Home when an overall total of 60 persons who fall within those categories are already accommodated within the Home. AN43335 The registered provider is able to admit the person of category DE, named specifically in variation application number AN43335 dated 18 February 2003, who is under 65 years of age. V55305 The registered provider is able to admit the person of category MD(E), named specifically in variation application number V55305 dated 13 September 2003. V22368 The registered provider is able to admit the person of category DE, named specifically in variation application number V22368. V29195 The registered provider is able to admit the person of category TI, named specifically in variation application number V29195 dated 01 February 2006, who is under 65 years of age. V29612 That the home is registered to admit one named Service User, named in application number V29612, under category PD. 20th September 2005 5. 6. 7. 8. 9. Date of last inspection Brief Description of the Service: Greyferrers is a 120-bedded care home providing personal and nursing care for older persons. Accommodation is provided within four separate units, these are known as Brandon, Bradgate, Stewards Hay and Woodville providing care for older persons with nursing, physical disability and dementia needs. Each unit is comprised of a large dining/ lounge area, a small quiet lounge, toilet, washing and bathing facilities and single room private accommodation. The home is located on the outskirts of Leicestershire and is easily accessed by public transport from the City of Leicester and from the County. The home DS0000001907.V301978.R01.S.doc Version 5.2 Page 5 provides nursing and residential care for service users whose care needs fall within the categories of Older Persons and or Physical Disability and Dementia over 65 years of age. The home is purpose built and is accessible to service users with disabilities. Accommodation is located on the ground floor. Each unit has a spacious lounge and adjacent dining area, which look out the gardens. All bedrooms are single occupancy and all are ensuite, many open directly onto the garden. The home is currently managed by a registered nurse and employs Registered General nurses, Registered Mental Health nurses and care staff. The home has ample parking and is close to a number of social amenities. DS0000001907.V301978.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The service was inspected against the Regulations as in the Care Standards Act 2000. This was an unannounced inspection, which took place over 10.5 hours and commenced at 09.30 am on 05/07/06. The acting care manager facilitated the inspection. Concerns had been raised with the Commission for Social Care Inspection prior to this inspection by external professionals and relatives in relation to continence management, communication, service users being left in chairs for long periods of time,(staffing) personal hygiene management (service users) and record keeping. Further concerns had been raised regarding management of nursing needs on a dementia unit (Woodville) The focus of inspections is upon outcomes for residents living at the home and obtaining their views of the service provided. This process considers whether the home meets the National Minimum Standards and highlights areas, which might need further development/improvement. The method of inspection used is called “case tracking’ which involved selecting four residents and tracking the care they received this was achieved by discussion with them (where possible) and looking at associated records. Residents were selected from three units, Woodville, Bradgate and Stewards Hay. No residents were tracked on Brandon Unit and this unit was not inspected on this occasion. During this inspection a tour of the rooms (occupied by those case tracked) and associated communal areas took place and the inspector viewed internal records, and care plans. The inspector spoke to residents (where possible), nurses; care staff, ancillary staff and visitors. Four relatives were available during this inspection for comments. Comments made by relatives about the home during this inspection were mostly positive. Engaging with many residents was predictably difficult in Woodville and Bradgate units due to dementia type illnesses however views were obtained where possible. Typical residents/relatives/ staff comments included: “ We offer the option of sitting at the table or in a lounge chair, this very much depends on the persons preference or mood at the time” DS0000001907.V301978.R01.S.doc Version 5.2 Page 7 We do manage to meet personal care needs but have little time for anything else” “I would like to be got up at about 10-10.30am but I rarely am” “ My relative has really settled well here” “ I have a lovely room and the food is very good, I have no complaints” “If I saw anything resembling abuse I would report it to an appropriate person” “I have not had any pressure area care training since I came here about two years now” “ I have never had Protection Of Vulnerable Adult training but would know how to report an allegation of abuse”(Bradgate) “I am not involved in recruitment of staff and feel that my expertise would be useful when choosing staff for the unit” “We do not have residents or staff meetings” (Stewards Hay) “Person centred care is not always possible as we work on minimum staffing levels, there is little time for supervision of new staff” “On one occasion I gave instructions to staff four times, when I went to check if the job had been done it hadn’t! Staff did not understand my instructions” “Residents who have soft diets do not get a choice, if they don’t like the meal offered they have to wait for an alternative meal to be provided” “I enjoy coming in at lunchtime to help feed my wife, its very important to me” “My relative visited the unit (Stewards Hay) and found no clean clothes in XXXX drawer and the laundry was shut, it was 4.30 pm (The day before XXXX was found by relatives in another person’s pyjamas.)” “My sister went to the unit (Stewards Hay) and it took her 10 minutes to find a member of staff. She was informed that 3 staff were on duty for 30 residents (evening/night staff). The unit was ‘frantic’ and in chaos” What the service does well: Premises and accommodation visited were extremely well maintained and decorated. Garden areas were well-managed and provided pleasant areas for people to sit outside. Rooms visited were personalised and the dementia units contained memory boxes situated outside residents rooms, which contained DS0000001907.V301978.R01.S.doc Version 5.2 Page 8 familiar artefacts (memorabilia). Staff spoken with on units were friendly and welcomed visitors to the unit without restrictions. Two staff spoken with (Bradgate unit) informed the inspector that they had taken on the role of “key continence carers” and were fully responsible for making sure service users on this unit had the correct continence products. Records kept by them were appropriate and had been fully discussed with trained staff. What has improved since the last inspection? What they could do better: The acting care manager should ensure that the admission process including emergency admissions are clearly described in corporate documentation and that residents are not moved to other units unnecessarily. Concerns were raised before the inspection about the levels of staff in the home and staff’s ability to meet basic and specialist care needs (such as dementia) and to offer choices. During this inspection and following the inspection it was evident through observation and discussion with residents, staff and relatives that staffing levels were inadequate (in relation to the units inspected). Further discussion with senior staff indicated that staffing levels were pre set by the organisation and that there were no opportunities to challenge them. Evidence was found to suggest that staff are unable to meet specific needs such as reasonable getting up times. Concerns were raised at the last inspection about service user choices and quality of food provided, although measures have been taken to address this, DS0000001907.V301978.R01.S.doc Version 5.2 Page 9 evidence was found to suggest that although food was improving, those persons requiring a soft diet have no choice and that where a choice has been made this could be changed with minimal notice resulting in them having to wait for an alternative to be produced. Care records on two units had improved however record keeping on Woodville was still in need of improvement. The acting care manager informed the inspector that this was being addressed through performance management of particular staff. Staff meetings were not being undertaken on two units and the inspector was informed that no supervision of staff had taken place on Bradgate unit, this does not allow staff to address personal concerns in a formal manner. The acting care manager is not currently involved in the recruitment of staff from overseas and therefore she is not fully informed about staff’s ability prior to commencing work at the home. It was evident through discussion with senior staff that a number of these staff had minimal previous care experience. Concerns had been raised with the inspector prior to and during this inspection about communication difficulties of some staff and their understanding of service user requests particularly when working on the dementia unit. Although staffing levels on the dementia unit are higher than other units concerns were raised over the skills, understanding and ability of some of the staff employed there. It was agreed that this matter would be formally discussed with the responsible individual and appropriate action taken to address. 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. DS0000001907.V301978.R01.S.doc Version 5.2 Page 10 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 DS0000001907.V301978.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3.6 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to the service. A qualified person assesses residents before admission; this process involves residents/relatives and other professionals. EVIDENCE: The inspector case tracked four residents to establish if assessments had taken place before admission, all care plans contained an assessment and additional mental health and nursing assessments where required. Residents tracked were unable to confirm their involvement in the assessment. Assessments are undertaken by the acting care manager or unit manager who are registered nurses. The inspector case tracked a resident newly admitted to the home and evidence was seen of external supporting assessments for nursing care. The organisation has a corporate admission and care planning policy which were seen prior to this inspection.It was recommended that the Statement of Purpose and service user guide ( Information about the service provided) are updated to include information about the admission process.Assessments for DS0000001907.V301978.R01.S.doc Version 5.2 Page 12 use of bedrails were seen in place where required these had been evaluted and were current. Following discussion with the acting care manager it was confirmed that some reassessments of residents had taken place in order to establish if nursing care needs had increased. The Commission for Social Care Inspection were informed that one resident had been moved to another unit. The care home is registered as a care home with nursing and two units are registered for dementia care and physical disability (Woodville and Stewards Hay). The Terms and Conditions were seen and identify that it may occasionally be necessary to move rooms, however no reference is made to moving units or the reason this may happen. It was agreed with the acting care manager that it should be possible to meet all care needs within the original unit accommodated in as both RMN and RGN nurses work in units concerned. Where this is not practical and where it is likely that a move from one unit to another may be required service users’ should be fully informed before signing a contract, and if this situation is likely to occur routinely, terms and conditions and the Statement of Purpose would need to be amended to be reflective of this. DS0000001907.V301978.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7.8.9.10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Care planning processes overall are reasonable and identify care needs but do not always involve consultation with the resident, or include information about personal choices,this prevents person centred care being delivered. EVIDENCE: Four residents were case tracked and all had a care plan in place, care plans inspected contained essential information including appropriate risk assessments and were evaluated and evidenced some relative involvement. In one instance the care plan was difficult to read and was not reflective of the personal care needs of the resident and none of the care plans inspected included the arrangements for ensuring privacy and dignity or social needs. Observation of care plans identified that external professionals were involved in the care of residents. Records seen relating to one person tracked (Woodville) were inaccurate and did not fully detail care provided by staff (turning charts). The resident was noted to be nursed in bed on the day of inspection and when questioned the inspector was informed that this was for DS0000001907.V301978.R01.S.doc Version 5.2 Page 14 pressure relief. Checking of care plans indicated that the reason was different. Discussion with the acting care manager confirmed that the reason for this was due to the home awaiting the arrival of a specialist chair, which was required for safety. Records seen on other units were reasonably maintained. Discussions were held with staff about the arrangements for managing continence, two staff spoken with on Bradgate unit informed the inspector that they had taken on the role of “key continence carers” and were fully responsible for making sure service users on this unit had the correct continence products. Records kept by them were comprehensive and had been fully discussed with trained staff. The acting care manager stated that she would consider this role on other units. Concerns had been raised about continence care by a ward sister before this inspection and relatives raised further concerns afterwards. Staff spoken with informed the inspector that usually they are able to meet the basic care needs of residents and that regimes for toileting are adhered to, this was witnessed in the three units inspected however, one service user was found in bed at 12.15pm who stated this was not unusual and indicated that they regularly had to wait to be put on the toilet and to be got up and dressed. Suitable arrangements must be made to ensure that residents are able to retain choice and control over the lives wherever possible. The unit manager had not addressed this matter in the care plan and staff had not informed the manager they were having difficulty in getting residents up (Bradgate), it was agreed with the unit manager that staff had a responsibility to inform unit managers if they were unable to meet the basic care needs of residents within reasonable times. It was further agreed that additional monitoring or staff deployment might be required to ensure basic care needs are met. Discussions took place with staff including those from minority ethic backgrounds and those from Eastern European Countries about diversity and the type of residents they may be required to care for.A member of staff stated that diversity was covered during induction and NVQ training. DS0000001907.V301978.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12.13.14. 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The Resident’s needs are not being met in all instances resulting in inadequate care being delivered. EVIDENCE: Discussions with the acting care manager indicated that action had been taken since the last inspection to address concerns regarding food provision, this included more robust monitoring of waste, visits to the units by the chef to check on presentation and cleanliness, discussions held on the units indicated that the chef did not spend time talking to residents about food. Observation of the midday meal in one unit indicated that a large number of people required assistance with their meal and relatives were encouraged to help with this, one said “I enjoy coming in at lunchtime to help feed my wife, its very important to me” Staff discussion indicated that in one unit there were a high percentage of people who required assistance and that staffing levels were not always adequate to manage this, and that on occasions people had to wait for long periods for assistance. In another unit higher levels of staff are on duty to manage the needs of those with dementia and to allow staff to have the time required for assistance. (Woodville) Staff were observed assisting in a sensitive and appropriate manner. DS0000001907.V301978.R01.S.doc Version 5.2 Page 16 Observation of the menus and discussion with staff highlighted concerns over choice where a soft diet was required. The inspector was informed that no choice was given to those on soft diets at lunchtime and although an alternative was available, many residents were unable to make choices. The inspector was informed that if an alternative is required it takes a long time to get the kitchen to prepare something and residents are left waiting. The lunchtime meal is served at approximately 1.00pm and was still being served in some units at 2.00pm, the evening meal is served at approximately 4.45pm, and this does not allow a reasonable time between meals. The inspector observed the menu on the day and found that the soft diet on offer had been changed at the last minute from bubble and squeak to mince casserole, residents spoke with said they had ordered bubble and squeak, but readily accepted the casserole. The acting care manager said that it had been identified with the cook that this was due to no cabbage having been ordered. An agreement was made with the acting care manager that two choices would be offered at lunchtime and that the system for ordering food supplies would be discussed and action taken to improve. Improvements are required to ensure that menu choices are fully detailed and that residents receive the meal they have ordered or prefer in a reasonable timeframe. Discussion with residents about routines indicated that toileting regimes are adhered to well, particularly on the dementia care units however concerns were raised with the acting care manager about two residents who were still in bed after midday. One resident said it was not unusual to be left in bed until lunchtime and that staff did not always respond to calls quickly as they were “pushed”. Discussions with this resident, the unit manager and the acting care manager indicated that although the person might change their mind about getting up times and going to bed times, generally it was not acceptable to be left in bed for breakfast and lunch, unless by personal choice or as a clinical need. The care plan was inspected and did not contain evidence of personal choices being agreed regarding routines. Dependency monitoring had been completed but did not include discussion or evidence about personal preferences. This was confirmed with one unit manager. Another resident case tracked was found in bed during the inspection; reasons given by staff were that this was for pressure relief and due to personal issues. Care plans inspected were not reflective of the real reason, which was described by the acting care manager as a safety measure whilst waiting for seating which the person had been assessed for. Some records for this person were not reflective of the routines as described in the care plan and were poorly evidenced. Good evidence was found in relation to nutritional intake monitoring however. DS0000001907.V301978.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16. 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Complaints are taken seriously and acted upon within appropriate timescales. Staff have a reasonable understanding of the prevention of abuse. EVIDENCE: Discussion with unit managers and the acting care manager and observation of complaints records indicated that no complaints or concerns had been recorded or reported this month. Concerns were raised with the Commission from a relative regarding the lack of complaint documentation available in a specific unit visited. Copies of the complaints policy were seen in each unit visited during this inspection and although official documentation may not always be available, relatives were reminded that complaints could be made in any format including direct contact with managers or staff. Discussion with the registered provider indicated that residents’ and their relatives were given the opportunity to raise concerns at relatives meetings and through the usual complaints process Information contained on a notification received by the Commission was not reflective of actions taken by the home following an incident. It was apparent through discussion that the unit manager was unaware of the details required and therefore had not completed the document satisfactorily. This resident was case tracked and identified to be at risk of falls. Documentation received was inconclusive of actions taken or any investigations. Discussion with relatives and staff indicated that residents meetings were not held regularly on all of the units inspected. DS0000001907.V301978.R01.S.doc Version 5.2 Page 18 Recent complaints have been brought to the attention of the registered provider since the inspection and the Commission for Social Care Inspection were waiting on responses at the time of this report being written. A number of staff were spoken with at this inspection and all were aware of their roles and responsibilities regarding report concerns or allegations. BUPA include abuse training into Induction and NVQ training (records were seen) however at least two staff spoken with said they had “not had abuse training” Discussions with senior staff indicated that a number of staff might not understand training provided due to communication difficulties. Evidence was seen during this inspection of the moving of a resident in a chair, the carer concerned was moving the chair alone, this resulted in the chair being banged into the wall, the resident’s legs were over the end of the chair, although the resident was unharmed two senior members of staff witnessing this incident raised no concerns. This matter was discussed with the acting care manager who agreed to investigate the poor practice seen and future practice. It was strongly recommended that moving and handling of residents is monitored to ensure techniques used are safe and that residents are protected from harm. DS0000001907.V301978.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19.22.26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home is clean, comfortable and premises are well maintained resulting in a suitable living environment for residents. EVIDENCE: A tour of the rooms and communal areas occupied by those persons case tracked demonstrated that accommodation was clean and hygienic and external areas, observed appeared to be well maintained. A programme of redecoration and carpet replacement was underway in Woodville unit as part of the annual decoration programme, new carpets were being fitted after decoration is completed. Rooms visited were personalised and the dementia units contained memory boxes situated outside residents’ rooms, which contained familiar artefacts (memorabilia). Staff spoken with on units were friendly and welcomed visitors to the unit without restrictions. Residents tracked (where possible) described the individual pieces of furniture they had brought into the home with them. DS0000001907.V301978.R01.S.doc Version 5.2 Page 20 Residents’ room were clean, comfortable and homely and were laid out in positions, which suited them or were environmentally appropriate. Two of the residents tracked required equipment for moving and handling and rooms were sufficiently large enough to allow safe movement whilst using equipment. Discussion with staff however indicated that despite an internal audit being undertaken there was an inadequate number of slings in Woodville unit. Staff confirmed that the bucket type slings used was only suitable for specific tasks and that other slings were not the correct size for all residents requiring hoisting. Discussions took place with the acting care manager in relation to concerns received from staff about provision of slings and assessment for equipment including wheelchairs and seating. Evidence was found to support that a referral had been made for a chair for a specific person, and sufficient evidence was found to demonstrate that adequate numbers of hoists are provided. The acting care manager agreed to ensure that all units receive the required number of slings. In Bradgate unit a resident explained that they required a specific type of hoist (standaid) and only one was available therefore resulting in long waits whilst other were using it. Concerns were raised by a relative about provision of equipment and these matters were being dealt with under separate correspondence. DS0000001907.V301978.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The numbers, experience and deployment of some staff are not adequate to meet residents’ care needs. EVIDENCE: Concerns had been raised with the Commission for Social Care Inspection prior to the inspection regarding the numbers of staff in particular units. Discussions with unit’s managers indicated that where possible the same staff worked on each unit. It was noted that on Woodville unit a large number of new staff had been deployed, this is a specialist unit and some staff had communication difficulties. Discussion with some senior staff indicated that regularly tasks took longer or were not completed due to lack of understanding of instructions given. A senior member of staff stated that they were unable to provide person centred care due to the inexperience or understanding of some staff. Many residents require assistance with food on Bradgate unit and staff discussions highlighted that there were inadequate staff to provide this level of input, which resulted in long delays at meal times. A number of residents were observed waiting for their meal and relatives were feeding some. In one instance a resident was still in bed after midday and informed the inspector that this was not by choice and was due to insufficient staff. Care plans seen did not evidence this arrangement as a personal choice although it was acknowledged that on occasions the resident did change their mind about the time they got up. DS0000001907.V301978.R01.S.doc Version 5.2 Page 22 Staff on this unit stated that they were responsible for getting up thirty people on the unit and that these people were heavily dependent requiring two staff. This was evidenced in care plans seen. Further discussion with the unit managers indicated that staff had not alerted the manager to difficulties they were experiencing in getting residents up within a reasonable time. Staff informed the inspector that it was not an unusual occurrence to be getting people up at lunchtime. Discussions with unit managers indicated that staffing levels were preset by the organisation and that they had not challenged them, the acting care manager was aware of difficulties with some staff and was attempting to address this by performance management. The acting care manager stated that she was not involved in the recruitment of overseas staff and therefore is unaware of their level of experience before they start work. The acting care manager informed the inspector that a new deputy manager was starting work the week after this inspection that would have a key role in staff management and performance and staffing levels. It was strongly recommended that discussions should take place with the Registered Provider about staffing levels and recruitment procedure when selecting overseas staff to ensure staff are deployed to the most suitable unit where they can be fully supported during induction. Evidence was provided through discussion and observation of records of a wide variety of training being provide although it was indicated by discussion that some staff had not received dementia or adult protection training. It was recommended that a staff training analysis be undertaken as soon as possible to ensure that all staff are trained to the same level. DS0000001907.V301978.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31.33 36 37.38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The health, safety and welfare of residents is promoted. EVIDENCE: The acting care manager is a registered nurse who has applied to the Commission for Social Care Inspection for registration. She has significant previous experience in managing large care homes. Information was supplied to the Commission for Social Care Inspection before this inspection relating to the general management of health and safety in the home. The information provided indicated that the home employs a full time maintenance person and that BUPA maintain accurate maintenance records and procedures. Exploration of additional documents including risk assessments, accident records and personal risk assessments indicated that overall reasonable DS0000001907.V301978.R01.S.doc Version 5.2 Page 24 measures are taken to minimise risk and promote and protect residents. Evidence was seen in one of the units inspected of residents and staff meetings taking place, however meetings are not regularly conducted on the other units. Staff supervision is not routinely undertaken although staff on one unit stated that the unit manager is always available for discussion. It was recommended that the method and frequency of supervision be increased to ensure staff are able to meet with their manager to discuss issue relating to their role. The frequency of residents meetings needs to be increased. DS0000001907.V301978.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 x X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 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 3 X 3 X X 2 2 3 DS0000001907.V301978.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP27 Regulation 18 Requirement Staff numbers and abilities must be appropriate to the numbers and needs of residents for whom they provide care. Residents’ must be assessed and equipment provided as deemed necessary to meet their needs. Resident’s health and personal care needs and choices must be reflected in their plan of care. Timescale for action 05/08/06 2 3 OP22 OP7 16 15 05/08/06 05/10/06 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 3 4 Refer to Standard OP37 OP36 OP27 OP10 Good Practice Recommendations Records kept should be accurate and reflective of actions taken by staff. The registered manager should improve the method and frequency of supervision in each unit. Appropriate staff should be deployed in units dependent on level of experience. Continence needs should be met in a manner which suits DS0000001907.V301978.R01.S.doc Version 5.2 Page 27 5 6 7 OP15 OP12 OP18 the needs of the resident. Suitable arrangements should be made to ensure that all residents have a choice of meal. Resident’s choices regarding preferred routines should be recorded in their care plan. All staff including bank staff and ancillary staff must attend adult protection training. DS0000001907.V301978.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 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 DS0000001907.V301978.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!