Inspection on 15/03/06 for Guide Lane Nursing Home

This inspection was carried out on 15th March 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Guide Lane Nursing Home 10/05/07

Guide Lane Nursing Home 23/08/05

Guide Lane Nursing Home 31/01/05

Guide Lane Nursing Home 04/08/04

Guide Lane Nursing Home 05/02/04

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

CARE HOMES FOR OLDER PEOPLE Guide Lane Nursing Home 232 Guide Lane Audenshaw Tameside M34 5HA Lead Inspector Mrs Fiona Bryan Unannounced Inspection 15th March 2006 09:00 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 Guide Lane Nursing Home DS0000025434.V284616.R01.S.doc Version 5.1 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. Guide Lane Nursing Home DS0000025434.V284616.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Guide Lane Nursing Home Address 232 Guide Lane Audenshaw Tameside M34 5HA 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 335 9989 0161 335 0948 Southern Cross Home Properties Limited Mrs Julie Richardson Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41), Physical disability (41), Physical disability of places over 65 years of age (41) Guide Lane Nursing Home DS0000025434.V284616.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Service Users to include up to 41 OP, 41 PD (E) and up to 41 PD. No service user under the age of 55 years of age to be admitted into the home. Two registered nurses must be on duty throughout each 24 hour period. Manager to be supernumerary to the above staffing requirement. Date of last inspection 23rd August 2005 Brief Description of the Service: Guide Lane is a purpose built home situated in the village of Audenshaw. The home provides nursing and personal care for up to 41 service users. The home is owned by Southern Cross Home Properties Limited, a private company, and is under the day-to-day control of a full time manager who is also a registered nurse. Accommodation is provided over two floors and consists of 37 single rooms, four of which offer en-suite facilities, and two double rooms for service users wishing to share accommodation. Two lounge/dining rooms and a smaller quiet lounge are provided offering choice to service users for socialising. A pleasant, well-tended garden is accessible to all service users. The home is on the main bus routes to Audenshaw, Ashton-under-Lyne and Manchester and is also close to Guide Bridge and Ashton-under-Lyne railway stations. Guide Lane Nursing Home DS0000025434.V284616.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Wednesday 15th March 2006 and was the second inspection of the year. It was undertaken by one inspector who spent time talking to residents, visitors and staff. At the last inspection in August 2005 the home was performing satisfactorily in many areas so the purpose of this inspection was to review progress in the areas that were identified as needing improvement. This was mainly related to how the care that was given to residents was monitored, the provision of activities and staff recruitment procedures and training. Five other key standards, which have to be assessed at least once year were not examined at the last inspection, and were therefore considered at this inspection. These standards included the home’s procedures for dealing with medicines and for dealing with residents’ personal finances, the qualifications of the manager and care staff and how the home protects the health and safety of residents and staff. A selection of documents was examined including residents’ care files, staff personnel files and maintenance records. Standards which were not assessed at this inspection, were considered to be satisfactory at the last inspection. For further information about how the home met these standards please refer to the report of the inspection on 23rd August 2005. What the service does well: What has improved since the last inspection? Since the last inspection many of the staff have undertaken comprehensive training in the care of people with dementia and were able to give examples of Guide Lane Nursing Home DS0000025434.V284616.R01.S.doc Version 5.1 Page 6 how this had changed their practice, as the training had improved their understanding of the needs of the residents and how they could best be met. What they could do better: 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. Guide Lane Nursing Home DS0000025434.V284616.R01.S.doc Version 5.1 Page 7 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 Guide Lane Nursing Home DS0000025434.V284616.R01.S.doc Version 5.1 Page 8 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): None of the standards in this section were assessed. EVIDENCE: Guide Lane Nursing Home DS0000025434.V284616.R01.S.doc Version 5.1 Page 9 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 and 9 Care plans do not always address all needs, particularly residents’ social care needs and this together with evidence that care is not always delivered as planned, leads to the risk that some residents’ needs will not be met. Procedures for the management of medicines within the home are generally satisfactory, ensuring the safety of residents. EVIDENCE: Care plans were generally detailed and person centred but there was evidence that they were not always followed in practice, for example the care plan for one resident stated that they needed to have two hourly pressure area care and that this must be recorded. Over a period of approximately four hours the inspector visited the resident several times and it was clear that their position had not been changed and other care had also not been carried out such as the emptying of their catheter bag. Records had not been adequately maintained to evidence how often the resident’s position was changed. Care plans did state the type of pressure relieving mattress in situ and the pump setting if applicable, which enables staff to check that the mattress is Guide Lane Nursing Home DS0000025434.V284616.R01.S.doc Version 5.1 Page 10 working effectively but did not always state if other measures were needed such as positional changes. Social care plans had not been developed for the majority of residents although there was some reference to social stimulation or activity in the daily records. One resident who had been assessed as being nutritionally at risk had not been weighed as this was not possible due to the resident’s physical condition. In these circumstances consideration should be given to other means of monitoring a resident’s nutritional status such as measuring their mid upper arm circumference. Since the last inspection the home has changed its pharmacy supplier. Examination of a number of residents’ medication administration records indicated that medicines were generally managed satisfactorily at the home. A record is maintained of all medicines received and sent for disposal by the home. The home utilises resident photographs as a formal system of identification prior to medication administration. Guide Lane Nursing Home DS0000025434.V284616.R01.S.doc Version 5.1 Page 11 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 and 15 Some progress has been made but further consultation is needed to ensure that the home satisfies all of the residents’ social and recreational needs. Residents are generally satisfied with the quality of food provided but the home needs to consider the timing of the meals to ensure they meet residents’ needs. EVIDENCE: Since the last inspection the activities organiser has attended in-house training regarding her role. The activities organiser was on duty on the day of the inspection and was observed to have a good rapport with the residents. The manager stated that the activities organiser spent quite a large percentage of her time on a one to one basis with residents as many are unable to participate in group activities. Throughout the day a pleasant, calm atmosphere was noted in both lounges, with either appropriate music or the television playing at various times. A record is maintained for each resident of the social activities they have participated in. The main activities for many of the residents seemed to be watching the television and receiving visitors. Only 2 of the 9 records Guide Lane Nursing Home DS0000025434.V284616.R01.S.doc Version 5.1 Page 12 examined indicated that residents had joined in with any other activities but some residents that were spoken to said they had joined in bingo sessions and enjoyed doing some arts and crafts. One resident said they did arm chair exercises and aromatherapy. As stated previously social care plans had not been written for many residents. Possible expansion of the key worker system and development of social care plans may help staff to further identify opportunities for preferred leisure interests. Many residents were still having breakfast at 10.45am and lunch, which was the main meal of the day was served at 12.30pm. Lunch was roast chicken, stuffing, roast and mashed potatoes and carrots. It looked and smelled appetising but the short time span between breakfast and lunch gave concerns that residents would not be sufficiently hungry to eat the meal properly. Although it was reported that menus had been reviewed since last inspection the most up to date menus had not been printed. The manager has been asked in a separate letter to this report to forward copies of the new menus to the CSCI for further examination. Guide Lane Nursing Home DS0000025434.V284616.R01.S.doc Version 5.1 Page 13 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): 18 Staff training has increased their knowledge of adult protection issues, providing a safe environment to protect residents from abuse. EVIDENCE: The majority of staff have undertaken a distance learning course in dementia care through Tameside College since the last inspection. The 12-week course is the equivalent of NVQ level 2 and covers topics such as the different types of dementia and the symptoms individuals suffer from, dealing with challenging behaviour and the prevention of abuse. It was reported that staff had worked on some aspects of the course in groups, which had been useful in discussing the various issues highlighted and all staff that had completed the course felt their awareness and understanding had increased. Guide Lane Nursing Home DS0000025434.V284616.R01.S.doc Version 5.1 Page 14 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, 24 and 26 Systems need to be reviewed to ensure that the home is kept clean and tidy and residents’ clothes are well maintained. EVIDENCE: A tour of the home indicated that rooms were generally clean and tidy although a lot of the walls and paintwork showed signs of wear and tear having been knocked by wheelchairs etc. One visitor said she came to the home on occasion to find her relative’s wardrobe was untidy with clothes not put away properly. A carer agreed that wardrobes were at times untidy and discussion with the manager revealed that storage has become more of a problem since residents started to be supplied with their own incontinence products, as they have to be stored in the resident’s rooms. Some malodours were detected in a small number of areas within the home. Guide Lane Nursing Home DS0000025434.V284616.R01.S.doc Version 5.1 Page 15 A window was cracked on the landing on the stairs and another window was cracked in one of the resident’s bedrooms. Guide Lane Nursing Home DS0000025434.V284616.R01.S.doc Version 5.1 Page 16 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): 28, 29 and 30 The percentage of care staff working at the home who have completed NVQ training does not meet the required targets. Recruitment practices ensure the protection of residents. Appropriate training has been provided which is relevant to the needs of the residents. EVIDENCE: 6 of the 15 permanent care staff employed at the home have achieved a NVQ level 2. This does not yet meet the target required for this standard. Examination of staff personnel files indicated that prospective employees had completed application forms and employment histories. CRB’s and references had been obtained for new employees. Copies of certificates of training and qualifications were on file. Over the last few months the majority of staff have been concentrating on completing the dementia care course through Tameside College. Other mandatory training has also been delivered. Guide Lane Nursing Home DS0000025434.V284616.R01.S.doc Version 5.1 Page 17 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, 32, 35 and 38 The manager has the skills and knowledge to properly manage the home, but a clearer definition of the responsibilities of key workers would enhance residents’ care and the smooth running of the home. Procedures are in place to ensure residents’ finances are safeguarded. The manager is aware of past failures on the part of some staff to follow procedures correctly creating a risk to the health and safety of themselves and residents and has put measures in place to prevent further shortfalls. EVIDENCE: The manager has successfully completed the Registered Managers Award and was able to provide evidence of further training she has undertaken to update her skills and knowledge. Guide Lane Nursing Home DS0000025434.V284616.R01.S.doc Version 5.1 Page 18 The roles of the nurses are clearly defined with nurses being allocated to a specific area of the home and supervising the carers working in that area. Although there is a key worker system in place, the role is not very clearly defined and expansion of this position could be useful in addressing some of the areas for development identified in this report, such as the maintenance of residents’ personal clothing and further exploration of how their need for social and mental stimulation can be met. The procedure for the administration of residents’ personal allowances has recently changed to an electronic format. Records and receipts are maintained of all transactions made on behalf of the residents and each resident has an individual ledger sheet detailing the balance of money that is kept on their behalf at the home. The majority of residents are assisted with their finances by their families. The day before this inspection it had been reported to the CSCI that a health care professional visiting a resident at the home had concerns about the moving and handling practices being used by staff. Whilst staff were observed during the inspection to be using safe working practices, the manager was asked to investigate the concern raised and subsequently reported that it was likely that some staff had not been moving and handling residents appropriately. The manager stated that this would be addressed through a staff meeting and further supervision. A small fire has occurred in the home since the last inspection and Greater Manchester Fire and Rescue Service advised the home regarding actions that needed to be taken or considered to reduce the risk of further fires. Since this event all staff have attended fire training and the home has produced an action plan to ensure that all matters identified by the Fire Authority are addressed. The home is also in the process of revising its fire risk assessment to address the shortcomings in its previous risk assessment. Guide Lane Nursing Home DS0000025434.V284616.R01.S.doc Version 5.1 Page 19 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 X 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 X X 3 X X 3 Guide Lane Nursing Home DS0000025434.V284616.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The registered person must ensure that the actions stated in care plans are carried out as planned. (Timescale of 31/10/05 not met). The registered person must ensure that care plans are developed to address the social care needs of residents. The registered person must ensure that intervals between meals are sufficiently far apart to allow residents to build an appetite and must ensure that the interval between supper and breakfast is not longer than 12 hours. (Timescale of 31/10/05 not met). The registered person must provide a programme of work to the CSCI to address the areas requiring redecoration. The registered person must ensure that the 2 cracked windows identified during the inspection are replaced. The registered person must review cleaning regimes within the home to ensure that the DS0000025434.V284616.R01.S.doc Timescale for action 31/05/06 2 OP12 15, 16 30/06/06 3 OP15 16 31/05/06 4 OP19 23 30/04/06 5 OP19 23 30/04/06 6 OP26 16 30/04/06 Guide Lane Nursing Home Version 5.1 Page 21 7 OP28 18 home is kept free from malodours. The registered person must ensure that care staff are supported to undertake NVQ training to ensure that the target ratio is achieved. 30/08/06 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 Refer to Standard OP8 OP32 Good Practice Recommendations The registered person should consider other means of measuring and monitoring residents nutritional status if it is not possible to weigh them. The registered person should clarify the role of the key worker to improve the opportunities to meet residents’ social needs and to address issues such as the maintenance of residents’ clothing. Guide Lane Nursing Home DS0000025434.V284616.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD 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 Guide Lane Nursing Home DS0000025434.V284616.R01.S.doc Version 5.1 Page 23 - 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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