Inspection on 18/10/06 for Hafod Nursing Home

This inspection was carried out on 18th October 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

Hafod Nursing Home 04/02/10

Hafod Nursing Home 27/10/09

Hafod Nursing Home 18/12/08

Hafod Nursing Home 02/07/08

Hafod Nursing Home 07/08/07

Hafod Nursing Home 08/11/05

Hafod Nursing Home 27/07/05

Hafod Nursing Home 18/10/04

Hafod Nursing Home 23/06/04

Hafod Nursing Home 09/02/04

Hafod Nursing Home 18/09/03

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

CARE HOMES FOR OLDER PEOPLE Hafod Nursing Home 9 - 11 Anchorage Road Sutton Coldfield West Midlands B74 2PJ Lead Inspector Amanda Lyndon Unannounced Inspection 18th October 2006 10:15 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 Hafod Nursing Home DS0000024844.V315556.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. Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hafod Nursing Home Address 9 - 11 Anchorage Road Sutton Coldfield West Midlands B74 2PJ 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) 0121 354 9442 0121 354 2616 hafodltd@aol.com none Hafod Care Homes Ms Mahnaz (Nazy) Mohtadi Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29), Terminally ill over 65 years of age (29) of places Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That Mahnaz (Nazy) Mohtadi undertakes and obtains successfully the Registered Managers Award or equivalent by December 2005. 8th November 2005 Date of last inspection Brief Description of the Service: Hafod Nursing Home provides general nursing care for up to 29 people who are aged 60 years or above. The Home does not accommodate residents with moderate or severe dementia. Four of the beds are contracted by the Primary Care Trust for the provision of intermediate care and two are funded by Social Care and Health for interim care. The Home comprises of two converted houses within a residential area that have been adapted for it’s current use and is located close to Sutton Coldfield town centre. There is good access to local bus and rail links and it is within 510 minutes walking distance of the town centre. There is off road parking at the front of the building for six cars. There is a choice of seating and dining areas located on the ground floor. There are a mixture of single and shared rooms located on both floors, all having an en suite facility. There is a passenger lift for residents to access both floors and a large well-established secure garden situated to the rear of the premises which is suitable for wheelchair users. There is a no smoking policy within the Home however smoking is permitted within the garden area. Assisted bathing facilities are provided and staff are available for assistance in these areas as required. Aids and adaptations are provided for residents with physical disabilities. There is a notice board displaying forthcoming events and other information of interest to residents and their visitors. The most recent CSCI inspection report is available in the reception area of the Home. The weekly fee to live at Hafod Nursing Home is between £480 and £640 and this includes physiotherapy. Items not covered by the fee include hairdressing, chiropody and newspapers. Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report reflects the findings of a one day unannounced field work visit undertaken by one Inspector when there were twenty nine residents living at the Home. Four of these people were receiving intermediate care and two were receiving interim care. All of the residents were female. Information was gathered by speaking with residents and staff, case tracking, examining care, medication and health and safety records and observing the staff perform their duties. A tour of the Home was undertaken. Prior to the field work visit positive comments were received from residents about the service provided including: “ The Home proved to be most accommodating and friendly from the offset” “ Where possible all requests have been acted upon” “ There has been a marked improvement in the quality and variety of menu recently” “We feel the medical care is very good” “The Home is kept very clean and fresh smelling” A negative comment was received from a relative about the lack of activities on offer to residents. The Registered Manager had completed a pre inspection questionnaire, giving some information about the Home, residents and staff which was taken into consideration. Shortly after the field work visit the Registered Manager sent an action plan to CSCI and this addressed any requirements made during the visit in a timely manner. What the service does well: The admission process is thorough. Prospective residents are invited to spend a day at the Home in order to sample what it would be like to live there. All of the staff team ensure that residents are supported to receive the appropriate care that they require in order to meet their health care needs and input from Health and Social Care Professionals is comprehensive and timely. The good standard of care is consistent for residents receiving intermediate, interim or permanent stay care. One resident receiving intermediate care said “ They are looking after me well here” Another resident said “ One of the carers are going with me for my hospital appointment today. It is so different to hospital, I can laugh here”. Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 6 Residents are provided with a comfortable living environment in which they feel safe and secure and visitors are made to feel welcome. One resident said “ The first thing that our visitors are asked is whether they would like a tray of tea”. Another resident said “ I talk to all of the ladies here, we are all friends”. Residents receive a choice of wholesome meals which meet any dietary needs for reasons of health, religion, culture or personal tastes. One resident said “ The meals are excellent, we have a choice of food, we only have to ask the kitchen staff and they are very obliging, the food is always served hot” Residents can personalise their bedrooms to reflect their individual tastes, cultural choices and interests and this ensures that they feel comfortable in their surroundings. There is an attractive garden for residents to enjoy and this is suitable for wheelchair users. Residents are cared for in a respectful manner and this ensures that their dignity and self esteem are maintained. One resident said “ The staff come promptly if I need them”. Residents are able to exercise choice over their daily lives and routines and this promotes their individuality and independence. Residents’ individual religious beliefs and cultural preferences are respected. There are opportunities for religious worship and support is provided by staff in this area. There is a comprehensive complaints procedure accessible to residents and visitors should they need to make a complaint and complaints are investigated in a timely fashion. Staff receive appropriate training to ensure that they have the knowledge to work competently within their job roles. Residents are invited to regular meetings to discuss the service provided at the Home and there was evidence that any suggestions made are acted upon. One resident said “ We had a meeting about food and discussed what we all liked and disliked, it was very interesting”. The Registered Manager is enthusiastic and approachable and this promotes a positive living and working environment. There is a robust system for the management of residents’ personal allowances should they choose for the Home to hold this on their behalf. One resident said “ The nurses can access my money when I need it, we sign a receipt. It’s great to know the money is there”. Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: On completion of the trial period residents that are privately funded do not always have the opportunity to formally discuss whether they would like to continue to live at the Home. Care plans are not agreed and reviewed with residents and their families and this may prevent their preferred routines in respect of their daily lives from being maintained whilst living at the Home. Residents do not have the facility to use the telephone in private. The activities on offer do not meet the needs and interests of all residents living at the Home. One resident said “ We used to have bingo, painting and handicrafts here but the lady that arranged them doesn’t come here anymore, we would like more”. Some areas of the Home are in need of redecorating and some of the bedroom furniture is in need of replacing. Not all residents have a lockable facility in their bedrooms and this does not afford their privacy. A report based on the results of service satisfaction questionnaires should be produced and made available to residents and their visitors in order for them to monitor any improvements made at the Home. Some staff choose to work an excessive number of hours each week and the management team must ensure that the work performance of these people is not affected as a result of this. A number of fire doors were wedged open and this would cause the spread of fire in the event of an emergency. Suitable door closures that are linked in to the fire alarm system must be fitted in order to safeguard residents. Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hafod Nursing Home DS0000024844.V315556.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 Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5 & 6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Admission processes are thorough and residents have adequate information in order to make an informed decision about whether they would like to live at the Home. The intermediate care facility provides a good standard of care for people in need of rehabilitation and this improves their quality of life. EVIDENCE: A statement of purpose and service user guide was available in each bedroom for residents to refer to and these are available in a large print format if required for people with impaired eye sight. The service user guide was very informative and easy to read. The statement of purpose required minor adjustments to reflect the current services provided. Senior staff undertake comprehensive pre admission assessments for all prospective permanent residents in order to ensure that their individual care needs could be met at the Home and thus prevent inappropriate admissions. Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 11 Prospective residents are encouraged to visit the Home in order to sample what life would be like to live there. Residents come to live at the Home on a four week trial period and on completion of this the Social Workers of residents funded by Social Care and Health arrange a care review involving the residents, their families and the Home’s staff to ensure that they are happy to continue to live at the Home and to ensure that their care needs are being met whilst living there. The Home must formalise their procedure for reviewing the care of privately funded residents on completion of their trial period. Intermediate care funded by the Primary Care Trust (PCT) is provided for four residents living at the Home at any one time for a period of up to approximately six weeks each person. The intermediate care team includes General Practitioners, an Occupational Therapist, Physiotherapist, Specialist Community Nurses and a Social Worker. Prior to coming to stay at the Home, the intermediate care team assess each person’s suitability to stay there and it is identified within the agreement that Hafod Nursing Home does not provide accommodation for people with dementia care needs. People receiving intermediate care are admitted directly from hospital and are often in need of rehabilitation care following trauma and orthopaedic surgery. Most of the specialist equipment required for people receiving intermediate care is funded and provided by the PCT. One resident receiving intermediate care said “ They are looking after me well here” Another resident said “ One of the carers are going with me for my hospital appointment today. It is so different to hospital, I can laugh here”. Interim care funded by Social Care and Health is provided for up to two residents living at the Home at any one time for a period of up to six weeks each. The majority of these residents are deciding where they would like to live in the future and would have previously of had to remain in hospital until this decision was made. Plans were in place for a further two interim care beds to be made available at the Home however there were currently no vacancies. Hafod Nursing Home DS0000024844.V315556.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 & 10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Health provision and care delivery is good. Residents are supported in a respectful manner by staff and this ensures that their individuality and self esteem are maintained. EVIDENCE: A comprehensive assessment of residents’ individual care needs was completed on admission to the Home and this included detail of their health, personal and social care needs, their abilities and some of their preferences in respect of their daily lives. Care plans were derived from this information and were reviewed regularly. Most of these included good detail of the specific support required by staff in these areas, however there were inconsistencies in respect of some care plans that had not been individualised and this may prevent residents from receiving the specific support that they require. One care plan for diabetes did not reflect the actual care that the resident was receiving, although the resident was receiving the appropriate care. Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 13 Care plans had not been agreed or reviewed with the involvement of the resident and/or their representative and this may prevent their individual preferences in respect of their daily routines from being maintained. Comprehensive personal risk assessments of individual residents had been undertaken and these identified the support required by staff to minimise any risks to residents’ health and welfare whilst maintaining their independence and preferred choices. Moving and handling risk assessments had been undertaken and were reviewed regularly however these did not identify the action to be taken should a resident fall and did not identify the type of hoist and sling size to be used in respect of individual residents. The moving and handling risk assessment of a resident who had been re admitted to the Home had not been updated since her previous stay at the Home. Bed rail safety assessments had been undertaken and these had been signed by residents or their representatives however did not identify the risks involved with the use of these. It was apparent that both permanent and intermediate/interim care residents received a good standard of health and personal care whilst living at the Home and support from both the Home’s staff and visiting Health and Social Care Professionals including opticians, dentists and dieticians was comprehensive and met both the acute and chronic health care needs of residents. All residents living at the Home were encouraged and supported to maintain their independence to the best of their individual abilities. Systems in place for wound management were good, appropriate pressure relieving equipment was available and staff had received comprehensive training regarding this. A resident had come to stay at the Home with very sore skin and this had healed well with the care of the Home’s staff. The Home’s nursing staff had built up a good rapport with community nurses who provided support regarding additional nursing tasks, for example the administration of intravenous medication and plans were in place for the Home’s staff to receive the appropriate training in this area. Hospital admissions were prevented as often as possible and residents and their families’ wishes in respect of this were respected wherever possible. Residents were weighed regularly and their blood pressure, pulse and other nursing observations were recorded regularly in order to monitor the state of their health. Staff provided support to a resident who had impaired speech and methods had been introduced to promote effective communication for this person, thus improve her quality of life. Annual care reviews involving the resident, their relatives, named nurse and key worker had been introduced recently and this is a good opportunity for all concerned to put forward any suggestions or comments about the care provided. Resident’s individual care plans will be discussed and reviewed at Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 14 this time in order to ensure that their preferred routines are maintained and that they are receiving the support that they require in order to meet their changing care needs. One resident said “ I prefer living here to my own house as I feel safe here”. There was a safe system for the management of the medication in place and the nursing staff team had a good knowledge of this. Careful checking of the medication prescribed on admission for residents receiving intermediate or interim care was undertaken to ensure that residents were administered the correct medicine. Medication administration charts were well maintained and the system was regularly audited for accuracy and this safeguards residents. Blank prescriptions for the General Practitioners’ use when visiting residents receiving intermediate care at the Home were kept on site and were not locked away and this does not safeguard residents and may lead to inappropriate use. Residents appeared to be well cared for and were supported to choose clothing appropriate to the time of year, their tastes, gender and cultural preferences. The preferred gender of care staff providing personal care to residents was recorded within their individual care plans in order to respect their wishes. A payphone was available for residents’ use however this was located in the reception area of the Home and did not afford residents’ privacy whilst on the telephone. Personal information pertaining to residents’ health and the trained nurses registration details was on display in the main office and this does not afford confidentiality and an alternative location for this information must be sought. Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The activities on offer do not meet the needs and expectations of all residents living at the Home. Residents have control over their daily lives and are provided with a choice of healthy meals that meet any special dietary requirements. EVIDENCE: Activities on offer include weekly music and movement sessions, library books, musical entertainment and film shows on the recently purchased television and DVD player. A bonfire night party is planned and residents are supported during shopping trips. One resident said “ I talk to all the ladies here, we are all friends”. The Home does not employ an activities person and the activity programme on display was out of date. A number of residents met during the field work visit stated that they would welcome more “in house” activities. One resident said “ We used to have bingo, painting and handicrafts here but the lady that arranged them doesn’t come here anymore, we would like more”. Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 16 One resident said “ The couple who come to teach us exercises have great personalities, we all enjoy it” A number of residents were unable to participate in group activities for reasons of poor health and there were no specific activities arranged to meet their individual interests and abilities. One resident who was nursed in bed stated that she felt too ill to participate in any activities, however this must be reviewed periodically and assessments of other residents who are nursed in bed must be undertaken. An activities register was kept however the information documented within this was not always relevant and would not be useful when planning future activities. Two hairdressers visit at weekends and a hair salon is provided for this purpose. The hair salon was very basic, the sinks and floor were dirty and in need of a refurbishment, however plans were in place to rectify this. A Church of England Minister visits the Home each week and Holy Communion is available regularly. Opportunities for worship for residents of non Christian faiths can be arranged as required. There is an open visiting policy and many positive comments were received from visitors about the standard of service provided at the Home. One resident said “ The first thing that our visitors are asked is whether they would like a tray of tea”. There were no rigid rules or routines at the Home and residents confirmed that they were able to choose how they spent their day, the time that they got up in the morning and the time they went to bed. This ensures that residents’ individuality and independence are maintained. Following consultation with residents, the menus had recently been revised and these included a variety and choice of wholesome meals to ensure that residents received a healthy diet. Residents who were unable to attend the recent residents’ meeting were also consulted about their ideas for the new menu options. Special diets are prepared for reasons of health or dietary/cultural preferences, however apart from a reducing, diabetic and soft diet, the residents currently living at the Home were receiving a normal diet. The menus were on display in the dining areas and these reflected the main meals of the day which was sausages and vegetables or beef salad. Residents confirmed that they had chosen which of these options they had been served and some residents had chosen a third choice if they did not want the main options of the day. Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 17 The meals were well presented and appetising, however the terrines of vegetables were not served from the dining tables in keeping with good practice to give residents control over portion sizes. The Registered Manager confirmed that the terrines were usually on the dining tables. One resident said “ We have a cup of tea and biscuits before bed” Another resident said “ The meals are excellent, we have a choice of food, we only have to ask the kitchen staff and they are very obliging, the food is always served hot” Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Complaints are investigated in a timely manner and vulnerable residents are protected by the Home’s staff. EVIDENCE: A number of compliments about the service provided at the Home were on display. A comprehensive complaints procedure was on display in a large print format and a suggestions box was available in the reception area of the Home in order for residents or their visitors to be aware of how to make a complaint if needed. Since the last inspection CSCI have not received any concerns or complaints about the service provided at Hafod Nursing Home. The complaints register held at the Home identified concerns regarding the laundry service, a missing item of clothing and the speed in which a staff member had supported a resident during their meal. These concerns had been investigated in a timely and appropriate manner to the satisfaction of the complainants and practices had been reviewed in response to these. There was one unresolved complaint regarding a dispute between the Registered Providers and the visitor of a resident and it is recommended that an advocate be sought in order for this situation to be resolved to the satisfaction of the identified resident. Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 19 Staff had recently received training about the protection of vulnerable adults and this safeguards residents. Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 & 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents are provided with a comfortable place to live in which they feel secure. The lack of mechanical commode pot disinfector facility may cause the spread of infection and does not safeguard staff. EVIDENCE: The secure external garden was spacious and well maintained. There was ramped access leading out to this area and it was suitable for wheel chair users to enjoy. There was some surplus equipment that had been left in the garden for example two bed frames and a filing cabinet and these are a trip hazard and must be removed in order to safeguard residents. One resident said “ I enjoy going in the garden”. The first impressions of Hafod Nursing Home was that it was warm and inviting and decorated in a homely style. New carpet had been fitted to some areas of the Home and a programme of replacing bedroom furniture and carpet was in place. Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 21 Some areas of the internal environment of the Home appeared to be in need of refurbishment or repair. Paint was chipped from walls, skirting boards and doors, the hairdressing room floor was dirty and in needs of replacing and some bedroom furniture was old, worn and furniture handles were missing. Plans had been submitted regarding a possible extension to the premises therefore some of the remedial work required would be addressed within these plans. Residents and their relatives stated that they were satisfied with the accommodation provided. There was a separate dining room and a further dining area leading from the second lounge so that residents had a choice of where they were served their meals. A staff training/visitors’ room had recently been created and this was decorated attractively. Residents were able to use this room as an alternative sitting area. One resident who had a shared bedroom said “ We have a separate room that we can use if we want to meet with our visitors in private” There was one assisted shower facility in use and two assisted baths as a third bath had been taken out of action as it was being used as the designated area for staff to manually clean commode pots. There was no mechanical commode pot disinfector facility at the Home and the Registered Provider stated that this was included within the submitted extension work plans for the Home. The majority of residents use a commode in their bedrooms and until hygienic cleaning equipment is provided a risk assessment must be undertaken and infection control procedure must be written in order to protect staff and prevent the spread of infection. There were two mechanical hoists available for residents use and staff confirmed that these were suitable to meet the needs of the current residents living at the Home. Pressure relieving equipment, raised toilet seats and wheelchairs were available and two new stair lifts had been installed. Hand rails were provided near to toilets however hand rails were not provided in all corridors of the Home despite it being identified that some residents were at risk of falling and this does not promote residents’ independence and safety. There was a mixture of single accommodation and the shared rooms were furnished to maintain the privacy of residents. Bedrooms contained residents’ personal possessions that reflected their tastes and interests in order for them to feel comfortable in their surroundings. Bedroom doors were fitted with privacy locks which could be overridden in the event of an emergency. There was a nurse call facility in each bedroom in order for residents to summon assistance from staff or to be used in the event of an emergency. One resident said “ The staff come promptly if I need them”. A lockable facility was provided in some bedrooms and new bedroom furniture with lockable facilities was being purchased in order to maintain residents’ privacy. Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 22 The Home was found to be clean and fresh on the day of the field work visit and there was a hygienic system in place for the laundry of residents’ personal clothing and bed linen. Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents are supported by an adequate number of appropriately vetted and trained staff. EVIDENCE: Staff met throughout the inspection were found to be very welcoming, polite and respectful and both residents and visitors confirmed this. A minimum of two registered nurses were on duty during day time hours and on occasions this included the Registered Manager. In addition to this, four care assistants provided support during day time hours. One registered nurse and two care assistants were on duty overnight. One housekeeper and one laundress were on duty Monday to Friday and one housekeeper was on duty during weekends to provide ancillary support. Staff met throughout the field work visit stated that they felt that these levels were adequate however did not allow for extra duties for example arranging activities for residents. Extra staff are provided to cover specific duties, for example staff training to ensure that the staffing levels are not depleted. A Cook and kitchen assistant were on duty during day time hours apart from one day when extra duties are required and three staff were on duty that day. The Cook stated that she felt that these staffing levels were adequate. Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 24 Staffing rotas identified that these staffing levels were maintained, agency staff were not used however a number of staff had chosen to work an excessive number of hours per week both on a regular basis and to cover staff holidays. In addition to this, an identified staff member had chosen to work a night shift followed by the afternoon shift. Risk assessments must be undertaken and remedial action must be taken as deemed necessary regarding this to ensure that residents receive a consistently good standard of care and staffs’ welfare is protected. Staff personnel files sampled included all pre recruitment information required by regulations and all staff were deemed to be safe to work with vulnerable people and this safeguards residents. Following the completion of an initial health and safety induction, new staff undertake comprehensive induction training in line with “Skills For Care”. 50 of care staff had achieved NVQ level 2 or above and this ensures that residents are supported by competent staff. Staff had received appropriate training including how to take blood samples, the handling and administration of medicines, pressure sore prevention and wound care, sight loss awareness and communication. The Registered Manager arranges weekly training sessions that are open to all interested staff. Topics included the protection of vulnerable adults and skin care. Continence promotion training is planned for the near future. Staff training records were well maintained and this assists in assessing individual staff training needs to ensure that all staff had the appropriate knowledge to work in a competent manner. Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The Home is run in the best interests of the residents living there. Residents and the staff team are involved in the running of the Home and this ensures that they have the opportunity to out forward any suggestions for improvements. EVIDENCE: The Registered Manager is working towards the Registered Managers’ Award in order to keep up to date and have the necessary skills to lead the Home’s team in a competent manner. She was enthusiastic about staff training and was keen to share her knowledge with the rest of the staff team. Positive comments were received about her management style. One staff member said “Our manager is a good role model”. One resident said “ The manager tries to keep us as comfortable as possible” Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 26 A residents’/relatives meeting had been held recently providing residents with the opportunity to put forward their views about the service provided at the Home. One resident said “ We had a meeting about food and discussed what we all liked and disliked, it was very interesting”. Staff meetings are held regularly and this ensures that staff are informed about any new procedures or services provided for residents living at the Home. Comprehensive health and safety auditing is undertaken using an external source and this included infection control procedures in order to identify any areas of concern and implement measures to safeguard residents. Service satisfaction questionnaires are distributed to residents and a report based on the findings of these should be produced and be made available to residents as part of the quality monitoring process. A facility for the safekeeping of small amounts of residents’ money was available and this could be accessed by the nurse in charge at any time the resident wished. The system for the management of this was good and receipts for all items purchased out of residents’ money was kept, however it is recommended that regular auditing of this be undertaken. One resident said “ The nurses can access my money when I need it, we sign a receipt. It’s great to know the money is there”. There was a rolling programme of statutory training in progress including health and safety, food hygiene, infection control, first aid, fire safety and moving and handling. The Registered Manager and Maintenance Officer had recently completed the Fire Marshall Trainers course. Accident records included good detail of any action taken following an accident, confirming that residents received the appropriate medical care if required and these were audited in order to minimise the risks of similar accidents occurring again. Accident records must be stored securely in order to maintain residents’ confidentiality. The Registered Manager confirmed in writing that remedial action required following the recent fire safety inspection had been addressed however attention in respect of protective strips on some fire doors was still required. A number of bedroom doors had been propped open using chairs and this would cause the spread of fire. One resident who was nursed in bed stated that she preferred to have her bedroom door left open and a suitable magnetic door closure must be fitted which is linked in to the fire alarm system. Other bedrooms were unoccupied and the doors to these rooms must be kept shut unless held open by suitable means. Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 27 Cleaning products had been left unattended in three areas of the Home that residents had access to and the door of the garden shed had been left open containing white spirits and tools. This poses a risk to the health of vulnerable residents and was brought to the attention of the Registered Manager. Remedial action was undertaken without delay. Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 2 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 3 2 x 2 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 x 3 x x 2 Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 29 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 OP1 Regulation 4(1) Requirement The statement of purpose must be amended to reflect the current services provided at the Home including: A separate room for residents to smoke is no longer provided • The activities that are currently on offer for residents to participate in The care needs of privately funded residents must be reviewed on completion of their trial period at the Home. • Timescale for action 18/12/06 2 OP4 14(2) 01/12/06 Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 30 3 OP7 15 The care planning system must be further developed to include: Care plans must be individualised and identify the specific support required by staff to meet residents’ individual care needs • Care plans must identify any specific nursing instructions required • Care plans must be agreed and reviewed with the involvement of the resident and/or their representative • Moving and handling risk assessments must include detail of the action to be taken should a resident fall and the type of hoist and size of sling to be used for each resident. These must be reviewed regularly Bed safety rail risk assessments/consent forms must include detail of the risks involved with the use of these. Blank prescription pads must not be held at the Home Telephone facilities that residents can use in private must be provided Confidential information pertaining to residents’ health and staff employment must be stored securely An activities programme must be developed in consultation with all residents living at the Home including those residents unable to participate in group activities. The garden must be cleared off surplus equipment • 01/12/06 4 OP7 12(2) 13(4) 13(2) 16(2)(b) 12(4) 15/11/06 5 6 7 OP9 OP10 OP10 01/11/06 31/12/06 01/11/06 8 OP12 16(2)(m) (n) 31/12/06 9 OP19 13(4) 01/11/06 Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 31 10 OP19 OP24 16(2)(c ) 23(2)(b)( d) The programme of replacing bedroom furniture with suitable lockable facilities and the replacing of floor coverings must continue The redecoration and refurbishment of the Home must continue either within the plans for the extension of the Home or as a separate plan. Hands rails must be provided in all areas of the Home that residents have access to A suitable mechanical commode pot disinfector facility must be available for staffs’ use. 31/01/07 11 12 OP22 23(2)(n) 13(3) 16(2)(j) 23(2)(k) 01/12/06 01/11/06 OP26 13 OP27 18(1)(a) Until the facility is available, a risk assessment must be undertaken and infection control procedure must be written in respect of the manual cleaning of commode pots. This written documentation must be available by: Risk assessments and remedial 01/11/06 action as deemed necessary must be undertaken in order to ensure that staffs’ work performance is not affected by the number of hours that they work each week and staff must have adequate rest breaks between shifts. (timescale of 31/12/05 not met) The Registered Manager must successfully complete the registered managers award. (timescale of 31/01/06 not met) Individual accident records must be stored securely in order to maintain residents’ confidentiality 31/03/07 14 OP31 9(2) 15 OP38 12(4)(a) 01/11/06 Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 32 16 OP38 23(4) 17 OP38 23(4) The Registered Manager must ensure that any work still outstanding following the mist recent Fire Officer’s visit must be completed Fire doors must not be held open unless by suitable means. Risk assessments must be undertaken until remedial action is taken. The Registered Manager received this in the form of an immediate requirement 01/11/06 18/10/06 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 OP12 OP16 OP33 OP35 Good Practice Recommendations It is recommended that a designated person be employed to develop and deliver an activities programme at the Home. It is recommended that an independent advocate be sought regarding a dispute between a residents’ visitors and the Registered Providers. A report based on the findings of the service satisfaction questionnaires should be produced and be made available to residents Residents’ money held at the Home for safekeeping should be audited regularly Hafod Nursing Home DS0000024844.V315556.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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