Inspection on 02/07/08 for Hafod Nursing Home

This inspection was carried out on 2nd July 2008.

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

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

Other inspections for this house

Hafod Nursing Home 04/02/10

Hafod Nursing Home 27/10/09

Hafod Nursing Home 18/12/08

Hafod Nursing Home 07/08/07

Hafod Nursing Home 18/10/06

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 23/11/2008.

CARE HOMES FOR OLDER PEOPLE Hafod Nursing Home 9 - 11 Anchorage Road Sutton Coldfield West Midlands B74 2PJ Lead Inspector Ann Farrell Unannounced Inspection 2nd July 2008 09:30 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.V367414.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.V367414.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 Manager post vacant 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.V367414.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th August 2007 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 is not registered to provide care for people who suffer with dementia. Four rooms are contracted by the Primary Care Trust for the provision of intermediate care and Social Care and Health fund four 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 is a mixture of single and shared rooms located on both floors and with the exception of one bedroom, all have en suite. There is a passenger lift for people 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 aids/adaptations are provided for people with physical disabilities. There is a notice board on entering the home, which displays a range of information for people living in the home and their visitors. A service user guide was available that gave brief information about the services and facilities, but did not include information about the fees and would have to be requested. Part of the most recent CSCI inspection report was available in the reception area of the Home for anyone interested to refer to. Hafod Nursing Home DS0000024844.V367414.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to plan the inspection, which included notifications received from the home or other agencies and an Annual Quality Assurance Assessment (AQAA). This is a questionnaire that was completed by the manager and it gave us information about the home, staff, people who live there, any developments since the last inspection and there plans for the future. In addition, random surveys were sent to relatives and health professionals before the inspection in order to gain their views about the service and three surveys were returned. Two inspectors undertook this fieldwork visit over one day. The manager was available for the duration of the inspection. The home did not know that we were visiting on that day. At the time of inspection twenty-three people were living in the home and information was gathered from speaking to and observing people who lived at the home. Three people were “case tracked” and this involves discovering their experiences of living at the home by meeting or observing the care they received, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Because people with dementia are not always able to tell us about their experiences, we have used a formal way to observe people in this inspection to help us understand. We call this a Short Observational Framework for Inspection (SOFI). This involved us observing up to five people who use services for approximately two hours and recording their experiences at regular intervals. This included their state of well being, and how they interacted with staff members, other people who use services, and the environment. Staff files, training records and health and safety files were also reviewed. At the time of inspection seven people who live in the home, two visitors and five Hafod Nursing Home DS0000024844.V367414.R01.S.doc Version 5.2 Page 6 staff were spoken to in order to gain comments. The feedback was mixed and included comments such as; What the service does well: What has improved since the last inspection? Arrangements are now in place that ensures that medicines are given to people as prescribed by the GP and a recording of all medicines onto the home are made on the medication administration charts. A manager has now been recruited to oversee the running of the home and to provide staff with leadership and direction so that outcome for people will be improved. Hafod Nursing Home DS0000024844.V367414.R01.S.doc Version 5.2 Page 7 What they could do better: Staff needs more training in caring for people so that they are able to understand and meet their needs. Pre admission assessments for people who are admitted for long term care need to be completed comprehensively so that people can be confident that the home can meet their needs on admission Care plans must provide staff with up to date and accurate information so that they know how to support people in a way that meets their needs and expectations. Care plans should be written in a person centred way so that the needs, wants and expectations of the person is taken into account. Night time routines should be reviewed on an individual basis so that people’s sleep is not disturbed unnecessarily. Medication must be stored at a temperature that is within its product licence so that its stability is not compromised. Staff must administer medication in accordance with the homes procedures to reduce the risk of medication errors been made. Infection control arrangements must be adhered to so that people are protected from harm. Where residents express their views about how the service is run the home should be able to demonstrate that these views are acted upon where reasonably practicable to do so. More activities should be provided so that people interesting and stimulating lifestyle. are able to lead an Receipts obtained to verify expenditure on behalf of people living at the home need to be more detailed so that people can be confident why money was spent on their behalf. People living at the home believe that they are kept waiting be met. for their needs to Hafod Nursing Home DS0000024844.V367414.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.V367414.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.V367414.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): 1,3,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements are needed in the quality of pre admission assessments so that people who are admitted for long term care can be confident that their needs will be met on admission to the home EVIDENCE: The home currently accommodates a number of older people who have dementia and have some communication difficulties It is of concern that the home is not registered to care for people with dementia and staff have had no specialist training to help them understand and meet the needs of people with dementia. The service user guide was available in the home and it gave brief information about the services and facilities provided. The service user guide was accessible, in a large print and gives information to people wishing to move into the home, so they can make a decision. Hafod Nursing Home DS0000024844.V367414.R01.S.doc Version 5.2 Page 11 The home provides care for people who require long term care. In addition they have a contract to provide short-term care that require intermediate and interim care. Intermediate care is funded by the Primary Care Trust (PCT) and is provided for up to four people at any one time for a period of approximately six weeks. People who require intermediate care are seen by General Practitioners, an Occupational Therapist, Physiotherapist, Specialist Community Nurses and a Social Worker and the aim is rehabilitation so that they can return to their own home. The intermediate care team assess each person’s suitability for rehabilitation prior to admission. People receiving intermediate care are admitted directly from hospital often following trauma and orthopaedic surgery. Most of the specialist equipment required for people receiving intermediate care is funded and provided by the PCT. One survey was received from a visiting professional who felt that nursing care given to her client met her needs. Interim care is funded by Social Care and Health and is provided for up to four people for a period of six weeks. Most people admitted to interim care are discharged from hospital and are deciding where they would like to live in the future. The manager told us that a full assessment is undertaken for all people before they move into the home. They try to meet family and the person with their family are invited to visit the home before moving in, so they can view facilities, meet staff and other people living in the home. The manager told us that the decisions to admission would depend on the needs of each person and if they had the appropriate equipment. Admission for intermediate or interim care is not here decision. On inspection of the assessments for people admitted for intermediate care and interim care were of a very good standard. However this quality was not seen in the people admitted for long term care. The assessments completed by staff in the home were very brief and only included details about past medical history, equipment needed, medication and personal details. There was no evidence of an assessment from social workers and there was no further assessment on admission to the home. Without a comprehensive assessment it cannot be guaranteed that peoples needs will be met effectively when they are admitted to the home. The manager stated that they did not routinely confirm admission to people in writing following assessment. It is recommended that the admission process is amended to include this as it provides confidence to the person that their needs will be met when they move into the home. Hafod Nursing Home DS0000024844.V367414.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 poor. This judgement has been made using available evidence including a visit to this service. People living at this home can not be confident that their health and personal care needs will be met consistently. EVIDENCE: Each person living in the home had a care plan. This is a document that is developed by staff following an assessment of individuals needs. It should include detailed information about what the person can do for themselves, the things people require assistance with , and what staff need to do and how to do it so that each person is supported to meet their needs. Care plans are written within 24 hours from admission and a summary of care on admission that gives staff brief information about a persons needs and the help they require is also completed. Hafod Nursing Home DS0000024844.V367414.R01.S.doc Version 5.2 Page 13 Three peoples care files were looked at in detail and there was evidence of a summary of care and care plans. Although the care plans covered a large range of areas they were pre printed and were not person centred. There were some vague instructions and conflicting comments observed. The vague statements and lack of guidance does not ensure that people needs are met consistently. For example: • Care plans stated ‘ensure preventative measure in place to reduce incontinence’, but did not give instructions as to how this should be achieved. Some of the care plans gave conflicting instructions. In one person’s record it stated ‘toilet 2 hourly’ and further in the record it stated ‘toilet 4 hourly’. Such instructions do not ensure staff provide consistent care. One person’s care plan for poor appetite stated to give nutritional supplements daily, but they had been prescribed by the GP three times a day. The care plan stated ‘to monitor their food and fluid intake’, these records were poorly maintained and did not indicate that the person was taking a balanced diet and good fluid intake. This could compromises the person health and well being. Another person’s care plan stated they should have a soft/puree diet and another person stated they should have their food fortified. On discussion with the catering staff they stated they were not fortifying foods or providing puree diets. The nurse stated later that the soft/puree diet had been discontinued. Unless care plans are up to date staff do not have the information they need to meet people’s needs. One person’s record indicated they had lost weight, but there was no evidence of any action taken by staff or referral to a health professional, despite the care plan stating to refer to the GP if there was weight loss. One persons care plan stated they should be supervised when sitting out of bed. On the morning of inspection two staff were observed to the leave the person’s room having sat them out of bed with a hoist and they were left unsupervised. This may result in injury or harm to this person. Risk assessments had been completed in respect of skin care and where risk were identified pressure relieving equipment was in place. In one instance it was noted that all areas of the risk assessment had not been completed. Where these are not fully completed the level of risk may be incorrect and therefore appropriate care may not be implemented. The tissue viability nurse specialist had seen one person who had been admitted with a pressure sore and regular dressings were being undertaken. The care plan stated that they should have their position DS0000024844.V367414.R01.S.doc Version 5.2 Page 14 • • • • • • • Hafod Nursing Home changed regular to reduce the risk of further complications. On inspection of the record it was noted that there were long periods where the person had not had their position changed although a nurse stated position changes were occurring regularly she was unable to evidence it. It was also noted that when the tissue viability nurse visited she had commented about having the mattress serviced as the alarm indicating that it was not working properly was sounding. It is disappointing that on the day of inspection it was found to be still sounding and there was no evidence that it had been serviced. • Procedures in respect of infection control were not adequate to prevent the risk of infection. Staff were observed to be wearing gloves and aprons when leaving one persons bedroom after attending to their personal care needs and go directly into another person’s bedroom. Our observations of interactions between staff and residents was predominately task orientated and not person centred. For example staff were allocated task of giving drinks. • The homes medication system consisted of a blister and box system with printed Medication Administration Record (MAR) sheets being supplied by the dispensing pharmacist on a monthly basis. The home had copies of some of the original prescription for repeat medication, so they were able to check the prescribed medication against the MAR chart when it entered the home, but this was not consistent and will need to be followed up to ensure a robust system. On inspection of the medication for the current month it was found that the majority of the audits were satisfactory. We observed that one person’s care plan said that they were self administering medication. On discussion with staff we were told that there were no facilities to enable people to self administer medication. This does not demonstrate that care is provided in a person centred way. A fridge is used to store some medication, and the temperature is recorded regularly. The temperature was not within a satisfactory range to ensure that the medication is stored in accordance with its product licence, therefore the stability of medication may be compromised. The temperature of the medication room was also monitored and at times was too hot. Medication should be stored below 25 degrees in accordance with the product licence. We observed a nurse carrying two medicine pots for different people with tablets in at the same time. This was discussed with the manager at the time of the visit as it is poor practice and can lead to the wrong medication been given accidentally to people. Hafod Nursing Home DS0000024844.V367414.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. People living at the home would benefit from more leisure and recreation activities been available so that they have things to do and the activities match their expectations. EVIDENCE: Visiting was flexible enabling people to visit at a time that suited them, so people living in the home could maintain contact with fiends and family. Comments received included: “Visitors are welcome at any time and staff will help move mum into a wheelchair so we can go where we please with her. There is always the offer of tea and biscuits or joining mum for a meal”. Staff said that people are able to bring personal items of small furniture, pictures, ornaments and other personal belongings with them providing a home from home atmosphere reflecting their personality. Hafod Nursing Home DS0000024844.V367414.R01.S.doc Version 5.2 Page 16 The home provides the opportunity for people to follow their own religion ensuring their religious needs are met. It was stated a minister visits and gives a lovely service. At the last inspection an activities person had been employed for six hours per week and hobby therapy equipment had been purchased. At that time a comment was received that this needed to be increased to provide more opportunities for residents to participate in “in house” activities. From the information provided this remains unchanged, but one of the senior managers has input into facilitating and organising events such as a BBQ that had recently taken place and people stated they enjoyed it. In addition, there is a weekly “movement to music” activity. On discussion with some people living in the home they stated they did get bored at times and did not feel the activities were suitable to meet their needs. Hairdressing is available in the home for an additional charge so that people can maintain their personal appearance. Records of previous residents meetings indicated that a library service was requested. At the time of the visit this was not available and when staff were asked about it they stated that it had not been arranged. Staff were seen to came into a communal room and turned up the sound on TV without consulting anyone. We observed that the TV receptions in one lounge was poor making it difficult for people to follow the programme easily, a resident commented that the TV needed replacing due to poor reception. Catering staff prepare all meals for the nursing home plus the nearby residential care home and for people living in the community. There was a four weekly menu, which demonstrated a choice of one hot meal and a salad at lunchtime. Meals are ordered a week in advance, but if something else is requested staff will try to accommodate it. Meals reflected the cultural backgrounds of people living in the home. Special diets can be prepared for reasons of health, taste or religious preferences. Diabetic and vegetarian diets were being prepared at the current time. On discussion with people living in the home comments ranged from OK to good about the quality of the food available .Some people commented that they did not always get a choice of meals. Snacks are provided between meals and early morning cup of tea. One person stated she looks forward to the cup of tea, but they do not always get one, but she does not complain. It was a concern that there were a high percentage of people observed sleeping during the observation. Discussions with three other people who were living at the home for intermediate care said that the night staff practice was to wake them every two hours by knocking on their bedroom door and asking them whether they were alright. If this practice is mirrored for the rest of the Hafod Nursing Home DS0000024844.V367414.R01.S.doc Version 5.2 Page 17 people living in the home this may account for the high level of sleep observed during the day and should reviewed. Our observations were that one person with complex behaviors was seen smiling and trying to engage with staff as they entered the room on several occasions. These gestures were ignored with the exception of one member of staff and a visitor of another person living in the home. As part of the case tracking process this persons care records were looked at. There was no written evidence to tell us that an assessment had been done to show they had considered that their lack of interaction may be a trigger for this person’s behavior. There is a hands free telephone in the reception area for people living at the home enabling them to receive calls in private, and maintain contact with their family and friends. Bedroom doors are fitted with locks and some rooms have lockable facilities. On discussion with some people living in the home they stated they had not been offered keys to their bedroom doors or lockable facilities so that they can maintain their privacy if they wish. Hafod Nursing Home DS0000024844.V367414.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 adequate. This judgement has been made using available evidence including a visit to this service. Staff have not received appropriate training or information so that they are able to respond appropriately in the event of an allegation of abuse to ensure that people are safeguarded from harm EVIDENCE: There was no complaints procedure on display in the home, so people may not know how to complain if they wanted to. There was evidence of “thank you” letters on notice boards. Feedback from relatives indicated that if they had any concerns they would speak to the person in charge, but they have never raised any concerns. On discussion with some people living in the home there were areas such as not receiving tea in the morning that they had not complained about. In another case someone stated they had raised a concern and initially action had been taken to address it, but it gradually went back to what it was. On inspection of the complaint register there was no record of the complaint recorded. This is not demonstrating that people are supported to voice their concerns and their comments are taken seriously. The homes record shows that two complaints have been received by the staff with a record of the action they had taken. Hafod Nursing Home DS0000024844.V367414.R01.S.doc Version 5.2 Page 19 We received concerns about one person, which resulted in a safeguarding referral meeting. There was no evidence to substantiate the allegations and the case was closed. The home has policies and procedures in respect of safeguarding and whistle blowing, which need updating. On discussion with three staff, one stated they were in the process of receiving training in respect of safeguarding and the others had not received training. Some had limited knowledge of the procedures, which will need developing further. The AQAA stated all staff have been made aware of the importance of reporting and recording concerns through staff training, and they planned to provide further training and awareness of procedures. From the records available they did not confirm all staff had received training in safeguarding. Following the inspection one of the senior managers informed the inspector that a number of records and training materials had gone missing from the home and they were arranging training for staff in a number of areas. Staff have not received training about the Mental Capacity Act to ensure that they are aware of their responsibilities and the implications this may have for those people living at the home. It is recommended that this training be provided to all staff, so that they are aware of the procedures for supporting people who lack capacity to make decisions. The senior staff manage the personal money for some people who live in the home, but do not act as appointee or power of attorney. Audits balanced with the money held in the home. Some receipts were of a poor quality and do not verify the reasons for the expenditure. The home has a satisfactory recruitment process ensuring that appropriate checks are completed, so that the home can assure that staff employed are suitable to work with vulnerable adults. Hafod Nursing Home DS0000024844.V367414.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): 19,20,21,22,24,26 Quality in this outcome area is good, adequate. This judgement has been made using available evidence including a visit to this service. People live in a comfortable home that provides a number of rooms so that they can choose where to spend their day. EVIDENCE: The home is a detached two-storey building with off road parking for a small number of cars in a residential area. The windows are in a poor state of repair and remain unchanged since the last inspection. A member of staff stated they were waiting to have new windows made by a carpenter. It was generally clean and odour free. Some areas such as commodes and extractor fans required more thorough cleaning to ensure that they are hygienic enough for people to use. There is a secure external garden which was spacious and generally well maintained. There is ramped access leading out to this area and is suitable for Hafod Nursing Home DS0000024844.V367414.R01.S.doc Version 5.2 Page 21 wheel chair users to enter the garden. There is a patio area and garden furniture for people to enjoy when the weather permits. There is an ongoing programme of refurbishment and re-decoration and at the time of visiting work was being undertaken in one of the double bedrooms. Some carpets thought out the home are in need of repair or replacement so that they do not pose a risk of trips or falls. Some bedrooms had already been completed and had been fitted with new furnishings, which included a lockable facility for people to store money or valuables. Another bedroom would also be completed in the next four months. We were told that planning permission has been granted for an extension to the home There are two main lounges for residents to use and are decorated in homely styles. There are two separate dining rooms one leading from the second lounge, people therefore have a choice of areas to sit to have their meals. A comment was received about the television as there was a poor reception and it was felt that it needed replacing. There is a mixture of single and shared bedrooms. Bedrooms contained people’s personal possessions that reflected their tastes and interests in order for them to feel comfortable in their surroundings. Bedroom doors are fitted with privacy locks, which can be overridden in the event of an emergency. There is a nurse call facility in each bedroom in order for people to summon assistance from staff when required or in the event of an emergency. There is a range of aids to assist people with mobility problems such as mobile hoists, raised toilet seats and grab rails near to toilets. The home have wet rooms and bathrooms enabling people to a have choice of a bath or shower. Hafod Nursing Home DS0000024844.V367414.R01.S.doc Version 5.2 Page 22 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 adequate or poor. This judgement has been made using available evidence including a visit to this service. Staff need some more training to ensure they have all the skills and knowledge they need to meet people’s needs consistently. EVIDENCE: At the time of inspection there were four care staff and two nurses on duty this is a typical staffing level for this home. At night there is usually one nurse and two carers on duty. In addition, there are two housekeepers, catering staff and maintenance staff. During the inspections observations indicated that peoples needs were not being responded to in a timely manner. Following the inspection the inspector was informed one of the housekeepers was not on duty during the morning of inspection. Comments received suggest that the staffing levels are not adequate to meet people’s needs in a timely manner. For example: “I am used to waiting”. “Sometimes I have to wait 10 minutes as staff are busy”. “It takes a long time to get things done; they say they will be back”. “The staff are very busy; chasing their tails”. Hafod Nursing Home DS0000024844.V367414.R01.S.doc Version 5.2 Page 23 “You can’t always get up when you want”. “The carers react as fast as they are able to with any request”. “They need more staff”. Comments about staff varied, it was stated “Some staff are good” and “Some staff are a bit slack”. There has been a considerable staff turnover over the past year with approximately half the staff having ceased employment. This can have an impact on care as it takes time to build up staff knowledge and skills in order that they provide a consistent standard of care. Also a number of changes can affect people’s confidence, security and well-being. In addition, the manager ceased employment due to health reasons last November and had only returned to work two days prior to the inspection. Recruitment records sampled showed that Criminal Record Bureau checks had been made and written references received before the employee began work, so that people can be assured that staff employed are suitable to work with vulnerable adults. Following employment new staff undertake the homes induction training and on discussion with one member of staff they stated they were in the process of undertaking Skills for Care induction training and had been supernumerary for three days on commencing employment. This training gives staff the opportunity to develop the knowledge and skills to meet the needs of people living in the home. Records of this training were not seen at the time of inspection. Records indicated that there had been a range of basic core training earlier in the year, which had been undertaken by staff from the nursing home, the records available were difficult to verify. Since the inspection the manager has requested training from a company in fire safety, first aid awareness, health and safety, manual handling, food hygiene and infection control over the course of the next few months and this should ensure staff have the knowledge to meet basic needs. Staff have not received training in meeting the needs of people with memory loss or dementia given that some people living at the home are diagnosed with these conditions. The manager told us that the nurses had undertaken a three day course in tissue viability. Other training in areas such as diabetes, epilepsy, and tissue viability would be recommended so that staff can develop their knowledge and understanding of treatment and care required leading to improved outcomes for people. From the records it was not possible to verify National Vocational Qualifications training that has been completed by staff. One of the senior manager stated Hafod Nursing Home DS0000024844.V367414.R01.S.doc Version 5.2 Page 24 that a number of records were missing at the time of inspection. The manager will need to review the process for keeping and storing records to ensure they have evidence available at future inspections with information that is easily accessible. Hafod Nursing Home DS0000024844.V367414.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): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has not benefited from a registered manager who is able to provide leadership and direction to ensure that the home is run in the best interest of the people living there. EVIDENCE: The home has been without a registered manager for some time. They have just recruited a person to manage the home who was previously employed as the manager of this service, and who is familiar with the home and the facilities and services it provides. One comment received was, “I am glad she’s back”. Hafod Nursing Home DS0000024844.V367414.R01.S.doc Version 5.2 Page 26 The manager stated that following the last inspection, questionnaires had been designed to be used as part of the internal quality assurance process. These had not yet been used. It is important that the home develops and implements a quality assurance system that takes into account of the views of people who use and work in the service so that improvements to the service can be made. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was completed. It is a legal requirement that the home sends us this information every yea. We had to send a reminder letter to the home advising them of their legal obligations. On receipt of the AQAA it only gave brief generalised information about the home, staff, and people who live there and the improvements over the past year. Personal money for some people are managed by the staff at the home. Audits balanced with the money held in the home. Some receipts were of a poor quality having been written on plain pieces of paper that were dated, but not signed and did not have the details of the reason for the payment. An assessment of this process and actions to be taken to improve this is recommended. Concerns were raised regarding the management of fire safety. The Fire Service were informed and subsequently visited the home and confirmed that some work was required so in the event of a fire people living at the home are safe. The fire service has written to the home and told them what they need to do. The gas safety certificate reported that some equipment was in poor condition but safe to use. Since the inspection the home have confirmed that this equipment has been replaced. One person living in the home had raised issues about the passenger lift. On discussion with the manager she stated the company had been out a number of times to see it and records were available to demonstrate this. At the last it was reported that the lift a new motor board was required. This situation will need to be monitored to ensure that people living at the home are able to have access to a fully functional lift. Hafod Nursing Home DS0000024844.V367414.R01.S.doc Version 5.2 Page 27 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 3 X 1 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X 3 3 X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 1 Hafod Nursing Home DS0000024844.V367414.R01.S.doc Version 5.2 Page 28 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 OP3 Regulation 14(1) a Requirement People must have a comprehensive assessment of their needs by a suitably qualifies person before they are admitted to the home so that they can be confident that their needs will be met Care plans must provide staff with accurate up to date information so that they can meet the care needs of people living at the home. Where health care professionals give advise these instructions must be followed so that residents receive appropriate care Referrals must be made to health care professionals where a need is identified so that they receive health care in a timely way Arrangements to reduce the risk of cross infection must be in DS0000024844.V367414.R01.S.doc Timescale for action 05/10/08 2. OP7 12 (1) 31/10/08 3. OP8 12(1)(a) 05/10/08 4. OP8 12 (1) 01/10/08 5. OP8 13(3) 01/10/08 Hafod Nursing Home Version 5.2 Page 29 place and followed so that people are protected from harm 6. OP12 16(n) People at the home should be offered a range of activities and facilities for recreation so that they are able to lead an interesting and stimulating lifestyle that meets their needs and expectations. All equipment in the home must cleaned and maintained in a hygienic condition at all times available for people to use. Staff must receive training so that they are able to meet the individual and collective needs of the people living at the home. Medication must be administered in accordance with codes of conduct and good practice guidelines to minimise the risk of medication errors. The home must comply with the recommendations of WMFS so that people are safe in the event of a fire. 15/10/08 7 OP26 16(2)j 30/09/08 8 OP30 18(1)c 01/02/09 9. OP9 13(2) 30/09/08 10. OP35 23(4) 30/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP7 Good Practice Recommendations Medication must be stored at temperatures within their product license so that its stability is not compromised Care plans should be written in a person centred way that DS0000024844.V367414.R01.S.doc Version 5.2 Page 30 Hafod Nursing Home 3. 4. OP10 OP33 takes into account the needs , wants and expectations of the individual Consideration should be given to providing opportunities for people to self administer their own medication with in a risk assessment framework Where residents express an opinion on the running of the home the home should be able to demonstrate that these views are listened to Consideration should be given to replacing the TV so that people’s enjoyment from this activity is not spoilt. The manager should audit the reasons for the high turnover of staff so action can be taken to improve staff retention. Prospective residents should be written to prior to admission by the home saying that their needs can be met so that people can be confident their needs will be met upon admission. Receipts must accurately identify the reasons money was spent on resident’s behalf. 5. 6. 7. OP16 OP28 OP3 8. OP35 Hafod Nursing Home DS0000024844.V367414.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hafod Nursing Home DS0000024844.V367414.R01.S.doc Version 5.2 Page 32 - 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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