Inspection on 27/10/09 for Hafod Nursing Home

This inspection was carried out on 27th October 2009.

CQC found this care home to be providing an Adequate 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 18/12/08

Hafod Nursing Home 02/07/08

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 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Hafod Nursing Home 9-11 Anchorage Road Sutton Coldfield West Midlands B74 2PJ Lead Inspector Donna Ahern Key Unannounced Inspection 27th October 2009 10:00 DS0000024844.V378659.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Hafod Nursing Home DS0000024844.V378659.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Hafod Nursing Home DS0000024844.V378659.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 Organisation Limited 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.V378659.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th December 2008 Brief Description of the Service: Hafod Nursing Home provides general nursing care for up to 29 people. 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 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 5 10 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 but this did not include information about the current fee rates. This information can be requested from the home. Additional costs include dry cleaning, hairdressing, chiropody and newspapers. A copy of the previous inspection report was available in the reception area of the Home for anyone interested to refer to. Hafod Nursing Home DS0000024844.V378659.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out by two inspectors over one day. The home did not know we were going to visit. This was the homes key inspection for the inspection year 2009 to 2010. The focus of inspections we, the commission, undertake 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 include notifications received from the home and an Annual Quality Assurance Assessment (AQAA) completed by the owner. This provides information about the home and how they think it meets the needs of the people living there. At the time of the visit there were 19 people living in general nursing beds and one person occupying an interim bed. We case tracked the care received by four people living there. This involved establishing individuals experience of living in the care home by meeting and talking with them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked at parts of the home and a sample of care, staff and health and safety records. The people living there who were able to communicate their views, the manager, staff on duty and relatives visiting were spoken with. As some people were not able to communicate their views, time was spent observing care practices and interactions from staff. There was no registered manager at the time of the visit. The owner was present for the majority of the visit and we gave feedback to her at the end of the day. We sent out ten surveys to be distributed to people living in the home and eight staff surveys. We received eight completed surveys from people living there; some had been completed on their behalf by a relative and two from staff. The comment comments received are included in this report. Hafod Nursing Home DS0000024844.V378659.R01.S.doc Version 5.2 Page 6 What the service does well: Robust systems are in place for the keeping of small amounts of personal money. People can choose from a range of communal areas to sit in and can choose how to spend their time. Activities are provided so people have the opportunity to do things they enjoy. People are supported to keep in contact with their family and friends so they maintain relationships that are important to them. People’s bedrooms are personalised and people can bring their own furniture if they want to. What has improved since the last inspection? What they could do better: Information about fees should be available to people so they have all the information they need to know about the home. Any risks to people from hot radiators or free standing heaters must be identified and removed. People’s bedrooms must be warm so their health and wellbeing is maintained. Care plans should be updated when needs change so people get the right support to meet their needs. Medication management should improve so people get their medication as prescribed. Staff should receive regular supervision so they get the support they need to meet people’s needs. Accidents and incidents should be monitored so risks to people are minimised. Hafod Nursing Home DS0000024844.V378659.R01.S.doc Version 5.2 Page 7 Regular meetings should take place with people who live in the home and their relatives so their views about living in the home are listened to and acted upon. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Hafod Nursing Home DS0000024844.V378659.R01.S.doc Version 5.3 Page 8 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.V378659.R01.S.doc Version 5.3 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s):3 and 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had most of the information they need to know about the home so they can make an informed decision about living there. People’s needs are assessed prior to admission so they know their needs can be met there. EVIDENCE: The statement of purpose and service user guide had recently been updated so they include current information about the home. This should ensure that people have the information they need so they can make a choice about whether or not they want to live there. Hafod Nursing Home DS0000024844.V378659.R01.S.doc Version 5.3 Page 10 The statement of purpose details arrangements for paying fees and specifies what will be included in the fees. However it states that specific details about fees can be obtained from the manager. Information about fee range should be detailed in the statement of purpose so people have the information they need so they can make a choice. The certificate of registration was on display it the entrance hall. We noted at our previous visit that the certificate was old and did not give the correct information about the home. CQC had sent a revised certificate to the home in June 2009 but unfortunately it had been sent to the wrong administration address. The owner made arrangements during the visit for the certificate to be re sent so it can be displayed. We saw by looking at two peoples case files that pre admission assessments are undertaken prior to people coming to live at the home. This should ensure that people’s individual needs can be met when moving into the home. Interim care contracted by the PCT (Primary Care Trust) and funded by Social Services is provided at the home. There was one person occupying an interim bed at the time of the visit and there were plans for them to be supported to move on to another home that meets their assessed needs. Hafod Nursing Home DS0000024844.V378659.R01.S.doc Version 5.3 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s):7, 8, 9 and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements in place do not fully ensure that health and personal care needs are met. People may not always receive their medication as prescribed. EVIDENCE: Each person has a written care plan. This is an individualised plan about what the person is able to do independently and states what assistance is required from staff to meet the person’s needs. We looked at the care plans of four of the people who live there. We saw that plans are in place telling staff how to meet people’s personal care needs they gave good detail so people’s needs are met in a way that they prefer. A care plan was in place for the care of a person with diabetes. It gave clear information about what staff should look for and how they should monitor Hafod Nursing Home DS0000024844.V378659.R01.S.doc Version 5.3 Page 12 the person including hand and feet care so the person’s needs are well met. We saw that people’s dietary needs and weight records are kept so their well being can be monitored. It was positive that night time care plans were under development. These will detail what and how people want to be supported with their care needs during the night. We were told by the owner that the homes handover process has improved. We observed the handover between the morning and afternoon staff. Every person living in the home was discussed and important information was passed on such as who needed closer monitoring and any G.P appointments. This information was recorded by the nurse taking over the shift. This should ensure continuity of care. The AQAA told us that there is a named nurse responsible for the overall care and care planning ensuring accountability for care. We saw that one of the people was now being cared for in bed most of the time. However their social activity care plan had not been updated to reflect this. Their care plan should be updated ensuring they still get opportunities for social integration and activities more suited to their change in need. We saw that a bowel care plan had not been put in place for one of the people detailing guidelines when prescribed medication should be given as directed by the G.P. We saw that for one of the people the use of bedrails had stopped but their care plan on falls had not been updated to reflect this. Some of the care plans had different monitoring times to what was recorded on the monitoring chart. For example one of the peoples care plan said turn every two hours and the chart said “every three hours”. This may mean that people are not turned as frequently as they need to be which could cause sore skin and effect their well being. We recommended that advice is taken from an occupational therapist about how to support people safely where bedrails are not suitable but the person is at risk of falling out of bed. It was positive that daily records of turns and observations were seen to follow the person. If they were in their room the records stayed there. If they were in the communal lounge the records move with them. This should ensure that staff complete them consistently. We spoke to three staff that had a good understanding of peoples assessed needs. They told us that improvements had been made to the homes care planning systems including using monitoring records and turn charts more consistently. They are looking forward to receiving further care plan training and the new care planning system. The owner told us that a new care plan system is to be introduced in November. Staff will receive training on how to complete the care plans from outside consultants then the new paper work will be introduced. The owner Hafod Nursing Home DS0000024844.V378659.R01.S.doc Version 5.3 Page 13 told us the new system should provide a comprehensive system of assessment, recording and monitoring of people’s needs. We saw that people have access to other visiting professionals such as G.P, opticians, physiotherapists, and dentists so they receive the support and advice they need to meet their health care needs. We saw that health appointments and follow up required, is recorded so that their well being is monitored. We were informed verbally that the Tissue Viability Nurses had recently completed an audit of the Home and assessed the individual needs of people living there. They had identified that improvements were needed in the recording of how sore skin is monitored and how staff record how they have turned and moved people to prevent sore skin developing. They also identified that pressure reliving equipment including cushions and mattresses required replacement as they were not fit for purpose. We saw that the home had made progress on how information is recorded. All pressure relieving cushions had been replaced. We saw that a number of mattress’s had been replaced and a further supply were on order. When we looked around the home we saw that staff knocked the doors of people’s bedrooms and spoke to people in a respectful manner. In shared rooms we saw that curtains dividing the rooms were in place so people’s privacy and dignity during personal care is respected. People told us “The staff are okay, I prefer to stay in my room”. “The staff are very good they help me when I ask them. I like to go to my room in the afternoon”. “The care at Hafod is good” “They look after people well” We looked at the arrangements in place for medication. We saw that copies of prescriptions are kept so staff can check that medication is correct when it comes to the home. Controlled medications were recorded and stored as required. We saw that liquid correction fluid had been used on one entry. Correction fluid should not be used on legal documents any changes should be corrected and signed so there is a full audit trail of information. We did audits on four people’s medication to check if all the medication had been given as required. We saw for one person that painkillers had been signed for before they were given. The person then refused the medication. Medication record Hafod Nursing Home DS0000024844.V378659.R01.S.doc Version 5.3 Page 14 charts should be signed after medication is given so they accurately reflect what has actually been given. We found two discrepancies where the amount of tablets left did not balance with the MAR records. This may mean medication has not been given as prescribed. The medication administration policy had recently been updated and improved. Hafod Nursing Home DS0000024844.V378659.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s):12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are offered a choice of meals to meet their dietary, cultural needs and preferences. Arrangements in place for activities generally meet people needs. EVIDENCE: Care plans generally included details about the support people need to meet their social and leisure needs. The home was in the process of employing a new activity coordinator. They will be employed for 12 hours per week working mainly afternoons. The owner told us they did a recent audit to find out what planned activities people would like. A weekly time table has been devised and included bingo, baking, tea party, manicures, skittles and card games. A weekly exercise to music session is provided by an external person and a monthly visit from a donkey sanctuary takes place. One of the relatives told us “They have barbecues and parties they are really good” A bonfire party had also been arranged to take place a week after our visit. We saw photographs of Hafod Nursing Home DS0000024844.V378659.R01.S.doc Version 5.3 Page 16 different parties that had taken place displayed in the Home. The AQAA told us that the home hopes to enhance their activity programme and is going to become a member of NAPA (The National Association for Providers of Activities for Older People) and they would like to arrange more day trips. A hairdresser visits the home weekly. We saw people reading, knitting and watching television. We were told that a lay preacher visits the Home to perform a church service which people can join in if they want to, which provides an opportunity for people to meet their religious needs. The home has an open visiting policy. We saw that people had visitors at different times of the day. One of the visitors told us.” We visit whenever we want to. We are really pleased with the care X receives, staff are very good”. The owner told us that she is trying to encourage routines at the Home to be more personalised. Night staff are now only getting up people who want to get up early. This means that day staff can support people to be more flexible with their morning routines. Some people told us that they prefer to spend most of the time in their own bedrooms this was respected by staff. Meetings take place with people. Unfortunately these were not regular for several months but have now been reinstated. We were told meetings will take place on a regular basis. This should ensure that people have the opportunity to express their views about the Home. We saw the menu which is planned on a four weekly basis. New menus had been prepared and were placed on the tables for people to see and make a choice. Comments from surveys included “Food is good and they will always cater for my needs “ “My relative could do with more help with feeding”. Hafod Nursing Home DS0000024844.V378659.R01.S.doc Version 5.3 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems in place do not fully ensure that people will be safeguarded from the risk of harm. EVIDENCE: The complaints procedure is displayed in the home and is included in the service user guide so that people should know how to make a complaint if they need to. It had recently been updated to include the new CQC contact details. Some minor rewording was required to ensure that it is clear about the different stages in the complaint process. A suggestions box was available in the home for the people living there and their visitors to make comments about the home. One of the relatives told us “If there is anything that I am not happy about I go straight to the office to tell them and they sort it out”. Of the eight surveys received and completed by people living in their home or their relatives all said there was someone to speak to informally if they are not happy. One person indicated in the survey that they did not know how to make a formal complaint. Hafod Nursing Home DS0000024844.V378659.R01.S.doc Version 5.3 Page 18 The home had received ten complaints since our last visit and these were recorded along with the actions taken and the outcomes. The complaints related to, care practices, noise disturbances, behaviour of other people living in the home and care of peoples clothing. We received two complaints one was referred back to the home to investigate and one was referred to Adults and Communities under safeguarding procedures. Adults and communities have undertaken investigations into a number of safeguarding matters at the home. Initially these were in respect of people referred to interim beds. Some further referrals were received which impacted across the whole home. Multi-agency safeguarding meetings took place and the concerns which were broadly around the health and wellbeing of people were shared with the owner. Investigations found a number of failings in systems that should be in place to ensure people are safe. In addition the home had failed to make a safeguarding referral in respect of pressure care management which puts the well being of people at risk. A decision was made in September not to place any further people in the home until things had improved and the home could demonstrate that people would be safe. An action plan has been produced to address the shortfalls in the service. We found at this visit that some progress had been made on improving the service so it is safe for people. At the time of writing this report some safeguarding matters were still being followed up by Adults and Communities. The adult protection policy was in the process of being revised and when completed will be renamed as the safeguarding policy. Contact numbers were available so staff would know who to contact in the event of an allegation being made. Training for staff on safeguarding has taken place very recently. Staff who we spoke to had an understanding of their responsibility to safeguard people and report concerns. Staff have had training in the Mental Capacity Act however we could not see that training in Deprivation of Liberty Safeguards training, which accompanies the Mental Capacity Act, had taken place. This training is required so that staff are aware of the legislation and how it may affect people living there. Hafod Nursing Home DS0000024844.V378659.R01.S.doc Version 5.3 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s):19 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, comfortable and homely environment and 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. When we walked around parts of the home it was generally clean. However a bathroom and bedroom carpet did require attention so that people were not put at risk of cross infection. We were told the cleaner was off sick on the day of our visit. Staff were brought in from the owner’s other registered care home, which is near by, to carry out the domestic duties. Hafod Nursing Home DS0000024844.V378659.R01.S.doc Version 5.3 Page 20 There are two main lounges for people to use these are comfortable and homely. There are two separate dining rooms one leading from the second lounge, people therefore have a choice of areas to sit to have their meal. There are a range of aids available to assist people with mobility problems such as mobile hoist, raised toilet seats and grab rails near to toilets. The owner is to implement a replacement programme for profiling beds. This will enable people who require the hoist to transfer from bed to chair to receive this support more efficiently as the hoist will be able to slide under the bed so it is easier to transfer people. There is a mixture of single and shared bedrooms. Bedrooms seen were personalised and people had several of their own possessions including ornaments and photographs which should help 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. In the bedrooms where people were being cared for in bed we saw that the nurse call was within their reach. The bedroom temperature in a person’s bedroom was cold in comparison to the rest of the home which was warm. The person told us they were cold and assistance was sought from a staff member to adjust their radiator. It’s important that bedroom temperatures are maintained at a comfortable temperature for people to maintain their health and well being. There is an ongoing redecoration and refurbishment plan in place. We saw that one of the vacant rooms was being painted. Some of the bedrooms have had matching curtains and bedspreads making them nicer for people to look at. The AQAA told us that bathrooms and en suites have been upgraded since our last visit. There are plans to replace some bedroom carpets, replace some art work and upgrade the first floor bathroom and improve access for people. There is a secure rear garden with ramped access so people who use wheelchairs can access it safely. There is a patio area and garden furniture for the people to enjoy when the weather permits. Comments from surveys included “Some decorating is needed in the minority of areas”. “Could improve some general fixtures and fittings”. Hafod Nursing Home DS0000024844.V378659.R01.S.doc Version 5.3 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s):27,28,29 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment practice ensures people are safeguarded from harm. Arrangements in place do not fully ensure that staff have all the knowledge and skills they need to support people. EVIDENCE: Nursing hours have been reduced since the amount of people living at the home has decreased. The owner said this will increase when the home starts taking admissions again. It’s important that staffing levels are kept under review. When admissions start taking place again there should always be adequate staff on duty so the home has the capacity to meet peoples assessed needs. In addition to nursing and care staff the home has cooks, housekeepers and maintenance staff to meet the needs of the people living there. Hafod Nursing Home DS0000024844.V378659.R01.S.doc Version 5.3 Page 22 The AQAA told us that 50 of the care staff has a national vocational qualification (NVQ) level 2 in care. This should help to ensure that staff have the knowledge and skills to meet the needs of people living there. We looked at the records of three staff. These included the required recruitment records including evidence of a satisfactory criminal records bureau (CRB) check had been completed. This should ensure that only staff suitable are employed to work with people living there. There was no staff training matrix. Some training were on staff personal files but it was difficult to assess training across the whole staff team. On the day of our visit infection control training was taking place. We could see that staff training had taken place recently in response to the concerns and safeguarding issues that had been made. Manual handling, safeguarding and quality assurance training had very recently taken place. First aid and care planning training was planned for November. A training assessment should be completed for the whole staff team so it is clear what training needs the staff team have so training needs can be better planned for. Staff we spoke to said they had received more training recently and they were pleased with what they had completed. They were looking forward to the new care planning training which was scheduled to take place in November. We recommended at the previous inspection that staff receive training in dementia care this training has still not taken place, which means staff may not have the skills to meet the needs of people with dementia. Comments in surveys included “The staff seem kind and considerate”. “The home is well staffed and friendly”. Hafod Nursing Home DS0000024844.V378659.R01.S.doc Version 5.3 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s):31,33,35, 36,37 and 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements in place do not fully ensure the health, safety and well being of the people living there. EVIDENCE: There have been significant management changes since the last visit. The acting manager decreased her hours and eventually worked on a casual basis. A new manager was employed but left in August after a few months employment. The temporary manager returned again to work as acting manager and then resigned. Hafod Nursing Home DS0000024844.V378659.R01.S.doc Version 5.3 Page 24 As previously raised we had received significant concerns about the home which was brought to a head with a number of safeguarding referrals in August and September. The home had not been run in the best interest of the people living there. There had been deterioration in systems that should be in place to ensure the home is being well run. This included failure to monitor peoples health and well being through good care planning systems, lack of staff training and supervision, failure by the owner to audit the home as required, failure to report safeguarding matters. The owners have taken on the support of consultants and have produced an action plan to address the shortfalls and ensure that people are safe. There was evidence at this visit that some progress has been made. We were informed that a manager has been appointed and will take up post in November. We received a letter and a regulation 37 notification informing us of concerns about peoples care. When these concerns were looked into there were serious inconsistencies in what was reported to us and what was recorded in the homes records. The recordings were to do with people’s health and well being and raised concern about the integrity of the person completing the reports. The owner told us that disciplinary action was taken in relation to this and other concerns reported under safeguarding investigations. The owner told us advice on disciplinary matters was sought from the Nursing and Midwifery Council (NMC). We looked at the minutes of the recent residents meeting. These have recently been re-established in the home which should now ensure that the views of people living there are asked for about how the home is being run. The owner told us that surveys have been sent out to people and their relatives. We looked at the most recent regulation 26 visit. These are visits which the provider or a representative must do monthly to ensure that the home is being run in the best interests of the people living there. No visits took place between March and August 2009. The minutes for September were seen and indicated that people living there and their relatives were spoken to and records were looked at thus ensuring the well being of people. We saw that systems are in place for holding and accounting for peoples personal monies. Records of incoming and outgoing amounts and receipts are kept. This should ensure people’s money is secure. We saw that systems are in place for recording and monitoring of accidents and incidents. However the process had not been followed for several months so trends and not been picked up and details of action to be taken to prevent further occurrence had not been recorded. We saw that care records were kept out on table tops in the communal area. We were concerned that confidential information may be seen by other people Hafod Nursing Home DS0000024844.V378659.R01.S.doc Version 5.3 Page 25 visiting the home. We found that there was no log kept of reportable incidents which made an audit trail of information difficult. Health and safety and maintenance checks had been completed to ensure that the equipment is maintained and safe to use. Maintenance checks had been completed on the fire system. Three fire drills had taken place over the last nine months however night staff had not been included in these. All staff working in the Home should take part in drills so they know what to do if there was a fire. We looked at the staff supervision schedule and could see that the owner has completed recent supervisions with all staff. Prior to these supervisions were very infrequent. We looked at the supervision schedule to see if Staff was receiving regular supervision sessions. This is when they meet with a manager or senior member of staff to reflect on their practice and consider any training needs that they may have. The owner had completed a recent supervision with all staff members. However prior to this we saw that supervision took place infrequently which meant staff were not getting the support to do their job. When we looked around the home we saw that some of the radiators in people’s bedrooms did not have covers on them and the radiators were extremely hot to touch. Risk assessments should be completed and actions taken to ensure people are not at risk of harm if they leant or fell against the radiator. We saw two free standing radiators in use in people’s bedrooms. We were concerned that these could be easily knocked over. The use of these should be assessed and steps taken to prevent any risks to people. Hafod Nursing Home DS0000024844.V378659.R01.S.doc Version 5.3 Page 26 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 X X x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 x x x x x x 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 2 2 2 Hafod Nursing Home DS0000024844.V378659.R01.S.doc Version 5.3 Page 27 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 OP7 Regulation 12 (1) a Requirement Care plans should be updated when needs change so people get the care and support they need. Care plans should be in place for specific health care needs so it is clear what action staff should take and should detail when further intervention maybe required. Systems should be in place so people receive their medication as prescribed. Radiators without covers must be assessed for the risk they present to people. Action must be taken on any identified risks so people living there are not at risk to injury. The use of free standing radiators in people’s bedrooms must be assessed for the risk they present to people. Action must be taken on any identified risks so people are not at risk of injury. Timescale for action 11/12/09 2 OP7 12 (1) a 11/12/09 3 4 OP9 OP38 13(2) 13(4) 11/12/09 11/12/09 5 OP38 13(4) 11/12/09 Hafod Nursing Home DS0000024844.V378659.R01.S.doc Version 5.3 Page 28 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 5 6 7 8 9 10 11 12 13 Refer to Standard OP1 OP7 OP16 OP18 OP22 OP25 OP26 OP27 OP30 OP30 OP36 OP37 OP37 Good Practice Recommendations Details of the range of fees should be detailed in the service user guide so people have the information they need to know to make a choice. Advice should be sought from other professionals about supporting people who are at risk of falling out of bed. The complaints procedure required some minor clarification so people know how complaints will be dealt with. Training in Deprivation of Liberty Safeguards should be provided so staff are aware of the legislation and know how to support people to be safe. Beds should be replaced on a planned rolling programme so that people who require a hoist to transfer from bed can be supported more efficiently. The temperature of people’s bedrooms should be maintained to a comfortable level above so to maintain their health and wellbeing. Arrangements should be in place so that risk of cross infection is dealt with promptly so people are not at risk. Staffing levels must be kept under review when new admissions take place so ensuring people get the support they need. A training assessment should be completed for the staff team so it is clear what training needs the staff team have so training needs can be planned for Staff should receive training in Dementia care so that they have the knowledge and skills to meet the needs of individuals with this illness. Staff should receive regular recorded supervisions with their manager and an annual appraisal so people benefit from being supported by a well supported staff team. Care records should be secure and confidential so people can be confident that their confidences are kept. We recommended that a log of all reportable incidents to us should be kept so that there is an audit trail of information. Hafod Nursing Home DS0000024844.V378659.R01.S.doc Version 5.3 Page 29 14 15 OP38 OP38 Night staff should take part in fire drills so that they know how to safeguard people in the event of a fire occurring. Systems should be in place for monitoring accidents and incidents and taking action to prevent further occurrence. Hafod Nursing Home DS0000024844.V378659.R01.S.doc Version 5.3 Page 30 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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