Inspection on 07/08/07 for Hafod Nursing Home

This inspection was carried out on 7th August 2007.

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

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

Other inspections for this house

Hafod Nursing Home 04/02/10

Hafod Nursing Home 27/10/09

Hafod Nursing Home 18/12/08

Hafod Nursing Home 02/07/08

Hafod Nursing Home 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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Hafod Nursing Home 9 - 11 Anchorage Road Sutton Coldfield West Midlands B74 2PJ Lead Inspector Amanda Lyndon Key Unannounced Inspection 7th August 2007 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.V346990.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.V346990.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hafod Nursing Home Address 9 - 11 Anchorage Road Sutton Coldfield West Midlands B74 2PJ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0121 354 9442 0121 354 2616 hafodltd@aol.com none Hafod Care Homes Ms Mahnaz (Nazy) Mohtadi Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29), Terminally ill over 65 years of age (29) of places Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: currently under review 1. That Mahnaz (Nazy) Mohtadi undertakes and obtains successfully the Registered Managers Award or equivalent by December 2005. 18th October 2006 Date of last inspection Brief Description of the Service: Hafod Nursing Home provides general nursing care for up to 29 people who are aged 60 years or above. The Home does not accommodate residents with moderate or severe dementia. Four of the beds are contracted by the Primary Care Trust for the provision of intermediate care and two are funded by Social Care and Health for interim care. The Home comprises of two converted houses within a residential area that have been adapted for it’s current use and is located close to Sutton Coldfield town centre. There is good access to local bus and rail links and it is within 510 minutes walking distance of the town centre. There is off road parking at the front of the building for six cars. There is a choice of seating and dining areas located on the ground floor. There are a mixture of single and shared rooms located on both floors and with the exception of one bedroom, all have en suite. There is a passenger lift for residents to access both floors and a large well-established secure garden situated to the rear of the premises which is suitable for wheelchair users. There is a no smoking policy within the Home however smoking is permitted within the garden area. Assisted bathing facilities are provided and staff are available for assistance in these areas as required. Aids and adaptations are provided for residents with physical disabilities. There is a notice board displaying forthcoming events and other information of interest to residents and their visitors. The most recent CSCI inspection report is available in the reception area of the Home for anyone interested to refer to. The weekly fee to live at Hafod Nursing Home is between £520 and £570 and the nursing care contribution is in addition to this. Physiotherapy is included in this fee. Items not covered by the fee include dry cleaning, hairdressing, chiropody and newspapers. Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 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 Home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Information obtained and used in the planning of this visit included Regulation 37 notification reports of any accidents or incidents involving people using the service. The Registered Manager had completed a self- assessment document, giving some information about the Home, residents and staff which was also taken into consideration. Prior to the visit eleven completed questionnaires were returned to CSCI from residents, their families and Doctors and these included positive comments about the service provided at Hafod Nursing Home: “The Home is extremely good with the basics of good caring, well fed, clean and helpful…” “The carers and nurses are very helpful all the time. I take part in bingo and painting”. “If I have a problem I always speak to the nurses or the manager”. “I feel confident that my wife is in the safe hands of the Hafod caring staff”. A negative comment was received about the lack of outings arranged for residents. The visit referred to in this report was undertaken over one day by one Inspector when there were twenty four residents living there. (Two residents were receiving intermediate care and two residents were receiving interim care). The Home was not aware that we were visiting. Information was gathered by speaking with six residents, two visitors, the management team and staff members. An additional method of obtaining information was “case tracking” two residents in order to establish their individual experiences of living in the Care Home. This involved meeting and observing them, discussing their care with staff, looking at care files and focussing on the outcomes for these people. A partial tour of the Home relevant for these people was also undertaken. Tracking residents’ care helps us understand the experiences of people who use the service. No immediate requirements were made on the day of the visit Following the visit a comprehensive action plan was sent by the Registered Manager confirming that requirements and recommendations made on the day of the visit had been addressed in a timely manner for the benefit of residents. Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 6 What the service does well: Prior to coming to stay at the Home prospective residents are encouraged to sample what life would be like to live there. During this time comprehensive assessments of their care needs are undertaken to ensure that their care needs could be met living at the Home. Any information of interest to residents can be made available in a large print format so that residents with poor eyesight can access this information. Residents have access to a range of Health and Social Care Professionals and staff provide support to ensure that any instructions are carried out and this ensures that any health care needs are met. One visitor said “The staff have a good knowledge of my Mother’s needs and a common sense approach to care”. Residents admitted to the Home on a temporary basis receive comprehensive input from the multidisciplinary team in preparation for their discharge from the Home in order to improve the quality of their lives. Residents are cared for in a respectful manner by staff working at the Home and this ensures that their self- esteem and dignity are maintained. One resident said “Staff give out the post unopened and you can ask them to help you to read it if you want to”. Another resident said “The staff always knock on the bedroom door for privacy”. The staff team have a good knowledge about residents’ individual care needs and staff approach residents in an understanding and sensitive manner so that residents feel calm, confident and relaxed. Residents are able to exercise control over their daily lives and this promotes their independence and individuality. There are no rigid rules or routines at the Home. One staff member said “Residents can have showers in the morning or afternoon and at other times when requested”. Residents are supported to form friendships with each other so that they can share their experiences with each other. One resident said “We are friends here, we look after each other”. Visitors are made to feel welcome at the Home and are encouraged to spend time there. One visitor said “The staff always offer me a cup of tea and I can have lunch here as well”. Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 7 Residents are supported to continue to practice their chosen religions and this ensures that their beliefs and individuality are respected. There is a choice of wholesome meals which meet any dietary needs for reasons of health, taste, culture or religion. Residents can choose where they would like to be served their meals. One resident said “They ask us where we would like to have our meals, nothing is too much trouble”. Another resident said “The menu comes round and we choose what we want”. Complaints are investigated in an appropriate and timely manner so that people are confident that their views are listened to. Staff have had recent training about adult protection so that residents should be protected from harm. One resident said “You can speak to the manager if you have any problems”. Aids and adaptations are provided so that the independence, choice and dignity of residents are promoted whilst maintaining their safety. Regular maintenance checks of this equipment ensure that they are safe to use. Residents and staff are satisfied with the staffing levels so that there is an adequate number of staff on duty to support residents. One resident said “The staff never refuse to do anything. There seems to be enough staff on”. One staff member said “There is time to sit and talk with the residents”. Agency staff are not used and this promotes continuity of care for residents. Staff recruitment procedures are comprehensive so that residents are cared for and supported by a carefully selected staff team. The gender mix of care staff reflects the gender mix of residents so that care is provided in an understanding manner. Comprehensive staff training is provided so that staff had the appropriate skills and knowledge to work safely and effectively and provide a good standard of care to residents. The Registered Manager has a good understanding of individual residents’ care needs and positive comments were received about her management style. She ensures that a family atmosphere is promoted within the Home and ensures that staff feel supported within their job roles. One staff member said “The Manager is approachable and easy to get on with”. What has improved since the last inspection? A statement of purpose (brochure) has been further developed to include good detail of the services provided at the Home. Residents who are privately funded have the opportunity to put forward their views about whether they would like to remain at the Home on completion of their four week trial period. Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 8 During care reviews residents have the opportunity to review their care plans so that their preferred daily routines can be maintained whilst living at the Home. A number of improvements have been made regarding the living environment provided for residents including: • New bedroom furniture has been purchased including a lockable storage facility for the safekeeping of valuable and personal items. • Two new “wet rooms” have been created and a bathroom has been refurbished so that residents have a choice of bath and shower facilities. • Hands rails have been provided in all areas of the Home that residents have access to, promoting the independence and safety of residents. • Two new mechanical transfer hoists have been purchased so that residents who are unable to stand could be assisted to transfer safely. • A mechanical commode pot disinfector facility has been purchased for the safe and hygienic cleaning of commode pots. Staff members do not work an excessive number of hours per week so they should provide a good standard of care for residents. The Registered Manager has recently achieved a management qualification so that she has the necessary skills and knowledge to lead the staff team in a competent manner. What they could do better: Each resident must have a care plan that outlines the specific support that they require from staff in order for their individual care needs to be met in the way that they prefer. Nursing staff must seek the advice of wound care nurse specialists for residents that have very sore skin so that the appropriate care can be given. A number of improvements are required to ensure that residents receive their medication in a safe manner. Staff must ensure that residents’ dignity is maintained whilst hoisting equipment is in use. Staff must ensure that original receipts are obtained for all items bought out of residents’ money and this must be checked regularly to detect any errors and protect both residents and staff. Suitable precautions must be in place to ensure that residents are safeguarded in the event of a fire occurring at the Home. Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 9 Cleaning products must be stored securely at all times so that vulnerable residents do not come into contact with these. Activities arranged at the Home do not meet the expectations of all residents and opportunities for residents to participate in trips outside of the Home are limited. Residents should be provided with opportunities to put forward their suggestions for improvements to the services provided and systems in place for the monitoring of these services should be further developed. 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.V346990.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admission processes are thorough and residents have adequate information in order to make an informed decision about whether they would like to live at the Home. The intermediate care facility provides a good standard of care for people in need of rehabilitation and this improves their quality of life. EVIDENCE: The statement of purpose had been amended to reflect the current services provided at the Home and the service user guide was informative and easy to read. These included good information about the Home and were available in each bedroom for residents to refer to. These were available in a large print format for people with impaired eye sight. Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 12 Senior staff undertake comprehensive pre admission assessments for all prospective permanent residents in order to ensure that their individual care needs could be met at the Home and thus prevent inappropriate admissions. Prospective residents are encouraged to visit the Home in order to sample what life would be like to live there, however due to the frailty of a number of prospective residents this is not always possible. Residents come to live at the Home on a four week trial period and on completion of this the Social Workers of residents funded by Social Care and Health arrange a care review involving the resident, their families and the Home’s staff to ensure that they are happy to continue to live at the Home and to ensure that their care needs are being met whilst living there. The Home has formalised their procedure for reviewing the care of privately funded residents on completion of their trial period so that they also have the opportunity to discuss whether they would like to continue to live at the Home. Intermediate care funded by the Primary Care Trust (PCT) is provided for four residents living at the Home at any one time for a period of up to approximately six weeks per person. The intermediate care team includes General Practitioners, an Occupational Therapist, Physiotherapist, Specialist Community Nurses and a Social Worker. Prior to coming to stay at the Home, the intermediate care team assess each person’s suitability to stay there and it is identified within the agreement that Hafod Nursing Home does not provide accommodation for people with dementia care needs. People receiving intermediate care are admitted directly from hospital and are often in need of rehabilitation care following trauma and orthopaedic surgery. Most of the specialist equipment required for people receiving intermediate care is funded and provided by the PCT. Interim care funded by Social Care and Health is provided for up to two residents living at the Home at any one time for a period of up to six weeks each. The majority of these residents are deciding where they would like to live in the future and would have previously of had to remain in hospital until this decision was made. Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are generally well met however inconsistencies regarding the content of care plans may prevent residents from receiving person centred care. Some improvements are required to ensure that residents receive their medication in a safe manner. Residents are cared for in a respectful manner and this ensures that their dignity and self esteem are maintained. EVIDENCE: Residents met during the visit stated that they were satisfied with the standard of care received and it was evident that staff had good knowledge of residents’ individual care needs. One visitor said “The staff have a good knowledge of my Mother’s needs and a common sense approach to care”. One resident said “You can always have a shower here”. One staff member said “Residents can have showers in the morning or afternoon and at other times when requested”. Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 14 On admission to the Home assessments of residents’ care needs are undertaken and care plans are derived from this information. There were inconsistencies regarding the content of these. Some care plans included good detail of residents’ individual preferences regarding their daily lives so that these could be maintained whilst living at the Home. A number of care plans gave clear details of the support required by staff in order to promote the dignity and independence of residents. Other care plans were generic in nature and did not identify the specific support required to meet residents’ individual care needs. For example a care plan written for a resident who had a sight impairment referred to eye surgery and eye drops although the resident had not had surgery and was not prescribed eye drops. One care plan identifying hygiene care needs stated “Establish and use preferred choice of products”, but didn’t identify what these preferred choices are. A care plan had not been written regarding the care to be provided for a resident who had an infection and this may prevent the appropriate infection control measures from being implemented. Social care plans required further development to include opportunities for residents to socialise based on their personal interests and abilities. Daily reports were recorded in good detail and reflected the care provided. Staff had a good understanding of how to communicate with a resident who was unable to talk in order for her care needs to be understood and personal wishes be conveyed to the staff team. A comprehensive care plan regarding this had been written and this identified the support required by staff in this area. Picture aids were being developed in order to enhance the quality of life for this person. Comprehensive wound assessment charts are completed each time that a wound dressing is changed however care plans have not been written regarding this. Care plans must identify any changes to wound dressing regimes so that residents receive the appropriate care. All staff responsible for wound care have had comprehensive training so that they should have the necessary skills and knowledge to provide good care in this area. It was noted that one pressure sore (sore skin wound) was not improving despite regular input from the Home’s staff and this should be referred to the tissue viability team for specialist advice regarding the choice of wound dressings and type of pressure relieving mattress provided. Pressure relieving equipment (mattresses and cushions) were available and residents were regularly assessed in order to reduce the risk of developing sore skin. Supplement drinks are provided for a number of residents in order to increase their nutritional intake, for example for those residents with sore skin who are in need of extra nutrition. Moving and handling risk assessments had been undertaken however these did not always include detail of the action to be taken should a resident fall and this may result in inappropriate actions being undertaken. Personal risk Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 15 assessments had been undertaken regarding the use of bed safety rails so that residents were aware of the risks involved in the use of these. Care reviews are undertaken annually or at any time that residents’ care needs should change. These involve residents, their families, social workers (If not privately funded) and the Home’s staff. This provides all present with the opportunity to put forward their views about whether residents’ individual care needs are being met whilst living at the Home and suggestions for improvements can be put forward. This includes both the physical and psychological health care needs of residents. Care plans are reviewed during this time with the involvement of residents and their relatives so that they received care and support in the way that they prefer. Residents are encouraged to retain their own General Practitioner on admission to the Home (if the GP is in agreement). Residents have access to other visiting Health and Social Care Professionals including Opticians, Chiropodists and Speech Therapists and regular physiotherapy is included within the fee at the Home. Hospital admissions are prevented as often as possible and residents and their families’ wishes in respect of this are respected wherever possible. Residents are weighed regularly and their blood pressure, pulse and other nursing observations are recorded regularly in order to monitor the state of their health. A number of nurses employed at the Home had extended nurse skills, for example are competent in taking blood samples from residents so that they do not have to go to the Doctor’s surgery. Systems in place for the management of medication were generally good so that residents should receive their medication in a safe manner. Since the last visit the system in place for the storage and use of blank prescription pads had improved so that all prescriptions written were accounted for. Stock balances of medication sampled during the visit were correct. A number of shortfalls were identified: • A number of nutritional supplements were in the drugs fridge and were not prescribed/labelled for individual residents’ use and this may result in them being given to the wrong person. • The actual doses administered in respect of variable dosages were not always recorded and this will prevent an accurate audit trail from being followed. • Not all medications were signed as confirmation of receipt into the Home. • Medication audits are not being undertaken at the current time and these must be introduced in order to ensure that residents receive their medication as prescribed. • Countersignatures had not been obtained as verification of all hand written entries onto medication administration charts (MAR). • One prescription item had been written onto the MAR chart twice and this may result in it being given twice. Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 16 Residents appeared to be supported to maintain their personal hygiene and choose clothing, make-up and jewellery appropriate for their age, gender and culture. The preferred gender of care staff providing personal care to residents was recorded within their individual care plans in order to respect their wishes. One female resident said “Normally female staff assist me to have a shower but we had one male carer who was marvellous”. A payphone was available for residents’ use however this was located in the reception area of the Home and did not afford residents’ privacy whilst on the telephone. The Registered Manager stated that residents could use the Home’s portable phone in order to make and receive calls in private. One resident said “Staff give out the post unopened and you can ask them to help you to read it if you want to”. Another resident said “The staff always knock on the bedroom door for privacy”. During the visit, whilst sitting in the lounge, staff were assisting a resident in to a wheelchair using a mechanical hoist and it was noted that the residents’ underwear was on display. This does not uphold the dignity of the resident and action must be taken to ensure that residents’ under garments are covered. Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. Activities provided meet the needs and expectations of the majority of residents living at the Home. Residents have control over their daily lives and are provided with a choice of healthy meals that meet any special dietary requirements. EVIDENCE: Since the last visit an activities person has been employed for six hours per week and hobby therapy equipment has been purchased. During this time residents are invited to participate in “in house” activities including painting, bingo, soft ball games and play dough. Activity records identified that the activities on offer were repetitive and not all are deemed to be age appropriate. In addition residents are invited to participate in a weekly “movement to music” activity. Hairdressing is available at the Home and large print library books are available for residents to enjoy. A number of residents choose to have newspapers delivered so that they keep abreast of local and national Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 18 news. A number of residents choose to go outside of the Home with their friends and families, on shopping trips and to restaurants. A negative comment was received about the lack of outings arranged for residents. The Registered Manager stated that only a limited number of residents were interested in participating in outings however she would look into opportunities for residents to join in with outings organised by a nearby care home (within Hafod Care Organisation). A comment was made that the Home was in need of designated activity hours to be increased to provide more opportunities for residents to participate in “in house” activities. It was evident that friendships had formed between residents and this promotes a family atmosphere within the Home. One resident said “We are friends here, we look after each other”. A Church of England Minister visits the Home each week and Holy Communion is available regularly. A number of residents choose to visit their chosen places of worship with their friends and families. Opportunities for worship for residents of non Christian faiths can be arranged as required. There is an open visiting policy and many positive comments were received from visitors about the standard of service provided at the Home. One visitor said “The staff always offer me a cup of tea and I can have lunch here as well”. There were no rigid rules or routines at the Home and residents confirmed that they were able to choose how they spent their day, the time that they got up in the morning and the time they went to bed. One resident said “There is no time limit for when we go to bed”. Residents can choose where they are served their meals. One resident said “They ask us where we would like to have our meals, nothing is too much trouble”. All meals are prepared at the nursing home and in addition meals for a nearby residential care home and people living in the community are prepared on site. Residents confirmed that they received a choice of meals and that they were satisfied with the standard of these. Since the last visit, menus had been revised with the involvement of residents so that their favourite meals were available at the Home. These included a choice of healthy meals, with both a hot and cold (salad) option at lunchtimes. Meals reflected the cultural backgrounds of residents and special diets could be prepared for reasons of health, taste or religious preferences. Diabetic, weight reducing and vegetarian diets are being prepared at the current time. The portions of pureed diets are served separately so that residents can experience the different tastes included in the meal. Breakfast is served at flexible times to suit residents’ preferences. Snacks are available at bed time and during the night so that residents are not hungry. The main meal options on the day of the visit were cod in mornay sauce and chicken salad. The meals were well presented and residents were encouraged to serve their own vegetables from terrines on the dining tables so that they Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 19 could choose how much they wanted to eat. One resident said “There is plenty of food here. We always get a choice, we had a lovely cooked breakfast today, the presentation was lovely”. Another resident said “The menu comes round and we choose what we want”. The rolling menus on display reflected the meal options on the day of the visit however were confusing as they did not identify the current date. Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are confident that any concerns raised will be acted upon in a timely and appropriate manner. Systems are in place that should protect residents from harm. EVIDENCE: A number of compliments about the service provided at the Home were on display. A complaints procedure was on display in a large print format however this must be amended to reflect that CSCI can be contacted at any stage in the complaints process. (the correct information regarding this was identified within the service user guide). A “suggestions box” and “comments register” were available in the reception area of the Home in order for residents or their visitors to put any suggestions forward. These included a number of informal suggestions and comments including a suggestion for a “quiet hour” to be introduced and the size of desserts served to be reduced in order to prevent food wastage. A record of actions taken in response to these was available. Since the last inspection CSCI have not received any concerns or complaints about the service provided at Hafod Nursing Home. The complaints register identified that three complaints had been made directly to the Home. These included issues raised regarding the attitude of a staff member, the behaviour of a resident towards other residents and visitors and the television picture Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 21 being poor. These concerns had been investigated in a timely and appropriate manner to the satisfaction of the complainants and remedial action had been taken in response to these for the benefit of residents living at the Home. One resident said “You can speak to the manager if you have any problems”. Staff had undertaken recent training about the protection of vulnerable adults so that they should have the necessary knowledge to take the appropriate actions following any incidents of alleged or actual abuse involving residents. One new staff member confirmed that she had been given guidance on adult protection issues and other staff members confirmed that they had undertaken recent training about this. Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 22 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. This judgement has been made using available evidence including a visit to this service. Residents are provided with a homely and clean living environment in which they are safe and secure and their privacy is maintained. Aids and adaptations provided promote residents’ independence and choice whilst maintaining their safety. EVIDENCE: Since the last visit a programme of refurbishment and redecoration throughout the Home has commenced. Extensive work is currently being undertaken on the first floor and two new “wet rooms” are being created on the ground floor so that residents have a choice of bath or shower facilities. The communal bathroom on the first floor has recently been redecorated and a new bathroom suite has been purchased to use with the existing bath hoist. Four new shower Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 23 chairs have also been purchased recently to enhance residents’ comfort when using these facilities. There were two main lounges for residents to use, decorated in homely styles and there was a separate dining room and a further dining area leading from the second lounge so that residents had a choice of where they were served their meals. A negative comment was received about the size of the television in the main lounge as it was too small for all residents to view. The Registered Manager stated that she was aware of this and remedial action will be taken in the near future. There was a mixture of single accommodation and the shared rooms were furnished to maintain the privacy of residents. One resident said “I share a room but it is very private and roomy”. Bedrooms contained residents’ personal possessions that reflected their tastes and interests in order for them to feel comfortable in their surroundings. Bedroom doors were fitted with privacy locks which could be overridden in the event of an emergency. There was a nurse call facility in each bedroom in order for residents to summons assistance from staff or to be used in the event of an emergency. Since the last visit three bedrooms and en suites had been redecorated and a rolling programme of replacing bedroom furniture with a lockable storage facility had commenced so that residents could store any valuable or private items securely. There were a number of bedrooms in which lockable facilities were yet to be provided however plans were in place to address this. Since the last visit hand rails had been fitted to all areas of the Home that residents have access to so that their independence and safety were promoted. Two new mechanical transfer hoists had recently been purchased so that residents who were unable to stand could be assisted to transfer safely. Raised toilet seats and grab rails near to toilets were provided to promote the independence and safety of residents. The secure external garden was spacious and well maintained. There was ramped access leading out to this area and it was suitable for wheel chair users to enjoy. Since the last visit surplus equipment had been removed from the garden so that it was safe for residents to use. Garden furniture was available for residents’ use however this was old and worn. The Registered Manager stated that she acknowledged this and furniture would be replaced in due course. External window sills were rotten and shabby in appearance and required remedial action so that residents were provided with an attractive a well maintained place to live. The Home was found to be clean and fresh on the day of the field work visit and since the last visit a mechanical commode pot disinfector facility had been purchased for the hygienic cleaning of used commode pots. Denture pots for residents sharing a bedroom had not been labelled and this may result in the spread of cross infection. Staff met during the visit appeared to have good Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 24 knowledge about infection control issues and this reduces the risk of the spread of infection within the Home. The Registered Manager confirmed that remedial action had been undertaken since the most recent environmental health inspection so that food continues to be prepared in a hygienic manner. Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by an adequate number of appropriately recruited and trained staff so that they are safeguarded and should receive a good standard of care. EVIDENCE: Staff met throughout the inspection were found to be very welcoming, polite and respectful and both residents and visitors confirmed this. The gender mix of staff reflected the gender mix of residents (predominanently female residents and staff) so that residents could be supported in an understanding manner. The staffing rotas identified that since the last visit measures had been implemented to ensure that staff did not work an excessive number of hours each week and there were currently no staff vacancies. Agency staff are not used and this ensures continuity of care for residents. A minimum of two registered nurses are on duty during day time hours and on occasions this includes the Registered Manager. In addition to this, four care assistants provide support during day time hours and one registered nurse and two care assistants are on duty overnight. Extra staff are provided to cover specific Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 26 duties, for example escort duties and caring for high dependency residents so that there are an adequate number of staff. One resident said “The staff never refuse to do anything. There seems to be enough staff on”. One staff member said “There is time to sit and talk with the residents”. Senior staff provide on call support to the person in charge of the shift so that they feel supported at all times. Housekeeping and kitchen staff provide ancillary support so that residents are supported in all aspects of their daily lives. Staff recruitment files contained all information required by regulations and this safeguards residents. In addition all staff are deemed to be safe to work with vulnerable residents prior to commencing employment at the Home. Following the completion of an initial health and safety induction, new staff undertake comprehensive induction training in line with “Skills For Care” so that they should have the necessary skills and knowledge to provide good care. One staff member who had recently commenced employment at the Home said “My induction was one week and someone was with me all the time. I could ask any of the carers anything, we work as a team”. Staff training records were well maintained and this assists in assessing individual staff training needs to ensure that all staff had the appropriate knowledge to work in a competent manner. Staff had undertaken recent training about infection control, continence promotion and pressure ulcer (sore skin) prevention. 48 of staff had achieved NVQ level 2 and other staff members are currently working towards this so that they should have the necessary skills and knowledge to work in a competent manner. Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This Home is run in the best interests of the people living there however opportunities for residents to put forward their views about the services provided are limited. A lapse in procedures regarding the system in place for the safekeeping of residents’ money does not protect residents or staff. Arrangements for health and safety are generally adequate so that residents should be safeguarded. EVIDENCE: The Registered Manager has many years of experience working within a managerial role and has recently completed the Registered Managers’ Award in order to acquire new skills and update her existing skills to lead the Home’s Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 28 team in a competent manner. She was enthusiastic about staff training and was keen to share her knowledge with the rest of the staff team. It was very evident that the Registered Manager had built up a good rapport with visiting health and social care professionals, visitors and the staff team. In addition she had a good knowledge of residents’ individual care needs. One staff member said “The Manager is approachable and easy to get on with”. The Registered Manager is supported by a Deputy Manager who worked alongside the rest of the staff team to ensure that they felt supported within their job roles. During the visit it was brought to the attention of CSCI that the Registered Manager was undertaking nursing duties at a nearby residential care home and this is considered to be unacceptable as it is not within her role as Registered Manager at Hafod Nursing Home. The pitfalls of this, including insurance cover were discussed with her during the visit and she stated that this arrangement would cease with immediate effect. Administration support is provided off site and a comment was made that the Home was in need of a receptionist/administrator on site so that the Registered Manager could spend more time supervising staff and providing staff training. With the exception of during care reviews, opportunities for residents to put forward their views about the services provided at the Home were limited. A residents’ meeting had not been held since October 2006 and the minutes of this were not on display. Service satisfaction questionnaires had not been distributed to residents or visitors in order to seek their views about the services provided. In addition formal quality assurance auditing had not been undertaken since 2005 and this prevents the quality of services provided from being monitored. Regular quality monitoring visits are undertaken by senior external management so that remedial action can be taken to address any issues raised for the benefit of residents and staff alike. A staff meeting had not been held since October 2006 and this prevents staff from having the opportunity to put forward their views about the service provided with support from their peers. A facility for the safekeeping of small amounts of residents’ money was in place and a number of residents had chosen to use this facility. Separate transaction records are kept for each person and money is stored separately. Receipts of the majority of items purchased out of residents’ money were kept with the exception of a recent hand written receipt for residents’ personal clothing that had been purchased by a former staff member on her behalf. The original receipt identifying the items of clothing bought for the person was not available and the transaction record had not been updated following the purchases being made. This is considered to be poor practice and does not safeguard either resident or staff member. Other balances of monies sampled Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 29 during the visit were correct. This system had not been audited for over two months and this has prevented errors, as identified above from being detected. There was a rolling programme of statutory training in place including health and safety, food hygiene, infection control, first aid, fire safety and moving and handling. The Registered Manager and Maintenance Officer had recently completed the Fire Marshall Trainers course and a fire risk assessment had been completed. Since the last visit magnetic closures had been fitted to a number of fire doors so that they would close automatically in the event of a fire. An exception to this was the office door that was wedged open during the visit. This may result in the spread of fire thus does not safeguard residents. A recent health and safety inspection had identified that there was a need for ramped access and hand rails to be provided to the fire exit on to the front of the building. The current fire exit may prevent residents from exiting the building safely in the event of an emergency. Health and safety checks of equipment were undertaken regularly so that they are safe to use. Despite being raised during the last visit to the Home, it was of concern that cleaning products had been left unattended in a resident’s bedroom. This poses a risk to the health of vulnerable residents who may accidentally come into contact with these chemicals. Accident records are filed confidentially however there was no evidence that these are audited regularly. Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 30 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 3 x 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 3 3 3 x 3 x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 x 2 x x 2 Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Each resident must have a care plan that identifies the specific support required by staff in order to meet their care needs. (Timescale of 01/12/06 not met) Arrangements must be made for specialist advice to be sought so that residents receive appropriate care in respect of tissue viability issues. Suitable arrangements must be made for the accurate recording of all medicines onto medication administration charts and the regular monitoring of these. Arrangements must be made to provide a robust system for the safekeeping of residents’ money so that both residents and staff are protected. Arrangements must be made to ensure residents’ safety in the event of a fire occurring at the Home. Timescale of 18/10/06 not met 6 OP38 13(4) Work practices must be revised DS0000024844.V346990.R01.S.doc Timescale for action 31/10/07 2 OP8 12(1)(a) 15/09/07 3 OP9 13(2) 15/09/07 4 OP35 13(6) 15/09/07 5 OP38 23(4) 30/09/07 15/09/07 Page 32 Hafod Nursing Home Version 5.2 to ensure that vulnerable residents do not come into contact with cleaning substances. 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 Refer to Standard OP7 Good Practice Recommendations Moving and handling risk assessments should include detail of the action to be taken should a resident fall and the type of hoist and size of sling to be used for each resident. These should be reviewed regularly Work practices should ensure that residents’ dignity is maintained whilst using transfer hoist equipment. Activities provided should meet the needs and interests of residents and consideration should be given to providing more opportunities for activities outside of the Home. Arrangements should be made so that residents and their visitors know that they can inform CSCI of any issues that they may raise about the Home. Remedial action should be taken to improve the external appearance of the Home for the benefit of residents living there. Suitable arrangements should be made to reduce the risk of cross infection between residents living in shared bedrooms. The Registered Manager should not undertake nursing tasks outside of her role and responsibilities so that she does not jeopardise her position at the Home. Consideration should be given to providing administrative/receptionist support at the Home so that the Registered Manager’s time is not taken away from her managerial duties. Arrangements should be made to provide residents and staff with opportunities to put forward their views about the services provided at the Home. Quality monitoring systems must be further developed so that actions can be taken to improve services for the benefit of residents living at the Home. DS0000024844.V346990.R01.S.doc Version 5.2 Page 33 2 3 4 5 6 7 8 OP10 OP12 OP16 OP19 OP26 OP31 OP31 9 10 OP32 OP33 Hafod Nursing Home Outstanding from previous visit 11 OP38 A system for monitoring the number of accidents involving residents should be introduced in order to identify any trends/patterns thus minimise the risk of further accidents occurring of a similar nature. Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hafod Nursing Home DS0000024844.V346990.R01.S.doc Version 5.2 Page 35 - 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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