Inspection on 28/08/08 for Halcyon Court Nursing Home

This inspection was carried out on 28th August 2008.

CSCI 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

Halcyon Court Nursing Home 20/09/07

Halcyon Court Nursing Home 03/10/06

Halcyon Court Nursing Home 07/12/05

Halcyon Court Nursing Home 06/09/05

Halcyon Court Nursing Home 12/11/04

Halcyon Court Nursing Home 30/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 23/11/2008.

CARE HOMES FOR OLDER PEOPLE Halcyon Court Nursing Home 55 Cliff Road Leeds Yorkshire LS6 2EZ Lead Inspector Catherine Paling Key Unannounced Inspection 28th August 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Halcyon Court Nursing Home DS0000055003.V369484.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. Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Halcyon Court Nursing Home Address 55 Cliff Road Leeds Yorkshire LS6 2EZ 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) 0113 2743006 0113 2307326 penny.fletcher@anchor.org keri.sherwood@anchor.org.uk Anchor Trust Manager post vacant Care Home 71 Category(ies) of Old age, not falling within any other category registration, with number (71), Physical disability (5) of places Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The 5 places for PD are for the use of specific named service users only. One specific service user under the age of 65, named on variation received on 18/9/06 may reside at the home. 20th September 2007 Date of last inspection Brief Description of the Service: Halcyon Court is owned by Anchor Trust, a registered charity. Halcyon Court is situated in a residential area of Leeds. Personal care with nursing is provided at the home for up to 71 people. Intermediate care is also provided for up to 15 people who have been discharged from hospital and are waiting for alternative accommodation in the community. Accommodation is provided on four floors and is split into different zones, all of which are named. A passenger lift is provided, in addition to the stairwells, which allow access to all floors. There are a number of shared rooms, although these are generally used for single occupancy. Communal bathroom and toilet facilities are provided throughout the building. A number of the rooms have en-suite facilities. There are three lounges, two large dining rooms and a smaller dining area available for communal use. The home has a large parking area. It is within easy reach of the city centre. Public transport is readily available a short walk from the home. There is a wide range of local amenities. The gardens to the rear of the home are accessible to service users and provide a seating area. To the front there is a small garden with planted raised beds and pathway. The current fees range from £530 to £650; the manager provided this information at the time of this inspection. The home should be contacted directly for up to date information about fees. Additional charges are made for hairdressing, private chiropody and newspapers. Information about the service is available from the home in the form of a Statement of Purpose and Service User Guide. Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced visit by two inspectors who were at the home between 09:30 and 17:05 on 28th August 2008. The purpose of our inspection was to make sure the home was operating and being managed for the benefit and well being of the people who live there and in accordance with requirements. Before the inspection we looked at accumulated evidence about the home. This included looking at any reported incidents, accidents and complaints. We used this information to plan the visit. We looked at a number of documents during the visit and visited all areas of the home used by the people who live there. We spent a good proportion of time talking with the people at the home as well as with the manager and the staff. We spent significant time with people who live at this home including a short observational framework inspection (SOFI) that lasted two hours and took place in the large lounge and main dining room. Detailed observations were made of the care given and interaction with staff. These observations were followed up by discussions with staff and the manager. We asked the home to provide some information before the visit by completing an Annual Quality Assurance Assessment (AQAA). We sent survey forms to the home before the inspection providing the opportunity for people to comment on the service, if they wish. Information provided in this way may be shared with the provider but the source will not be identified. A small number of surveys were returned and some of their comments are included in the report. What the service does well: People moving into the home permanently have their care needs assessed before moving in. The home liaises with other healthcare professionals wherever necessary for intermediate care and permanent clients, to gather Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 6 information about people before they move in. This means that they know how to support people. The staff at the home work well with the intermediate care staff team in making sure that they are looking after intermediate care clients properly. Although the home is experiencing recruitment difficulties they make sure that the skill mix and staffing numbers are maintained at satisfactory levels. This means that there are enough staff to look after people. People spoke well of the food with one person saying that it was ‘always adequate, often brilliant’ What has improved since the last inspection? What they could do better: The provider is clear about what needs to be improved at the home and has identified the areas within their action plan. Extracts from the action plan have been included in the body of the report. The recruitment of permanent staff is crucial to the sustained overall improvement of the service and facilities at the home. The quality of life for people living at the home will be improved with stability and consistency among the staff group. The individual care records need to be developed in a person centred way. This will mean that staff will have detailed personal information about how to care for and support people and people will be looked after in the way they want. Nutritional risk assessments need to be reviewed to make sure that they are accurate. Where risk has been identified there must be clear plans of the action to be taken to address the risk and the plans must be fully implemented Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 7 and evaluated. This is so that people at nutritional risk do not have their needs overlooked. Staff need to be properly supervised to make sure staff respect people’s dignity and privacy. The level of activities provided on a day to day basis, needs to be improved. This will provide people with occupation and stimulation so that they are not bored. The ongoing refurbishment of the home should continue to make sure that people live in comfortable and well-maintained surroundings. Requirements and recommendation we have made as a result of this visit appear at the end of this report. 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. Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 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 Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People who use the service experience adequate quality outcomes in this area. Overall, people are provided with enough information to enable them to make an informed choice about the home. Information is gathered from a variety of sources before admission to make sure that people’s care needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA stated – “good pre admission assessments, new person centered planning, experienced management team” Evidence: “service user plans, service user guide, statement of purpose; we work closely with the intermediate care team to ensure the care we provide is of correct Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 10 standard, who will offer support and advice where required; Anchor’s vision, mission, and values in action and regular reviews of service user plans and 6 monthly updates of statement of purpose. We provide 15 intermediate care beds”. The new manager is currently reviewing the Statement of Purpose and Service User Guide so that people considering moving into the home have accurate and up to date information to help them make up their mind about moving into the home. There is a detailed format that is used to record pre-admission assessment information. We looked at a completed example for a recent admission to the home. The quality and detail of the information recorded varied. There was some good detail that included the number of people needed to help this person to mobilise and the equipment needed. However some other areas lacked the necessary detail. For example, “needs assistance of care staff for her personal hygiene needs” gives no indication of exactly what help or support is needed and does not identify individual strengths. Of some concern was that this person had a serious drug allergy which had not been identified at the pre-admission assessment. The manager said that the plan was that all pre-admission assessments would be carried out by the clinical nurse manager accompanied by her wherever possible. This will lead to a consistant standard of information so that staff will know how to look after people properly. When people are admitted for intermediate care information about them, the reasons for admission and the support needed is provided by the intermediate care team. People admitted for intermediate care can sometimes be admitted at short notice but staff said that they always had information about the person before they were admitted. The intermediate care staff team, including nurses, physiotherapists and occupational therapists, are responsible for assessing the individual needs and for developing the plan of care needed. Members of the team visit the home every day. Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience adequate quality outcomes in this area. The information in care plans is not always detailed enough. This means that there is a risk of some care needs being overlooked. Some staff practices did not respect people’s dignity and their right to privacy. People at the home are protected by safe medication practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information from the Home’s action plan – Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 12 • • • • • • • • • • • • A re-assessment of residents dependency rating was completed May 2008 and the information used to review staffing levels Service User Plan training to be organised for care staff and nurses, to ensure full involvement of all nurses and care staff in daily reporting and monthly review process – May 2008 Service user plan review process to be monitored to ensure that all service users needs are met – May 2008 All residents named relatives to be involved in the review process – ongoing General Service User Plan audit to be undertaken on a 6 monthly basis – full audit to be started 18/08/08 Steps taken to identify and address odour problem through a review of continence management Nutritional assessments reviewed Medication training completed for staff – formal competency assessments to be carried out by clinical manager Monthly medication audits in place Privacy and dignity audit by community matron – completed July 2008 Company to do audit by dementia team 1st September Establish support from the PCT relating to community care needs, e.g. Psychiatric and tissue viability support – last PCT meeting 03/06/08 Information provided in the AQAA – “holistic assements tools available as part of our service user plans” “staff training on specific areas of health care takes place according to service user need. Senior staff work closely with other health professionals to ensure referrals and assessments are made accurately.” “Robust medication policies and procedures in place” “individual drug storage for service users” “new audits in place and undertaken regular by clinical manager” “work closely with our care specialist team to constantly improve” “policies and procedures in place” – (to address privacy and dignity) “choice given to residents to use communal lounge or own room for privacy” We looked in detail at the care of two people staying at the home for intermediate care and two people who were living at the home permanently. In addition, we recorded in-depth observations of care and staff interaction with a small group of people in one of the lounges. Some of the staff treated people with respect when assisting them with their personal care needs speaking to them throughout explaining what was Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 13 happening and checking on their wellbeing. One staff member was seen to spend a lot of time with one person encouraging her to have a drink, they were patient and spoke gently to her offering her a choice of drinks and explaining to her why she should have a mid morning drink. One staff member however was observed to openly check a person’s catheter while the person was seated in the lounge and to discuss this with the person concerned in front of numerous other people in the room. This did not promote this individual’s dignity or their right to privacy. One staff member also spoke to one individual whilst leaning over them in their chair, some people might find this approach frightening although the person concerned did not seem to experience distress during this incident. Some conversation was had between staff and people when it was time to move to the dining room for lunch. This period seemed to be quite disorganised and people’s anxieties were seen to increase. One person was transferred from her chair to a wheelchair and taken out of the lounge without the staff concerned speaking to her at all. Most of the interaction between staff and people living in the home was task orientated. We saw that the intermediate care records have enough information about care needs and the rehabilitation needs of the individual. The home staff complete daily notes about care and visiting members of the intermediate care team record progress against the plans for rehabilitation. One person at the home following a fall said that the care was ‘pretty good’ and that they ‘couldn’t fault’ the day staff. However, this person did comment on how disturbing they found the regular checks carried out by night staff. These checks are carried out 2 hourly and involve the door being opened ‘noisily’ and the main lights being switched on. The result is that their sleep is continually disturbed. This person also said that the night staff came in at 05:00 with a clean towel and asking them to get up and have a wash. This individual refused to do so but this raises concerns if this is regular practice by the night staff and someone is not able to make the choice about getting up at such and early hour or not. The manager was asked to include a review of this and the practice of night time checks in the review of the service provided at the home. The care plans of those people who live at the home were task based not person centred. Individual strengths were not identified and information was vague and unclear. For example, ‘assist as necessary’ and ‘provide correct equipment for the purpose of maintaining hygiene needs’. This does not help staff understand how to look after this person properly. Other detail such as what time a person preferred to have a bath or shower was recorded but was not being acted upon by staff. In the case of one person it was clearly noted in the care plan that they wanted a bath or shower at night time. Staff were heard telling this person ‘you are going for a shower’ at 11:00. There was no choice offered. Evaluation of this care indicated that personal care was being regularly refused with no apparent understanding of why this might be or what could be done about it. A food diary was in use for this person and we saw that there was no supper recorded for the last 6 days and some other mealtimes had no record of food being offered. A nutritional risk assessment Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 14 indicated a ‘medium risk’. Evaluation noted ‘eating and drinking well’ which conflicts with other evidence seen. Care plans are evaluated on a daily basis but there is no overall daily record. The lack of specific person centred information in care plans makes evaluation difficult. Daily evaluation records were not informative and it was not possible to get an indication of an individual’s health and well-being from the records as they currently stand. Records of another person showed some good personal information about care needs. This person was unable to communicate verbally. The care plan on communication included good detail for staff on how this person communicates by means of facial expressions and gestures. The manual handling risk assessment was good and included information about the number of staff and the specific equipment needed. Comments from surveys: • Sometimes kept waiting for someone to change dressings • Most of the time I am happy with the care I receive • If I need a doctor they would get it for me • Depends who is working (if staff listen and respond to requests) The provider, the manager and the clinical nurse manager have re-assessed the dependency levels of all the people living at the home and are aware of the shortfalls in recording and work practices. They have plans in place to address these and are committed to doing so. There are new and detailed medication procedures available to staff and recent training has been provided. The clinical nurse manager is trying to access more suitable in-depth training for the nursing staff. There are now medication audits being completed and the manager is trying to complete these every two months. The medication room is due to be refurbished and this will include the fitting of more suitable storage in this area. Observed practices on the day of the visit were satisfactory. Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience adequate quality outcomes in this area. People are supported in maintaining contact with their family and friends. There is a lack of stimulation and occupation for people living at the home. This means that people could be bored. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information in the Home’s action plan – • Re-establish monthly communication with all residents/relatives at care plan review, documenting and acting on identified needs and requests, made by named relatives. • Establish quarterly relatives meetings to positively discuss any system changes or quality assurance process reviews • Regular meetings with residents to be introduced to discuss all areas of the home Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 16 Information provided in the AQAA – • social activities of choice are outlined in the service user plans • residents are involved in menu planning • no pre ordering of meals • chef is on catercraft course at present • cultural menu offered • resident meetings • community particiation is activly encouraged • staff activley take part in fund raising and trips out for residents. • open visiting times • independence is encouraged Some people felt they had choice about getting up and going to bed and how they chose to spend their time. Observations of staff interaction with people indicated a tendency to carry out tasks rather than work with people in a person centred way. There was little discussion or chat with people other than in relation to care. There is an activities organiser for a few hours a week and the range of activities and the opportunities for occupation are limited. The manager acknowledges this is another area that needs to be addressed so that people are occupied and stimulated. Some of the things people said in surveys: • There is activities but I never do take part in anything • Always asked if I would like to take part in anything and I join in when I want to • I don’t know about any activities • Occasionally activities I take part in • Please have the bubbly friendly staff help those who are able to get some fresh air – a little encouragement will pay dividends and should aid conversation between staff and residents. People sitting in the main lounge during the morning were not provided with any activities. The small amount of stimulation came from one staff member who engaged some of the people in conversation on several occasions. There were no objects for people to interact with and although the television was turned on the volume was turned so low that people could not hear it and therefore lost any interest in it. At one point during the observation one member of staff was working on mending the lounge door. Several people were evidently interested in this activity but this individual did not engage Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 17 them in any conversation. A number of people slept throughout the observation time in the lounge (from 10:55 a.m. to 12:45 p.m.) some seemingly falling asleep when they had no one to interact with or activity to get involved in. Observation continued in the top floor dining room (12:24 p.m. to 12:55 p.m.) identified that the same people became more animated here as they had more staff available to talk with as well as some of the other people who live at the home. The lunchtime meal was served in the two dining areas and some people chose to have lunch in their rooms. As part of the outcome of a complaint concerning intermediate care clients not being able to socialise at mealtimes, a small dining room has been created on the intermediate care floor so people are no longer eating in isolation in their rooms. We observed the lunchtime meal in the large lounge/dining room on the top floor. Out of the 16 people in this area 13 remained in wheelchairs to eat their meal and as a result were not positioned properly to easily feed themselves. There was a choice of food – with soup and either sandwiches or a jacket potato and a sweet. Alternatives were given to people who did not want either of these choices. The main meal of the day is served in the evening. Some • • • of the things people said about the food: Do you like the meals – Well I eat them! Would like more mash Always adequate, often brilliant Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. There is a complaints procedure and people can be assured that any concerns will be taken seriously. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the Home’s action plan: • Complaints files to be reviewed • Complaints policy (A3) to be placed in reception • ‘How are we doing’ leaflet to have CSCI address on back, and be made available. • All complaints to be reviewed each month and fed back at head of department meetings devising a plan of action to improve service delivery • All staff to be assessed to ensure they understand PoVA principles. Assessment to be documented as part of a supervision process • Residents Amenity Fund to be reviewed to ensure all monies accounted for • No adult protection issues at the moment – all staff have been trained however more dates booked for July and August Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 19 Information provided in the AQAA – • complaints and feedback is now actively welcomed as a mechanism to improve our service. • feedback books are in place for everyone who uses our service for minor/major issues. • Anchor has an updated policy in place for complaints • Safeguarding policy in place • Safeguarding training in place for all staff through Anchor and Leeds PCT Since the last inspection we have received a number of concerns and complaints about the home. All have broadly related to similar issues and have included the odour in the home, staff attitudes and care issues. The provider has responded appropriately to the complaints according to their own complaints procedures and we received copies of their responses. The number of complaints received resulted in the development of an action plan by the provider to address the shortfalls at the home to do with both the service and the facilities. There have been management changes at the home since June 2008 meaning that there is now a new home manager who is supported by a clinical nurse manager. There is a clear commitment to improving the quality of the service provided to people. Records of the complaints received over the last five months show a clear reduction in the number received to just one during August. Some of the thing speople said in surveys: • I can speak to the manager if and when I am not happy • Never any upper staff available to help, I have never seen one of them The Anchor Trust has provided adult safeguarding training to most staff. Some bank staff have yet to receive this training. Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience adequate quality outcomes in this area. Ongoing refurbishment and redecoration will make sure that people continue to live in a safe, comfortable and well maintained environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA – • All bedrooms have ensuite facilities • Fresh flowers are displayed in the reception area each day • Residents can bring their own furniture and accessories to personalise their rooms Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 21 • • • • What • • • • What • • • • What • • • • • Homes maintenance programme in place to ensure continuous improvement supported by Anchors surveyors team Handwashing posters in bathrooms Alcohol gel used Infection control policy in use the Home feel they could do better – infection control training a new decoration programme new signage provide better soft furnishings i.e curtains the Home feels has improvednew communal carpets bedroom decoration programme elimated urine odur developed a 3rd floor room into a lounge/dinning room the home has planned for the next 12months – infection control training ongoing refurbishment programme new door system to ensure safety at all times decoration of 8 bedrooms infection control audits We completed a partial tour of the building visiting many of the areas used by the people who live there. There has been a significant problem with unpleasant odours in the home over the last twelve months. There has been some refurbishment and replacement of carpets which has gone some significant way in addressing this problem. The manager is also reviewing cleaning practices together with the products in use as another part of getting rid of this problem. On the day of the visit the home was largely odour free apart from one specific problem area. The manager has tried to resolve this problem and we discussed other ways of tackling this issue. Comments from surveys: • it is generally clean The home is in need of redecoration and refurbishment with many areas looking shabby with worn furniture and badly damaged paintwork. There is an ongoing programme in place to improve the environment and facilities and the manager was able to show us two rooms which have been refurbished to a good standard. In addition, corridor carpets have been replaced in some areas of the home. Work was completed on the kitchen in November 2007 Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 22 and radiators were replaced in May 2008. The home employs a maintenance man who was doing minor repairs at the home on the day of the visit. Infection control practices were satisfactory and infection control training is to be provided to staff. Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience adequate quality outcomes in this area. There are enough staff to look after the people living at the home although a lack of staff stability and consistency could mean that some care needs are overlooked. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information from the Home’s action plan: • Recruitment ongoing in areas of nurses, carers and housekeeping – agency use to make up numbers in the meantime • Refresher training planned for communication and key worker system • All staff have had adult protection and rights and responsibility training in June. • Training needs to be looked at along with the monitoring of staff competency • All staff have documented supervisions to enable staff to reflect back on their performance • Staffing levels to be reviewed Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 24 • • • Whilst recruitment is ongoing, staffing numbers to be brought up to correctly identified level with agency staff, ensuring that the agency staff are inducted formally with evidence recorded, and supplying agency provides staff familiar to the home Recruitment advertising to be arranged for vacancies Staff files to be audited and missing items/information collected Information provided in the AQAA – • robust recruitment procedures in place supported by recruitment team • a variety of training programmes offered to all staff • probationary periods for all staff • induction training for all staff • NVQs offered to staff free of charge • regular staff meetings held • staff supervision and PDPs in place Staff recruitment is a major problem at the home, which the provider is working to address. Getting the right staff employed at the home is crucial so that the provider can fully and effectively implement their action plan to improve the service and quality of life for people living at the home. A recruitment fair was to be held at the home the day after this visit and the home is working closely with the job centre in an attempt to recruit suitable care staff and nurses. In the meantime there is significant use of agency staff to keep the numbers of staff at the right level. Another initiative is the appointment of care team leaders who would provide support for the nurses by giving supervision and guidance for the carers in their day-to-day work. These posts are being advertised. Although the staffing numbers are maintained at good levels the use of agency staff means that staff do not necessarily really know the people who live at the home. Agency use includes nurses as well as carers and this can lead to problems with the supervision of the care staff. This results in people feeling that there aren’t enough staff and there is a lack of stability and consistency for people. Comments from surveys: • The staff always seem to be short handed here The area manager and the manager said that they were considering ‘block booking’ agency staff for a period of time whilst permanent staff are recruited. This would mean that the same staff would be supplied to the home by the Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 25 agency providing consistency for the people living at the home. This would also mean that agency staff would be able to get to know people and be better able to look after them in the way they want. We looked at the recruitment records of two recently employed staff and found that all the required checks are completed before people start working at the home. The manager told us that there are now separate supervision and training files for staff. Supervision sessions are being used to help to identify individual training needs. Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use the service experience adequate quality outcomes in this area. The management of the home is well organised and is committed to making sure that practices promote and safeguard the health, safety and well being of people living at the home. This will improve the quality of life for people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the Home’s action plan – Day to Day Operations: Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 27 Nursing Development • Arrange a programme of monthly sessions for nurses on the current nursing agenda Clinical Communication • Handover process to be reviewed to ensure clear communication of prioritised care needs to all nursing and care staff • Team Leaders to have responsibility to ensure all care plans comply with reviews and that all outcomes are actioned • Regular staff meetings to continue with a planned agenda and ensure adequate cover on floor for the following groups: o Head of department weekly initially o Nurses - monthly o Care Staff – monthly o All staff- 2 monthly (New manager) to do a care shift to observe practice first hand • • Staff notice board in the staff room to be kept up to date with relevant information and copies of meeting notes. Notices displayed around the home to be reviewed and their appropriateness decided. Alternative communication processes to be discussed, to prevent the Home environment looking institutionalised and prevent compromise of the residents’ dignity and confidentiality. Staff Supervision sessions to be pro-actively planned via Heads of departments on a cascade model. Administrator development programme to be devised and all training and supervision to be documented • • Local Policy (health and safety) • Review and update the local Home Emergency Arrangements book • Ensure all documentation relating to safe working practices inc. risk assessments, audits and maintenance are complete and available for inspection in line with legislation. Information provided in the AQAA – • Acting buisness manager Karen Wilson has many years expeirence in management, RMA ongoing and BTEC national diploma. • clinical manager Miriam Nkosua is RGN. • ongoing training programmes for both managers and monthly managers meetings. • Home buisness plan outlines the development of the service and plans for future • anchors self assesment manual in place • finacial and occupancy information produced regular from smart • the home has regular support form the area manager and Anchor’s support services care specialists, catering, H.R , H S and dementia • new management structure Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 28 • • • a business manager and clinical manager working well together business manager to complete RMA and commence degree in dementia studies clinical manager to have to commence an ongoing training plan to suit her role and ensure she is competant in all areas The new manager has only been at the home for 2 months and originally came as part of a secondment opportunity. This is now a permanent post and she will be making application to be registered as manager of the home. She is an experienced committed and enthusiastic manager who is working to provide clear leadership and direction to staff. She is working closely with senior staff from Anchor in identifying the priorities to improve service and facilities at home and the quality of life for people living at the home. The manager is not a nurse and a senior nurse at the home has been appointed as clinical manager to provide clinical leadership and support to the nursing staff. The manager has yet to meet with relatives but a meeting is arranged for 10th September 2008. She meets regularly with the different staff groups and notes are kept of the discussions. The manager was unsure about previous arrangements at the home for surveying people about the service but told us about her commitment to satisfaction surveys being distributed every 6 months to help her monitor the services and facilities at the home. The manager and regional manager are aware of the shortfalls at the home and the action plan produced in April has identified priorities. The full implementation of the action plan together with effective monitoring systems will improve the quality of life for the people living at the home. Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X 2 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 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 30 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 OP8 Regulation 13(4) Requirement Nutritional risk assessments must be reviewed. This is to make sure that they are accurately calculated and that those at risk are clearly identified. Where risk has been identified there must be clear plans of the action to be taken to address the risk and the plans must be fully implemented and evaluated. This is so that people at nutritional risk do not have their needs overlooked. Supervision of staff practices must be reviewed to make sure that staff respect the dignity and right to privacy of people living at the home. Clinical procedures such as the checking of catheter bags must be carried out in private. This is so that people feel their privacy and dignity is respected. Timescale for action 04/01/09 2 OP10 12 04/01/09 Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 31 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 Care plans should be developed in a person centred way so that people can be confident that they will be looked after properly in the way they want. Care plans should include accurate information about a person’s health and well being. The current system of night time checks should be reviewed to make sure that people’s expectation of a good nights sleep is respected. The level of activities provided on a day to day basis, should be improved. They do not always meet people’s needs, which means that some people are left with little stimulation. The ongoing refurbishment of the home should continue to make sure that people live in comfortable and well maintained surroundings. Recruitment should continue to establish a permanent staff team and reduce the amount of agency staff at the home. This will provide stability and consistency for the people living at the home. Staff training must continue to make sure that they have the knowledge and understanding of how to look after people properly. 2 3 OP10 OP12 4 5 OP19 OP27 6 OP30 Halcyon Court Nursing Home DS0000055003.V369484.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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