CARE HOMES FOR OLDER PEOPLE
Hall Nursing Home, The 100 Old Station Road Bromsgrove Worcestershire B60 2AS Lead Inspector
Sandra J Bromige Unannounced Inspection 12:30 22 September 2006
nd 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 Hall Nursing Home, The DS0000004112.V300656.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. Hall Nursing Home, The DS0000004112.V300656.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Hall Nursing Home, The Address 100 Old Station Road Bromsgrove Worcestershire B60 2AS 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) 01527 831375 01527 873746 Worcestershire Care Group Limited Margaret Anne Green Care Home 43 Category(ies) of Dementia - over 65 years of age (12), Learning registration, with number disability (1), Old age, not falling within any of places other category (43), Physical disability (6), Physical disability over 65 years of age (43), Terminally ill (6) Hall Nursing Home, The DS0000004112.V300656.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. An age limit of 55 - 65 years applies to people with needs in category PD. 8 beds are for the rehabilitation of people over 50 years of age. An age limit of 52 - 65 years applies to the person in category LD. The home may also accommodate 2 people under 65 years with a learning disability and a physical disability. 1 bed for the rehabilitation of people over 40 years of age Date of last inspection 10th February 2006 Brief Description of the Service: The Hall Nursing Home is a well-established care home with nursing situated in a quiet residential area close to the centre of Bromsgrove. It is set in attractive, well maintained gardens with paved seating areas which are accessible to residents and their visitors. Accommodation is provided over two floors. A passenger lift provides access to the first floor. In addition to providing long term and permanent accommodation, the home has a selfcontained rehabilitation unit. As part of the registration the home can accommodate six people with a terminal illness. The terminal illness category no longer exists for any care home with nursing and will be removed from the registration as it is recognised that end of life care may be required by all residents at some stage who are living in the home. The home is owned by Worcestershire Care Group Limited, which also owns another establishment, The Meadows Nursing Home in Lydiate Ash. Hall Nursing Home, The DS0000004112.V300656.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over 3 days by 1 Inspector and lasted for the duration of 17.5 hrs. The purpose of this inspection was to assess the outcomes for residents against the key National Minimum Standards. Information to inform the inspection has been sought from many sources. The Commission gathers information from the date of the last inspection to inform the next inspection. This information comes from notifications that the home sends into the Commission, any concerns, complaints or allegations, written feedback from residents, relatives and visiting General Practitioner’s and a visit to the home which includes case tracking a number of residents care. No complaints have been received by the Commission about this service since the last inspection. No safeguarding adult issues have arisen about this service. What the service does well:
The home provides information about the service offered to prospective residents in the format of a Statement of Purpose & Service User guide. All residents are assessed prior to admission by one of the trained staff in the home. The assessment is carried out at the resident’s current place of residence, it is thorough and informative and enables the home to make an informed decision as to whether they have the skills & facilities to meet the resident’s care needs. The home offers care for people in need of rehabilitation in a separate dedicated unit for this purpose. There is a good care planning system in use. This system in the main provides staff with the information they need to enable them to meet the needs of the people living in the home. The Registered Nurses seek advice and guidance from healthcare professionals within the community when the need is identified. The home has a good system in use for the ordering, receipt, administration & disposal of medication. Residents are respected by staff and their privacy & dignity is respected. Residents are well dressed and their clothes are nicely laundered. Staff were seen to address residents in a caring and friendly manner. Written feedback from relatives state that ‘all the staff are very kind, caring and have been very supportive. ‘ I cannot praise them enough and am very grateful to them all’. ‘My ***** and I have nothing but praise for all of the staff. We can’t thank
Hall Nursing Home, The DS0000004112.V300656.R01.S.doc Version 5.2 Page 6 them enough for their care and attention and their management of **** complex and challenging needs’. Residents are offered a choice of a well balanced & varied diet. They are able to eat in one of the dining rooms or in the privacy of their bedroom. An Activity Co-ordinator is employed by the home on a part time basis to provide a programme of recreational therapy for the residents. One relative commented that ‘entertainment put on is excellent’. Visitors are made welcome in the home and are able to visit at any time. Meetings are held four times a year for residents & relatives to attend so that the home can consult them and keep them informed of progress & changes. The home has a complaints procedure that is available at the entrance to the home and residents and relatives are encouraged to raise any concerns that may arise. The home is situated in a quiet residential area of Bromsgrove set in attractive, well maintained gardens with paved seating areas which are accessible to residents and their visitors. The Hall has a homely and comfortable environment. The home has been converted and extended to care for residents with physical disabilities and provides a range of aids & adaptations for this purpose. The home is clean and there are no bad smells. A relative stated that ‘the cleanliness of the home is impressive’. The home employs staff from a multi-cultural background including staff from overseas. The staff employed by the home are trained, skilled and in sufficient numbers to fill the aims of the home and meet the changing needs of the residents. The home is committed to providing staff training to ensure that residents are in safe hands at all times. Care staff receive regular supervision to assess the ongoing quality of the care that they provide to the people living in the home. The manager has worked at the home for 4 years and for 2 years as the registered manager. The home is well managed in an open and respectful manner. Systems are in place to enable the home to review the quality of the service provided. Monies held by the home are auditable and transparent with receipts for all purchases. What has improved since the last inspection?
The information recorded in the care plans has improved and referrals are being made to the relevant healthcare professionals when required. Medication is being given by the home as prescribed by the General Practitioner. Staff are recording on the Medication Administration Records each time that medication is given or a reason for it not being given. There are charts available in the residents’ rooms clearly showing the creams and ointments that have been prescribed for the resident with instructions for use. The staff applying the creams and ointments are signing these.
Hall Nursing Home, The DS0000004112.V300656.R01.S.doc Version 5.2 Page 7 The residents are offered a choice of meals each day. Condiments and sauces are available to residents at mealtimes. Glasses are being used on the table instead of plastic beakers. Residents are offered a cold drink with their meal and a hot drink afterwards. A record is being held in the home of all complaints received with evidence of their investigation and outcome. An electronic coded lock has been fitted to the cellar door to prevent unauthorised access to this area. The owner has opened a bank account for a named resident. Brakes were being used on the wheelchairs prior to transferring residents to another place. What they could do better:
The homes contract must be reviewed with regard to the receipt and payment of the nursing contribution as the Care Home Regulations have changed and more specific information must now be given to each resident. Care plans need further development to ensure that they are all being reviewed regularly and reflect the current care needs of the resident. Written consent must be obtained from the resident or their next of kin prior to the use of any form of restraint such as bedrails. All prescribed food supplements must be recorded as being administered. On the residents Medication Administration Records the allergy boxes must always be completed, any handwritten entries must be signed and checked and signed by a trained nurse. Prescribed creams and ointments must be locked away at all times when not in use. The temperature of the room where the medicines are being stored must be checked and recorded each day. Staff should obtain a new copy of a medicine reference book and ensure that insulin pens are labelled with the resident’s name. The manager must review the adequacy of the privacy curtains in the shared rooms to ensure that neither resident’s privacy is compromised at any time. The home must review the colour scheme and signage throughout the home to ensure that the people living there can find their way around the home. Residents’ clothes must not be hand washed in the same sink that is used by staff to wash their hands. Foul laundry must not be sluiced by hand. The home must ensure that the procedures they use for the recruitment of staff are thorough and robust and that they obtain all of the information required by the regulations. Checks must be made with the Nursing &
Hall Nursing Home, The DS0000004112.V300656.R01.S.doc Version 5.2 Page 8 Midwifery Council to ensure that staff have a current Personal Identification Number and that there is evidence of these checks on the staff record. Staff rotas should state the surname of the staff member for identification purposes. The money belonging to the named resident must be transferred into their named account. All chemicals used in the home must be locked away when not in use. Bedrails must be checked each month to ensure that they are still safe to use and do not require any adjustment. These checks must be recorded. The current practice for carrying laundry up and down stairs must be reviewed taking into account the risk assessment that is in place and the recorded control measures. The health & safety poster in the staff room must be completed to display the relevant information for staff. 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. Hall Nursing Home, The DS0000004112.V300656.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hall Nursing Home, The DS0000004112.V300656.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives have the information needed to choose a home which will meet their needs. They have their needs assessed prior to admission to ensure that the home is able to provide the appropriate care and services for each resident. Residents admitted for rehabilitation are well supported by staff, which enables them to regain confidence and maintain independent living skills and prepare to return to their own home EVIDENCE: The home has a Statement of Purpose. Pre-inspection information provided by the home states that the Statement of Purpose has not been revised since the last inspection. The rehabilitation unit has a ‘residents handbook’ on display. The handbook needs reviewing as the section for complaints refers to the National Care Standards Commission. Discussion with relatives of a resident confirmed that they had looked around a number of homes and chose this one. They received a copy of the homes Service User guide. Hall Nursing Home, The DS0000004112.V300656.R01.S.doc Version 5.2 Page 11 All residents’ case tracked had a contract giving clear information relating to fees and terms & conditions of residence. The homes contract needs to be reviewed due to the changes made to the Care Home Regulations which came into force on the 1st September 2006. Further information now has to be supplied to residents regarding the nursing contribution. All residents’ case tracked had been assessed prior to admission. The home has a rehabilitation unit, with dedicated space and facilities separate from the rest of the home for this purpose. This unit provides short term care & treatment to enable the residents to return home. Hall Nursing Home, The DS0000004112.V300656.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a care planning system in place that in the main provides staff with the information they need to enable them to meet the needs of the people living in the home. The health needs of residents are well met with evidence of good multi-disciplinary working taking place on a regular basis. The medication at this home is well managed promoting good health. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Care plans were in place for all three residents’ case tracked. These had been generated from the pre- admission assessment. The format for the care plans enables the home to clearly document the problems, goals, action plan & evaluation of the progress of the action plan. Residents are allocated a trained nurse, team leader and key worker who are responsible for ensuring that their care needs are identified, recorded accurately and provided by the home. Overall the care plans were very informative and generally complete. They are being reviewed each month and planned health care reviews are taking place every 6 months in consultation with the resident, their representative, and key staff from the home. One care plan seen was not so well completed. Two of
Hall Nursing Home, The DS0000004112.V300656.R01.S.doc Version 5.2 Page 13 the care plans had not been reviewed since 07/08/06 and a care plan dated 10/08/06 relating to the ‘risk of malnutrition’ had not been completed properly to give clear instructions to the staff. Risk assessments are in use for skin assessment, continence, nutrition, falls, pain, moving and handling & the use of bedrails. These risk assessments are generally being reviewed each month and action is being taken by the home where the assessed needs require it, including referral to other healthcare professionals. Two residents were using bedrails. One of the bedrail risk assessment had not been dated or signed by the assessor and there was no evidence of review. A second bedrails risk assessment had also not been signed by the assessor and had not been reviewed since 07/08/06. There was no evidence of any signed consent to the use of bedrails for either resident. One resident’s daily records contain evidence that they are falling frequently and these falls were being recorded on an accident form on each occasion. There was no falls log with the falls risk assessment, the Director of the Company said that this is because they are logged as part of the accident forms and audited each month as part of the homes health & safety audit. The pain assessment chart for one resident had not been completed since 24/05/06, although the care plan states ‘Assess ******* pain using the WCG pain assessment chart’. Good outcomes of care were seen for residents who are up and about the home to a resident who is very frail and being nursed in bed. Residents seen were clean & tidy, appropriately dressed, and their clothes were clean and nicely laundered. A resident being nursed in bed was clean and appeared very comfortable. Equipment was in use for the prevention of skin damage and there was written evidence to show that their position was being changed every 2-3 hours. They were receiving & recording the amount of fluids taken and the use of additional fluids being given to the resident through a drip under the skin. A syringe driver was in use giving prescribed medication for the comfort of the resident. This and the giving of fluids under the skin was being monitored by the District Nurses. There was also evidence of mouth care being given. Instructions were also available for care staff regarding the creams prescribed for the skin and directions for use for this resident. This is all good practice. Written information from 4 residents states that ‘always’ receive the care and support they need and 3 residents stated that they ‘usually’ receive the care and support they need. Written comments from relatives were all very positive and include ‘the care she receives is excellent’, the nursing and care afforded my mother is of the highest standard’, ‘we are very pleased with **** care at The Hall’. Written feedback from 3 General Practitioner’s who visit the home was positive. Medication is generally well managed. On the first day of the inspection the Primary Care Trust Pharmacist was in the home reviewing all medication for
Hall Nursing Home, The DS0000004112.V300656.R01.S.doc Version 5.2 Page 14 residents and giving general advice. This visit had been requested by the home. This is good practice. The home uses a Monitored Dosage System for the administration of medicines. Medication Administration Records seen showed that the medication was being given as prescribed. The allergy boxes had not been completed on the front of the Medication Administration Records for 2 residents. Paracetamol was being given for pain when needed for one resident, although there was not a care plan in place for this. This was discussed with the nurse on the unit. A list of staff signatures are held with the Medication Administration Records, and the homes ‘homely remedies’ policy had been signed by the General Practitioner’s from all 4 surgeries in July 2006. The homes medication reference book needs updating as the one available was dated 2004. The Patient Information Leaflets were not available, as they had been borrowed by one of the Adaptation Nurses. Systems are in place for the ordering, administration and disposal of medication. The homes management of controlled medicines is good. Medicines are being stored in a separate drug fridge and the temperature is being recorded each day. Creams and eye preparations are being dated when opened. An insulin pen was in use, although this is the only insulin pen in use, guidance was given to label the insulin pen with the resident’s name to assist with safe practice. The temperature of the room where the external medicines are being stored is not being recorded. Cream and ointments are being stored in residents’ rooms. They are very neatly stored all together in baskets provided by the home, but they are not secure. This was discussed with the Pharmacy Inspector following the visit. Prescription Only Medicines (POM), including ointments and creams that are POM must be securely stored at all times. Written feedback from 3 General Practitioner’s state that the residents’ medication is appropriately managed in the home. The privacy & dignity of residents was seen to be observed. Staff knocked on doors before entering and closed doors when assisting with personal care. The privacy curtains in a shared room need altering to ensure that the residents bed nearest the door is totally enclosed by the curtain, so that the resident nearest the window can leave the room without compromising the other residents privacy & dignity. Written feedback from 12 relatives and 3 General Practitioners all confirmed that they are able to visit the resident in private. Hall Nursing Home, The DS0000004112.V300656.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 at least once during a 12 month period. 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. Residents are able to choose their social activity and keep in contact with family and friends. Social & recreational activities meet resident’s expectations. Residents receive a healthy, varied diet according to their assessed requirement and choice. EVIDENCE: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care records seen during this visit contained social history of residents and written evidence of social care being provided. The home employs an Activity Co-ordinator who works 14 hours each week. When a new resident is admitted their care plan is used for reference regarding the social history and the resident is spoken too about their interests. An activity form is completed for each resident. Group activities may include singing, exercising, word games, poetry & flower arranging and 1 to 1 contact may involve just spending time talking to the resident, providing books and specialist music at the residents request. The notice board at the entrance to the home contains a list of activities for September 2006. The activities listed include 2 sessions of active minds, a singer, a barn dance outside the home (the pictures on
Hall Nursing Home, The DS0000004112.V300656.R01.S.doc Version 5.2 Page 16 display looked as if all who went enjoyed themselves), a visit to Evesham Country park, hairdressing every Tuesday, a church service and various birthday celebrations. Written feedback from 7 residents indicates that 5 are of the opinion that there are ‘sometimes’ activities in the home they can take part in and 2 said ‘always’. One resident also noted that they had visited the Birmingham Art Gallery & Museum. Written feedback from relatives state the ‘entertainment put on is excellent’, ‘ a birthday party is held for everyone with a birthday in the month and food is provided for family/then they get their own special day on their birthday’. The visitors book at the entrance to the home indicates that the home receive quite a lot of visitors at various times of the day. Written feedback from relatives confirm that they are able to see the resident in private and the staff welcome them into the home at any time. Visitors were observed in the home and arriving at the home to see a resident. Staff were very welcoming providing seating for the visitors and offering them a drink. Residents were seen spending time in one of the dayrooms in the home or in the privacy of their bedroom. One resident told the Inspector that they choose to stay in their room most of the time and showed the Inspector the poetry that had been written whilst in the home. The manager has 4 meetings a year for residents and relatives to attend and any agreed action plans from the meetings are put into place. The pre-inspection information provided by the manager indicates that 1 resident currently maintains their pension/benefit book. The home does not know if any residents handle their own finances. Information in residents’ records shows that the residents likes & dislikes for food was discussed upon admission and recorded. This is done for all residents and a follow up discussion with the resident after a period of time takes place with the catering manager. Sherry is offered to all residents before lunch to stimulate their appetite. The menus are put together by the homes Hotel Services manager and residents views are taken into account when compiling menus. Discussion with residents and menus seen show that residents are able to have a cooked breakfast of their choice each day, they have a choice of 2 main courses each day and soup, sandwiches and salad are also available every day. The care staff ask the residents the day before for their meal choice, these forms also show that other meal request other than the stated choices are being catered for by the home. Homemade soup is made each day, and desserts such as mousses etc are freshly made and are not made from convenience products. Fresh vegetables are provided each day. Lunch was seen on one day of the visit. The tables in the dining room were laid nicely with cloths, paper napkins, condiments & a glass for a cold drink. Meals are portioned individually from the hot trolley by the staff in the dining room. The trained and care staff were observed to be assisting residents to eat on a 1:1 basis in the dining room. This was being done very discreetly by sitting by the resident and making it a social occasion. Lunch on this day was Cumberland sausage or vegetable burger & onion gravy with carrots, spinach & potatoes, followed by a dessert of apricot sponge & custard or bananas &
Hall Nursing Home, The DS0000004112.V300656.R01.S.doc Version 5.2 Page 17 custard. Written feedback from residents stated that they ‘always’ or ‘usually’ liked the food provided. Residents spoken with confirmed that they had a choice of food including a cooked breakfast. One resident told the Inspector that they were on a strict diet provided by the dietician, which the home is following. A hot drink was provided after the meal. Hall Nursing Home, The DS0000004112.V300656.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have access to a robust, effective complaints procedure, but are not being fully protected from any potential abuse. EVIDENCE: The home has a complaints procedure that is clear and accessible as a ‘complaints leaflet’ which is on display for people to pick up and complete at the entrance to the home. The homes complaints records show that they have received 3 complaints since the last inspection. The records show evidence of the nature of the complaint and evidence of investigation and outcome of the complaint. The day prior to the inspection the home had received a complaint about money being stolen from a resident. The home had taken appropriate action regarding notifying the Police, although the home had not referred the issue into the multi-agencies for safeguarding adults. Advice was given to do this as a matter of urgency. This was done the same day. No complaints have been received by the Commission about this service. Written feedback from residents indicates that they know how to make a complaint, one resident who stated they knew how to complain stated ‘if needed, haven’t needed to’. Written feedback from 3 General Practitioners reported that they had not received any complaints about the home. It was evident from one care record seen through case tracking that the staff in the home recognise complaints and offer and encourage residents to formalise any verbal complaints if they so wish for investigation by the home. Staff spoken with were aware of the homes complaint procedures.
Hall Nursing Home, The DS0000004112.V300656.R01.S.doc Version 5.2 Page 19 When the Inspector arrived at the home on the first day, a trained nurse invited her into the home who had not met the Inspector before. No identification was asked for by the home. The home has a policy for safeguarding adults. Staff records show that a care assistant had been employed by the home prior to receipt of a Criminal Records Bureau check. (Please refer to staffing section) The training manager confirmed that all staff are given a booklet that has been produced by Worcestershire Council with contact details for reporting abuse. There is evidence of safeguarding adults training upon induction and at annual intervals for all grades of staff. All staff spoken with were clear of the action they would take to safeguard the residents in the home. Hall Nursing Home, The DS0000004112.V300656.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally well maintained and provides a clean, comfortable & homely environment for the people living there. The colour scheme of the home needs reviewing as currently due to the many corridors and level changes it is disorientating for residents who are confused or may have a sight impairment, which does not encourage independence. A good range of equipment is provided throughout the home for people with physical disabilities. Systems in place for the management of foul laundry do not currently fully protect the health & safety of the staff in the home. EVIDENCE: Parts of the premises were seen during this visit including public lounge/dining areas, toilets, bathrooms, sluice rooms, bedrooms, and kitchen and laundry areas. The home is clean and generally well maintained. Written feedback from 7 residents state that the home is ‘always’ or ‘usually’ fresh and clean. Written feedback from a relative stated that ‘the cleanliness of the house is very impressive’.
Hall Nursing Home, The DS0000004112.V300656.R01.S.doc Version 5.2 Page 21 The pre-inspection information provided by the manager states that 9 bedrooms, a lounge and dining room have been redecorated since the last inspection. A new washing up area has been built to a high standard and it will be in use once the appliances have been installed. A new conservatory has been built and is in use. The freezers have been moved out of the corridor into the kitchen. The home received a visit from the Environmental Health Officer in April 2006 in response to an outbreak notification and 7 requirements & 2 recommendations were made. The pre-inspection information completed by the manager states that these have been implemented. The Commission were not notified of this outbreak of infection. The pre-inspection information states that the Fire Officer last visited the home in September 2005 and the requirements have been met and are ongoing. Day space is provided in a variety of lounge and dining areas throughout the home. These areas are all well furnished. There are rooms with a television and some without or with a system for listening to music or the radio. The home has been extended and has many similar looking corridors with level changes that could be confusing particularly for people with dementia or have impaired sight. One resident told the Inspector ‘I get lost walking around as everywhere looks the same’. Throughout the home there is a good range of equipment for people with physical disabilities such as overhead hoist tracks in public, bedrooms and toilet/bathrooms, varying height chairs, height adjustable beds, portable hoists and other equipment for moving and handling and a range of pressure relieving cushions and mattresses. Grab and hand rails are situated in bathrooms and in the corridors of the home. A call system is provided throughout the home which was accessible to the residents. A mechanical and manual sluice area was seen. Staff are sluicing foul linen by hand. This is poor practice as it is a risk to health & safety and an immediate requirement was made. The laundry room is situated in the basement. (Please also refer to the management section). Two commercial washing machines are supplied, although one was broken at the time of the inspection. 2 tumble dryers are provided. Systems are in place for the management of infected linen, although poor systems were in place for foul laundry. Only one sink is provided in the laundry and staff confirmed that this is used for hand washing of clothes and their hands. This is poor practice. Plenty of gloves and aprons are provided by the home for the prevention of cross infection. Hand washing facilities are available throughout the home for staff. Hall Nursing Home, The DS0000004112.V300656.R01.S.doc Version 5.2 Page 22 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. 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. Staff in the home are trained, skilled and in sufficient numbers to fill the aims of the home and meet the changing needs of the residents. The procedures for the recruitment of staff are not robust and do not offer protection for the people living in the home. The home is committed to providing staff training to ensure that residents are in safe hands at all times. EVIDENCE: Staff on duty at the time of the inspection visits to the home were 3 trained nurses & 8/9 carers in the morning and 2 trained nurses & 6/7 carers in the afternoon. 1 trained nurse & 3 care staff are on at night. The manager was on holiday when the first visit took place and her deputy was in charge of the home. They were supernumery to the staff rota. The nursing and care team are supported by an Activities Co-ordinator (part time), a Training Manager (part time), a Hotel Services Manager (full time) and a team of catering and domestic staff. Administrative staff are also working in the home as the offices are based there for the company. The staff rotas submitted with the preinspection information confirmed that these are the normal staffing levels for the home and are the same as the ones published in the homes Statement of Purpose. The staff rotas only list the majority of the staff team by their first name. This makes it difficult for people not employed at the home to identify the staff. A multi-cultural team of staff are employed by the home including staff from overseas. Written feedback from 7 residents stated that there are ‘always’ or ‘usually’ staff available when you need them. One resident
Hall Nursing Home, The DS0000004112.V300656.R01.S.doc Version 5.2 Page 23 commented that ‘sometimes there is a delay in mornings waiting to be taken downstairs’. Information provided by the manager with the pre-inspection information indicates that 15 care staff have achieved NVQ level 2 or 3 and 3 staff who are trained nurses in their own country, are working as care staff. The training manager confirmed that the company funds the cost of the NVQ training. Two staff records were seen. The first was a carer employed from overseas through an Agency. The application form had gaps in their employment history and there was no evidence to show that these had been explored by the home. There was no evidence to show that the person had been interviewed by the home and the manager confirmed that the Company had not interviewed the employee. There were 2 testimonial type references on file, neither provided any reason for leaving that employment and there was no evidence to show that they had been checked for authenticity by the home. The person had been employed by the home prior to receipt of POVAfirst & Criminal Records Bureau clearance. The second record was for a trained nurse and this confirmed that all of the relevant checks are in place pre-employment. The person Nursing & Midwifery Council Personal Identification Number (PIN) had expired and there was no evidence to show that the home had sought confirmation from the Nursing & Midwifery Council that it had been renewed. The staff records showed evidence of induction and ongoing training for these staff. Discussion with the Training Manager confirmed that the induction period for staff is approximately 2 weeks and during this period staff are supernumery to the staff rotas. The staff are assigned to a Team in the home and a mentor (a senior carer with NVQ 2 or 3). Once the induction period is completed they then proceed to study the ‘Skills for Care’ induction standards. Once completed they are offered to study for their NVQ 2. The training registered contained evidence that recent training has taken place in the home for fire, first aid, Percutaneous Endoscopic Gastrostomy (PEG) feeding & the use of supplementary feeds, food hygiene, Learning Disability Awards Framework, dementia & laundry competence. Hall Nursing Home, The DS0000004112.V300656.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect has effective quality assurance systems developed by a qualified competent manager. Systems are mostly in place to promote and safeguard the health & safety of the people living and working in the home. EVIDENCE: The manager was registered with the Commission in November 2004. She is a registered nurse with recent experience in palliative care. She has attained her NVQ 4 and since that last inspection has undertaken training updates in the following topics; computers, Learning Disability Awards Framework, palliative care, and fire legislation. She receives supervision from her line manager. She also attends monthly meetings with the Primary Care Trust where there are also speakers on various topics. A member of staff told the
Hall Nursing Home, The DS0000004112.V300656.R01.S.doc Version 5.2 Page 25 Inspector that the management of the home is ‘open and receptive’ and all staff spoken with were very happy working at the home. The home systems in place for measuring & monitoring the quality of the service. The manager and the Director of Quality for the Company hold monthly meetings with the staff team. They review each area of the service based on the National Minimum Standards and they cover all 38 National Minimum Standards in a year. Improvement plans/action plans are created according to the outcome of the review of the standard. Questionnaires were sent to the families & other healthcare professional at the beginning of the year. Two were not complimentary, but were anonymous and a letter followed up these issues to all relatives. Complaints & outcomes are reviewed and full healthcare reviews take place every 6 months. An external audit has been carried out of the home in February 2006 and the manager reported that they did very well. Meetings are held with relatives and residents 4 times a year and outcomes from the meetings are sent by letter to all relatives for information. The pre-inspection information confirms that one of the owners is appointee for a resident. These records were seen. A bank account was opened for the resident in their name in May 2006. There has been a delay in the monies being transferred from the homes business account to this account as the family were considering taking over as appointee. The records were seen for the management of these monies, including the receipt of benefits & allowances, the resident’s contract & contribution towards their fees and any deductions for expenditure are maintained with receipts. These accounts are transparent and fully auditable. During feedback at the close of the inspection visit the owner reported that she would ensure that the monies for this resident would be transferred to their named account within 2 weeks. Documentary evidence & discussion with care staff confirm that they are receiving regular supervision. A coded electronic lock has been fitted to the door to the cellar to stop any unauthorised people accessing this area. Staff records and discussion with staff confirm that staff are receiving training for fire, first aid, food hygiene and moving and handling. Staff were observed using the correct procedures and equipment for moving and handling residents. Chemicals were found in 2 sluice areas unsecured and accessible to residents, this was addressed immediately and reviewed on the second day of the inspection. The preinspection I nformation completed by the manager confirms that fire, gas, electrical, heating, and water systems in the home are being maintained and equipment is being serviced. Records show that a risk assessment for Legionella is in place and has been reviewed and systems are in place for monitoring hot & cold water temperatures. The fire alarm was tested during the inspection visit. Bedrails are being checked and the last recorded check was the 10.05.06. These must be done each month.
Hall Nursing Home, The DS0000004112.V300656.R01.S.doc Version 5.2 Page 26 The laundry is in the basement and access is via a coded lock on the door down steep steps with a handrail on one side and non-slip treading on the steps. The steps are worn at the edge due to their age. A risk assessment is in place for the transportation of laundry by hand up and down the stairs. It was evident from observation that the control measure to prevent an accident when going up and downstairs was not being used at all times. This was brought to the attention of the Hotel Services manager. There is a health & safety poster on display by the staff room; this has not been completed with the relevant details. Accidents are being recorded in an appropriate format for Data Protection purposes. Hall Nursing Home, The DS0000004112.V300656.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 3 3 X 2 X 2 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 3 X 2 Hall Nursing Home, The DS0000004112.V300656.R01.S.doc Version 5.2 Page 28 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. Standard Regulation Requirement Timescale for action 30/11/06 1 OP7 17(1)a m12(1)15 (1) 2 OP7 13 3 OP9 13 4 OP9 13 Care plans must be further developed to ensure that they record specific instructions for care staff to follow, to ensure that residents needs are met in full. Timescale of 28/04/06 partly met Written consent must be obtained prior to the use of bedrails and risk assessments must be reviewed each month. All prescribed dietary supplements must be recorded as administered. Brought forward, not met The registered person must ensure that: • ‘Allergy’ boxes are completed on the front of all Medication Administration Records. • Handwritten entries on Medication Administration Records are signed & checked by a second nurse. • Creams & ointments that are Prescription Only
DS0000004112.V300656.R01.S.doc 31/10/06 31/10/06 31/10/06 Hall Nursing Home, The Version 5.2 Page 29 5 OP10 OP24 12, 16 6 OP19 23 7 OP26 13 8 OP26 13 Medicines (POM) must be securely stored at all times. • The temperature of the room where externals medicines are store must be checked and recorded each day. The registered person must review the adequacy of the privacy curtains in the shared bedrooms. The home must review its use of colour and signage throughout the home to improve the orientation of people with dementia. Advice can be sought from the Alzheimer’s Society. Brought forward with the same timescale. Clothes must not be hand washed in the same sink that is used by staff for washing their hands. Foul laundry must not be sluiced by hand. An immediate requirement was made 31/10/06 31/03/07 31/10/06 27/09/06 9 OP29 19 10 OP35 20(1) a,b 11 OP38 13 The registered person must 31/10/06 ensure that they seek confirmation from the Nursing & Midwifery Council that trained staff have a current PIN and evidence of this must be retained in the employees records. Money belonging to any service 11/10/06 user must not be paid into a bank account unless the account is in the name of the service user that the money belongs to. The account is not used by the registered person in connection with the carrying on or management of the care home. Brought forward, partly met. All chemicals must be secure at 22/09/06 all times to prevent access by residents. An immediate
DS0000004112.V300656.R01.S.doc Version 5.2 Page 30 Hall Nursing Home, The 12 OP38 13 13 OP38 13 14 OP38 13 requirement was made. Bedrails must be checked by the home every month to ensure that they remain safe to be used. These checks must be recorded. The risk assessment for transporting washing to and from the laundry must be reviewed. The health & safety poster must be completed to provide information for staff. 31/10/06 31/10/06 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations The registered person should: • Obtain a new copy of a medicine reference book (BNF). • Label insulin pens with the resident’s name when in use. The surname of staff should be written on the staff rotas. 2 OP27 Hall Nursing Home, The DS0000004112.V300656.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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