CARE HOMES FOR OLDER PEOPLE
Hartcliffe Nursing Home Murford Avenue Hartcliffe Bristol BS13 9JS Lead Inspector
Kathy Marshalsea Key Unannounced Inspection 09:30 20 & 22nd February 2007
th 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 Hartcliffe Nursing Home DS0000031895.V330866.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. Hartcliffe Nursing Home DS0000031895.V330866.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Hartcliffe Nursing Home Address Murford Avenue Hartcliffe Bristol BS13 9JS 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) 0117 9641000 0117 9641100 home.fxg@mha.org.uk Methodist Homes for the Aged Mrs Ruth Andrews Care Home 66 Category(ies) of Old age, not falling within any other category registration, with number (66), Physical disability (10) of places Hartcliffe Nursing Home DS0000031895.V330866.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. May accommodate up to 66 persons aged 65 years and over requiring nursing care May also accommodate up to 10 persons with physical disability under the age of 65 requiring nursing care 27th March 2006 Date of last inspection Brief Description of the Service: Hartcliffe Nursing Home is owned by Methodist Homes for the Aged and provides nursing care for up to sixty-six older people and 10 persons with physical disability under the age of 65 requiring nursing care. It is located in a suburban position and can be accessed by public transport. Transport is needed to reach local shops and amenities. The home itself is purpose built and has now been in operation for 5 years. 64 bedrooms are for single occupancy and there is one double room. They are set out over two floors accessible via the passenger lift. Communal space is offered in 4 lounges and there is a spacious dining room on each floor. There is a small garden and parking spaces for visitors. Hartcliffe Nursing Home DS0000031895.V330866.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was announced and conducted over two days. Due to the size of the home a second inspector joined the lead inspector for one day so that more residents and staff were spoken with. The Manager completed a preinspection questionnaire, and survey forms sent to residents and relatives were returned to the Commission. Information from these surveys is included in the inspection report. The Manager was present for both days and was given the feedback to close the inspection. What the service does well:
The following are some positive comments made in survey forms by relatives and residents; “I believe my relative is very well looked after. I appreciate they can be difficult at times but overall I am happy with the care and attention they get.” “The staff are caring and make you feel comfortable. They work hard to balance my relative’s drugs and create a routine that suits them. The food is very good. Lots of activities for users and they always include family and friends where possible, and it’s also kept very clean.” “I would give them ten out of ten”. “A big thank you for Hartcliffe Nursing Home staff for their unfailing work and care.” “It’s a great relief to the family that our relative is so well cared for. They seem content and have settled very quickly. We also feel the family are well supported.” “My relative is always kept clean and has all their needs taken care of. I would not wish them to be anywhere else. Staff are very kind.” The inspector’s findings were: Each prospective resident has an assessment completed by the Manager, using a comprehensive pre-admission assessment tool, covering all aspects of people’s needs. This process should ensure that the home is appropriate for the prospective resident. Residents and relatives who commented on the Hartcliffe Nursing Home DS0000031895.V330866.R01.S.doc Version 5.2 Page 6 admission process stated that they had sufficient information before moving in to the home to make an informed choice about that decision. The home has good procedures in place to make sure that medication systems are safe for the residents. Procedures for the ordering receipt into the home, storage, administration and disposal of medicines are safe. Residents healthcare needs are usually fully met by the staff and referrals are made where necessary to other healthcare professionals. Residents benefit from having an activities co-ordinator working at the home. This ensures that there is a varied and ongoing programme of various social events and activities organised for them to participate in if they wish to. The activities organiser also tries to spend time with people who need to be or choose to stay in their room. Spiritual needs are also considered and there are regular events in the home for people to celebrate their religious beliefs. Complaints are taken seriously, investigated fully, and action taken where necessary to amend any areas of weakness. Survey forms confirmed that people feel able to talk to members of staff or the manager about any concerns they have. Staff have regular training in the prevention and detection of abuse. The manager had acted appropriately when an allegation was made in 2006 by a resident about a member of staff. All the appropriate agencies were informed of this incident. Residents benefit from a well maintained home, which is in good decorative order. It is kept very clean and free from offensive odours. The home employs a maintenance person who is on site to deal with any issues and also is responsible for creating various safety tests. Every effort is made to ensure that bedrooms for residents are personalised, many contain their own items. Staff receive regular updates in various topics such as mandatory training as well as topics that are relevant to the care of the client group the are looking after. This should ensure a competent and skilled workforce. There is a commendable commitment to NVQ training and 18 care staff have completed their NVQ qualification. Residents and staff benefit from a manager who is competent and able to meet the homes objectives. There is an open and inclusive management style. Regular meetings are held for various groups throughout the home including residents, relatives and staff groups. The health and welfare of the staff and residents are promoted and protected. There are an assorted amount of safety checks done very regularly, this Hartcliffe Nursing Home DS0000031895.V330866.R01.S.doc Version 5.2 Page 7 includes fire safety tests. Staff also receive regular fire safety training updates. Nutritious meals are offered with choices and individual likes / dislikes taken into account. Menus are seasonal and residents are consulted about the menus, this includes the cook seeing new residents as soon as they come into the home. The kitchen is run professionally and all safety checks are completed regularly. Staff responded promptly and calmly to an emergency situation during the inspection. What has improved since the last inspection? What they could do better:
Care plans were not person centred, holistic and some were disorganised and often too wordy. The actions recorded to meet the identified need were vague and did not include the residents remaining abilities. There is also not enough information in the review of each need, this was especially so for the behavioural problems. The care plans need to provide the staff with clear and up to date information about the care that they are to deliver. There was inappropriate use of ABC (behavioural) charts. In all but two instances these were being used for when residents refused care. This was discussed with the trained nurses and the manager who by the second day of the inspection had removed most of these charts. The care plans for wound care were confusing and it was difficult to determine if and when wounds had healed. An audit of falls is done on the computer by the Manager, if a pattern emerges then it is expected that the care plan is to be reviewed. One inspector tracked a resident who had 3 falls; there was no review of their care plan. Other accidents records were checked and staff spoken with about their actions if a resident has a fall. There is generally no overview by staff as the accident forms get filed away, so this information is not used when the care plan is reviewed. This does not show evidence that staff are trying to minimise any risk of falls for those residents who may be at risk. There were some examples seen of a lack of respect and not promoting a resident’s dignity during the course of the inspection. These included one
Hartcliffe Nursing Home DS0000031895.V330866.R01.S.doc Version 5.2 Page 8 member of staff making derogatory comments to one resident, no instructions being given by some staff before approaching a resident and delivering care, and also drinks not being given to each resident, nor those who needed assistance with drinks being given that assistance. Social time spent with those residents who have to or choose to stay in their rooms should be recorded. Key workers need to be encouraged to spend this social time with the residents in their care. An allegation of abuse recently was dealt with by a new member of staff as a complaint. This lead to a delay in the manager being informed and the appropriate actions being taken. This new member of staff will need additional training in the recognition of abuse and how to deal with that allegation. There are call bells in each lounge but these, during the inspection, were not given to a resident so that help could be summoned. There was also a poor arrangement of small tables in the lounges; this meant that some residents had nowhere to put the drinks that they were given. There had been some comments on the survey forms received about call bells not being answered promptly and about staff being very busy. This was not completely substantiated during the inspection, while there were many buzzers ringing during the inspection some of these were answered and then replaced by new call bells. The home has very recently had a system in place to monitor the ringing of call bells and how long staff take to respond to those. This will be monitored at a future inspection. The recruitment records for 2 members of staff that had been recruited from the EU were not satisfactory. The employment agency used had supplied various documents to the home. These did not meet the standards required in the care home regulations. All new staff must be subject to a satisfactory Criminal Records Bureau clearance, or POVA check in the first instance, before they commence their employment. The home also needs to explore a full employment history with the person when they start their employment. The manager had recognised that there were insufficient and poor quality supervision sessions taking place. In order to remedy this some supervision training has been arranged for March 2006. 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. Hartcliffe Nursing Home DS0000031895.V330866.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 Hartcliffe Nursing Home DS0000031895.V330866.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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 families can be assured that a full assessment will take place before a decision is made about the suitability of the home for each individual. EVIDENCE: Standard 3 The home has a comprehensive assessment tool, covering all aspects of personal, healthcare, social and mental health needs. There is also an identification of any equipment needed. The assessments are undertaken by the home manager visiting the person either in hospital or in their home. Other important information is also gathered in the form of hospital social worker care plans and healthcare assessments. Survey forms returned to the Commission confirmed that people have the information they need about the home before making a decision about moving into the home. The manager is
Hartcliffe Nursing Home DS0000031895.V330866.R01.S.doc Version 5.2 Page 11 clear about the admission criteria for the home and the categories of care that she is registered to accept. Hartcliffe Nursing Home DS0000031895.V330866.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans seen during the inspection were not well written. They also concentrated on inabilities and were not holistic. Social needs were not recorded consistently. There was little evidence that the plans are written or reviewed with the residents themselves. Most health care needs are regularly assessed and any changes acted upon. This was not so for the risk posed when residents suffered a fall/falls as this was not reviewed and assessed to prove that staff were minimising risk to those residents. Medication systems are safe and well organised. Not all staff promote the dignity and respect of the residents. EVIDENCE: Hartcliffe Nursing Home DS0000031895.V330866.R01.S.doc Version 5.2 Page 13 Standard 7 The inspectors looked at 6 care plans as part of the case tracking process. As well as using the pre admission assessment, staff also complete a full assessment of care needs, based on the activities of daily living. Other information which informed the care plan was present in some instances but not all. In al incidences there was a medical history. However social assessments and life histories and previous interests had not always been assessed. Most plans seen included full mental health assessment, however the information it contained in these did not always tally with information gained pre-admission or in the care plan that was recorded. There seem to be judgements made which were not based upon any medical history or psychiatric evaluation. The information generally in care plans was vague, and did not give full information enabling the person reading the plan to use that to deliver appropriate and up to date care. Where there had been a change in need this often resulted in a new plan being formulated, and did not necessarily mean the existing plan was amended. One resident who was case tracked had particular urgent problems with their nutritional intake. This was not well reflected in the care plan and will need to be re-written immediately. There are also two examples of residents who are having their behaviour monitored; this is in particular relation to swearing. It was evident from talking to staff and reading various documents for these two residents, that actually this swearing forms a part of their normal behaviour. This needs to be clearly documented in the care plan and not used as part of a challenging behaviour plan. In another plan there was confusing old information about mental health requirements, this was obviously not a current problem and needs not to be in the current file. It was disappointing that despite this resident choosing to stay in their room there was no social care plan for them. There was no evidence within the plans that they had been written with the resident themselves or their representative. Standard 8 On the second day of the inspection there was an emergency, one resident collapsed. The registered nurse acted very swiftly and correctly and an ambulance was soon called. Staff are to be commended for the way they dealt with this situation. An audit of falls is done on the computer by the Manager, if a pattern emerges then it is expected that the care plan is to be reviewed. One inspector tracked a resident who had 3 falls; there was no review of their care plan. Other accidents records were checked and staff spoken with about their actions if a resident has a fall. There is generally no overview by staff as the accident
Hartcliffe Nursing Home DS0000031895.V330866.R01.S.doc Version 5.2 Page 14 forms get filed away, so this information is not used when the care plan is reviewed. This does not show evidence that staff are trying to minimise any risk of falls for those residents who may be at risk. Registered nurses have undertaken a range of training to ensure that they can meet residents healthcare needs. These included topics such as male catheterisation, taking blood, and the use of syringe drivers. There are various healthcare assessments and risk assessments for each resident to ensure that their health needs are met. These should also alert staff to any change in the residents condition. There are inconsistencies in the way that these assessments had been reviewed. The manager was asked to check the nutritional assessment, completed recently, for one resident identified as being at high risk nutritionally. This assessment had only come out as a medium risk. The records of GP visits show that there are regular referrals to the GP. Records showed that residents were also weighed monthly where possible. As mentioned previously some of the mental health needs assessments were not completed in a useful way. Staff should be wary of making entries in these assessments unless they feel they are competent to do so. This may be a training issue for staff. Standard 9 The home has good procedures in place to ensure that medication systems are safe. All medicines are correctly stored, both in a trolley, in a secure cupboard and in a lockable cabinet kept in that cupboard. The procedures for the ordering, receipt into the home, storage, administration and disposal are safe. Standard 10 During the inspection the inspectors heard residents being spoken to in a friendly manner by some staff. Some residents said that the staff are very kind to them. One inspector overhead a member of staff speaking in a derogatory way to one resident in front of the inspector. This information was passed to the manager. It was noted that some residents in the main lounge did not have access to a call bell, nor have tables in front of them to place their drinks upon. It was noted that cups of tea offered were then left on the side and the residents were not helped to finish their drinks. Nor were offers made of fresh drinks when these became cold. This was the same when cold drinks were distributed by the same member of staff later than morning. Some of these drinks were left in the lounge but were out of the reach of the residents. This was discussed with the manager. It was also noticed during the inspection that some members of staff did not give information to the resident when approaching them. This included one
Hartcliffe Nursing Home DS0000031895.V330866.R01.S.doc Version 5.2 Page 15 member of staff who was assisting a resident to eat their meal. There were very little interaction between the resident and the member of staff, this included the member of staff not informing the resident when they were giving them either food, which was done with a big spoon, nor when they were giving them a drink. The other inspector heard one nurse trying to sit up a sleeping resident and place their meal in front of them, and then being surprised that the resident was not co-operative as they were still very sleepy. Hartcliffe Nursing Home DS0000031895.V330866.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a varied activities programme which should cater for most people’s interests. For residents who do not join in those activities staff should spend time with them, which is not about delivering care. Residents have a nutritious and varied diet and are offered choices of meals. EVIDENCE: Standard 12 The home has a full time activities coordinator. The inspector talked with the coordinator and looked at the record of activities and events held in the home. The record for January 2007 showed the following; A well attended bingo session, craft classes, books and magazines, songs of praise, sing-along with Dave, Alan’s music group, a singer, holy communion and the taking round of the shop. Forthcoming events include a quiz night and lots of Easter activities. The records of events held were detailed and included which residents had joined in, and whether or not they had enjoyed the event. The co-ordinator also tried to spend time with those residents who choose to or have to be in
Hartcliffe Nursing Home DS0000031895.V330866.R01.S.doc Version 5.2 Page 17 their bedrooms. She gave an example of one resident in their room who expressed and interest in playing skittles so this is going to be done in her bedroom. The coordinator has also recently started putting information in the care plans and has been adding some life history details, which she has found out both from the residents themselves and from relatives. There is also an annual planner showing various events which are to be carried out throughout the year, this included celebration of religious events such as Easter. The co-ordinator would also like to be involved in encouraging the keys workers in spending more one to one time with residents and assisting with some of the activity events held. One resident spoke very positively about the activities coordinator and said how cheerful and helpful she is. Standard 15 The home has a spacious dining room which was well used on both days of the inspection. The tables were laid with attention to detail. Staff assisted those residents who needed help with their meal discreetly. It was noted that some residents who perhaps have a smaller appetite, had smaller plates and appropriate portions. Menus are seasonal and discussed at residents meetings. The menus are displayed in reception. The catering manager meets new residents and has a list of likes / dislikes in the kitchen. The residents are asked every day what they would like for their meals. The kitchen staff are also informed of individual problems such as weight loss, and take steps therefore to increase their calorie intake. Cultural needs are also taken into account. It was noted throughout the home that fresh fruit was on display. Homemade cakes are made daily and also home made biscuits. The manager discussed with the catering manager one resident who has a specific and acute weight loss problem. After discussing this the inspector recommended that instead of giving 3 traditional meals per day, that very tiny meals were given very regularly, for example 2 hourly. The inspector also recommended using a small amount of alcohol as an appetite stimulant. The inspector also recommended to continue chopping and changing with traditional food as well as finger foods which had previously been tried. It was noted that the catering manager had gone to all sorts of lengths to try and cater for the preferences of this resident. The kitchen had an Environmental Health inspection in 2006 in which no recommendations or requirements were made. This means that the home does not have to have another inspection for 2 years. This is commended. Hartcliffe Nursing Home DS0000031895.V330866.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously and investigated thoroughly. Residents are protected from abuse by staff being trained in this subject and a Manager who acts appropriately if there is an allegation of abuse. EVIDENCE: Standard 16 Since the last inspection there have been 4 complaints made to the manager. One of these complaints was actually an allegation of abuse, which the manager has dealt with appropriately. The records of these investigations showed the manager had a contentious and thorough approach to investigating these areas of concern. Survey forms returned to the commission confirmed that most people feel able to and know who to turn to in case they have a concern. Standard 18 As previously inspection since the last inspection, there has been a recent allegation of abuse. Initially this was reported to a new trained nurse, who dealt with this as a complaint rather than an allegation of abuse. As soon as the manager was informed of this fact she immediately took steps to instigate the local procedure. This involved informing the relevant agencies, such as social services and the commission. The manager has fully investigated this
Hartcliffe Nursing Home DS0000031895.V330866.R01.S.doc Version 5.2 Page 19 allegation, which could not be substantiated. It was a requirement at the last inspection that all staff attend Social Services Protection of Vulnerable Adults training. All staff completed this training in 2006. Staff also have an annual in-house update in this subject. The only form of restraint used in the home are bed rails and wheelchair straps. Consent for the use of bedrails was obtained in some files seen, but does need to be regularly reviewed. This had not been done in some instances. It was noticed during the inspection that the staff kept the cigarettes of those residents who smoked. This restriction needs to be fully detailed in the care plan and reviewed for its appropriateness. Hartcliffe Nursing Home DS0000031895.V330866.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, well maintained and purpose built. EVIDENCE: Standard 19 Hartcliffe Nursing Home is purpose built and set out over 2 floors. The corridors are wide allowing for easy wheelchair access. It is well maintained. Residents are encouraged to personalise their room and bring in small items of furniture. On the downstairs floor there is a large lounge and a small smoking lounge. The smoking lounge is only for residents. The furniture and fixtures and fittings are appropriate to the client group and age group. As mentioned previously there is a spacious which has level access to the patio and garden. There are ample assisted toilets and bathing facilities. It was noted that the 2 main bathrooms on both floors have been tastefully decorated
Hartcliffe Nursing Home DS0000031895.V330866.R01.S.doc Version 5.2 Page 21 with a lot of thoughtful touches. One bathroom on the ground floor is to be converted to a shower room. There are 64 single bedrooms and one double room. All bedrooms meet the national minimum standard size. It was noted that there were colourful nameplates on each bedroom door, these were individualized. All of the beds in the home are electrically adjustable which makes for safe manual handling for both staff and residents. There is lockable storage in each room. It was seen that all bedroom doors are held open with automatic closures on them so that doors will be kept open for residents preferences, but comply with fire regulations. This is commended. It was noted that the home has several lifting hoists and stand aids for manual handling purposes. Both the inspectors noted that the home was clean and had no unpleasant odours during the inspection. Hartcliffe Nursing Home DS0000031895.V330866.R01.S.doc Version 5.2 Page 22 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels need to ensure that they meet the dependency levels of the residents. Recruitment processes need to be robust wherever the person is recruited from to protect the resident’s. Staff benefit from being sufficiently trained and updated in topics relevant to the needs of the residents. EVIDENCE: Standard 27 Some survey forms returned to the Commission stated that they felt that there were not enough staff on duty and that call bells took too long to be answered. Trained nurses spoken with and carers during the inspection stated that there has been a higher dependency of resident in the home over the last few months. This has lead to a lot of residents now needing two staff to help them to get up and to wash. They also stated that new admissions to the home seemed to be of a higher dependency than previously. On the downstairs floor staff have 5 or 6 baths to do daily. The inspector was also told that there had
Hartcliffe Nursing Home DS0000031895.V330866.R01.S.doc Version 5.2 Page 23 been some new staff starting recently who are not yet fully confident. This has impacted on permanent staff. Residents and relatives spoken with during the inspection confirmed this increased dependency and that staff seem to have less time to spend with the residents than they used to have. One relative commented that staff no longer seem to have the time to spend just sitting and talking to the residents. This information was passed to the manager. There is a registered nurse on duty at all times both upstairs and downstairs with the addition of 4 to 5 care staff on both floors of the home. The inspector noticed during the inspection that one care assistant, was actually deployed for the serving of breakfasts and for the distribution of drinks both hot and cold. This was discussed with the manager and it was agreed that possible this task could be done by a kitchen assistant and not a member of the care staff. This would give additional help on the floor. If this is not possible then an extra member of staff must be put on each shift to meet the needs of the residents in a timely way, and also to meet their social care needs. This will be monitored at future inspections. Standard 28 18 care assistants employed at the home have completed their Level 2 NVQ in care. Other carers are in the middle of doing their course. The manager is to be commended for her commitment to encouraging staff to complete their NVQ training. Standard 29 The recruitment records were checked for the 3 members of staff who have recently been employed at the home, 2 of these were care assistants who had been employee from the EU. The home uses an employment agency for these workers. Documentation from the employment agency was checked by the inspector. There were copies of the members of staff’s passports and marriage certificates and police checks had been completed in their own country. It was noted that references were stated ‘to whom it may concern’ and had not been requested by the agency or by the home. In both instances the telephone interview conducted by the nursing home had also not been noted. The inspector was informed that Criminal Records Bureau checks are sent off once they start employment. The manager was under the impression that they did not need to complete these checks until the applicant had started work. The manager was informed that a POVA first check needs to be completed before the applicant starts their employment. The manager does get new employees from the EU to complete the homes own application form. The manager was advised that new regulations meant that a full employment history needed to be obtained from now on. Hartcliffe Nursing Home DS0000031895.V330866.R01.S.doc Version 5.2 Page 24 The third recruitment file checked was for a new trained member of staff. This contained a completed application form, 2 references-one from the last employer, 2 sets of interview questions for the interview, an equal opportunities monitoring form, a medical questionnaire, a PVA first and CRB application and also proof of identity. There is also confirmation from the Nursing and Midwifery Council of their fitness to practice nursing. This member of staff did not start work until the POVA first had been obtained. Standard 30 The home continues to have good arrangements for the training of the staff paying particular attention to specialist training relating to the care of the elderly. The home still continues to have links with the University of the West of England in providing training. The inspector examined 3 records of staff training and it was noted that some training needs identified in supervision had been honoured. The home now has a training matrix which is computerised, alerting the administrator to when mandatory training updates need to happen. The inspector was able to confirm training indicated on the matrix with training records in files. Staff spoken with confirmed that they are able to access training courses externally and also have sufficient in house training to ensure their competency for their role. Hartcliffe Nursing Home DS0000031895.V330866.R01.S.doc Version 5.2 Page 25 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and staff benefit from an experienced, competent and caring Manager. The views of the residents are sought to ensure that the home meets its aims and objectives. Supervision sessions for staff need to be constructive and organised. The health and welfare of residents and staff is protected. EVIDENCE: Standard 31
Hartcliffe Nursing Home DS0000031895.V330866.R01.S.doc Version 5.2 Page 26 Mrs Andrews continues to be the registered manager of the home. She is a registered nurse and very experienced in the care of the elderly. She works full time supernummary to the staff on the floor, and has recently recruited a new deputy manager. The manager is very professional, approachable and friendly. This was verified by staff spoken with and residents and relatives spoken with during the inspection. Standard 33 The commission received 19 completed survey forms to inform the inspection, from residents and relatives. The home also had a standards and value assessment completed by the MHA group in September 2006. This was a means of measuring the performance of the nursing home. This covered areas such as wellbeing and spirituality and whether the home was delivering person cantered care, social care needs, the environment with catering and housekeeping, records and documents, care plans, training and staffing, and drug administration and storage. An action plan was also completed by the assessor at the end of the assessment. The identified needs to meet the actions were some gaps in one to one activities, some gaps in recording and filing for care plans staff files and training records, the health and safety risk assessment was out of date, and emotional and spiritual needs were not being fully identified therefore appropriate action wasn’t being taken. All of these actions needed to be achieved by the end of December 2006. Standard 36 The manager had already identified that supervision sessions were not being conducted in the was that is expected to meet the standards. This was both in the frequency of the sessions and the content of the sessions. She therefore arranged for staff to have training in his area in March 2006. The inspector had already looked at the supervision records for 4 members of staff. The inspector agreed that the content was lacking and must cover all aspects of practice, philosophy of care in the home, and career development needs. This will be checked at future inspections. Standard 38 As mentioned previously, the home employs a full time maintenance person who is responsible for some of the health and safety checks. They work full time and are also on call. Apart from the fire safety tests the maintenance person also checks the safety of the portable appliances, the wheelchairs, the safety of bedrails, that the window locks are secure and the call bell system. They also completed a joint risk assessment of the building with the manager. The fire log record shows that there are weekly checks of the alarm system, visual checks of the extinguishers and visual checks of the emergency lights and sensors. Records show regular unannounced fire drills incorporating evenings, weekends and nights. Hartcliffe Nursing Home DS0000031895.V330866.R01.S.doc Version 5.2 Page 27 There are monthly checks of the water temperatures to ensure that the restrictive valves keep the temperature of the hot water below 45 degrees centigrade. The checks to test for legionella are also completed regularly. The inspector asked the maintenance person about the safety checks for bedrails, the bedrails are all integral to the beds so the safety checks to are to check the gap between the bedrail and the bottom of the bed is below the minimum distance recommended. Records are also held of maintenance checks by contractors such as ARJO for the hoists, stand aids, bath chairs and the sluice. An external contractor also maintains the lift. Hartcliffe Nursing Home DS0000031895.V330866.R01.S.doc Version 5.2 Page 28 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 2 X 3 Hartcliffe Nursing Home DS0000031895.V330866.R01.S.doc Version 5.2 Page 29 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 OP29 Regulation Requirement Timescale for action 22/02/07 2. OP8 3 OP7 19(4)(b)(c The registered person shall ) ensure that no person shall commence their employment until a satisfactory POPVA first check is received, and that the references are satisfactory. 13(4)(c) The registered person shall ensure that the care plan and relevant risk assessments are reviewed after a service user suffers a fall/falls. 15(1)(2) The registered person shall ensure that care plans cover all aspects of the service user’s health, personal and social care needs. 22/02/07 30/05/07 4 OP7 15 5 OP10 12(4)(a) There also needs to be evidence that the plans are written with the service user and/or their representative and reviewed with them. The registered person shall 01/03/07 ensure that the care plan and risk assessments (identified during the inspection as being inadequate) for SH is re-written. The registered person shall 01/03/07 ensure that all staff treat all
DS0000031895.V330866.R01.S.doc Version 5.2 Page 30 Hartcliffe Nursing Home 6 OP8 12(4)(a) 7 8 OP36 OP27 18(2) 18(1)(a) service users with respect and promote their dignity. The registered person shall ensure that the welfare and safety of the service users in the lounges is promoted by the allocation of a care assistant to each lounge. The registered person shall ensure that staff are regularly and appropriately supervised. The registered person shall ensure that there are sufficient staff on duty to meet the dependency levels of the service users. 31/03/07 22/05/07 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP12 OP15 Good Practice Recommendations Any social time spent with service users should be recorded. The service user identified during the inspection as suffering a particular weight loss problem has small, regular meals in addition to finger foods. Hartcliffe Nursing Home DS0000031895.V330866.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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
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