Random inspection report
Care homes for older people
Name: Address: Hartcliffe Nursing Home Murford Avenue Hartcliffe Bristol BS13 9JS one star adequate service 22/12/2008 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Vanessa Carter Date: 2 1 0 5 2 0 0 9 Information about the care home
Name of care home: Address: Hartcliffe Nursing Home Murford Avenue Hartcliffe Bristol BS13 9JS 01179641000 01179641100 ruth.andrews@mha.org.uk www.mha.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Methodist Homes for the Aged care home 66 Number of places (if applicable): Under 65 Over 65 66 0 old age, not falling within any other category physical disability Conditions of registration: 0 10 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 Date of last inspection Brief description of the care home 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 six years. 64 bedrooms are for single occupancy and there is one shared room. They are set out over two floors, with the upper floor accessible via a passenger lift. Communal
Care Homes for Older People Page 2 of 10 2 2 1 2 2 0 0 8 Brief description of the care home 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. Care Homes for Older People Page 3 of 10 What we found:
We have written this report following a number of concerns being raised that have been dealt with under safeguarding protocols. Five separate cases have been dealt with and there have been individual meetings in respect of the issues raised held by the local authority - some of these meetings we have also attended. We have met with representatives from the home and from the Methodists Homes for the Aged on two occasions - 29 April and 21 May 2009, along with social care colleagues from the local authority, and healthcare colleagues from the PCT and the GP practices. Currently the home has a 1 star adequate rating, this followed a key inspection in Decemeber 2008. Five requirements were issued following this inspection in respect of care plan recording and reviewing, ensuring that people get the healthcare advice and support that they need, staff training in the protection of vulnerable adults, and the storage of confidential information about the people who live in the home. We are extremely concerned that some of the recent issues that we have been looking at, link in with these requirements, and therefore demonstrate that the home did not address the shortfalls sufficiently enough. What the care home does well: What they could do better:
Some recent placements at Hartcliffe Nursing Home have been difficult to manage and have highlighted the need for a more robust admissions process to be re-established. Whilst we are aware that people are transferred from hospital into PCT funded beds, you must ensure that placement is not offered to any person whose needs can not be met. You must ensure that a thorough pre-admission assessment is completed prior to people being admitted. This will ensure the home is an appropriate placement for the person, the staff team have the necessary skills and competencies, specific equipment that is needed is available and you know what you are going to need to do to meet the persons care and support needs. We discussed the care of five specific people as issues have been raised under safeguarding protocols. As a result of strategy meetings the outcome was that further placements by the local authority and PCT were suspended for a temporary period. We had concerns about the ability of the home to manage peoples care effectively. We had concerns over some aspects of medication management . You told us that you have now changed the procedures for obtaining medications prescribed following GP visits. We had concerns that nursing equipment malfunctioned and care staff had not taken any action. You told us this equipment has now been serviced, and that staff have been instructed to always check the equipment in use. In addition you must ensure that risk assessments regarding the likelihood of developing pressure sores (Waterlow score), are reviewed as often as is necessary, and a review made of the equipment being used. We have concerns about the abilities of some registered nurses to provide appropriate catheter
Care Homes for Older People Page 4 of 10 care, but you have told us that training has already been arranged to address this. We looked at documentation kept to monitor one persons fluid intake and output and found the records to be wholly inadequate. The forms were not filled out correctly meaning it was difficult to see how much fluid had been taken in a 24 hour period. No output was recorded on the documents we saw. At the end of a 24 hour period no one had looked at the forms and reviewed this persons care. In this instance the home neglected to monitor this persons care and as a result they became severely dehydrated. As part of these safeguarding meetings we have learnt that people may not always be provided with meals that are suitable for them. In one case, a person who could only tolerate a soft diet because of swallowing problems had been given a normal diet. This is not good enough and is potentially very harmful. You must ensure that the whole staff team are aware of peoples specific dietary needs and that people receive the appropriate foods. Concerns have been raised by several different agencies about the communication skills of some of the newly appointed staff. This has led to problems with the transfer of information to or from the home. You have told us that a course in English Language Skills has already been started and that this will include spoken, written and telephone skills. You also told us that you have identified two nurses who will take the lead role (one on each unit) and who will deal with telephone calls. There are also concerns about the clinical competency of some registered nurse. Issues highlighted include catheter care and re-catheterisation, syringe driver and suction equipment competency, the ability of the nurse to recognise changes in a persons health care status and to then take the appropriate action. You have told us that training has already been set up in respect of catheter care, you are awaiting dates for the syringe driver training and that because of recent events staff awareness to take the apporpriate action has been raised. You must ensure that at all times that people are being looked after by staff who have the necessary skills and competencies to be able to meet their needs. We are advised that the registered manager has now left and the deputy manager is acting up as home manager. The acting home manager will not be covering nursing shifts, but will be managing the home. You are already recruiting for a deputy. This is essential in getting the home back on track as it needs to be well managed to ensure that the changes that are necessary, are implemented. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 5 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must ensure that each persons plan is reviewed and revised as needed. Care plan reviews must be meaningful, evidence who was involved in the review and the plans must be revised as necessary 27/02/2009 2 7 15 The registered person must ensure that care plans are based upon assessed needs Care plans must be clear, detail what action staff are to take and take account of all their care needs 27/02/2009 3 8 12 The registered person must ensure each person has access to the healthcare services that they need Staff must make proper provision for healthcare matters to be addressed. 27/02/2009 4 18 13 The registered person must 07/02/2009 ensure that all staff are trained to prevent service users being harmed or being placed at risk of harm. Staff must make sure their Care Homes for Older People Page 6 of 10 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action actions do not harm service users and that the appropriate action is taken to report concerns about bad practice. Care Homes for Older People Page 7 of 10 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 3 14 The registered person must 23/05/2009 ensure that the needs of any prospective resident have been assessed prior to placement at the home being offered This is to ensure that the home is able to meet the persons needs. 2 7 15 The registered person must 29/05/2009 ensure that the plan of care for each person is kept under review and updated as necessary This is so that each person receives the care and support that they need 3 8 12 The registered person must 29/05/2009 ensure that proper provision is made to meet peoples health and welfare needs. There must be appropriate measures in place to monitor healthcare status, for example hydration and skin integrity. Care Homes for Older People Page 8 of 10 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action This is so that people receive the healthcare support that they need 4 27 18 The registered person must 29/05/2009 ensure that at all times suitabily qualified, competent and skilled staff are working in the home. This is so that staff have the necessary skills to meet the care needs of the people they are looking after. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 2 8 9 The Acting Manager should arrange a meeting with the health centre to agree best communication methods. The Acting Manager should raise a formal complaint with their medications supplier regarding the recent difficulties and should copy their letter to the Clinical Governance (Medication Management) Dept, PCT. All the records kept in respect of care given to people should accurately reflect what has been provided and be clear and easy to follow. 3 37 Care Homes for Older People Page 9 of 10 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 10 of 10 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
