Inspection on 19/04/07 for Haydock Nursing & Residential Care Home

This inspection was carried out on 19th April 2007.

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

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

Other inspections for this house

Haydock Nursing & Residential... 28/04/08

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Haydock Nursing & Residential Care Home Pleckgate Road Ramsgreave Blackburn Lancashire BB1 8QW Lead Inspector Mrs Janet Proctor Unannounced Inspection 19th April 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Haydock Nursing & Residential Care Home DS0000067797.V331743.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. Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Haydock Nursing & Residential Care Home Address Pleckgate Road Ramsgreave Blackburn Lancashire BB1 8QW 01254 245115 01254 245510 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) Grange Healthcare Ltd vacant post Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50), Physical disability (50) of places Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 50 service users to include: Up to 50 service users in the category of OP requiring nursing care Up to 50 service users in the category of PD requiring nursing care Up to 36 service users in the category of OP requiring personal care Up to 2 service users in the category of PD requiring personal care Date of last inspection Brief Description of the Service: Haydock Nursing Home is registered to provide accommodation and personal care for service users who are elderly and some who are elderly and need nursing care. They also provide care for service users who are physically disabled and need nursing care. The home is registered for fifty service users. Haydock Nursing Home is owned by Grange Healthcare Limited. The day-today management of the home is undertaken by a manager. Haydock Nursing Home is a two-story purpose built home situated on the edge of a small estate in the Brownhill area of Blackburn. There are open countryside views from all the rooms located to the rear of the home. There is easy access to bus stops and shops. There are places of worship located within a short distance. The facilities within the home include a large dining room and a variety of lounges, including a conservatory. There are 39 single rooms and 7 double rooms at the home and all but two of the rooms have an en suite facility. Access to the first floor is via a passenger lift or a stair lift. Information for prospective residents is available in a Statement of Purpose and a Service User’s Guide. In April 2007 the fees charged were £330-00 to £370-00 per week for those requiring personal care and £460-00 for those requiring nursing care. No additional charges were made. Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted at Haydock on the 19th and 20th April 2007. On the day of the inspection there were 45 residents at the home. One additional visit had been made since the previous inspection. This was because a complaint had been made to the Commission about the attitude of staff. Some of the allegations were found to be correct. Prior to the visit the Registered Person had submitted information in a preinspection questionnaire. This gave information that was used in the planning of the inspection. Surveys were sent out and were returned by one resident and their relative. On the day of the inspection information was obtained from staff records, care records, and policies and procedures. Information was also got from talking to residents, the Manager, staff members and visitors. A tour of the building took place. Wherever possible the views of residents were obtained about their life at the home and their comments are included in the report. What the service does well: A full assessment was carried out of residents’ needs before they came to live at the home. This meant that arrangements could be made to ensure that they received the right care and that any equipment needed was obtained. Residents were cared for in a friendly and professional manner and it was evident that staff and the residents got on well together. Residents said, “They look after me well and the staff are nice”, “They’re very kind. They always have a chat with me and treat me nicely” and “It’s very nice here. I’m well looked after.” Visitors were made welcome at the home and could see their relative in private. A relative survey form said that the home “generates an atmosphere of warmth, security and caring.” Visitors also felt that they could go to the Manager if there was anything wrong. A visitor said, “I’ve no complaints, I’m sure they would deal with them if I had.” Residents were pleased with their rooms at the home. They said, “I like my room, it’s very nice” and “ It’s a lovely room and we’re quite happy with it. We can’t clean it ourselves but we’ve no worries about how the cleaners do it.” Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 6 There was a good percentage of carers who had completed the NVQ training or equivalent. This meant that they had been given the knowledge and skills to be able to do their work correctly. What has improved since the last inspection? What they could do better: When an assessment has been done the Manager needs to write to the prospective resident telling them whether the home can meet their needs or not. This is because Prospective residents need to be confident that they will be looked after correctly at the home. Residents or their relatives must be given the chance to read the plan of care and be involved in what is included. This is so that they have some say over how they are cared for. All identified needs or problems should be written in the plan of care so that staff know exactly what to do if this occurs. This ensures that care is given correctly and consistently. All residents should be moved in a way that is safe. This is so that no harm occurs to them or the staff members. An assessment of the risk of falls should be done for all residents. This is so that potential harm to the resident can be identified before a problem actually occurs. If a resident has repeated falls then the assessment should be reviewed and a plan to manage this put into place. Medication practices must be improved so that the health and safety of residents is protected. The records of all medications entering the home and given to residents must be complete and accurate. If a resident only has medication when it ‘is required’ there should be details to tell staff in which situation it must be given. This ensures that it is given in a consistent manner. Suitable activities should be organised for residents who were not able to occupy themselves. This meant that their recreational needs were not being met. The religious and cultural needs of a resident where not widely known by staff particularly in relation to her diet. This lack of knowledge meant that there was the potential for the wrong foods to be given. Recruitment practices must be improved so that they ensure that staff are suitable before employment commences. Proper background checks must be carried out in all cases. Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 7 All staff must receive regular training sessions so that they keep up to date with the skills, knowledge and competence that they need to do their work properly. This training should include items relevant to care practices, health and safety, and safe working practices. An application for registration should be made by the current manager. This is so that there is someone taking legal responsibility for managing the home. All care staff should receive regular, formal supervision. This is needed to ensure that they are aware of their roles and responsibilities and the philosophy of the home. 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. Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient information was available to allow prospective residents to make an informed choice about whether they would like to live at Haydock. Residents’ needs were properly assessed before they were admitted but they could not be confident that these could be met, as they did not get a letter to confirm this. EVIDENCE: The Statement of Purpose and the Service User’s Guide had been updated in November 2006 to show the details of the new manager. Residents spoken to expressed their content at living at Haydock. One couple said, “It’s the best thing we ever did coming in here”. A contract stating the terms and conditions of living at the home was given to residents when they came to live at the home. The contracts for residents who had come to live at Haydock before September 2006 were not available for insepction. They were not in the residents’ files in the office where they were Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 10 normally stored. A pre-admission assessment was done by the Manager before a resident came to live at Haydock. The manager said that she did not send a letter confirming that the home could meet their needs. The pre-admission assessments for residents who came to live at Haydock before September 2006 were not available for inspection. They were not in the residents’ files in the office where they were normally stored. Intermediate care was not given at Haydock. Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all of the care plans fully identified residents’ needs and therefore staff were not told how to meet these. Medication practices were not completely safe and placed residents at risk. Residents felt they were treated with respect. EVIDENCE: The records for three residents were examined. A new format of care plans was being introduced and two of the records examined had been changed to this style. This was a self-care deficit model that stated what the resident could do and what the staff must do to ‘fill in the gaps’. These records showed that a full assessment had been done on admisison. This covered all aspects of health, personal, psychological and social care. A plan had then been written that gave directions to staff on what they had to do to ensure that the needs of the resident were met. There were insufficient directions to staff on how to deal with confused behaviour. This may lead to inconsistency when giving care. Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 12 The plan had space for recording that the resident or their relative had read the care plan and agreed to the contents. This had not been done even though two residents had frequent visits from their families. The relatives of one of these residents said, “We asked to see his care plan one night but it was locked in the manager’s office.” One of the plans seen had been reviewed in March 2007. There was no indication in the review of the progress that was being made to meet the needs of the resident. One of the three plans had not been reviewed since January 2007 and therefore it was not known whether his needs remained the same or not. Risk assessments were available for a variety of health issues: development of pressure sores; nutritional risk; risk of falls; moving and handling; and the use of bedside rails. From this assessment the level of risk was decided and a plan of care written to inform staff on how to reduce or manage the risk. Two residents were seen to be moved by an ‘underarm’ lift. This type of handling can cause dislocation of the shoulder or damage to the brachial nerve and should be discontinued. A falls risk assessment had not been completed for one resident who was immobile. Another resident had had seven falls in 12 days. An assessment of his risk of falls and how this was to be reduced and managed had not been done. Other professionals were involved as necessary in the care of the resident e.g. Speech and Language Therapist, GPs and District Nurses. There was evidence of some good practice in the management of medication in the home. The room was secure and the trolley chained to the wall. There were signs warning of which rooms oxygen was stored or used in. An air conditioning unit was being used in the room. This made sure that too high a storage temperature did not ruin the medications. Controlled drugs were stored correctly and a register kept for recording when they were given. The amount stored was checked with the register and was correct. Records were kept of what medication had been ordered, received, given and destroyed. There was a photograph of the resident with their Medication Administration Recording chart to assist in identification. Not all charts examined had been signed and witnessed when a handwritten entry had been made. This means that any error made in writing the drug name and dosage would not be spotted. There was no amount of the medications received for two residents whose records were checked. This meant that it could not be audited whether they had been given correctly or not. There was a medicine pot with tablets in trolley for a resident. The Registered Nurse said that he did not want them when she originally tried, and she was going to go back and try later as it was important that he took these. However, Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 13 the chart for the morning medication had been signed as having been administered. A resident received her medication through a PEG tube. There was no evidence that authority had been obtained for administering medication via PEG tube and there was no protocol in place for this. The chart for one resident had not been signed for on two occasions. The medication was not in the blister pack and there were no details to show whether the resident had received this or not. The GP had changed the amount of times a medication was to be given. The records kept did not clearly show when it had been reduced to three times daily. There was no criteria for when an ‘as required’ medication was to given for agitation. This meant that there was the potential for this to be used inconsistently. There was some stock for residents who were no longer at the home. There were a number of additional items stored in the Controlled Drug cupboard. This meant that the cupboard was being accessed for reasons other than getting medication and had the potential to reduce the security of the storage. There was a self –medication agreement form that stated “I have had an assessment by my GP and the Nurse in charge”. There was no evidence of this assessment on record. Creams and other medications that were selfadministered by residents were being ‘ticked’ on the chart at 10.00 pm. This did not give a clear indication of whether they were taken at that time or not. Staff training on privacy and dignity and respect commenced in Induction training. Issues about privacy and dignity were noted in the plan of care. The preferred term of address was noted in the plan of care and used by staff. All treatment was given in private. Staff were seen to close toilet doors when attending to residents. Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lack of recreational activities meant that residents’ social interests and needs were not being met. The daily routines for residents matched their preferences and choices. Residents were able to have family and friends visit them. The food served at the home was to the liking of the residents and offered a varied and nutritious diet. EVIDENCE: There was no evidence that activities were done on a regular basis. A resident said, “There’s nothing going on, nothing to do all day”. Staff spoken to confirmed that these were not done. One member of staff said, “Activities are not being done now. We used to do them all the time but not now. There’s some residents who would definitely benefit from it.” Religious services were held at the home and residents could attend if they wished to. The fact that a resident was a devout Roman Catholic was recorded in his care plan and directions given to staff that he liked his rosary beads to hand and they should be placed in his jacket pocket. This meant that the resident’s religious needs were known and met. Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 15 Both residents and staff said that the routines of the home were flexible to fit in with diverse needs and desires. The preferred daily routine was noted in the plan of care for one resident whose records were examined. This meant that all the staff knew what he liked to do and when. Residents were able to choose their own rising and retiring times. They could have meals in their room if they wish to and could use their bedrooms as and when they wished to. Visitors were welcome and could come at any time. Visitors spoken to said that they were made to feel welcome and kept informed of anything affecting their relative. There was a choice of meals at lunchtime and tea. There was a record of the choices made by residents and if anyone had anything different to the menu. Each item at meal time was served individually to residents at the table. This meant they could have as much or as little as they wanted. Any pureed diets had their components done separately so that they looked more attractive and appetising. The staff gave discrete assistance to residents. Fresh vegetables, fruit and salad were seen. There was food available for the night staff to prepare snacks. There was a Cook on duty every day and usually a kitchen assistant. Records of storage and cooking temperatures were kept. One resident was Jewish and the Cook spoken to was aware of the need to separate meat and dairy products and not to serve pork. This was not identified clearly in the plan of care. Staff spoken to were not aware of the significance of this. This meant that there was the potential for the resident to be served food that did not meet her religious dietary needs. Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were confident that their concerns would be listened to and acted upon. The lack of staff training in Safeguarding Adults may result in abusive practices being unrecognised and unreported. EVIDENCE: The complaints procedure was on display in the reception area. This had a warm tone to it and gave clear directions on who to make a complaint to and that a response would be made within 28 days. The procedure also had the address and telephone number of the Commission and also gave information about other Agencies who could be of help, for example, Age Concern. There was a recording book for complaints. There were two complaints recorded in this since September 2006 and included details of the issues, the investigation and the outcome. The record of complaints made to the home before September 2006 could not be located. There were procedures for the protection of residents in place. A resident said, “I’m very happy here and I feel safe.” Staff had not had any training on protection in the last year and this meant that not all staff might know what to do if they saw, heard or suspected that something was not right. The staff spoken to said that they were aware of the procedures. One recently employed member of staff confirmed that she had been told about this in her Induction training. The Manager said this training was in the process of being arranged. Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 17 An allegation had been received by the management of the home and dealt with correctly. Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were happy with their accommodation at the home and lived in a safe, clean, well-maintained environment. EVIDENCE: The home was clean and well maintained. There was one dining room, two lounge areas and a conservatory available on the ground floor of the home and a further lounge area located on the first floor. The conservatory was designated as a smokers lounge area. Some of the areas of the home and some bedrooms had been redecorated and looked fresher and more pleasant. There was a small garden area to the rear of the home, which was accessible by a ramp from the conservatory area of the home. Benches were located in this areas and patio furniture was available for the summer. Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 19 All but two of the bedrooms were en-suite. There were sufficient bathing and toilet facilities. Some residents had brought in small items of their own possessions and this made their bedrooms more homely. Residents could have a key to the lock on their door and had lockable storage space. This meant that they had some control over their privacy. All clothing and linen was laundered on site and there was a well-equipped and clean laundry area for this. The washing machines were fitted with a pre-wash and boil wash facility for laundering very soiled linen and clothing. Infection control policies were available in the home. Some staff were doing an Infection Control course through a local College. Gloves and aprons were available and staff used these correctly. Liquid soap and paper towels were provided in all areas. Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were sufficient staff on duty to meet the needs of the residents. The recruitment procedures did not fully ensure the protection of residents at the home. Staff did not receive regular updates to their training and this meant that their skills and knowledge might not be up to date. EVIDENCE: There was a duty rota showing the names and grades of staff and what hours they worked. The number of staff rostered for duty was sufficient for the number of residents living at the home. There was a Registered Nurse on duty 24 hours per day. The manager was also on duty Monday to Friday and there was a part time administrator. There was an adequate amount of ancillary staff, which consisted of: cleaners; Cooks; Kitchen assistants; and a part-time Handyman. The recruitment procedures included completion of an application form, a faceto-face interview, obtaining of references and a POVA First and Criminal Records Bureau check. The files for 3 new employees were checked. These showed that the procedures had not been followed fully. One person had worked at the home as an Agency staff and had then been employed part time at the home. She had started her employment before her Criminal Records Bureau check had come through. Two other files only had one reference in them and no explanation as to why. All of the files viewed had proof of Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 21 identity. Although there was a copy of the General Social Care Council’s code of conduct at the home staff were not issued with their own personal copy to refer to. The manager had just introduced a first day induction sheet that covered fire safety and other important issues. There was an Induction booklet that was done with all new staff. The new carers were given a more senior member of staff to work with who took responsibility on ensuring that they covered all the subjects in the Induction booklet. An Induction booklet examined had all the subjects signed off as the member of staff being judged competent on one day. There was no overall training matrix to show what training had been done and when by each member of staff. The amount of training given to staff had substantially reduced over the last eight months, and staff spoken to confirmed this. Arrangements were being made for this to be increased. The training records for staff since September 2006 could not be located. They were missing from the folders where they were usually stored. There were 29 carers employed of whom 27 of these had the National Vocational Qualification in care level 2 and one had level 3. This meant that staff were given the skills and knowledge to do their work. The lack of regular updates meant that these might not be up to date. Three other carers were enrolled on the National Vocational Qualification in care level 3. Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was managed by an experienced person and was run in the best interests of residents. Staff were not being appropriately supervised with the potential that they might not fully understand their roles and responsibilities. The lack of training for staff meant that the health, safety and welfare of residents and staff was not fully promoted and protected. EVIDENCE: A new Manager had been appointed in September 2006. She was a Registered Nurse and had many years experience of managing a care home. She was starting the Registered Manager’s Award from May 2007. Her application for registration with the Commission had not yet been submitted. This meant that there was nobody taking legal responsibility for the day-today management of the home. The manager said that she had a job description but felt that the Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 23 content needed updating. She was aware of her role and responsibilities and was well supported by the registered persons. The home had been awarded the Investors in People award. There was a development plan for the coming year with intended dates for completion. The documentation previously used as a Quality Assurance tool was no longer available in the home. The manager had developed her own audits for specific areas. If the audit identified any deficiencies there was an action date for completion. Residents meetings were not held. The manager said that these are to be arranged as some residents have asked for this to be done. No resident or relative surveys had been done since she was in post. The manager said she was intending to do and had involved residents in meal planning and menu changes. She said that she took time each day to go out and talk to residents. No relatives meetings were held. The manager had invited each relative to a case conference where, on a 1:1 basis, the care and any particular issues of concern were discussed. Staff meetings were held. A meeting for Team Leaders and night staff had been held and one for all grades of staff arranged. The minutes of the meeting were seen. They did not give an indication of who would be taking action on the issues raised. Residents could manage their own money if they wished to and were capable. In practice the residents’ family generally did this. The Responsible Individual was appointee for seven residents and collected their pensions and distributed their personal allowances. Money was kept in the safe in the office for some residents. There was a record book with the balance in. The record did not give an account of where the money had come from and did not have a signature to record who had completed the transaction. The amounts held and the record book were checked and agreed. There were no supervision records in staff files. Staff spoken to said that they had not had 1:1 supervision for quite some time. This meant that they did not have the opportunity to bring up issues or concerns that affected their work Not all of the records required to be kept at the home were available since September 2006. This is not a reflection on the current manager but is obviously a cause for concern. All the required testing and servicing was done on equipment. This ensured that the home was safely maintained. Any accident that happened was recorded. Safe working practices training needed to be updated for staff to ensure that they health and safety of residents and themselves was maintained. Training in safe working practices had not been done for some time and meant that staff may not be fully aware of how to keep themselves Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 24 and residents safe. This was demonstrated by seeing staff using the under-arm lift, which is unsafe for both themselves and the resident. Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 2 2 Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14(1)(d) Requirement Prospective residents must be informed in writing before they are admitted as to whether the home can meet their needs or not Residents or their representatives must be consulted about the care plan wherever this is practicable The care plan must be kept under review and any necessary amendments made The registered person must ensure that full and accurate records are kept of all medicines received, administered and leaving the care of the home The registered provider must ensure that authority is obtained for administering medication via PEG tubes. Individual protocols for this procedure must be in place for each resident. (Previous timescale of 31/03/06 not met) There must be evidence of an assessment of the resident’s capabilities before they selfmedicate any items. DS0000067797.V331743.R01.S.doc Timescale for action 30/04/07 2 OP7 15(1) 30/06/07 3 4 OP7 OP9 15(2) 13(2) Schedule 3(i) 13(2) 30/06/07 30/06/07 5 OP9 30/06/07 6 OP9 13(2) 31/05/07 Haydock Nursing & Residential Care Home Version 5.2 Page 27 7 OP12 16(2)(m) & (n) 12(4)(b) 8 OP15 9 OP29 19 10 OP30 18(c)(i) A range of social and recreational activities must be provided so that residents needs in this area are met. Arrangements must be made for residents’ religious and cultural dietary needs to be met and for all staff to be aware of these so that they get the correct diet All the relevant documentation must be obtained before a new member of staff starts work at the home. All staff must receive training relevant to the work they are to perform. This must include: moving and handling; fire safety; infection control; food hygiene; first aid; and Protection of Vulnerable Adults. 31/05/07 30/04/07 21/04/07 30/09/07 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 Refer to Standard OP2 Good Practice Recommendations Copies of contracts for those residents admitted before September 2006 should be obtained form either the resident or their relatives. Alternatively, new contracts should be issued. Copies of the assessments for those residents who are publicly funded and were admitted prior to September 2006 should be obtained from the relevant Local Authorities. The plan of care should include adequate directions on how to deal with confused behaviour. When doing the care plan review there should be a statement made as to the progress being made to meet the needs All residents should be assessed for their risk of falls and this kept under review. Where risks are identified there should be directions in the plan of care on how to reduce DS0000067797.V331743.R01.S.doc Version 5.2 Page 28 2 OP3 3 4 5 OP7 OP7 OP8 Haydock Nursing & Residential Care Home or manage these. 6 OP8 Appropriate moving and handling techniques should be used for all residents. The use of the under-arm lift must be discontinued, as it is unsafe for both residents and staff. Criteria for the administration of when required and variable dose medication should be clearly defined and recorded for all service users prescribed such items. A second member of staff should witness all hand written annotations on Medication Administration Record charts. Items for residents not longer at the care home should be disposed of so that they are not inadvertently used for other residents. Non-medicinal items should not be stored in the Controlled Drug cupboard as this may affect the security of the storage. 8 9 10 OP12 OP15 OP29 Suitable arrangements should be made to enable residents to engage in local, social and community activities. All staff should be made aware of any religious or cultural needs of the residents and ensure that these are met. Each member of staff should be issued with their own copy of the General Social care Council’s code of conduct and practice. The Induction books should be completed as the new employee is deemed competent and not ‘signed off’ all on one day. An application for Registered Manager should be submitted to the Central Registration Team as soon as possible. The job description for the registered manager should be revised to ensure that the role and responsibilities stated are still up to date. Meetings for residents should be arranged so that they can make their views known Surveys of residents and relatives views of the home should be done. Any minutes taken of meetings should show who is to take responsibility for taking action on the points raised. Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 29 7 OP9 11 OP30 12 13 OP31 OP31 14 OP33 15 OP35 The financial records should have more detail and should contain the signature of the person who has made the entry. All care staff should receive regular supervision 16 OP36 Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Haydock Nursing & Residential Care Home DS0000067797.V331743.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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