Inspection on 28/04/08 for Haydock Nursing & Residential Care Home

This inspection was carried out on 28th April 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Haydock Nursing & Residential... 19/04/07

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Haydock Nursing & Residential Care Home Pleckgate Road Ramsgreave Blackburn Lancashire BB1 8QW Lead Inspector Marie Matthews Unannounced Inspection 28th April 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Haydock Nursing & Residential Care Home DS0000067797.V360794.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.V360794.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 Mr John Hardy 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.V360794.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: A review of the registration certificate was underway to reflect changes to accommodate people with a dementia. Haydock Nursing Home provides both nursing and personal care for up to thirty-eight residents who are elderly and up to twelve who suffer from dementia. The home is registered for up to fifty residents in total. Haydock Nursing Home is owned by Grange Healthcare Limited. A manager is responsible for the day-to-day management of the home. 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. There is a self-contained unit located on the first floor for up to twelve residents who suffer from a dementia. All rooms have an en suite facility. Access to the first floor is via a passenger lift or a stair lift. Information about the services offered by the home is provided in the form of a service user guide and is available, with a summary of the most recent inspection report, to existing and prospective residents and their relatives. On the day of the inspection the weekly fees ranged from £342.50 to £550.00. No additional charges were made. Haydock Nursing & Residential Care Home DS0000067797.V360794.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The key unannounced inspection, including a visit to the home, took place on 28th April 2008. The inspection process included looking at records, a tour of the home, discussions with the registered manager, two care staff, one visitor and six residents. Information was also included from survey forms filled in by three staff, six visitors and one resident. The inspection also looked at things that should have been done since the last visit and a number of areas that affect people’s lives. There were thirty-seven residents living in the home on the day of the inspection. What the service does well: People were given clear information about services available at the home to be able to decide whether the home was suitable for them and whether their needs would be met. 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. Visitors were made welcome at the home and were kept up to date and consulted about changes to care. Visitors were complimentary about the care; comments included ‘staff are very attentive and always keep me in the picture’, ‘staff respond well to any requests made regarding my mothers health and wellbeing’, ‘medical problems are well monitored and cared for’ and ‘they treat my mother with respect and her dignity is maintained. One visitor commented that ‘the home has a good community spirit; it works hard at ensuring residents feel as much at home as possible. Staff treat residents as individuals and show a real interest in them and their lives.’ During a tour of the home it was clear that the home was maintained, safe and comfortable and was equipped with specialist equipment and adaptations to Haydock Nursing & Residential Care Home DS0000067797.V360794.R01.S.doc Version 5.2 Page 6 meet resident’s individual needs; re-decoration was underway on the first floor. Resident’s rooms were clean and bright and most had been personalised with treasured possessions. One resident was very pleased with her coordinating carpet, curtains and light fitting. Another resident commented ‘I have a lovely room with a view over the fields’. Records showed that most of the care staff had a recognised qualification (NVQ) in care and staff said they were given training that was relevant to their role and this helped them to look after residents properly. Residents were confident about the staff and about the care they received; the comments included ‘most of the staff look after me very well and are extremely kind on the whole, I am very happy at Haydock’ and ‘some of the staff are excellent others are okay. The majority of them are very kind’. The staff team were competent, well supported and provided in sufficient numbers to be able to meet residents’ needs. What has improved since the last inspection? The information about services available at Haydock had improved; it was available in various formats and there were staff that could translate the information fluently into other languages if needed. When an assessment had been completed the registered manager contacted the prospective resident telling them whether the home could meet their needs or not; this would reassure people that they will be looked after correctly. Care plans had been reviewed since the last inspection; the plans were clearer, and included details about how residents care needs would be met. The care plans were at different stages of improvement; staff said they were ‘updating care plans to give an accurate representation of changing needs’. Some medication practices had been improved to ensure the health and safety of residents was protected. Care Staff had received training to support them with medication administration practices; this would ensure medicines were handled safely. Residents’ social interests and needs were being met and the daily routines for residents matched their preferences and choices. Comments from residents included ‘there are things going on or I can do whatever I want. I enjoy reading my paper’, ‘ministers visit irrespective of your religion’ and ‘I can lie in bed in the morning and breakfast comes when I’m ready’. The menu showed that residents were offered a varied and nutritious diet; comments from residents included ‘I always get a choice. They will make something else for me if I ask’ and ‘the food is lovely you can have what you Haydock Nursing & Residential Care Home DS0000067797.V360794.R01.S.doc Version 5.2 Page 7 want. If I don’t like it they will make me something else’. One relative said ‘the food is excellent and they (residents) are given a choice each day’. Mr John Hardy had recently been registered with the Commission for Social Care Inspection to manage the day-to-day running of the home. People made positive comments regarding Mr Hardy’s contribution to improving the home. Regular support and supervision had been introduced for staff; this ensured they were aware of their roles and responsibilities. There was a new unit on the first floor that provided specialised care for residents with dementia; this unit was staffed separately and could be accessed using a key code to ensure people were safe. Staff on this unit had bee provided with specialised training to help them to look after residents properly. A number of staff had been provided with training to help them to meet resident’s needs. Staff said the provision of training had improved. People were consulted about whether their needs and expectations were being met. Methods included surveys, meetings and newsletters and residents were able to discuss the improvements made so far. What they could do better: All residents should be issued with a copy of their statement of terms and conditions or contract; this would inform them of their rights and obligations during their stay at Haydock. Residents and their relatives had not been involved in the development and review of the care plans or involved in decisions about care. The care plans could be improved to include resident’s individual choices and preferences to ensure they received the care they needed and wanted. Some areas of medication management need to be improved to ensure resident’s medicines were administered and stored correctly. The procedures to protect residents from harm did not provide staff with the appropriate guidance and could put residents at risk. Staff had still not had safeguarding adults training and failure to provide this training may result in abusive practices being unrecognised and unreported. Some areas of the home needed redecoration and refurbishment although there was no formal development plan that supported ongoing and future improvements. One visitor had commented that ‘replacement of carpets, dining furniture, residents chairs and bedding’ was needed to improve the home. Haydock Nursing & Residential Care Home DS0000067797.V360794.R01.S.doc Version 5.2 Page 8 Audit systems were not yet in place to monitor whether staff were adhering to policies and procedures although systems had been introduced to audit the kitchen and financial areas of the home. The registered manager said systems were being developed. There were concerns that staff were not provided with regular updates of safety training to ensure they continued to have the skills to meet people’s safety needs; failure to update staff in safe practices could put people at risk. The registered manager was aware that there were gaps in the provision of training and was dealing with this; he had developed links with training providers to access appropriate training for staff. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Haydock Nursing & Residential Care Home DS0000067797.V360794.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 Haydock Nursing & Residential Care Home DS0000067797.V360794.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): 1, 2, 3 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were given clear information about services available at the home to be able to decide whether the home was suitable for them and whether their needs would be met. Detailed information was collected about residents before they were admitted to determine whether they could be looked after properly. EVIDENCE: Information about the services provided at Haydock Nursing & Residential Home had improved so that people could make informed decisions about whether it was a suitable for them to live. A monthly newsletter named the ‘Haydock Gazette’ had recently been introduced; this contained useful information about what was happening within the home and a number of residents said they had found it very informative Haydock Nursing & Residential Care Home DS0000067797.V360794.R01.S.doc Version 5.2 Page 11 and interesting. There was also a ‘hotel services’ pack that contained useful information about menus and available choices. All of the information was available in various formats and there were staff that could translate the information fluently into other languages if needed. One resident and six visitors commented that they were given sufficient information about services offered at Haydock. Three residents files were looked at in detail. Only one resident had a copy of their statement of terms and conditions or contract; the contract would inform people of their rights and obligation during their stay at Haydock. Two of the residents had recently been admitted. There was evidence that staff had completed assessments of residents needs although it was unclear whether these had been done prior to admission, as they were not dated. Care management assessments and nursing assessments had been obtained prior to their admission to the home; this would help to determine whether their needs could be met. All three files had letters confirming that their needs could be met following the assessment visit. Records showed that staff had a range of skills and experience to look after residents properly. Specialised dementia training had been provided for some staff to help them to care for the residents on the new unit. Residents and their visitors confirmed that their needs were met. Haydock Nursing & Residential Care Home DS0000067797.V360794.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): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s health and personal care needs were met although people were not involved in decisions about their care. The medication policies and procedures had improved and provided guidance for safe practice although there were some aspects in need of improvement to ensure that medicines were managed safely. EVIDENCE: Three residents care records were looked at in detail. Care plans had been reviewed since the last inspection; the plans were clearer, developed from information obtained prior to admission and included details about how residents care needs would be met. The care plans were at different stages of improvement and a member of staff commented that they were ‘updating care plans to give an accurate representation of changing needs’. Haydock Nursing & Residential Care Home DS0000067797.V360794.R01.S.doc Version 5.2 Page 13 The care plans did not always reflect individual choices and preferences although the registered manager said he was aware of this and ‘person centred planning’ training in this aspect was to be provided. The care plans had been reviewed every month (since January 2008) and there was evidence that the plans had been updated to reflect current care needs. The records did not show that residents and their relatives had been involved in the development and review of the care plans or involved in decisions about care. The registered manager said he intended to invite residents or their relatives to participate in annual reviews and information in the newsletter advised people of this process. Survey information indicated that visitors were kept up to date and consulted about changes to care. One visitor said ‘staff are very attentive and always keep me in the picture’ another commented ‘staff respond well to any requests made regarding my mothers health and wellbeing’. Assessments were in place to identify any risks to individual residents and these were supported by a plan of action that would help staff to prevent or reduce any risks; however they had not always been regularly reviewed or dated and it was unclear whether they reflected the current level of risk. There were two residents with pressure sores but the care plans did not detail the current treatment regime or record whether there had been improvement or deterioration as there were separate wound care plans stored in the office. The registered manager was advised that the information on the care plan should be up to date or reference made to a separate plan as staff needed clear information to ensure residents received the correct care and attention. There were records to support residents had access to specialist health care. One resident said ‘I have recently been ill. The care given to me during this time and following this illness has been excellent’. One visitor commented ‘medical problems are well monitored and cared for’. Residents were provided with a range of specialised aids and adaptations to maintain their comfort and safety and to help them to maintain their independence wherever possible. As yet there were no systems in place to monitor whether care plans had been completed correctly or whether residents needs were being met. The medication policies and procedures provided safe guidance for staff in most aspects of management of medicines. Procedures were needed to support staff with ‘PRN’ or ‘as needed’ medicines, transcribing or handwritten Haydock Nursing & Residential Care Home DS0000067797.V360794.R01.S.doc Version 5.2 Page 14 directions and self-medication. Records were checked and these were generally clear and accurate. However there were still no clear protocols to help staff with their decision to administer ‘PRN’ or ‘as needed’ medicines and handwritten directions had still not been witnessed which could result in errors; both issues had been raised at the last inspection. Medicine disposal records should be witnessed to prevent any mishandling. Medicines were stored securely and temperatures of storage areas had been recorded. It was noted that the treatment room temperature was very warm and had been reading above 25 degrees for approximately a week but no action had been taken to respond to this; there was an air cooler in the room but it was not switched on. This was discussed with the registered manager, as medicines must be stored at the correct temperature to maintain their effectiveness. Not all residents had a safe means of identification such as photographs; the registered manager said all photographs had been taken but were not yet in place. The registered manager said there were no residents who were self medicating therefore this requirement could not be assessed. There was no evidence within the care plans to support residents had been given the opportunity to self-medicate. Qualified nurses and a number of care staff who had attended appropriate training were responsible for the safe administration of medicines. Care staff spoken to confirmed they could only administer medicines if they had been trained to do so although there were no assessments of competency seen and it was unclear how many care staff had attended training; assessments of competency should be completed to confirm care staff had understood the information. There were no audit systems in place, as detailed in the AQAA, although the registered manager said they would soon be introduced. It was clear that some aspects of medicine management had improved although there were still some areas in need of attention. Staff were seen responding to residents and visitors in a friendly but respectful manner and resident’s privacy was respected. There were procedures to support staff with all aspects of meeting people’s needs and staff had received appropriate training. One visitor commented ‘they treat my mother with respect and her dignity is maintained at all times’. Haydock Nursing & Residential Care Home DS0000067797.V360794.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ social interests and needs were being met and the daily routines for residents matched their preferences and choices. Residents were offered a varied and nutritious diet that met their individual preferences. EVIDENCE: A range of suitable activities and entertainments were advertised although the home did not have an activities co-ordinator and staff were expected to provide this service; staff said they were sometimes called away to support other residents or staff which made it difficult to meet residents social needs at times. The registered manager said he planned to advertise for an activities person to improve the provision of activities for residents. Each resident had a social assessment but these were very basic and did not help staff to plan suitable activities for individual residents. There were limited records to support that individual residents had taken part in a range of suitable activities although some residents were able to describe the activities Haydock Nursing & Residential Care Home DS0000067797.V360794.R01.S.doc Version 5.2 Page 16 on offer and others said they preferred to spend time in their rooms and read or watch TV and this was respected by staff. Comments from residents included ‘there are things going on or I can do whatever I want. I enjoy reading my paper’, ‘ministers visit irrespective of your religion’ and ‘I can lie in bed in the morning and breakfast comes when I’m ready’. The recent newsletter encouraged residents to discuss any activities that they would like to participate in. Visitors commented that residents were given support to live life they chose. One resident said her visitors were able to visit at any time and in any area of the home; there were a number of seating areas for this purpose. One visitor commented that ‘the home has a good community spirit; it works hard at ensuring residents feel as much at home as possible. Staff treat residents as individuals and show a real interest in them and their lives.’ One resident said she had ‘made some good friends’ since coming to live at Haydock. Many of the bedrooms were personalised and some had telephones in their rooms to help them maintain contact with friends and family; others were given support to keep in touch with people. The menu showed that residents were offered a varied and nutritious diet; although records of food served were incomplete and did not support choices were offered at all times. One resident said they were not always offered a choice of meal at lunchtime but always offered a choice at teatime. Other comments from residents included ‘I always get a choice. They will make something else for me if I ask’ and ‘the food is lovely you can have what you want. If I don’t like it they will make me something else’. One relative said ‘the food is excellent and they (residents) are given a choice each day’. Residents and staff confirmed that meals could be served in resident’s rooms if preferred and suppers were available throughout the night. Each resident was supplied with a ‘hotel services’ pack informing them of the menu and choices available. The lunchtime meal served was nutritious and attractively presented; two residents who were spoken to said they had enjoyed the meal. Dietary needs were recorded in the care plan and special occasions were celebrated. A number of residents needed assistance with their meals and staff were seen giving unhurried support although the practice of ‘feeding’ residents in the main lounge needed to be reviewed as everyone should be given the opportunity to dine in the dining areas. Dining areas were bright and tables were generally attractively set. There were two separate dining areas for residents on the dementia unit and a large dining area on the ground floor; the carpet and some of the furniture looked ‘tired’ and needed replacing. There was a kitchenette area on the ground floor where Haydock Nursing & Residential Care Home DS0000067797.V360794.R01.S.doc Version 5.2 Page 17 residents and their visitors could make a drink; another was planned for the first floor. An audit tool had recently been introduced to monitor standards in the kitchen. Haydock Nursing & Residential Care Home DS0000067797.V360794.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People were confident their concerns would be listened to and acted upon. The safeguarding procedure did not provide staff with clear and appropriate guidance and the lack of staff training may result in abusive practices being unrecognised and unreported. EVIDENCE: The complaints procedure was clear and accessible to people and available with the service user guide in different formats. People were aware of how to raise concerns and were confident they would be responded to appropriately. One resident said she would speak to the registered manager as ‘he would listen’. The complaints record was looked at and showed there had been three complaints in the last twelve months; two had been dealt with appropriately and the third was being responded to although the complainant said he had not had a written response as yet. This will be monitored at the next key inspection. The home had safeguarding procedures in place but these did not provide staff with the appropriate guidance to ensure residents were protected from harm. They needed to include the correct contact information for local agencies and information stating that any suspicion or incidents of abuse must be reported Haydock Nursing & Residential Care Home DS0000067797.V360794.R01.S.doc Version 5.2 Page 19 under the safeguarding procedures. There had been one incident that had been referred under safeguarding; the home had responded appropriately. Previous concerns had been raised about the lack of safeguarding adults training as failure to provide this training may result in abusive practices being unrecognised and unreported. There were still no records to support that staff had received safeguarding training; staff said they had not attended any training but one was able to describe how to respond if they suspected any abuse. There were procedures to support staff with dealing with verbal and physical aggression although staff had not had any training to support them with challenging behaviour; this training was needed to protect residents and staff from harm. There were procedures to support staff with reporting any concerns and to guide them with safe management of resident’s financial affairs. There was also a procedure to support staff with decisions to use physical restraint; the use of restraint was risk assessed and discussed with the resident concerned or their relative. Haydock Nursing & Residential Care Home DS0000067797.V360794.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was safe, clean, comfortable and well maintained although records did not support that further improvements were planned that would develop the home and provide a pleasant place for residents to live. EVIDENCE: During a tour of the home it was clear that the home was maintained, safe and comfortable and was equipped with specialist equipment and adaptations to meet resident’s individual needs. Re-decoration was underway on the first floor although the ground floor areas were in need of attention as these areas looked ‘tired’. One visitor had commented that ‘replacement of carpets, dining furniture, residents chairs and bedding’ was needed to improve the home. There was no formal development plan that supported ongoing and future improvements although the registered manager had a number of plans to improve the home. A number of residents were able to discuss the Haydock Nursing & Residential Care Home DS0000067797.V360794.R01.S.doc Version 5.2 Page 21 improvements made so far and the ‘Haydock Gazette’ contained information to keep people up to date. A passenger lift was used to access both floors; there had been two comments regarding problems with the lift breaking down. The registered manager confirmed there had been a number of problems with the lift and said it had been serviced recently to address the problems; a stair lift was available as an alternative although access was limited due to storage of furniture. A recommendation was made to ensure this area was easily accessible as it was a fire exit. There was a new unit on the first floor that provided specialised care for residents with dementia; this unit was staffed separately and could be accessed using a key code to ensure people were safe. There were memory boxes that included personal items and photographs outside some of the bedroom doors to help residents to easily recognise their rooms. Garden areas were safe, well maintained and accessible. There were seating areas for residents and their visitors to enjoy the warmer weather and the views of the countryside. There were a number of communal areas within the home and toilets and bathrooms were close to lounge and dining areas. All rooms had en suite facilities; some were equipped with hand basins and others with showers or baths. Residents were provided with specialised aids and equipment to assist with their comfort and safety and to help them to maintain their independence wherever possible. All rooms were fitted with nurse call systems for residents to use to summon assistance from staff and there were assessments in place to explain the reasons for non-provision of call leads. Resident’s rooms were clean and bright and most had been personalised with treasured possessions. One resident was very pleased with her co-ordinating carpet, curtains and light fitting. Another resident commented ‘I have a lovely room with a view over the fields’. The registered manager said that some of the beds and furniture had been replaced and this would be ongoing; a number of residents had brought in their own furniture to enhance the homely feel. Residents doors had locks in place and one resident told the inspector that she had been given a door key; secure storage space was also provided for personal items. The provision of keys was not routinely risk assessed although residents could have a key to their room if they wished. The laundry was suitably equipped and organised to ensure residents clothing was returned promptly. People said the home was always clean. One resident said ‘the home is always clean and doesn’t smell’ another said ‘my clothes are looked after’. Haydock Nursing & Residential Care Home DS0000067797.V360794.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): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team were competent, well supported and provided in sufficient numbers to be able to meet residents’ needs although records did not always support this. The recruitment procedure was clear and would help to ensure that residents were protected from harm. EVIDENCE: Rotas showed the home was staffed with sufficient numbers of staff to meet the needs of the residents. One resident commented that ‘there are usually staff available when needed’, two visitors commented that the home is ‘sometimes short staffed and staff don’t have the time to tend to the finer details of care’ and ‘there are so few staff and they are far too busy in essential tasks’. Three staff commented there was sufficient staff. The rotas did not clearly show the full names and role of staff on duty; this was discussed with the registered manager. Staff were divided into teams and each resident had a key worker; this would help to provide continuity of care for residents and their visitors. One visitor said she always knew who to speak to for information and regularly spoke to her relatives’ ‘special’ carer. The staff group was a mix of male and female staff of various ages and cultural backgrounds to assist residents with individualised personal care. Haydock Nursing & Residential Care Home DS0000067797.V360794.R01.S.doc Version 5.2 Page 23 The recruitment procedure was clear. The registered manager said there had been no new staff for some time therefore it was difficult to establish whether a safe procedure had been followed. Recruitment checks were in place for the three staff files looked at. A system to identify when Nursing and Midwifery Council (NMC) registrations are due to expire should be developed as the registered manager needs to ensure nurses had a current registration to practice and recent photographs, as a means of identification, should be maintained on all staff files. Records showed that most of the care staff had a recognised qualification in care and staff said they were given training that was relevant to their role and this helped them to look after residents properly. Staff commented that training, supervision and appraisal were provided and was ‘more structured’ another staff said ‘we have appraisals every so often to see how we are doing’. They said the provision of training had improved. There was a training matrix but this did not record all the training that had taken place or the training that was planned. It was unclear from the records whether staff had attended mandatory safety training (see standard 38), safeguarding training, safe management of medication training (see standard 9) or management of aggression training. From the three staff files reviewed it was clear that two staff had not received up to date fire, safeguarding and moving & handling training and this could people at risk (see standard 38). The registered manager was aware that there were gaps in the provision of training and was dealing with this; he had developed links with training providers to access appropriate training for staff. Records showed that any new staff had completed induction training and staff confirmed they would be assigned to a member of staff to ‘shadow’ them. Staff meetings have been introduced and minutes were recorded. Staff were able to voice their opinions and be involved in decisions about the way the home was run. Residents were confident about the staff and about the care they received; the comments included ‘most of the staff look after me very well and are extremely kind on the whole, I am very happy at Haydock’ and ‘some of the staff are excellent others are okay. The majority of them are very kind’. Visitors comments included ‘they give her quality of life in a nice atmosphere and all the staff are caring and concerned about my mothers health. I cannot commend staff enough for their aid to mum at this difficult time. Their concern about her well being is appreciated’ and ‘I am very involved in her care. She has always been happy at Haydock and from the outset staff have been kind and caring and the standard of care has been good’. Haydock Nursing & Residential Care Home DS0000067797.V360794.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People were able to air their views and opinions about whether the home was meeting their needs and expectations although safety training had not been provided for all staff and meant that the health, safety and welfare of residents and staff was not fully promoted and protected. EVIDENCE: Mr John Hardy had recently been registered with the Commission for Social Care Inspection to manage the day-to-day running of the home. He has had 25 years of experience in the management of care, has suitable management qualifications and is a registered nurse. People made positive comments Haydock Nursing & Residential Care Home DS0000067797.V360794.R01.S.doc Version 5.2 Page 25 regarding Mr Hardy’s contribution to improving the home. One member of staff commented that communication had improved between management and staff and another said ‘more effective communication methods have been implemented’. Systems to determine whether people’s needs and expectations were being met had improved. A residents survey had been sent out in March 2008 and responses would be analysed and made available to people; it was anticipated that this would be done every three months. Meetings with residents and staff had been introduced and minutes were recorded; this meant that people were able to express their views. People were kept up to date through a monthly newsletter; a number of residents were able to discuss what changes had been made and what was planned for the future. The home had achieved an external quality award Investors In People award; this monitored how staff are developed and how the business is managed. Audit systems were not yet in place to monitor whether staff were adhering to policies and procedures although systems had been introduced to audit the kitchen and financial areas of the home. The registered manager said systems were being developed. The registered provider visited the home on a regular basis and completed a detailed report of her findings; this showed she was monitoring the day-to-day management of the home. Policies and procedures had been reviewed to provide safe guidance with current practice for staff. A formal development plan was not yet available; the registered manager said this should be done soon and would show plans for the coming year. The AQAA was provided before the inspection visit and gave us a reasonable picture of the current situation. Two residents financial records looked at; records were clear and accurate and showed that their finances were safe guarded by the systems and record keeping. Regular one to one individual and team support had been introduced for all staff; this would ensure that they were following policies and procedures and identify any training and development needs. At the last inspection there were concerns that staff were not provided with regular updates of safety training to ensure they continued to have the skills to meet people’s safety needs. A training matrix showed that there were forty staff in total and training in safe working practices had commenced; twelve Haydock Nursing & Residential Care Home DS0000067797.V360794.R01.S.doc Version 5.2 Page 26 staff had received health and safety training, eleven had attended first aid training, eight had received mental capacity training and nine had attended dementia awareness. Only ten had received fire safety training and this was overdue, thirteen had received moving and handling update training and attendance at safeguarding, infection control, food hygiene and medication training was not recorded; there were no records to support further training was planned. From the three files reviewed it was clear that two had not received up to date fire, safeguarding and moving & handling. Failure to update staff in safe practices could put people at risk. Records showed that systems were serviced and safely maintained. Haydock Nursing & Residential Care Home DS0000067797.V360794.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 2 2 3 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 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 3 X 3 X 3 STAFFING Standard No Score 27 2 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 2 Haydock Nursing & Residential Care Home DS0000067797.V360794.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? 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 OP7 Regulation 15 Requirement Residents or their representatives must be consulted about the care plan wherever this is practicable. Timescale of 30/11/07 not met. 2. OP18 13 The safeguarding procedures must be reviewed to provide clear guidance for staff. All staff must receive training in safeguarding adults to ensure they recognise and respond appropriately to protect residents from abuse. 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 and Protection of Vulnerable Adults. Timescale of 30/11/07 not met. 30/06/08 Timescale for action 30/06/08 3. OP30 18 30/06/08 Haydock Nursing & Residential Care Home DS0000067797.V360794.R01.S.doc Version 5.2 Page 29 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. 3. 4. Refer to Standard OP2 OP3 OP7 OP8 Good Practice Recommendations All residents should have a signed copy of their contract informing them of their rights and obligations. Pre admission assessments should be clearly dated at the time of the assessment visit. Care plans should detail resident’s choices and preferences to ensure all aspects of their care needs are met by staff. Assessments of risks to residents should be dated at the time of the initial assessment and kept under regular review. Wound care information should be included on the care plan. 5. OP9 There should be procedures to support staff with the safe administration of ‘when required’ or ‘PRN’ medicines, witnessing handwritten directions and self-medication. Criteria for the administration of ‘when required’ or ‘PRN’ medication should be clearly defined and recorded for all residents prescribed such items. A second member of staff should witness all hand written directions on Medication Administration Record (MAR) charts. Records of medicines for disposal should be witnessed to prevent mishandling. Photographs, as a means of identification, should be stored with residents MAR charts. Action should be taken in response to any variance in the temperatures of medicine storage areas to ensure medicines are stored at the correct temperature. There should be evidence to support residents have been Haydock Nursing & Residential Care Home DS0000067797.V360794.R01.S.doc Version 5.2 Page 30 given the choice to self medicate. Assessments of competency should be available for all care staff that have completed medication training. 6. 7. OP12 OP15 There should be records to support a range of suitable activities have been provided for residents. There should be records to support that residents are given choices and alternatives at each mealtime. All residents should be allowed to dine in the dining room areas and the practice of ‘feeding’ residents in the lounge should be reviewed. 8. OP18 The safeguarding procedures should include the contact information of local agencies that would need to be contacted in the event of any abuse or suspicion of abuse. Staff should be provided with training to help them to respond safely and appropriately to verbal and physical aggression. 9. OP19 There should be a formal programme to support ongoing and future improvements to all areas of the home. Furniture stored in the ground floor rear exit areas should be removed to allow for clear access in the event of an emergency. 10. 11. OP27 OP29 Staffing rotas should clearly state the full name and role of all staff members. There should be a record of when NMC checks are due to expire to ensure all nurses are fit to practice. Photographs, as a means of identification, should be included each staff file. 12. OP30 The staff training matrix should include up to date information regarding any training that has taken place or is planned. A range of auditing systems should be introduced to monitor whether staff are complying with policies and procedures and to determine whether people’s needs are met. These include care planning, medications and environmental audits. DS0000067797.V360794.R01.S.doc Version 5.2 Page 31 13. OP33 Haydock Nursing & Residential Care Home There should be an annual development plan for the home. Haydock Nursing & Residential Care Home DS0000067797.V360794.R01.S.doc Version 5.2 Page 32 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.V360794.R01.S.doc Version 5.2 Page 33 - 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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