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Inspection on 04/04/08 for Hebburn Court Nursing Home

Also see our care home review for Hebburn Court Nursing Home for more information

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff collects information together about the person before anyone moves into the home to make sure they can meet their needs. Visitors are always welcomed and there are links with the local community.The in house maintenance records and external contract certificates were up to date. Many of the staff have worked at the home for a long time and they have formed a good team and take pride in the work they do. People spoken to said "There is always plenty to eat" "everything is champion" and "I have nothing to grumble about". Visitors said: "we are always welcome" "I am happy with X`s care" and "A is well looked after". There is plenty of food with alternatives available. The home is clean, tidy and a comfortable place to live.

What has improved since the last inspection?

The Company have recruited an experienced manager to improve the standards and to make sure that there is clear leadership and direction given to all staff in the day-to-day management of the home. There has been redecoration and replacement of furniture, which has improved the environment. Staff say they feel supported and their views are being listened to.

What the care home could do better:

The staff must continue to be supported so that they can feel confident that they will be able to meet people`s needs in a professional manner, taking the principles of a person centred approach to care into account The quality of the care planning needs to improve and all additional records need to be completed in detail. Care plans need to be reviewed and brought up to date. Qualified nursing staff must follow the policies for the safe administration for medicines. Staff must make sure that people`s rights to dignity and privacy are respected at all times. People must also be given the right to make choices about all aspects of their lives. These details must be recorded in the care plan and then followed by all staff.Training and skills of the staff team need to be reviewed so that the staff are confident they have the skills to do the job. The Company`s recruitment, selection and induction programmes must be followed at all times.

CARE HOMES FOR OLDER PEOPLE Hebburn Court Nursing Home The Old Vicarage Witty Avenue Hebburn Tyne And Wear NE31 2SE Lead Inspector Irene Bowater Key Unannounced Inspection 07:15 4 and 11th April 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hebburn Court Nursing Home DS0000039411.V361789.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. Hebburn Court Nursing Home DS0000039411.V361789.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hebburn Court Nursing Home Address The Old Vicarage Witty Avenue Hebburn Tyne And Wear NE31 2SE 0191 428 1577 0191 483 5555 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) www.southerncrosshealthcare.co.uk Southern Cross Care Homes No 2 Limited Position Vacant Care Home 55 Category(ies) of Dementia (27), Old age, not falling within any registration, with number other category (28), Physical disability (15) of places Hebburn Court Nursing Home DS0000039411.V361789.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 28 Dementia - Code DE, maximum number of places: 27 2. Physical disability - Code PD, maximum number of places: 15 The maximum number of service users who can be accommodated is: 55 26th June 2007 Date of last inspection Brief Description of the Service: Hebburn Court Nursing Home is a purpose built home situated in a quiet and discreet residential area of Hebburn, at the site of an old vicarage. The rear of the building provides a pleasant garden view and ample privacy. The Home is registered to accommodate older people who require personal and/or nursing care, including up to 15 people with physical disabilities. The home has been registered to care for up to 18 people who have Dementia needs and who also require nursing care. A separate unit, named The Rivers, has been developed on the first floor of the home accessible by a passenger lift as well as stairs. The unit is divided in two parts, Tyne View and Wear View. In total throughout the home there are 44 single bedrooms, and 12 double bedrooms that are used for single occupancy. En-suite facilities are not provided but there are adequate toilets and bathroom facilities throughout the building. A large central reception area on the ground floor provides seating, in addition to the large lounge/dining areas, and is available to service users and visitors. A large patio with seating facilities is provided to the rear of the ground floor Hebburn Court Nursing Home DS0000039411.V361789.R01.S.doc Version 5.2 Page 5 lounge. Access for wheelchair users is available throughout the Home. The Home is within easy reach of public transport facilities, and the local shops and amenities. The Home is about one mile from Hebburn town centre and approximately two miles from the nearby town of Jarrow. Fees for this service range between £355 and £482 per person per week. Hebburn Court Nursing Home DS0000039411.V361789.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. Before the visit: We looked at: • Information we have received since the last visit on 26 June 2007 • How the service dealt with any complaints and concerns since the last visit • Any changes to how the home is run • The provider’s view of how well they care for people • The views of people who use the service and their relatives, staff and other professionals The Visit: Unannounced visits were made on the 4th and 11 April 2008. The pharmacist completed an audit of medication on the 9 April 2008. During the visit we: • Talked with people who use the service, relatives, staff, the manager and visitors • Looked at information about the people who use the service and how well their needs are met • Looked at other records which must be kept • Checked that staff had the knowledge, skills and training to meet the needs of the people they care for • Looked around the building to make sure it was clean, safe and comfortable • Checked what improvements had been made since the last visit • We told the manager what we found and wrote to the provider about the serious concerns we had. What the service does well: The staff collects information together about the person before anyone moves into the home to make sure they can meet their needs. Visitors are always welcomed and there are links with the local community. Hebburn Court Nursing Home DS0000039411.V361789.R01.S.doc Version 5.2 Page 7 The in house maintenance records and external contract certificates were up to date. Many of the staff have worked at the home for a long time and they have formed a good team and take pride in the work they do. People spoken to said “There is always plenty to eat” “everything is champion” and “I have nothing to grumble about”. Visitors said: “we are always welcome” “I am happy with X’s care” and “A is well looked after”. There is plenty of food with alternatives available. The home is clean, tidy and a comfortable place to live. What has improved since the last inspection? What they could do better: The staff must continue to be supported so that they can feel confident that they will be able to meet people’s needs in a professional manner, taking the principles of a person centred approach to care into account The quality of the care planning needs to improve and all additional records need to be completed in detail. Care plans need to be reviewed and brought up to date. Qualified nursing staff must follow the policies for the safe administration for medicines. Staff must make sure that people’s rights to dignity and privacy are respected at all times. People must also be given the right to make choices about all aspects of their lives. These details must be recorded in the care plan and then followed by all staff. Hebburn Court Nursing Home DS0000039411.V361789.R01.S.doc Version 5.2 Page 8 Training and skills of the staff team need to be reviewed so that the staff are confident they have the skills to do the job. The Company’s recruitment, selection and induction programmes must be followed at all times. 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. Hebburn Court Nursing Home DS0000039411.V361789.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 Hebburn Court Nursing Home DS0000039411.V361789.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 & 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are given detailed information about the home and receive full and comprehensive assessments of need to help them make the right decision about using the service. EVIDENCE: The home has a Statement of Purpose and Service User Guide, which gives a good range of information about living in the home. The Guide is readily available and everyone is given a copy on admission. Information includes how people’s rights will be respected regardless of their age, gender, sexual orientation, race and religion. Hebburn Court Nursing Home DS0000039411.V361789.R01.S.doc Version 5.2 Page 11 The manager or a senior member of staff carry out a full needs assessment for anyone is admitted to the home. They also make sure that the Care Managers assessment and care plan is available. Information is also gathered about peoples previous lifestyles and looks at what they can do for themselves and what support they will need during their stay in the home. These preadmission assessments are used as the basis of the care planning process for each person. Hebburn Court Nursing Home DS0000039411.V361789.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 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Access to health care is satisfactory, but lack of detailed care planning does not demonstrate that peoples’ needs are being fully met. EVIDENCE: Each person has a plan of care based on the admission assessment carried out by care managers, the home manager and where necessary nurse assessors. Staff complete pressure sore risk, dependency, moving and handling, nutritional assessments using the Malnutrition Universal Screening Tool (MUST), continence and fall risk assessments. These tools are there to help staff understand the level of risk each person and help them complete a care plan. Hebburn Court Nursing Home DS0000039411.V361789.R01.S.doc Version 5.2 Page 13 During both visits to the home nine care plans from both units were looked at. They all varied in content and evaluation. Where people have been assessed as needing the hoist or help with mobility the care plans do not specify the specific moving and handling equipment or techniques to assist that person safely. Staff have involved Speech and Language Therapists (SALT) when people have lost weight or are at risk of choking but the care plan records “soft feed as recommended by SALT”. The care plan had not been up dated although this person kept food in their mouth and could possibly be at high risk of choking. The daily progress record shows that this person could be verbally aggressive and regularly shouted. There was no care plan in place to show staff how they should support and manage this behaviour. A care plan for falls had not been up dated since November 2007 and another showed that weights had not been done since January 2008. Daily records show that some people can become very aggressive and one incident escalated into violence. There was no plan of how people could be supported or how staff are to manage behaviours that can challenge The care planning for catheter care on the downstairs unit showed recording of catheter changes, product identification and when catheters were to be changed. There were also examples of catheters being taken out and other continence management techniques used. This was done to prevent further infection for that person. The staff have had training in “person centred care” But there was little evidence to show that this was happening in practice. Unless staff record and have information about peoples previous likes, dislikes and lifestyle it is difficult to understand how individual needs will be met. Staff still need to develop care plans to show how peoples previous history and lifestyle affects their current needs and aspirations. Decisions on how care is given are based on health care needs and not on a person centred approach. People who have low weight or have poor appetite did not have food charts and fluid balance charts for two weeks so that staff could see what they have eaten and drank daily. Without these charts being completed in detail staff could not be sure that peoples health care needs were met. When a qualified member of staff was asked whose responsibility it was to ensure the charts were available the response was the “carers”. There were two good examples of care assessments showing that someone had never married, not a fussy eater and as a Roman Catholic wanted regular Hebburn Court Nursing Home DS0000039411.V361789.R01.S.doc Version 5.2 Page 14 Communion in the home. Another gave details of how staff are to help someone transfer using the hoist “likes staff to count as it calms her and she then smiles”. Everyone has access to all NHS facilities to ensure their healthcare needs can be met. There are regular visits from GP’s and other health professionals including, dentists, opticians and chiropody services. Appropriate pressure relieving devices are available. Several people have air cell mattresses and cushions to prevent pressure damage. Advice is sought from, occupational therapists, speech therapists and continence advisors. Visits from the multi disciplinary team are recorded in individual care plans. A Pharmacy Inspector from the Commission completed an audit of medication in the home. There is a good detailed policy in the home covering all aspects of medicines management. This means staff have access to up to date information on legal requirements and guidance. Stock control appears to be robust and systems are in place to maintain stocks of medicines and to obtain medicines urgently when required. This means that people have prompt access to the medicines they need to maintain their health and wellbeing. Medicines storage facilities are good and fridge temperatures are monitored daily. A urine sample was found in the fridge. Only medicines should be stored in the medicines fridge to avoid the possibility of contamination of medicines. The controlled drugs cupboard appears to meet the safe custody requirements and is of an adequate size. The controlled drug register is suitable for use and entries are legible and complete. There is a record with signatures of staff authorised to administer medicines but the list is not up to date. This makes it difficult to identify who was involved in administration if a problem or error was to occur. There was inconsistency in handwritten entries on the MAR charts and a witness signature was missing on four MAR charts. All hand written entries on the Mar charts should be signed by the person making the entry and an appropriate witness to make sure that there is an accurate record of any changes or new medicines. Duplicate MAR charts for one resident were located in the MAR chart folder and both charts had been used to record the same medicines for this person. If a MAR chart is replaced for whatever reason it is important to remove the old chart immediately. This makes sure that people are only getting medication Hebburn Court Nursing Home DS0000039411.V361789.R01.S.doc Version 5.2 Page 15 that is currently prescribed and prevents additional doses of medicine being given. Allergies to medicines are not always recorded on the MAR chart record for each person. Recording allergies on the MAR chart reduces the risk that persons are given inappropriate medication. There were no gaps on the MAR charts indicating that medicines are being given as prescribed. A system must be in place to check expiry dates of medicines and medication with limited use once opened. This makes sure medication is safe to administer and reduces the risk of contamination. Care plans for three people were looked at. The plans were comprehensive with details of the person’s medication, medical condition, preferred technique for administration and outcomes of visits from healthcare professionals. Staff involved in the administration of medicines should attend some additional training courses to make sure that their training follows current best practice guidance. This means that staff will understand how to handle and administer medicines safely. The manager now undertakes a monthly audit of the medicines processes in the home. This is important to ensure that staff follow medicines procedures and helps identify and resolve promptly any problems with any aspects of medication in the home. Many of the care staff know the people who live in the home very well. There was a difference in how the care was given on the two units. Staff on the downstairs unit interacted well and the atmosphere was friendly and relaxed. The people who live upstairs all have a dementia type illness and can display behaviours that challenge both staff and others. The care was not always given in a person centred way and when people became distressed and anxious staff were unable to explore how to calm the situation. Hebburn Court Nursing Home DS0000039411.V361789.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Opportunities to take part in meaningful activities and keep control of everyday decisions are limited, and mealtimes are not always organised. This prevents people from leading full and active lives. EVIDENCE: The home has an activity programme, which is readily displayed in the entrance and lift of the home. The notices are colourful as well as easy to read. Daily activities and events are generally recorded in the care plans. Staff haven’t fully developed care plans to show how peoples previous history and lifestyle affects their current needs and aspirations. On the first floor unit staff had little insight into how to support people with dementia They knew little about how to support some people who thought they had to go at collect the children or make someone’s dinner. Hebburn Court Nursing Home DS0000039411.V361789.R01.S.doc Version 5.2 Page 17 Some staff did sit and talk in the afternoon but there was no meaningful activities taking place. On arrival at 7:15 am on the ground floor, five people were sitting in the dining room and four were up and dressed sitting in their bedrooms. All were offered a cup of tea. They said that “I am always up early and always got a cup of tea” and “I am alright, I get a cup of tea then wait for breakfast” On the upstairs unit eight people were sitting in the lounges and three were sitting in the dining room. No one was able to express an opinion about what time they got up. Visitors were seen to come and go throughout the visits. Those spoken to said that their relative “got good care” and were “well looked after”. Some relatives said they were regular visitors and “were always made welcome” During the first visit the breakfast meal consisted cereals, porridge, toast and preserves. There were also choices of fried or scrambled eggs, tomatoes and bacon. There were also choices of fruit juices and hot drinks. On both units the staff gave assistance in a sensitive discreet manner and made sure everyone had sufficient to eat. Choices for lunch were fish, fish fingers, scampi with chips and peas. An alternative choice was mince, mashed potatoes carrots and peas. The meal for those who needed a soft diet was nicely presented. Choices for dessert were home made trifle, ice cream and yoghurts. Plenty of hot and cold drinks were available at all times. Comments included “it’s a nice meal”, “good food” “there is always plenty to eat”. Relatives also said that they ate at the home regularly and the food was good and there were always choices. The mealtime experience was different on the two units. Downstairs was a pleasant relaxed time with staff sitting assisting in a discreet manner. The mealtime upstairs was much busier. Some people did not want to sit for the meal and were constantly getting up and leaving the room, one lady was constantly banging crockery and cutlery to the annoyance of her table Hebburn Court Nursing Home DS0000039411.V361789.R01.S.doc Version 5.2 Page 18 companion, another was extremely agitated and disrupted the whole mealtime experience. No one took charge or tried to calm the situation. Several people did not eat their meal and although this was being recorded it was unclear what alternatives were offered. Hebburn Court Nursing Home DS0000039411.V361789.R01.S.doc Version 5.2 Page 19 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 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although good complaints and protection procedures are in place people cannot be sure that their views are always listened to or that they can be protected from harm. EVIDENCE: The Company have a detailed complaints procedure, which is easy to understand, and it is readily available in the home. There have been four complaints since the last inspection. The Company has always worked with CSCI and the Local Authority to make sure complaints are resolved to everyone’s satisfaction. Staff have had training in Safeguarding Adults procedures and a recent alert has triggered a serious investigation into care practices and service provision in the home. The Company are involved in the investigation and the new manager has produced an action plan of how the issues have been put right. There was another referral in 2007 and the Company made sure the issues were resolved. Hebburn Court Nursing Home DS0000039411.V361789.R01.S.doc Version 5.2 Page 20 Staff have had training in “Yesterday Today and Tomorrow”. However, this was some time ago and it was evident that further training is needed as staff were unable to adequately support some people who became aggressive and distressed. Hebburn Court Nursing Home DS0000039411.V361789.R01.S.doc Version 5.2 Page 21 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, 24 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained and a pleasant, clean and comfortable place for people to live. EVIDENCE: The home has two units, which have their own dining areas and lounges. From the ground floor communal area there is direct access to a pleasant enclosed courtyard garden. Since the last inspection new furniture has been provided and there is an ongoing replacement and redecoration programme. The upstairs unit was developed to reflect people’s previous lifestyles. There is a market place seating area and bar that people enjoy sitting in. Hebburn Court Nursing Home DS0000039411.V361789.R01.S.doc Version 5.2 Page 22 Doors are brightly coloured but people have difficulty finding their way around the unit. The new manager confirmed that further work needs to be done so that it meets the specific needs of the people using the service. Bedrooms are being redecorated and new bedroom furniture has been purchased. People have been encouraged to bring small items with them and many of the rooms are highly personalised and homely. There are a number of profiling beds available for those who need nursing care. Bathrooms and showers have also had some refurbishment. The bathroom opposite room 33 contained three wheelchairs, a white plastic chair and various slings. The flooring is split and the enamel has been scraped off the bath by the assisted bath chair. The laundry was clean and organised and staff knew what steps to take should there be any outbreak of infection. The domestic staff take pride in the home and work hard to make sure it is kept clean, tidy and fresh smelling. Hebburn Court Nursing Home DS0000039411.V361789.R01.S.doc Version 5.2 Page 23 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 & 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although there are clear recruitment and selection processes in place this has not always been followed and has on occasion placed people at risk of harm.. EVIDENCE: At the time of the site visits the home had forty-three people with varying needs living there. The ground floor unit had eleven people who need nursing care and fourteen who had social and personal care needs. The unit upstairs eighteen people who had dementia care needs. The manager confirmed that there are two qualified nurses on duty over twenty-four hours. Seven care staff are on duty during the day, three working upstairs and four work downstairs. Overnight there are three care staff. There are sufficient ancillary staff are on duty over seven days. These include laundry, catering, administration, maintenance and an activity person. Since the last inspection the registered manager has transferred to another home within the Company. The deputy manager was given management responsibility for some time then left and then a manager from another home Hebburn Court Nursing Home DS0000039411.V361789.R01.S.doc Version 5.2 Page 24 came in for a short time until a new manager was designated to be employed on a permanent basis. She has only been in post since February 2008. It means that there sometimes has been an inconsistent approach to care delivery with staff not knowing how to care for people in a person centred way. The care staff have worked in the home for a long time and have developed a strong team. They have been allocated work to do that is the responsibility of the nursing staff and have tried to make sure that the people living in the home received a good standard of care. This has resulted in a workforce who sometimes feel that they are not listened to or respected. While the Company have comprehensive recruitment and selection policies and procedures in place, staff files showed that all the procedures were not always fully followed. One persons references were not checked regarding last employment, another only had one written reference the other was a verbal reference only. Criminal Record Bureau checks are carried out, however there has been an incident where one person was working unsupervised in the home before the CRB was cleared. Interview checklists were not completed and although the staff induction booklet was given they were not returned or completed. Staff have completed, moving and assisting, food hygiene, health and safety, safeguarding adults and first aid training. Fire training is due to be updated and no one has had infection control training. When qualified nurses have been employed their skills and competencies regarding clinical skills are not always explored. Staff did complete “Yesterday Today and tomorrow training in 2006.Staff need to have some refresher training as a person centred approach to care is not evident on the Dementia Care Unit. Some staff said they “had no training” and “did not know how to deal with difficult behaviours”. The management have recognised these shortfalls and are putting plans in place to make sure these problems are addressed. Hebburn Court Nursing Home DS0000039411.V361789.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The companies systems are comprehensive but changes to senior staff means there are areas in which the home has not always been well managed and run in the best interests of people using the service. EVIDENCE: The registered manager transferred to another home within the Company in January 2008. Hebburn Court Nursing Home DS0000039411.V361789.R01.S.doc Version 5.2 Page 26 Before then there was a period of time when the deputy manager was given management responsibility before a manager from another service came into the home until a suitable manager was recruited. This was done in February 2008. The new manager has yet to be registered with the Commission. She does have a wealth of experience and has been registered in another area. During this period there has been a lack of leadership and supervision in the home. The changes in home manager has not helped with staff being unsure what is expected of them and then doing what they think is right. This means the focus has been the task, getting the job done without looking at the individual needs of those using the service. The new manager has started to complete internal quality monitoring of the service and care and is aware of the shortfalls and she is completing an action plan to show how things will be put right. Staff have said that they “now feel supported” and that the “manager is always available” and they felt they “would be listened to”. The personal allowance records demonstrated that receipts and double signatures are maintained for all transactions. These could be cross-referenced and weekly checks are carried out to make sure there are no discrepancies. Some of the receipts have not yet been entered onto the system. Regular maintenance checks are carried out both internally and from external contractors. These were up to date. A fire risk assessment is in place and fire records are up to date. Staff are due to have fire and infection control training. An appropriate record of accidents is maintained and there are systems in place to monitor and track trends. Hebburn Court Nursing Home DS0000039411.V361789.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 3 X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 2 X X 3 X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 X X 3 Hebburn Court Nursing Home DS0000039411.V361789.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP4 Regulation 12,18 Requirement The registered persons must ensure that all staff receives training that is based on current good practice and reflects specialist and clinical guidance The registered persons must ensure that all care plans set out in detail all assessed needs, and how those needs will be met. All care plan documentation must be completed and be brought up to date. The registered persons must ensure that the staff promotes and maintains peoples health care. Fluid balance and food charts must always be completed to evidence practice. The registered persons must ensure that medication with limited use, once opened must only be used in line with the manufacturers recommendations. This makes sure that medicines are always safe to given when needed. The registered persons must ensure that duplicate MAR charts DS0000039411.V361789.R01.S.doc Timescale for action 01/09/08 2 OP7 15 01/06/08 3 OP8 12,14,17 01/05/08 4 OP9 13 01/05/08 5 OP9 13 01/05/08 Hebburn Court Nursing Home Version 5.2 Page 29 6 OP9 13 7 OP14 12 8 OP15 12 9 OP18 13 10 OP18 13 11 OP21 14,23 12 OP29 7,9,19 13 OP30 18 14 OP31 9,10,12 15 OP33 10,24 are not in use simultaneously to avoid incorrect or additional medication being given The registered persons must make sure that all handwritten directions on the Medicine Administration Records have two signatures. Timescale of 01/08/07 not met The registered persons must ensure that people are supported to make choices regarding their everyday lives and this must be recorded in detail The registered persons must review the organisation of the mealtimes on the dementia care unit. The registered persons must ensure that all staff receive training in dealing with physical and verbal aggression The registered persons must ensure that all staff understand and are confident to raise safeguarding alerts. The registered persons must ensure that the bathroom opposite room 33 has the flooring and bath repaired The registered persons must ensure that the robust company recruitment ,selection and induction procedures are always followed. The registered persons must provide training to ensure that the staff working in the home have the skills and experience necessary for the work they do. The registered person must submit an application to register a manager with Commission for Social Care Inspection. The registered persons must maintain and develop systems of evaluating all aspects of the DS0000039411.V361789.R01.S.doc 01/05/08 01/05/08 01/05/08 01/09/08 01/05/08 01/08/08 30/04/08 01/06/08 01/05/08 01/06/08 Hebburn Court Nursing Home Version 5.2 Page 30 16 OP38 13,23 service and take the views of people using the service into account The registered persons must ensure fire and infection control training is up to date. 01/05/08 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 Refer to Standard OP9 OP9 OP9 Good Practice Recommendations The medicines fridge should only be used for the storage of medicines. Additional provision should be made for the appropriate storage of clinical samples. Records of administration should be made after medication has been given. This makes sure that there is an accurate record. The signature list of staff authorized to administer medicines should be updated to include all staff administering medicines. This helps to identify who was involved in administration if a problem or error was to occur. The registered persons should consider changing colour schemes and provide pictures and signage to help people with memory loss find their own way around the unit. 4 OP19 Hebburn Court Nursing Home DS0000039411.V361789.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. 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