Inspection on 01/03/06 for High Trees Nursing Home

This inspection was carried out on 1st March 2006.

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

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

Other inspections for this house

High Trees Nursing Home 05/02/08

High Trees Nursing Home 15/09/07

High Trees Nursing Home 26/01/07

High Trees Nursing Home 07/06/06

High Trees Nursing Home 19/12/05

High Trees Nursing Home 04/01/05

High Trees Nursing Home 12/07/04

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

CARE HOMES FOR OLDER PEOPLE High Trees Nursing Home 3 Glenferness Avenue Talbot Woods Bournemouth Dorset BH4 9NB Lead Inspector Chris Gould Announced Inspection 09:45 1 March 2006 st 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 High Trees Nursing Home DS0000059925.V284960.R01.S.doc Version 5.1 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. High Trees Nursing Home DS0000059925.V284960.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service High Trees Nursing Home Address 3 Glenferness Avenue Talbot Woods Bournemouth Dorset BH4 9NB 01202 761380 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) 3 Glenferness Avenue Ltd Care Home 13 Category(ies) of Dementia (13), Dementia - over 65 years of age registration, with number (13), Mental disorder, excluding learning of places disability or dementia (13), Mental Disorder, excluding learning disability or dementia - over 65 years of age (13), Physical disability (13), Physical disability over 65 years of age (13) High Trees Nursing Home DS0000059925.V284960.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. There should be a manager appointed and registered with the Commission for Social Care Inspection by 31st December 2005. Conditions concerning minimum staffing levels remain in force. Date of last inspection 19th December 2005 Brief Description of the Service: High Trees is registered with the Commission for Social Care Inspection to provide nursing care for a total of thirteen people with dementia, mental disorder and/or physical disability. The home is situated in Talbot Woods, a residential area of Bournemouth and is close to the shopping area of Westbourne. The building is on two floors, with a passenger lift, which enables easy access. Five of the rooms are single rooms and the other four are shared. There is a small comfortable lounge on the ground floor, which is also used as a dining area. Meals are prepared on the premises. A nurse is available on the premises at all times and a nurse call system is installed in all rooms. High Trees Nursing Home DS0000059925.V284960.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection by two inspectors took place over two days on the 1st and 2nd March 2006. A total of ten hours was spent at the home. The purpose of the inspection was to review the requirements and recommendations made in the last report and to assess some key standards. The manager Mr Thomas was available throughout the inspection. He has submitted an application to the Commission for Social Care Inspection for registration, which is being processed. Residents of the home, a visitor and members of staff on duty were spoken with and asked their views on the services provided at High Trees. Relevant documentation was viewed and a tour of the premises was undertaken. Respite on a day care basis is provided for one service user once a month. Christine Main the CSCI pharmacy inspector visited the home on the 8th February 2006 to inspect the arrangements for the handling and administration of medicines. The inspection took two and a half hours and involved discussion with the registered person and checking the medicines in stock with the records to see if they were being given as prescribed. The outcome of the inspection is included in this report. The requirements and recommendations made by the pharmacy inspector will be reviewed at a later date. Feedback was provided to Dr Guy Powell and Mr Phillip Bamborough, directors at a meeting on Wednesday 8th March 2006. This report should be read in conjunction with the announced inspection report dated 19th December 2005. What the service does well: Although it was a very cold day the home was maintained at a comfortable temperature. Throughout the inspection staff made all visitors welcome to the home and were very friendly and extremely helpful. At lunchtime the staff observed assisting residents to eat their lunch sat at the same height with bowls or trays on their laps. Encouragement was given to the resident to chew and swallow their food. High Trees Nursing Home DS0000059925.V284960.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: 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. High Trees Nursing Home DS0000059925.V284960.R01.S.doc Version 5.1 Page 7 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 High Trees Nursing Home DS0000059925.V284960.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 An assessment of need is undertaken prior to the resident moving into the home to ensure the home is able to meet their needs. EVIDENCE: Mr Thomas was unable to provide a signed and dated contract with the funding authorities for all service users placed by Social Services therefore this requirement has again been brought forward. The care file for a recently admitted resident contained a pre admission assessment and a letter to the funding authority from the home stating the care they would be able to offer. High Trees does not provide intermediate care therefore standard 6 is not applicable. High Trees Nursing Home DS0000059925.V284960.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 There is no clear or consistent assessment and care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users needs. The poor recording systems in place do not ensure that residents’ health care needs are fully met. The storage and some systems for managing medication in the home need improving to protect service users. The practices in the home do not consistently ensure that the resident’s privacy and dignity is upheld. EVIDENCE: The care records of five residents were viewed and the information provided was limited. There was no photograph or description for a resident who was identified as at risk of going absent without informing her carers. There are a number of residents requiring assistance with mobility although manual-handling assessments had not been undertaken and a plan of action High Trees Nursing Home DS0000059925.V284960.R01.S.doc Version 5.1 Page 10 had not been developed. An immediate requirement notice was issued. A poor example of manual handling was observed in the lounge when a resident was being transferred from a chair to a wheelchair using a hoist. The chair was too close to the occupied adjoining chair making it very difficult for the staff to undertake the task comfortably. The resident having been transferred to the wheelchair was wheeled backwards out of the room with their feet dragging on the floor. The footrests had been removed from the wheelchair. Two residents are identified in the accident book as having frequent falls. The care records did not contain a care plan of the actions to be taken in order to minimise the risk or how the resident was to be assisted following a fall. A number of resident’s have bedrails fitted to their beds although an assessment has not been undertaken. The accident book records that a resident had been found with both feet wedged through the bed rails. This is not recorded in the resident’s care file and there is no record of the action to be taken to prevent a reoccurrence of the incident. Residents are identified as nutritionally at risk but there was no written plan of care as to how the resident’s needs would be met. Three residents were identified as having wounds. Two files did not contain an assessment or care plan the third file included an action plan but this was confusing and not up to date. Files did not evidence that either the resident or their representative were invited to be part of the care planning process. A visitor to the home confirmed that they had not been involved in the care plan but was confident in their relative’s care. Staff were observed walking into occupied bedrooms without knocking on the door and waiting for a reply. Residents’ rooms are used for storage due to the lack of available space in the home. A frequently used linen cupboard is situated in the room of one resident. Continence products are left on view in many rooms and the urinary catheter bag of one resident was within sight as you enter the room. Christine Main the CSCI pharmacy inspector visited the home on the 8th February 2006 to inspect the arrangements for the handling and administration of medicines. The inspection took two and a half hours and involved discussion with the registered person and checking the medicines in stock with the records to see if they were being given as prescribed. The home has a medicines policy but it needs improving. Guidance was provided. High Trees Nursing Home DS0000059925.V284960.R01.S.doc Version 5.1 Page 11 The last recorded visit by a chiropodist was seen as June 2005. Information relating to foot care was not included in care records including the two residents with diabetes. Medicines were stored in a locked trolley or cupboard but the trolley was not secured to the wall. The fixing point needs moving so that this can be done. The home has a Controlled Drugs (CDs) cupboard for storing CDs but the fixing of it does not comply with the Misuse of Drugs (Safe Custody) Regulations 1973. There is a dedicated medicines refrigerator and the maximum and minimum temperatures were within the recommended range but were not recorded daily. The date of opening one eye drop was not recorded so that it could be discarded after 4 weeks use to prevent infection. There were signs of possible covert administration of medicines and Mr Thomas said that they had doctors’ letters for 2 residents to have medicines covertly, if needed, but the methods of administration were not in their care plans. Two other residents were reluctant to take their medicines sometimes and he described how this was managed but this was not included in their care plans. There is no guidance on this in the home’s medication policy and this needs addressing. The home administers medicines from original packs and it was difficult to confirm that they were given as prescribed, as the audit trail was incomplete. The dose of one medicine had been changed from “half a tablet twice a day” to “one twice a day” but there were no details of the doctor responsible for initiating this change. Mr Thomas said the dose should have been one daily as advised by the hospital and he changed the MAR chart accordingly. Nurses had only recorded giving one tablet each day. Medicines handwritten on the MAR chart were usually countersigned but this dose change was not. The balance of one Controlled Drug (CD) in the CD record book was one tablet short. According to the record no tablets had been given since they were received. Mr Thomas investigated and sent a report to the office. Mr Thomas was unsure of the arrangements for the disposal of medicines. There was a disposal box and a doop kit for CDs but no official arrangement or record of collection from the clinical waste company. This documentation should be kept with the records of medicines disposed of, signed and witnessed by nurses in the home. The box containing medicines for disposal must also be stored securely. Mr Thomas said that he is arranging for nurses to do a safe handling of medicines course in March. There was no recent British National Formulary available at the time of the visit and this should be kept on the premises. Patient information leaflets were available for most medicines. Mr Thomas said that the GP reviews medication regularly and It was suggested that a record of this should be kept with the MAR charts. High Trees Nursing Home DS0000059925.V284960.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 The social care provided in the home does not satisfy the social and recreational interests and needs of the residents. Visitors are welcome to visit or telephone the home at any time to enable residents to maintain contact with their family, friends or representatives. Some institutional care practices compromise the right of residents’ choice and control over their lives. The choice and presentation of food offered does not ensure residents receive a wholesome, appealing diet. EVIDENCE: An activities programme is not arranged for the residents. An occasional entertainer visits the home and the manager said that the church would visit at Easter to provide prayers and a choir otherwise there are no activities planned. The needs of a recently admitted resident included the provision of an occupational therapist on a one to one basis for twenty-one hours a week. This has so far not been provided. A number of residents remain in their rooms during the day. There are no action plans in place to identify how their social needs will be met. The television in the lounge was turned on showing High Trees Nursing Home DS0000059925.V284960.R01.S.doc Version 5.1 Page 13 the picture but the sound had been turned down and unrelated music was being played. There were no orientation aids observed in the home and although the bedroom doors displayed residents’ names they did not always relate to the occupant of the room. A visitors’ book in the reception area of the home evidenced that residents receive visitors at all times. A visitor that was visiting her relative was spoken with during the inspection and commented that they were ‘always made very welcome’ and the ‘staff are always very friendly and helpful’. The home does not adopt a flexible approach in the running of the home but a routine approach based on the numbers of staff available. The manager who said that there ‘were quite a few’ residents needing two carers to meet their care needs confirmed this. There are two staff on duty from 8pm so most of the residents are in bed before they come on duty. Mr Thomas said that when the night staff ‘change’ the residents at 6am if they are awake they are got out of bed and sat in a chair in their room. There is no record in the care documentation relating to residents personal choice concerning the times that they prefer to get up or go to bed. Residents eat their meals sat in the lounge from trays or tables placed in front of them or in their own rooms. Where staff were observed assisting residents to eat their lunch they sat at the same height and had bowls or trays on their laps. Encouragement was given to the resident to chew and swallow their food. The individual foods of the pureed diets were mixed together and not served separately. One resident was observed as not eating with the others. Staff said that they would receive their lunch when a member of staff was free. It was later confirmed that the resident had been refusing food. The cook works four days a week from 9am until 1pm to provide the mid day meal. The remaining three days are covered by a care assistant working additional hours. Breakfast and the evening meal are prepared and provided by the care staff on duty. The cook decides on the menu and orders the food. The menus need reviewing to ensure that they are nutritionally balanced to meet the needs of the residents. The menus viewed did not provide at least five portions of fruit or vegetable a day. The cook confirmed that eight residents require their food pureed. The reason for these residents requiring their food pureed is not recorded in the care records. The record of food eaten states that these residents had been provided with a menu including cheese sandwiches and sausage rolls for their evening meal. There are no records to evidence that food is offered between the evening meal at 5pm and breakfast the following morning. The manager said that the night staff do offer and provide food but this is not documented. High Trees Nursing Home DS0000059925.V284960.R01.S.doc Version 5.1 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The home’s complaints procedure does not ensure that residents’ complaints will be dealt with fully and appropriately. EVIDENCE: Since the last inspection the complaints procedure has not been updated to make it clear that the complainant may contact the Commission for Social Care Inspection at any time. The procedure also needs to include the timescales for investigation. The hand written log of complaints has been removed from the front hall and is now kept in the office. A visitor spoken with had not had cause to make a complaint and said she would know who to go to if she had any concerns. No complaints have been recorded since the last inspection. A complaint that was made directly to the Commission for Social Care Inspection relating to the time it took staff to summons medical help was investigated and upheld. Requirements that were made following the investigation are included in this report. Disciplinary action is being taken by the home. This is the second similar complaint to be investigated and upheld by the Commission for Social Care Inspection within twelve months. High Trees Nursing Home DS0000059925.V284960.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 Residents are not provided with an environment that is safe and well maintained with safe and comfortable indoor and outdoor facilities. Systems are not in place for the management of the laundry to ensure that residents own clothes are returned and that they are well presented. EVIDENCE: Although it was very cold on the days of the inspection all areas of the home were maintained at a comfortable temperature. One bedroom has recently been refurbished but the rest of the home would generally benefit from some redecoration, maintenance and repair. Bedrooms are not always well presented and could be improved by a change of layout and items being appropriately stored. A programme of routine maintenance was not available. The bathroom/toilet on the ground floor is out of use as water has come through the ceiling above the electrics. This is the only communal toilet in the home. The sluice on the ground floor is also not in use. The first floor sluice room also has the staff toilet and is used for storage High Trees Nursing Home DS0000059925.V284960.R01.S.doc Version 5.1 Page 16 including toilet rolls and continence products. The suction machine is also inappropriately stored in this room. The concrete paths around the outside including the entrance to the home are broken in places and very uneven causing a tripping hazard. A drain appeared blocked outside the back kitchen door. Waste water was lying on the concrete. An immediate requirement notice was issued. The directors later clarified that it was not a drain that was blocked but a soak away that has been put in place and will be more effective when the ground around has been covered with tarmac. The manager was unable to provide the date of or any correspondence relating to the last inspection by the Environmental Health Officer. A letter containing recommendations made by the Dorset Fire and Rescue Service in March 2005 was seen but no further information. The fire escape is routed through a resident’s room and when visited she was sat in the path of the route that would be taken in the event of a fire. The resident mostly remains in her room during the day. A conservatory is nearing completion to provide additional communal space that at present consists of a lounge containing ten comfortable chairs in a home that is registered for thirteen residents. A member of staff said that the conservatory would be used to provide a dining area. The call bell system will need to be extended to include the conservatory. The home does not have sufficient storage space and as a result items not belonging to or used by the resident were observed inappropriately stored including chairs, a television and spare mattresses. A through floor lift provides access to all but one room on the first floor. This room is accessed by stairs and should only be occupied by a resident whose mobility needs can be safely met. The resident currently occupying the room is to be transferred to a room on the ground floor more appropriate to their needs. A number of items of furniture were in need of repair or replacement including a missing wardrobe door and broken drawer fronts. In one room the curtains at the window were hanging down where they had come off the curtain rail. The manager said that the home has purchased four new electric beds. A number of the mattresses were observed as being too small and inappropriate for the beds they were being used on. A number of the bed sheets were very thin and some were stained. The pillows were generally very thin and lumpy with some staining. The bedrails used on a number of beds did not fit safely and would enable the resident to roll over into the space between the mattress and the bedrail. High Trees Nursing Home DS0000059925.V284960.R01.S.doc Version 5.1 Page 17 The accident book recorded that a member of staff had pricked her finger with a used needle putting her at risk from infection. The home does not have a procedure for dealing with a needle stick injury and there is no record of any action that had been taken. The care staff undertake the laundry tasks but there is no clear system of how this is managed. Baskets of soiled linen were observed throughout the home during the inspection. The laundry has a wash hand basin but soap and hand towels were not available. To access the laundry room the staff need to leave the main building. Staff spoken with commented that the night staff undertake the ironing at night but do not leave the building to go out to the laundry. The residents clothes in their wardrobes were not were not always well presented some requiring ironing and hanging appropriately on the hangers. Clothes were not always marked with the resident’s name so it was not possible to be sure whom they belonged to. A number of items that were marked had been placed in the wrong wardrobe. High Trees Nursing Home DS0000059925.V284960.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The numbers and skill mix of staff need to be reviewed and additional staffing hours provided to ensure service users needs are met. The induction and training provided does not ensure that staff are competent to do their jobs and that residents are in safe hands at all times. Major shortfalls in recruitment practices do not protect residents from risk. EVIDENCE: A duty rota is maintained showing the number of staff on duty day and night. The number of registered nurses and care assistants on duty meet the minimum staffing levels required as a condition of registration. The care staff also maintain the laundry, prepare and serve the evening meal and provide social activities. These duties are additional to the role of the care assistant and need to be provided using additional staff hours. Training records available in staff files demonstrated that staff have received minimal training. There was no evidence in their file that a new member of staff, with no past experience in care, had been provided with an induction programme. The duty rota showed that they had been counted as a full member of staff on their first day in the home. Staff have received training in food hygiene and Dr Guy Powell the responsible individual for the home provided a training session on the Mental Health Act. The manager said that training is planned to cover infection control and the administration of medication but there is no training programme in place. Staff confirmed that High Trees Nursing Home DS0000059925.V284960.R01.S.doc Version 5.1 Page 19 they have not received training or updating in dementia care, diabetes or specialist areas relevant to the needs of the residents. Two members of staff have achieved an NVQ in care one at level 2 and one at level 3. The files of all members of staff were viewed. A file was not available for one member of staff. The files were variable in their content with all including an application form. A number of files did not evidence that a CRB or POVA 1st had been obtained prior to the member of staff starting work. The majority of files did not contain references or proof of identity including a member of staff that commenced work within the last month. The file of a registered nurse did not contain evidence that their Personal Identification Number had been checked with the Nursing and Midwifery Council following the expiry date in 2004. In two files evidence of the staff member’s immigration status and their right to work at the home was not available. High Trees Nursing Home DS0000059925.V284960.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35 and 38 The present management of the home is poor and does not promote and safeguard the welfare of residents. There is no clear development plan and vision for the home that has been communicated to residents, relatives and staff. The systems for resident consultation in this home are poor with little evidence that residents’ views are sought or acted upon. The lack of staff training for manual handling and fire safety do not promote and safeguard the health and safety of residents, leaving them potentially at risk of harm. High Trees Nursing Home DS0000059925.V284960.R01.S.doc Version 5.1 Page 21 EVIDENCE: The Commission for Social Care Inspection has received and is processing an application to register Mr Thomas as the manager. Mr Thomas is a level 1 registered nurse, learning disabilities. Mr Thomas’ past experience has been confined to this area of work. He acknowledges that he does not have experience of nursing older people with dementia who are also physically frail. The majority of the residents at High Trees are within this category. The manager has attended training courses since being appointed but still identifies that further training is required. He has been employed at High Trees since November 2005. In discussion and his actions during the inspection Mr Thomas did not appear confident in the role and responsibilities he is undertaking. At times he seemed overwhelmed by the amount of work that is required for High Trees to meet the National Minimum Standards and Care Homes Regulations. The manager confirmed that there has been little progress since the last inspection in regard to the quality assurance process therefore this requirement is carried forward. Since the last inspection the manager confirmed that the home no longer holds’ pocket money for the residents. Documents were available to evidence that services and equipment had been serviced as required. There is no evidence that staff including the manager have received manual handling training within the last year. A member of staff commented that it must have been at least two years since they had last received manual handling training. The last recorded fire training took place in April 2005 and the last fire drill in August 2005. There is no evidence that newly recruited staff receive fire training including the manager. An immediate requirement was issued. High Trees Nursing Home DS0000059925.V284960.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 X 1 X X X X 1 X 1 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 X X 1 High Trees Nursing Home DS0000059925.V284960.R01.S.doc Version 5.1 Page 23 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. Standard Regulation Requirement The home must ensure that a signed and dated contract exists with the funding authorities for all service users placed by Social Services. Original date for compliance was 31/12/04 The registered person must ensure that care plans are drawn up with the involvement of the resident, recorded in a style accessible to the resident; agreed and signed by the resident whenever able and/or representative (if any). Original date for compliance was 28/02/06. The registered person must ensure that care plans set out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the residents are met. Original date for compliance was 28/02/06. The registered person must ensure that nutritional screening is undertaken on admission and subsequently on a periodic basis, a record maintained of nutrition, DS0000059925.V284960.R01.S.doc Timescale for action 1. OP2 5(1) 31/05/06 2. OP7 15(1)(2) 31/05/06 3. OP7 15(1) 31/05/06 4. OP7 1417(1) (a)Sch 3 31/05/06 High Trees Nursing Home Version 5.1 Page 24 5 OP7 13(5) 6. OP8 14 7. OP8 12(1)13 (1) 8 OP8 13(4)(c) 9. OP9 13(2) including weight gain or loss, and appropriate action taken. Original date for compliance was 28/02/06. The registered person shall make suitable arrangements to provide a safe system for moving and handling residents. The registered person must ensure that all assessments made prior to drawing up the residents care plan are completed correctly. Original date for compliance was 28/02/06. The registered person must ensure that as residents’ medical conditions change they have access to medical care by ensuring reviews are carried out and GPs are notified of changes. This requirement was made following a complaints investigation and will be reviewed at a later date. The timescale has been extended. The registered person shall ensure that all bed rails fitted to beds occupied by residents are risk assessed and reviewed to ensure that they meet the needs of the resident and are appropriate for the type of bed and that they are fitted correctly. The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home including: (a) All lotions must be labelled to identify who they belong to. (b) Having a clear audit trail for medicines e.g. dating packs when they are started or entering a carry forward balance on the MAR chart and this must be monitored to ensure DS0000059925.V284960.R01.S.doc 10/03/06 31/05/06 31/05/06 31/05/06 31/03/06 High Trees Nursing Home Version 5.1 Page 25 10 OP9 13(2) 11 OP10 4(a) 12 OP12 16(2)(n) 13 OP14 12(2) 14 OP15 16(i) 15 OP16 22 medicines are given correctly. (c) All medication administered must be recorded, or the reason for its omission. The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home including: (a) Updating the medicines policy with the recommended additions; (b) Securing the trolley to the wall when not in use; (c) Improving the fixing of the CD cupboard to comply with the Misuse of Drugs (Safe custody) Regulations 1973. The registered person shall make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. Residents must be consulted about a programme of activities and the home must provide facilities for recreation. Original date for compliance was 28/02/06. The registered person shall so far as practicable enable residents to make decisions with respect to the care they are to receive and their health and welfare. The registered person shall provide suitable, wholesome and nutritious food which is varied and properly prepared and available at such time as may be required by residents. The registered person shall establish a complaints procedure that includes the name, address and telephone number of the Commission for Social Care DS0000059925.V284960.R01.S.doc 31/03/06 31/05/06 31/05/06 31/05/06 31/05/06 31/05/06 High Trees Nursing Home Version 5.1 Page 26 16 OP19 23(2)(b) 17 OP24 16(2)(c) 18 OP26 13(3) 19 OP26 13(3) 20 OP27 18(1) 21 OP29 19 Schedule 2 22 OP30 19(9)(10) (11) Inspection and the timescales for undertaking the investigation. A programme for all planned maintenance shall be drawn up with proposed timescales. A copy of this programme to be forwarded to the Commission for Social Care Inspection. The registered person shall undertake an audit of the pillows, bed linen and mattresses used in the home and replace as assessed necessary. Soap and hand towels must be provided in the laundry. The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. The registered person shall, ensure that at all times the numbers and skill mix of the staff deployed are sufficient to meet the needs of the residents. The registered person must ensure that, prior to a member of staff commencing employment he must obtain all the information outlined in Schedule 2 of the Care Homes Regulations 2001 Original date for compliance was 28/02/06. Where the registered person permits a new worker to start work pending receipt of, and satisfying himself with regard to the outstanding information in relation to the criminal record certificate the registered person must Appoint a member of staff who is appropriately qualified and experienced to supervise the new worker. So far as is possible, ensure that the staff member is on duty at DS0000059925.V284960.R01.S.doc 31/05/06 31/05/06 31/05/06 31/05/06 31/05/06 31/05/06 31/05/06 High Trees Nursing Home Version 5.1 Page 27 23 OP30 18(1) 24 OP30 18(1) 25 OP31 9 26. OP33 24 23(4)(c) (i) 27 OP38 28 OP38 23(4)(d) the same time as the new worker. Ensure that the new worker does not escort service users away from the care home premises unless accompanied by the staff member. It was not possible to review this requirement as no new members of staff have been employed since the last inspection. The previous timescale of 28/02/06 has been extended. The registered person must ensure that care staff receive common induction training to National Training Organisation specification. Original date for compliance was 28/02/06. The registered person shall ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. Original date for compliance was 28/02/06. The registered person shall ensure that the home is managed by a person who is fit to be in charge and able to discharge his or her responsibilities fully. The home must have an effective quality assurance and monitoring system. (Original date for compliance was 31/03/04). The registered person must ensure that all fire doors close to latch. The registered person shall make arrangements for persons working at the care home to receive suitable training in fire prevention. Ensure by means of DS0000059925.V284960.R01.S.doc 31/05/06 31/05/06 31/05/06 31/05/06 10/03/06 17/03/06 High Trees Nursing Home Version 5.1 Page 28 29 OP38 13(5) fire drills and practices at suitable intervals that the persons working at the care home and so far as practicable, residents are aware of the procedure to be followed in the case of fire. All care staff must undertake manual handling training every year. Original date for compliance was 28/02/06. 31/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard OP7 Good Practice Recommendations The resident’s care plan should include the purpose of their medicines, any monitoring required and the rationale and method of any covert administration of medicines. This must have been agreed with the prescribing GP and there must be evidence of the agreement in the home. The home should follow guidance from the Royal Pharmaceutical Society: A second nurse should check that handwritten changes to the MAR chart are accurate and countersign them. The date of opening eye drops should be recorded so that they can be discarded after 4 weeks to prevent infection. The temperature of the medication fridge should be recorded on a daily basis. Fresh fruit should be available to residents at any time. A copy of the menu should be available to residents and the menu should offer choice. The policy for dealing with complaints should make it clear to the complainant that they can approach the Commission for Social Care Inspection at any time. 1 2 OP9 3. 4 5 6 OP9 OP15 OP15 OP16 High Trees Nursing Home DS0000059925.V284960.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 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 High Trees Nursing Home DS0000059925.V284960.R01.S.doc Version 5.1 Page 30 - 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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