Inspection on 15/09/07 for High Trees Nursing Home

This inspection was carried out on 15th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 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

High Trees Nursing Home 05/02/08

High Trees Nursing Home 26/01/07

High Trees Nursing Home 07/06/06

High Trees Nursing Home 01/03/06

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 Maxine Martin Key Unannounced Inspection 10:15 15th September and 4th October 2007 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.V349299.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. High Trees Nursing Home DS0000059925.V349299.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service High Trees Nursing Home Address 3 Glenferness Avenue Talbot Woods Bournemouth Dorset BH4 9NB 01202 761380 01202 761189 office@3glenfernavenue.bt.com 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 ** Post Vacant *** 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.V349299.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Conditions concerning minimum staffing levels remain in force. Schedule of requirements, set out in a separate letter to the provider, to be complied with by 31.12.06. 26th January 2007 Date of last inspection 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. There is parking space for visitors available at the front of the home. 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. There is also an attractive garden and conservatory for residents and visitors use. A nurse is available on the premises at all times and a nurse call system is installed in all rooms. The home is owned by Three Glenferness Avenue Ltd; there is no manager currently in post as of the date of this inspection. They are in the process of recruiting a manager. A hairdresser visits the home each week; there is an additional charge for this service. During each Thursday a reflexologist visits to provide individual private therapy to particular residents; there is an additional charge for this service. A public transport bus stop, for buses to the nearby town centre, is opposite the home. Fees are charged weekly; at present fees range between £450 and £1025 per person. High Trees Nursing Home DS0000059925.V349299.R01.S.doc Version 5.2 Page 5 Information regarding the subjects Value for Money and Fair Terms in Contracts can be obtained from the web link: www.oft.gov.uk A report entitled Care Homes in the UK - A Market Study is available on web link http:/www.oft.gov.uk/NR/rdonlyres/5362CA9D-764D-4636-A4B1A65A7AFD347B/0/oft780.pdf High Trees Nursing Home DS0000059925.V349299.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced key inspection was undertaken in line with the Care Standards Act 2000 and following the Commission’s Inspecting for Better Lives guidance. An inspection team undertook the inspection on Saturday 15th September 2007; it commenced at 10.15 and finished at 19.15, taking 9 hours. During the fieldwork inspection discussions were held with residents and seven members of staff, care practice was observed, five residents’ experiences were case tracked, premises viewed, records and files inspected and detailed feedback given to the services representative (Finance Director). A follow on visit was undertaken on 4th October 2007. The inspection team would like to thank all the staff for their positive and helpful approach during the inspection. One survey form was received from a resident living at the home, two from relatives, carers and advocates, and two from health professionals visiting the service. At the time of the inspection twelve residents were accommodated at the home and discussions were held with seven members of the staff team during the inspection. Other sources of information used to inform the report were the homes Annual Quality Assurance Audit (AQAA) report submitted September 2007, a regulation 26 report completed in February/March 2007, Regulation 37 reports which record significant events and records of correspondence with the Commission. What the service does well: Residents spoken with during the inspection said: ‘Staff are very kind.’ ‘I have no complaints.’ Two relatives who returned survey forms said that they feel that the care home meets the needs of their family member. One relative said that there is ‘a very loving, caring staff.’ Pre- admissions processes are in place, which support the development of appropriate care plans, ensuring that no resident moves into the home without having their needs assessed. High Trees Nursing Home DS0000059925.V349299.R01.S.doc Version 5.2 Page 7 Relatives and key people are actively encouraged to be involved in the life of the home and in the planning and meeting of residents’ needs. Residents are treated with respect, their history and life style informing care practice. A balanced diet is provided and residents are supported to make choices and enjoy their meals. High Trees provides a comfortable clean environment that has been improved to support residents with dementia and mental health needs, where a smaller calm environment makes High Trees feel like home. What has improved since the last inspection? What they could do better: At the end of the report a total of five requirements and six recommendations are made. The service needs to ensure that all care and health plans are up to date, relevant and signed to ensure that the specific health and social care needs of residents are fully met. To ensure that residents health care needs are fully addressed further detail on the management of diabetes should be included in the care plan of the resident with this condition and any future residents to support positive care practice. The service currently uses a basic nutritional guidance tool however to enable them to have more detailed information and meet the specific health care needs of residents, it is recommended that they start to use a clinical nutritional risk assessment tool. High Trees Nursing Home DS0000059925.V349299.R01.S.doc Version 5.2 Page 8 Current medication procedures do not sufficiently ensure that medicines are safely administered, recorded, stored or disposed, protecting residents from the risk of harm. An audit system must be established to ensure medicines are regularly checked from receipt to disposal and throughout administration, ensuring that amounts of medication held are correct and support the health care needs of residents. An immediate requirement was issued at the time of the inspection regarding the safe storage of medicines. The timescale for compliance was 15th September 2007. A return visit was made to the home on 4th October 2007. Medicines were securely stored and kept in the office, which now has key coded access. However the trolley was not secured to a fixed point and two sharps disposal boxes; one full of needles were found in an unsecured area. (See Management and Administration section). The management needs to ensure the safe storage of all medicines and sharps. Recruitment practices must be established that complies with the regulations and ensures that all documentation required is in place before staff members commence employment, ensuring that residents are in safe hands at all times. Staff members must complete all mandatory training and the service needs to establish clear processes of ensuring that staff members are trained to meet the identified needs of residents. The service needs to ensure that all hazardous substances must be consistently stored safely in line with regulatory guidance and for the safety and well being of residents. This was issued as an immediate requirement at the time of the inspection with a timescale of 15th September 2007. It is recommended that a risk assessment be completed for the room with a balcony, to ensure safe use of this room. The relatively new conservatory offers a pleasant addition to the home and provides residents with the opportunity to benefit from overlooking the garden area. To ensure it’s ongoing benefit to residents it is advised that the blinds are used in hot weather. 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. High Trees Nursing Home DS0000059925.V349299.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 High Trees Nursing Home DS0000059925.V349299.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): 3. (The home does not currently offer intermediate care- standard 6) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory pre-admission assessments are completed before people move into the home so that residents can be assured that their needs will be met by the service. EVIDENCE: Two residents files were inspected who had recently moved into the home and contained pre-admission assessments, although one had been completed on the day of admission. Information had been gathered from a range of sources and correspondence reflected consultation on care needs with a range of appropriate health and social care professionals. Specific care plans had been developed and reviewed since admission; some documentation seen had not High Trees Nursing Home DS0000059925.V349299.R01.S.doc Version 5.2 Page 11 been fully completed; e.g. an assessment checklist not signed or dated. Overall the detail regarding people’s personal, social and health care needs and their preferences and wishes reflected effective procedures in place to support the home to make an informed decision about whether it is able to meet prospective residents’ needs. On the day of the inspection the letters confirming that the home could meet the needs of individuals were not on the files. However the provider representative was able to show the inspectors an example of a letter, which he confirmed is sent out to all residents and their representatives prior to them moving into the home. One resident who had recently moved into the home said that they felt well cared for. High Trees Nursing Home DS0000059925.V349299.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 poor. This judgement has been made using available evidence including a visit to this service. Residents have individual care plans, which are generally satisfactory in supporting residents to receive appropriate care to meet their identified health, social and personal care needs. The medication management and current practice are not in line with regulatory guidance and best practice, which would ensure the safe provision of medication to residents. Residents are treated with respect, enabling people living at the home to experience both privacy and dignity in their daily lives. High Trees Nursing Home DS0000059925.V349299.R01.S.doc Version 5.2 Page 13 EVIDENCE: There were assessments and records on file, which informed the planning of care and support to meet residents’ needs. Daily logs were detailed, signed and dated with clear guidance. For new residents there was evidence that relatives had been consulted regarding the development of the care plans, as appropriate. Care plans are regularly updated. Care staff on duty demonstrated that they had a good understanding of the needs of residents in the home. One resident said that they felt ‘well cared for.’ In the AQAA there is reference to care plans being put on to the computer system, to improve the clarity of record keeping. Documentation is in place that should support health needs, however some had not been fully completed. In one file a weight chart had not been completed since December (the year was not specified) when this was a need identified for this resident’s care. However, from other files it is clear that there is a regular process of weighing residents and monitoring this. In discussions with the representative of the service it was confirmed that the home has scales in place. Some residents were in bed and would require hoist scales, in order to monitor their weight as necessary. Although there was information relating to diabetics this did not provide specific information such as guidelines to indicate a residents level was becoming unstable and what steps should be taken to stop this. Bed rail assessments were seen but on two files were not signed. On one file a mental health assessment and physical health assessment were last reviewed in December 2005. There was a basic nutritional risk assessment on files seen. Given that some residents in the home are vulnerable in terms of maintaining an adequate dietary intake, it was advised that the use of a clinical nutritional assessment tool be considered. In the AQAA the provider identified key problems in getting dental support for the residents. Positive news was given during the inspection that this had just been resolved. Files also evidenced contact with other health professionals such as the chiropodist, Psychiatrist, and General Practitioners. The home also employs an Occupational Therapy Consultant who has been reviewing activities for individuals with the activities co-ordinator. High Trees Nursing Home DS0000059925.V349299.R01.S.doc Version 5.2 Page 14 The home has made positive steps in obtaining specialised beds and pressure relieving equipment for the residents, which is supporting their health care needs. During the visit it was noted that four residents were slipping down in their chairs, or in bed. On two occasions during the visit the inspectors asked care staff members if they would come and assist residents who were slipping out of their chairs and one resident had slipped down awkwardly in bed and was not adequately supported to eat the meal in front of them. Discussions were held with the representative of the service regarding obtaining occupational therapy assessments for some residents in relation to their safe seating and positioning. In relation to medication the medicines trolley was in the office when the inspectors arrived. The trolley was unlocked and was not secured to the wall. A tablet was left in a pot on the top of the medicine’s trolley. The medicines for return were also in the office and were not locked away. There were no staff members in the office on arrival and a resident was stood in the reception area. This presented a serious risk to residents. These concerns were discussed in detail at the feedback with the representative of the service and an immediate requirement notice was issued at the time of the inspection in connection with the safe storage of medications. A return visit was made to the home on 4th October 2007. Medicines were securely stored and kept in the office, which now has key coded access. However the trolley was not secured to a fixed point and two sharps disposal boxes; one full of needles were found in an unsecured area. (See Management and Administration section) Medication processes were inspected with the Registered nurse on duty; records and amounts checked on the day indicated several errors in recording and amounts left. One record on the Medication Administration Record (MAR) chart stated that thirty tablets had been received; there were seven tablets remaining. However there were twenty-eight signatures on the MAR chart. The amount of medication therefore did not correspond with the signatures verifying administration. There were no signatures for handwritten entries on two of the MAR charts seen. In addition to the tablet in the pot on the top of the medicine’s trolley, which the Registered nurse said that she had found on the floor, it was noted that three other tablets had been found on the floor since the 12th June, from the records in the medicines returns book. High Trees Nursing Home DS0000059925.V349299.R01.S.doc Version 5.2 Page 15 One resident was taking warfarin. There were no records confirming the number of tablets given on the MAR chart. One box of warfarin had not been dated on opening, so it was not possible to audit that records corresponded with amounts in stock. Allergies were recorded or ‘none known’ on MAR charts. During the tour of the premises creams were found in two resident’s rooms that were not labelled or dated on opening. The Registered nurse in charge was asked if the home has a suction machine they were unsure if the home had one. Due to the needs of residents the equipment should be available and staff aware of how to use it to ensure all residents health care needs are supported appropriately. The representative of the service confirmed later on that they had a suction machine and that it was held in the office. Five residents files were viewed during the inspection. It was noted that the documentation reflected sensitivity in supporting residents; an example on one care plan was the aim to “ensure privacy and dignity”. This evidence was supported by observed practice where staff supported residents in a caring and respectful manner. Staff members knocked on residents’ doors before they entered; residents were approached sensitively when they had fallen sleep in the lounge. Staff supporting residents to eat sat in positions so that residents were aware of what was happening. During the inspection positive relationships were observed between residents and staff, with staff liaising with senior members of staff regarding the meeting of people’s needs. High Trees Nursing Home DS0000059925.V349299.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 good. This judgement has been made using available evidence including a visit to this service. Resident’s preferences are taken into account and their history and life style informs the care provided. They are supported to maintain contact with people who are meaningful to them and as far as possible they are supported to have control over their lives. Residents are supported to have a balanced diet that is in line with their nutritional requirements and the home supports residents to enjoy the meals provided. EVIDENCE: Full life histories were seen on files and references to regular contact by a range of family members and significant people. Files evidenced awareness of cultural heritage and diversity. Key information on how to contact people was detailed and records evidenced that residents were supported to maintain these contacts. Post cards and letters received were also seen. High Trees Nursing Home DS0000059925.V349299.R01.S.doc Version 5.2 Page 17 The home now has an activities co-ordinator who works each weekday and is developing a range of activities for individuals. Files seen included details of a Barbeque, residents involved in watering the garden, reflexology, painting and trips to the shops. The home also has the use of a unit car and information was provided that the car is used regularly for the enjoyment of residents. During the inspection one of the staff had the responsibility in the afternoon to undertake activities with residents. An activities file is now held in the office where events are recorded. During the inspection staff provided residents with choices, care plans supported this and evidenced liaison with family members and key people about decision-making. Residents were seen having breakfast at a range of times according to personal choice and some were still in bed, the staff advised this was because some people did not choose to get up early. The food cooked was well presented and residents were supported to eat where required. The menu viewed included a range of food appropriate to a healthy diet and a full range of vegetables and fruit was in the kitchen. Residents who required pureed foods were supported with the same. Speech and Language Therapy assessments had been undertaken to advise on texture and thickeners to be used and these were recorded on the file. The director confirmed that residents receive pureed diets individually rather than mixed together to improve presentation and taste. Records of fluid intake were held centrally in the kitchen. One chart had not been completed after lunch and the staff member said that they needed to complete it. It was advised that if charts are kept near to where staff members are helping residents to access their food and fluids, this might support accurate recording and monitoring. A detailed list of individual dietary requirements is also held in the kitchen, but needed to be up dated. High Trees Nursing Home DS0000059925.V349299.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, 18, Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Positive steps have been taken to improve the environment within the home and as a result of this complaints have reduced as confirmed by the provider in the AQAA. However current staff records do not evidence that required recruitment procedures are in place or adequate training to ensure that residents are safeguarded and protected at all times. EVIDENCE: A complaints policy is displayed as you enter the home. Evidence in the files recorded requests for family members to be consulted on care practice. The AQAA records that the home ‘ encourages the early discussion over any concerns’. There have been no complaints since the last inspection, which the provider feels has partially been the result of a quality assurance system the home has developed. The AQAA recorded a significant reduction in complaints over the last year and none since January 2007. The office contained files with a range of policies and procedural guidance including an adult protection policy; there have been no adult protection High Trees Nursing Home DS0000059925.V349299.R01.S.doc Version 5.2 Page 19 referrals since the last inspection. However, it was not clear how many staff had read these polices. Discussions held with residents during the inspection supported that they were happy with the home. However, the protection of residents is not ensured by the current recruitment and training practices from the evidence available on the day on staff files. (See staffing section.) High Trees Nursing Home DS0000059925.V349299.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, 21, 23, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Significant improvements are being made to the environment, which is kept clean and hygienic, providing residents with comfortable surroundings. EVIDENCE: The home was clean and pleasant on arrival. The home has a maintenance manager who was present at the start of the inspection. He advised of the stages of refurbishment to date. In the last two reports, the AQAA and Regulation 26, information is given of the improvements made. This has included new specialist beds for residents, the last three due in the next few weeks. Rooms have been redecorated and the garden now provides a delightful area for residents to enjoy, which is enclosed and has a water feature. High Trees Nursing Home DS0000059925.V349299.R01.S.doc Version 5.2 Page 21 Individual bedrooms viewed were seen to reflect the individuality of the residents and had their possessions in them. They were clean and well presented. The conservatory was well furnished. One resident was sat in the conservatory, with the sun directly shining on them during the inspection. There are blinds in the conservatory, which are available for use to provide adequate shade in hot weather. A rusty bath chair was seen in the downstairs toilet, which should be replaced under the refurbishment programme. The kitchen area was well presented and equipped. The cupboards evidenced a range of appropriate stock and equipment. The home has a laundry, which is to the side of the main building in an out building. It has one industrial washer and one industrial dryer. Currently this building is used for the storage of obsolete equipment due to the refurbishment and is awaiting disposal. The floor of the laundry was noted to require re surfacing. The representative of the service confirmed that this is on the current list of ongoing work. Staff members observed good practice in terms of infection control during the visit, washing their hands between tasks and wearing gloves appropriately. High Trees Nursing Home DS0000059925.V349299.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, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents can be confident that there are sufficient staff members on duty at all times. However records do not confirm whether staff have been appropriately recruited or adequately trained. EVIDENCE: Staffing levels on the day of the inspection were adequate and the rota viewed supported that this is a consistent picture. Observed care practice was positive and supported residents rights, dignity and choice. The home has two staff members with a National Vocational Qualification (NVQ) at level 2 in Care and one member of staff with an NVQ at level 3 of the nine care staff members working in the home. There are also two staff members working toward an NVQ. There was only one staff file seen for a staff member who had been recruited since the last inspection. Seven staff files were viewed on the day and significant omissions in required documentation and procedures were found in both the member of staffs’ file who had started work since the last inspection High Trees Nursing Home DS0000059925.V349299.R01.S.doc Version 5.2 Page 23 and in files for staff members who had been working in the home prior to the last inspection: • Five files only had one reference and two had no references. • One file had no evidence of a check of the Protection of the Vulnerable Adults’ (POVA) list or a Criminal Records Bureau (CRB) check. • Another file held a copy of the persons CRB requested by another organisation, which is not adequate. • Two Registered nurse files had no evidence of current nursing PIN numbers. • Three files had no application forms or record of work history • Three had no pictures. • There were no records of any induction training for the most recent staff member. • It was difficult to clarify from the files if staff had attended any essential training. • The student visa had expired on one file. The last report states that two files were examined and found to contain all essential information. Records seen on this occasion did not contain the documentation required as part of good recruitment practice and training of staff to meet satisfactory competence in meeting the needs of people living at High trees. There was some building work taking place in the area where records were stored. The inspectors sampled the records that they were shown as being the complete files. However it could not be ascertained if due to works being carried out, some documents may have been stored elsewhere. Staff files viewed did not evidence up to date essential training for staff, which would support appropriate care practice. The representative of the service advised that most of the staff are currently on a correspondence course with Bournemouth College for Dementia care. There was no summary sheet of mandatory training. Courses were advertised but there was no indication of planned attendance. The AQAA records that the Director will be attending a three-day course on Adult Protection in November 2007. One file for a Registered nurse had no record of any training attended, since they had started work in the home. There was no records of two staff members attending manual handling training and there had been issues, according to the records seen, regarding the members of staff using correct techniques to move residents safely. Attention was drawn to the www.skillsforcare website where learning sets and logs can be downloaded to support training. Also the Local Partners in Care website; www.picdp.co.uk provides advise on funding sources for training. Suggestions on the development of a training matrix were offered to support the home in recording training and identifying where training is required. These are matters of serious concern in relation to the documented evidence of the suitability and competency of staff members, which does not support the High Trees Nursing Home DS0000059925.V349299.R01.S.doc Version 5.2 Page 24 welfare of residents. Prompt action needs to be taken to avoid enforcement action. High Trees Nursing Home DS0000059925.V349299.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, 33, 35, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is no Registered Manager in place to ensure that the home is safely managed and well organised and run in the best interests of residents. Resident’s interests and needs are generally taken into account in the planning and development of the home. However, some areas and current practices require further management by the home to ensure the safety and well being of staff and residents. High Trees Nursing Home DS0000059925.V349299.R01.S.doc Version 5.2 Page 26 EVIDENCE: At the time of the inspection the home did not have a Registered Manager in place and this is reflected in the concerns highlighted in this report. However, from the input and commitment expressed by the representative of the service, it was evident that any issues highlighted will receive prompt attention. Observed care practice and records evidenced the needs of residents being assessed and generally taken in to account in the running of the home. A quality assurance assessment was seen that supports the development of the home after consultation with residents and family members. Great time and commitment has been put into implementing this system on the part of the providers and this is reflected in the positive improvements seen in the home’s environment. The providers are clearly concerned about the day-to-day running of the service and improving the service in the best interests of residents. Although the inspection took place on a Saturday, a representative of the service came to the home and was keen to receive feedback and act upon any concerns. The quality assurance system now needs to be developed to include audits of working practice in the home, including medicines and recruitment, ensuring that residents are safeguarded by the home’s policies and procedures. The provider confirmed that the home does not currently manage the finances of any resident; these are undertaken by relatives or appointed representatives. Only one staff file inspected contained evidence of staff appraisal, which was in 2006. Insufficient records available at the inspection meant staff’s supervision, current training and professional status were unable to be clarified. Inconsistencies in staff records prevented confirmation of safe recruitment procedures and consequently the safety and welfare of residents and staff. (Please cross reference to the section on staffing) During the tour of the premises hazardous substances were found to be present in three unsecured areas. The provider immediately removed these. A door to a cupboard on the first floor that contained hot water pipes and electrical equipment was not locked. As already discussed in the environment section some chairs need to be replaced and residents sitting positions assessed, replacement made of any equipment that is rusty, the laundry floor re done. The ongoing refurbishment needs to be completed to ensure the High Trees Nursing Home DS0000059925.V349299.R01.S.doc Version 5.2 Page 27 environment and standard of furnishings is appropriate and adequate to meet the needs of the residents. In the two sluices and the laundry hazardous substances were found which the services representative removed immediately and stored away securely. An immediate requirement was issued on the day in relation to this matter. The inspectors returned to the home on 4th October and found that the home had made progress in meeting the immediate requirement issued; with hazardous substances locked away. However, there were two boxes of used sharps for disposal in an open sluice, which was placed in a locked cupboard at the time of the visit. Servicing records were not available at the inspection and therefore maintenance records and servicing could not be evidenced from this source. However the provider advised that these had all been completed. Systems are in place to support resident’s health and safety however management need to undertake further work to ensure that regulations, standards and requirements are consistently adhered to for the welfare of residents and staff. On two files recorded incidents relating to poor manual handling practice were seen but there was no documentation to evidence that the staff members had received manual handling training. In the detailed feedback given on the day the services representative was keen to address these matters. High Trees Nursing Home DS0000059925.V349299.R01.S.doc Version 5.2 Page 28 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 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 3 x 2 X 3 X 2 3 Score Standard No 27 28 29 30 3 3 1 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 1 High Trees Nursing Home DS0000059925.V349299.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No 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 Timescale for action 30/11/07 2. OP9 13 All care plans and health records must be kept up to date and be easily accessed to ensure that the health and social care needs of residents are always fully met. 31/10/07 The registered person must ensure that medicines are safely administered, recorded, stored and disposed of, protecting the health and well being of residents. There must be an audit system in place so that medicines are regularly checked from receipt to disposal / administration, ensuring that amounts of medication held correspond with Medication Administration Records. An immediate requirement was issued at the time of the inspection regarding the safe storage of medicines. The timescale for compliance was 15th September 2007. A compliance visit was made on the 4th October 2007. See Health High Trees Nursing Home DS0000059925.V349299.R01.S.doc Version 5.2 Page 30 and Personal care section of this report for details. 3. OP29 19 The registered provider must 31/10/07 ensure that standard recruitment practices are fully adhered to, which will ensure that residents are protected and their welfare maintained. Staff members need to be 10/12/07 trained sufficiently to ensure that residents are in safe hands. 15/10/07 All hazardous substances must be consistently stored safety in line with regulatory guidance and for the safety and well being of residents. Sharps boxes must be securely stored. Protecting residents from harm. This was issued as an immediate requirement at the time of the inspection with a timescale of 15th September 2007. A compliance visit was made on 4th October 2007. See Management Section of this report for full details. 4. 5 OP30 OP38 18 13 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations It is recommended that specific information on the management of diabetes is included in the care plan of the resident with this condition. DS0000059925.V349299.R01.S.doc Version 5.2 Page 31 High Trees Nursing Home 2. OP8 It is recommended that a clinical nutritional risk assessment tool be used to assess the dietary and nutritional needs of residents at the home. High Trees Nursing Home DS0000059925.V349299.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 High Trees Nursing Home DS0000059925.V349299.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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