CARE HOMES FOR OLDER PEOPLE
High Trees Nursing Home 3 Glenferness Avenue Talbot Woods Bournemouth Dorset BH4 9NB Lead Inspector
Amanda Porter Announced Inspection 10:00 19 December 2005
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 DS0000059925.V276224.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. DS0000059925.V276224.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) DS0000059925.V276224.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 4th January 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 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. DS0000059925.V276224.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place during the morning and early afternoon of the 19th December 2005 and took two inspectors a total of seven hours. The purpose of the inspection was to review some of the requirements and recommendations made in the last report and to assess key standards. The newly appointed manager, Mr Thomas, was on hand throughout to aid the inspection process. He has submitted an application to register with the Commission for Social Care Inspection, which is being processed. Six residents, two visitors and five members of staff were spoken with and asked their views on the services provided at High Trees. Prior to the inspection taking place residents, relatives, visitors and health and social care professionals were invited to complete comment cards about the home. The Commission for Social Care Inspection received two responses from visitors/relatives and one from a GP. Comments included: “Food is excellent and staff are very good.” “We have a good staff team.” “Staff are a bit rough sometimes.” “The food is not good.” “The home has improved over the last three years.” “I am not able to visit very often but when I do I am always impressed with the staff’s patience and kindness.” Comment card responses indicated that visitors were made welcome to the home. One stated that they were happy with the overall care provided another said they were not. Some documentation was reviewed, including care files, personnel and training records, policies and procedures. A tour of the premises was undertaken. What the service does well: What has improved since the last inspection?
Since the last inspection the home has reviewed it’s policy and procedure to respond to suspicion or evidence of abuse and staff had received training on the protection of vulnerable adults. Their knowledge helps to provide a safe environment, which will protect residents from abuse.
DS0000059925.V276224.R01.S.doc Version 5.1 Page 6 What they could do better:
As a result of this inspection a total of seventeen requirements and five recommendations have been made. A full assessment of needs must be undertaken prior to any resident being admitted to the home so that staff can assure the resident their needs can be met. Further work needs to be done to make sure care plans give details of how residents’ needs are to be met. The information gained through assessment must be used to develop a suitable care plan. Residents and their chosen representatives must be invited to participate in the drawing up and review of plans of care that affect them and their views must be considered. To ensure that all medicines in the home are held securely and administered appropriately all lotions need to be labelled clearly so that staff know to whom they belong. The temperature of the medication fridge should be recorded on a daily basis. Social activities are limited at present and consideration should be given to addressing the individual needs of residents who do not wish to participate in group activities and make group activities more relevant to the residents undertaking them. The meals in the home offer very little choice. A copy of the menus should be made available to all residents. To improve the overall nutrition of residents they should be offered fresh fruit on a daily basis. Although High Trees has a policy for investigating complaints the registered person had not followed it. This meant that residents and visitors could not be confident that complaints would be listened to or acted upon. The home was seen to be generally clean, however some areas still needed attention to ensure that residents are protected from any cross infection. The systems for care staff undertaking laundry duties need to be reviewed to ensure that at night staff are not leaving the main building to go to the laundry, situated in an outbuilding. If a member of staff leaves the home at night it only leaves one member of staff to respond to residents and to meet their needs. Recruitment records were seen to be incomplete, resulting in the management not being able to guarantee that staff were being employed appropriately. The home needs to develop its staff training programme to include the common induction training for care staff, which will meet the National Training Organisation workforce targets and to continue NVQ training. This will equip
DS0000059925.V276224.R01.S.doc Version 5.1 Page 7 staff with the ability to meet the assessed needs of the service users effectively at all times. An annual development plan must be developed as part of the quality assurance monitoring system so that residents can be assured the home is run in their best interests. So that residents’ financial interests are safeguarded any monies held by the home on behalf of a resident should be accounted for and clear records must be kept. To ensure that the residents’ and staff safety is maintained all staff need to have regular fire safety and moving and handling training. 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. DS0000059925.V276224.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000059925.V276224.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable as home does not provide intermediate care. The assessment process is insufficient and does not enable the home to thoroughly assess a persons needs or establish whether those needs can be met. EVIDENCE: The care files for five residents were reviewed. Some contained information gained through pre-admission assessment and some did not. Where a preadmission assessment had taken place insufficient information was gained to be able to construct a meaningful care plan or to be able to give assurances to the prospective resident that their needs could be met. These assessments did not indicate where they had taken place or who was involved with the assessment process. Standard 2 was not assessed on this occasion and the requirement made relating to this standard has been brought forward into this report. DS0000059925.V276224.R01.S.doc Version 5.1 Page 10 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. 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. Health needs are not always assessed properly, which may result in care not being given appropriately. The systems for the storage of some medications are poor and potentially place service users at risk. EVIDENCE: The care documentation records for five residents were reviewed. Each file contained a variety of risk assessments, which included: Mental health Physical health assessment Falls risk assessment Behaviour assessment Pressure sore risk assessment Nutritional screening. One file contained a bowel care pathway assessment, which had been left blank, and an incomplete urinary continence care pathway assessment form.
DS0000059925.V276224.R01.S.doc Version 5.1 Page 11 Although incomplete the continence assessment did show the resident has problems but there was no written plan of care as to how the resident’s needs would be met. Some files contained a life history of the resident. This information was not then used to develop a plan of care. Some care plans did not give specific information for staff to follow so that needs could be met satisfactorily. One plan for a resident with a rash stated, “ To ensure area is clean and prescribed cream applied.” It did not indicate which cream should be used. Another plan referring to the mental health needs of one resident stated “does not respond well to any intervention.” It did not give any positive advice as to how to help the resident. One file showed that the resident had a very high risk of developing a pressure sore and special assistance was required. The care plan then gave conflicting information and stated that the resident moved quite freely in bed and he did not require a pressure relieving mattress. Files did not show that either the resident or their representative were invited to be part of the care planning process. The medication administration records were reviewed and appeared to have been completed accurately. Most of the medicines were stored securely in the drug trolley. The home has a lockable medicine fridge in the nurses’ office, however a recording of the fridge temperatures was not done on a daily basis. The fridge contained some eye drops, which had not been dated when opened and therefore it was not possible to ascertain when they became out of date. It was noted in one of the shared rooms there were pots of aqueous cream and sudocrem which did not have a label on them to distinguish which resident they belonged to. DS0000059925.V276224.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 & 15. The social and recreational needs of the service users are not wholly satisfied, which results in some residents being bored and under stimulated. The menu in the home showed little evidence that residents were offered choice at mealtimes. EVIDENCE: There was no programme of activities for the residents and the manager confirmed that other than the occasional outside entertainer visiting the home there were no other activities organised at present. Some staff spoken with said that where time allowed they would play games and assist with physical activities. However some residents spoken with said they were bored at times. There was no provision to meet the recreational needs for those residents unable or unwilling to join any group activity. On the day of inspection the chef was off sick and a health care assistant was cooking. Lunch was home made lamb hotpot with fresh vegetables. However the shopping lists seen for a period of time contained a lot of processed ready meals including Cornish pasties, fish fingers and frozen vegetables. There was no fresh fruit available on the day of inspection. DS0000059925.V276224.R01.S.doc Version 5.1 Page 13 One resident said, “The food is excellent.” Another said, “The food is not good.” The menu did not offer a choice for the residents but staff said that if they knew a resident did not like what was on offer a choice was given. A copy of the menu was not made available to each resident. DS0000059925.V276224.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 & 18. The complaints process in this home is poor with little evidence that residents’/relatives’ views are listened to or acted upon. Staff’s knowledge and understanding of Adult Protection issues helps to provide a safe environment to protect service users from abuse. EVIDENCE: The home has a policy for dealing with complaints but it does not make it clear that the complainant may contact the Commission for Social Care Inspection at any time. A visitor to the home stated they had made a complaint but no information was held by the home. One personnel file contained a complaint about the member of staff. There was no evidence that an investigation of that complaint had been undertaken. A hand written log of complaints was kept in the front hall for all to see, which would breach the confidentiality of any person wishing to make a complaint. Since the last inspection one complaint was made directly to the Commission for Social Care inspection with regard to the time it took staff to summons medical help. This complaint was upheld. The home had a policy and procedure to respond to suspicion or evidence of abuse or neglect and a copy of the Department of Health guidance “No Secrets”. Through discussion staff demonstrated knowledge of this policy. DS0000059925.V276224.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): 26. The home is generally clean and hygienic. The systems for dealing with laundry result in the home being inadequately staff for periods of time during the night. EVIDENCE: Most areas of the home were clean and free from unpleasant odours. One resident was sat in a chair, the arms of which were encrusted with stale food. The staff toilet is also a general storage area. There was no soap in this room for staff to wash their hands. The laundry is situated in an outbuilding. The care staff undertake laundry duties. This means that at night, when the staffing levels consist of one registered nurse and one healthcare assistant, one person may be outside leaving only one member of staff to meet the needs of the residents in the home. Should an emergency arise there is no way of contacting the person in the laundry.
DS0000059925.V276224.R01.S.doc Version 5.1 Page 16 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): 29 & 30. Major shortfalls in the recruitment procedure do not protect residents from risk. Some short falls in the training results in some care staff not being fully competent to do their jobs properly and therefore residents could not be assured they were in safe hands at all times. EVIDENCE: The personnel files for four members of staff were reviewed. The quality of information contained in each file was variable but they all contained: • A job application form • Terms and conditions of employment • A recent photograph. The work history for one member of staff was incomplete and there was no Criminal Record or POVA First check. Two files did not contain evidence that work permits had been sought from the Home Office. No references had been sought for one member of staff although they had been working in the home for over a year. Because the recruitment process was not robust residents could not be assured that appropriate staff were appointed. Training files did not demonstrate that healthcare assistants were receiving the common induction training, which meets National Training Organisation workforce training targets.
DS0000059925.V276224.R01.S.doc Version 5.1 Page 17 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): 33, 35 & 38. Some management practices do not promote and safeguard the welfare of residents. The manager does not have a clear development plan and vision for the home, which 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. EVIDENCE: The Commission for Social Care Inspection has received an application to register Mr Thomas as manager and he will attend interview in due course. Standard 32 was not assessed on this occasion and the recommendation made in the last report has been brought forward in to this one.
DS0000059925.V276224.R01.S.doc Version 5.1 Page 18 The manager confirmed that there had been little progress made yet with regard to quality assurance processes within the home. One audit for hotel services had taken place and an action plan had been written but not actioned, although three of the concerns raised within the audit had been deemed as urgent. The home holds “pocket money” for some of the residents. However there were no written records of any transactions made on behalf of the resident concerned. Through reviewing training records and talking with staff it was evident that some staff had not had fire safety training within the last six months or manual handling training in the last year. The manager and registered nurse on duty on the day of inspection had not had any recent fire safety training. Cleaning materials and other substances hazardous to health were seen to be stored securely when not in use. A record of accidents to residents and staff were held appropriately. DS0000059925.V276224.R01.S.doc Version 5.1 Page 19 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 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 3 X X X X X X X 1 STAFFING Standard No Score 27 X 28 X 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X 1 X X 1 DS0000059925.V276224.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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 only admit a resident into the home after ensuring that a thorough assessment of his/her needs is carried out and given assurance that these needs will be met. 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 cable and/or representative (if any). 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. The registered person must ensure that all assessments made prior to drawing up the residents care plan are completed correctly.
DS0000059925.V276224.R01.S.doc Timescale for action 1 OP2 5(1) 28/02/06 2 OP3 14(1) 28/02/06 3 OP7 15(1) & (2) 28/02/06 4 OP7 15(1) 28/02/06 5 OP8 14 28/02/06 Version 5.1 Page 21 6 7 OP9 OP12 13(2) 16(2)(n) 8 OP16 22 9 10 OP26 OP26 13(3) 13(3) & 16(2) 18(1) 11 OP26 12 OP29 19 & Schedule 2 13 OP30 18(1) 14 OP33 24 15 OP35 17 & Schedule 4 23(4)(d) 13(5) 16 17 OP38 OP38 All lotions must be labelled to identify who they belong to. Residents must be consulted about a programme of activities and the home must provide facilities for recreation. The registered person must investigate and act upon any findings of any complaints made. A record must be kept of all complaints Soap must be provided in the staff toilet. Any soiled chairs must be thoroughly cleaned or replaced. Where laundry duties take staff out of the home they must only take place when sufficient staff remain in the home 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. The registered person must ensure that care staff receive common induction training to National Training Organisation specification. The home must have an effective quality assurance and monitoring system. (Original date for compliance was 31/03/04). A clear record must be maintained of all money held on behalf of a resident. This must include a record of any transactions made on their behalf. All staff must undertake fire safety training every six months. All care staff must undertake manual handling training every year.
DS0000059925.V276224.R01.S.doc 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 Version 5.1 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP9 OP15 OP15 OP16 OP32 Good Practice Recommendations 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. The minutes and action relating to staff meetings should be available for inspection. DS0000059925.V276224.R01.S.doc Version 5.1 Page 23 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
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