Inspection on 07/06/06 for High Trees Nursing Home

This inspection was carried out on 7th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 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 Jo Pasker Key Announced Inspection 09:30 7 & 8th June 2006 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.V295064.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. DS0000059925.V295064.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 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.V295064.R01.S.doc Version 5.2 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. The conditions of registration stated are those which were in place at the time of the inspection. However, these are due to change imminently upon registration of the new manager. Date of last inspection 1st March 2006 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 Glenfurness Avenue Ltd and is currently without a registered manager but is managed on a day to basis by a registered nurse, Mr Gerry Thomas. The fee prices in June 2006, range from £600-£800 per week for nursing care. DS0000059925.V295064.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection by an inspector and a regulation manager, took place over 2 days on 7 and 8 June. A total of 8.5 hours was spent at the home. The inspection team spoke to all residents, 5 staff members and gathered information from the manager, registered providers and documentation available. A tour of the premises was conducted and staff interaction with residents and the carrying out of routine tasks observed. Additional information used to inform the inspection process included formal notifications of events regularly provided to the Commission by the registered provider and comment cards received. Of these, 8 were received from relatives and visitors and 1 from a GP. A pre-inspection questionnaire was also received from the home. No complaints have been made to the Commission since the last inspection. What the service does well: What has improved since the last inspection? Contracts are available for all funded residents now. Individual’s care plans are now well written and detail any interventions necessary for care. Residents and their chosen representatives are also now involved in the drawing up of care plans and sign them accordingly. All assessments undertaken prior to writing a care plan are also now completed fully and accurately. The medication policy has been updated and procedures are now being followed, ensuring that residents are protected from any unnecessary risks. All residents are now offered 5 portions of fruit and vegetables a day, following dietary advice. DS0000059925.V295064.R01.S.doc Version 5.2 Page 6 The home’s complaints policy and procedure has now been updated. All staff have now received mandatory fire training. A quality assurance system has now been implemented regarding the running of the home. What they could do better: As a result of this inspection a total of 13 requirements and 6 recommendations have been made. The drug trolley must be securely affixed to the wall when not in use. Residents’ dignity must be promoted and incontinence seat covers should not be used. Promotion of continence and proper management of incontinence must be the focus of care, where this is necessary. There continues to be a lack of meaningful activities for residents and this must be improved to accommodate their varying levels of ability and needs. A more ‘person centred’ approach needs to be followed to ensure residents’ individual needs and preferences can be achieved. Residents must have access to drinks at all times, the daily menu should be displayed in an accessible format and dry foods must be stored appropriately. The home still needs further maintenance and refurbishment to make it a more pleasant and safe environment in which to live. The home needs to ensure that adequate numbers of staff are on duty at busy times to ensure that all of the residents’ needs continue to be met. The recruitment process must be fully followed so that residents can be assured suitable staff are providing their care. The home must obtain 2 suitable references for any newly employed staff, prior to them commencing work. An appropriate induction programme should be available for new staff and completed in a timely manner. The home must ensure a suitable manager is appointed to ensure that the home is run in the best interests of the service users. The home should devise a formal documented means of obtaining residents’, visitors’ and stakeholders’ opinions on the running of the home to ensure that the home is run in the best interests of residents. DS0000059925.V295064.R01.S.doc Version 5.2 Page 7 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.V295064.R01.S.doc Version 5.2 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.V295064.R01.S.doc Version 5.2 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): Standards 2 & 3 (Standard 6 does not apply to this home) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 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: Individual contracts were available for some of the funded service users, however others were covered by a group contract, which had been supplied by the funding authority. This was viewed and although did not name individual service users, it stated was for a block contract and was signed and dated appropriately. This met the requirement made in the last report. The file for a recently admitted resident was viewed and contained a preadmission Care Management assessment and other documentation to suggest that other appropriate mental health care professionals had been involved. DS0000059925.V295064.R01.S.doc Version 5.2 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): Standards 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is now a clear and 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 assessed properly, ensuring that care is being given appropriately. The home has appropriate policies and procedures in place for the administration and storage of medication, ensuring that residents’ health needs are safely met. Residents are treated with respect, however their privacy and dignity is not always promoted. DS0000059925.V295064.R01.S.doc Version 5.2 Page 11 EVIDENCE: The care records of 3 residents were viewed on the day of inspection. These were found to be comprehensive, up to date and relevant and were based on the findings of appropriate assessments. They provided suitable information to staff about the needs of each resident and how they are to meet each need. Where possible, care plans have also been signed by the resident or their representative or state that the resident is unable to sign. Observation sheets kept in 1 resident’s room though were misleading regarding the amount of assistance needed and given by staff. These need to be reviewed and their purpose clarified with the staff team. All assessments undertaken regarding nutrition and mobility that identify needs are now accurately reflected with appropriate interventions in the care plans. Risk assessments were seen for residents with bed rails and weights are now being regularly monitored and advice taken from their GP on any loss or gain incurred. Food charts are also being kept on advice from the dietician and ensuring that residents receive 5 portions of fruit and vegetables a day. There was clear evidence of regular GP involvement on the daily entry sheets. Comment cards received from both professionals and relatives, reflected their feelings regarding care given at the home currently: • • “The home is excellent….they look after her very well” “I am very happy with the loving care and attention my husband receives at High Trees. He couldn’t be in a better place”. During the inspection, medicines were properly stored, being locked away and with a refrigerator for cold storage. Staff record fridge temperatures regularly and the records were seen to support this. Records were kept of the receipt, administration and disposal of medication and examination of these showed that all was well recorded and there is a clear audit trail available. One service user is given covert medication and the care plan and GP’s consent was seen to support this. Medication reviews were also seen for each resident. The medicines policy and procedure has now been satisfactorily updated and the Controlled Drugs cupboard repositioned following previous requirements made. However, the medicines trolley was observed to not be fixed to the wall whilst not in use, despite a previous requirement regarding this. Staff were observed to exhibit a caring, committed attitude to the residents and their interaction was always cheerful and supportive. Staff were seen to knock on resident’s doors before entering and address them appropriately. DS0000059925.V295064.R01.S.doc Version 5.2 Page 12 The home is also looking into providing staff with some training in customer care skills. Some residents were observed sitting on seat covers for incontinence in the communal lounge and this does not promote their dignity and may also be regarded as a substitution for regular toileting by staff and is poor practice that must stop. Promotion of continence and proper management of incontinence must be the focus of care, where this is necessary. DS0000059925.V295064.R01.S.doc Version 5.2 Page 13 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): Standards 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The social care provided in the home does not wholly satisfy the social and recreational interests and needs of the residents. Residents are encouraged to maintain contact with the local community and visits by their friends and relatives are welcomed by the home. Individuals and staff’s daily routines do not always promote and protect service users’ rights, which they are entitled to. Generally the meals in this home have improved and offer more choice and variety ensuring that residents receive a wholesome diet, although some improvements are still needed to ensure residents’ needs are met. DS0000059925.V295064.R01.S.doc Version 5.2 Page 14 EVIDENCE: The care files reviewed showed that many of the social care plans have improved and the manager is working towards documenting individual service user’s life histories with the assistance of their relatives. The home does not employ a dedicated activities organiser and therefore care staff are responsible for planning and implementing any activities. This is clearly dependent on numbers of staff on duty and their existing workloads. During the course of the inspection, hand massage took place and reminiscence music was playing in the lounge, however there were periods when residents were seen just sitting with no stimulation. There is a basic activities programme in place but the manager was unable to supply a copy of this and the day’s activities were written on the board in the lounge. Activities need to improve ensuring that they are specific to the residents’ needs and varying abilities. A visitors’ book in the reception area of the home evidenced that residents receive visitors at all times and residents were seen being taken out by relatives during the course of the inspection. All comment cards received from relatives and visitors prior to inspection confirmed that they always felt welcomed into the home and also showed that relatives were happy with the level of communication received from the home regarding their relatives care and comments included: • • “…a good friendly atmosphere between staff, residents and family” “I am very satisfied with the care my father receives”. It was observed though, that some service users were left lying in bed or sitting in chairs in their room or communal areas, for long periods of time, either in front of a television or with music playing. This was also mentioned in comment cards received. Given the level of some resident’s communication difficulties, the lack of specific staff training in this area and absence of any involvement from independent advocates, it is impossible to say that service users rights are fully recognised. During the course of the inspection no communication aids or tools were seen to be used and staff spoken to confirmed they did not have any dementia specific training. The home has a local choir group visiting once a month and also an entertainer, who performs comedy and wartime songs. There is access to different denominational representatives if required and the home has recently held a garden barbeque for residents and their relatives and this was well attended. DS0000059925.V295064.R01.S.doc Version 5.2 Page 15 Meals and food provided appear to have improved since the last report. Lunchtime was observed during the course of the inspection and staff were seen to appropriately assist residents with meals and all pureed food was separately presented. Menu’s are still not displayed to residents and visitors though and should be made available in the interests of best practice. The kitchen was seen and appeared clean and tidy and there was adequate supplies of food seen, including fresh, frozen and dried/canned food stuffs. Dry store cupboard goods, which had been decanted into other containers, did not display the best before date or the date that goods were decanted on the named foods. The manager and staff confirmed that there is a choice of evening meals for the service users if required and a snack is given at 8pm. Food is also available overnight for the residents as the kitchen is always open, with some residents regularly requesting cereal or toast. However, on the first morning of inspection there appeared to be no evidence of water or cold drinks being given to service users during the tour of the home, despite the fact that it was a very hot day and there is a cold water dispenser in the main hallway. By the afternoon this situation had been rectified. Care must be taken to ensure residents remain properly hydrated, especially during particularly hot weather. DS0000059925.V295064.R01.S.doc Version 5.2 Page 16 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): Standards 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s complaints procedure now ensures that residents’ complaints will be dealt with fully and appropriately. Written policies are in place at the home to safeguard service users against abuse, neglect and self harm. EVIDENCE: The Commission has received no complaints since the last inspection and the complaints procedure has now been updated to make it clear that the complainant may contact the Commission for Social Care Inspection at any time. The procedure also now includes the timescales for investigation. In comment cards received from relatives and visitors prior to inspection, more than 62 of them confirmed that they were aware of the complaints procedure and only one had made a complaint to the home. The home has adequate policies and procedures in place for the protection of residents from abuse or neglect, including ones for whistle blowing, physical intervention and restraint. There have been no adult protection referrals made since the last inspection. Since the last inspection one ex member of staff has been referred for inclusion on the Protection of Vulnerable Adults list. This person was formally dismissed DS0000059925.V295064.R01.S.doc Version 5.2 Page 17 from High Trees following a previous complaint made and records relating to the incident were available for inspection. DS0000059925.V295064.R01.S.doc Version 5.2 Page 18 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): Standards 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is comfortable and homely although some on going maintenance work is needed to ensure a safe environment is maintained. The home is generally clean and free from any offensive odours, providing a pleasant and hygienic environment. EVIDENCE: There has been an improvement in environment at the home following previous requirements made and a programme of routine maintenance has now been supplied to the Commission. The new conservatory is now completed and 2 bedrooms have also been redecorated and refurbished to a good standard. DS0000059925.V295064.R01.S.doc Version 5.2 Page 19 However, it was evident from a tour of the premises that there are still a number of refurbishment and maintenance issues, which need attention so that the home becomes a more comfortable, safe place to live, including: • • • • • • • • • • Replacement of a stained shower tray in one room Rusted bath seat in downstairs bathroom needs replacement/refurbishment Pictures and call bell system list not affixed to wall in some areas Overflow pipe leaking onto flat roof above kitchen Signs for different rooms either missing or misleading Bathroom door handle loose as missing a screw En suite door stop in a room needs repositioning and replacing with a safer one Loose floorboard by lift entrance on first floor needs to be secured Ramp needed for wheelchair access to conservatory Broken/loose radiator cover in lounge needs to be replaced/affixed. In 1 bedroom a mattress had been placed down the side of the bed to protect the resident from falls, as bed rails did not fit the existing bed. The manager was advised that a low profiling bed would be a more appropriate and safer option. Also discussed with the manager and providers how the conservatory and lounge areas would benefit from more ‘homely’ furniture, as some of the current tables and chairs appear quite ‘institutionalised’. All areas of the home were clean and there were no unpleasant odours, but clean linen was seen left unattended spilling over from a basket in the hallway outside the kitchen. Clean towels were also seen being stored in a bathroom used by residents and is a risk for cross infection/contamination. The laundry is sited separately outside of the home and staff must access it by a side gate. The laundry was viewed and was in good order, with all equipment in working order and adequate to cope with the washing needs of the residents. However, a pile of unnamed clothes was seen heaped on a shelf in the laundry and when asked, the manager confirmed that it belonged to a resident with mental health needs who had stated these items were no longer wanted. Advice was given to label and store them appropriately in the interests of the resident, who is known to have frequent changes of mind with regard to such matters. Adequate supplies of soap and hand towels were also seen in the laundry for staff use. The soak away that was causing wastewater to remain on the concrete outside the back kitchen door has now been covered with concrete and is no longer a health hazard. Two previous requirements made in the last report have now been met from these actions. DS0000059925.V295064.R01.S.doc Version 5.2 Page 20 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): Standards 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. The numbers and skill mix of staff need to be reviewed and additional staffing hours provided to ensure service users needs are met. The home is continuing to work towards staff training for National Vocational Awards (NVQ), to ensure that residents are safely cared for. There is a recruitment procedure in place but his has not always been followed by the home, therefore placing service users at risk of possible harm or abuse. 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. EVIDENCE: The duty rota was seen during the inspection and it showed that sufficient numbers of care staff were employed to meet the needs of the residents. However, care staff continue to 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. Some new staff have been recruited since the last inspection and there has been some use of agency staff. The residents would benefit from an additional DS0000059925.V295064.R01.S.doc Version 5.2 Page 21 member of staff being employed to cover peak hours of activity, such as early morning and early evening, to ensure that their needs are being fully met. Currently 2 members of staff have achieved a National Vocational Award (NVQ) in care, 1 at level 2 and 1 at level 3 and 5 other members of staff are currently also undertaking an NVQ level 2. The files of 4 staff members were viewed during the inspection but 1 file was found to contain only 1 reference and another contained no proof of identification, as required. All other necessary documentation was present. Both employees had been recruited prior to the current manager starting in post and he confirmed that he is attempting to fill the gaps in documentation now. It appeared that for 1 employee, a reference was never returned and advice was given that a verbal documented reference would have been appropriate in these circumstances and that all future prospective employees must have 2 references prior to starting work. The 2 new staff employed since the last inspection, had received enhanced CRB and POVA first checks prior to commencing work and evidence was seen of this. There has been an improvement in training undertaken since the last inspection, with some evidence available in individual staff files. Courses included the administration of medication, food hygiene/nutrition and health and safety. All staff have now undertaken mandatory fire training but only 50 have completed a manual handling course, with the rest booked on the course later in the month. Some staff spoken to confirmed that they have not yet received training or updating in dementia care, diabetes or specialist areas relevant to the needs of the residents. However, the manager discussed that he was aware of the registered nurses clinical training needs, such as continence and planned to access free training offered by the local Primary Care Trust (PCT) and other training for dementia care and infection control was booked. There was some evidence that the new members of staff were undertaking a suitable induction programme, however 1 member of staff has still not completed their induction standards since the last inspection and has been employed since September 2005. Attention was drawn to the local Partners in Care website: www.picbdp.co.uk which contains information on funding for training, including life skills, NVQ and leadership for shift leaders. Attention was also drawn to the availability of learning sets and logs through the skills for care. Website: www.skillsforcare.org.uk Information was also provided for assessing the competence of Registered Nurses, including those taking charge of shifts. DS0000059925.V295064.R01.S.doc Version 5.2 Page 22 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): Standards 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The current manager of the home is not yet registered and his fitness in being qualified, competent and experienced to run the home in the best interests of service users was partially assessed during the inspection. The home has implemented some quality assurance systems, however these could be improved to ensure that the home is run in the best interests of the residents. The health, safety and welfare of residents and staff are generally well promoted and protected. However, some areas require further risk management by the home to ensure that risks to others’ safety are kept to a minimum. DS0000059925.V295064.R01.S.doc Version 5.2 Page 23 EVIDENCE: As documented in the last report, the Commission for Social Care Inspection has received and is processing an application to register Mr Thomas as the manager. Part of this assessment to determine Mr Thomas’s fitness as a manager took place during the course of the inspection and a final decision will be made after fully reviewing other supporting evidence available. 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 and is supported by other registered nurses who are experienced in the field of care provided. The home has now developed a quality assurance and monitoring system and plan, which is being conducted by the responsible individual and owner. Evidence was seen of quality assurance audits of different areas, including bedding and soft furnishings, furniture, catering and cleanliness. Other planned audits include key worker roles, recruitment and client choice. There was no formal evidence seen of how the home gathers residents, relatives and other stakeholders’ opinions, such as GP’s and district nurses, although the manager does regularly speak with them and discuss any concerns or issues. The manager confirmed that the home no longer holds’ pocket money for the residents and all finances are handled by relatives or appointed representatives. As already discussed in the staffing section of this report, 50 of the staff have now received manual handling training within the last year but the rest had not yet completed it. This was a requirement made in the last report. All staff have now received fire training and records were seen to evidence this as well as plans to ensure that it is given at regular intervals, alongside fire drills. As already documented in the environment section of this report, a tour of the home revealed that there are several maintenance issues, which need to be addressed. Other potential hazards noticed during the inspection, included: • A cupboard housing very hot water pipes left unlocked on the first floor DS0000059925.V295064.R01.S.doc Version 5.2 Page 24 • • • No sign to indicate potential tripping hazard over step of door from lounge into conservatory Door to outside motor room not locked Staff carrying heavy baskets of laundry-should be using trolleys to prevent injury. These issues pose a risk of potential injury to residents, staff and visitors. All maintenance and servicing records checked were found to be up to date. DS0000059925.V295064.R01.S.doc Version 5.2 Page 25 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 1 DS0000059925.V295064.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Timescale for action The registered person shall make 10/07/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home including: (a) Securing the trolley to the wall when not in use. Previous timescale of 31/03/06 was not met. A programme of activities must 30/09/06 be developed to ensure that all residents have the opportunity to engage in meaningful activities should they wish to do so. Previous timescales of 28/02/06 & 31/05/06 were not met. All beds and bedrails must be assessed as suitable and safe to meet the individual residents. The home must be well maintained and repairs made in a timely fashion. 30/09/06 Requirement 2. OP12 16(2)(n) 3. OP19 13(4) 4. OP19 13(4) 30/09/06 DS0000059925.V295064.R01.S.doc Version 5.2 Page 27 5. OP19 23(2)(b) The leaking overflow pipe onto the flat roof above the kitchen must be attended to. 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. Previous timescale of 31/05/06 was not met. 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. Previous timescales of 28/02/06 & 31/05/06 were not met. The registered person must ensure that care staff receive common induction training to National Training Organisation specification. Previous timescales of the 28/02/06 & 31/05/06 were not met. 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. Previous timescales of 28/02/06 & 31/05/06 were not met. 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. Previous timescale of 31/05/06 was not met. All care staff must undertake DS0000059925.V295064.R01.S.doc 30/09/06 6. OP27 18(1) 30/09/06 7. OP29 19 Schedule 2 30/09/06 8. OP30 18(1) 30/09/06 9. OP30 18(1) 30/09/06 10. OP31 9 30/09/06 11. OP38 13(5) 30/09/06 Page 28 Version 5.2 manual handling training every year. Previous timescales of 28/02/06 & 31/05/06 were not met. 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 OP8 Good Practice Recommendations Residents’ observation sheets should be reviewed regarding their purpose and appropriate training given to staff as necessary. Staff should not place incontinence seat covers on chairs. Drinks should be available at all times for residents. A copy of the menu should be available to residents and the menu should offer choice. All decanted dry foodstuff should be labelled and dated. The home should devise a formal documented means of obtaining residents’, visitors’ and stakeholders’ opinions on the running of the home to ensure that the home is run in the best interests of residents. 2. 3. 3. 4. 5. OP10 OP15 OP15 OP15 OP33 DS0000059925.V295064.R01.S.doc Version 5.2 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 DS0000059925.V295064.R01.S.doc Version 5.2 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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