Inspection on 12/03/09 for Holbeche House Nursing Home

This inspection was carried out on 12th March 2009.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Holbeche House Nursing Home 23/07/07

Holbeche House Nursing Home 02/08/06

Holbeche House Nursing Home 08/02/06

Holbeche House Nursing Home 09/09/05

Holbeche House Nursing Home 14/12/04

Holbeche House Nursing Home 20/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Holbeche House Nursing Home Wolverhampton Road Wall Heath Kingswinford West Midlands DY6 7DA Lead Inspector Yvette Delaney Unannounced Inspection 12 March 2009 11:00 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 DS0000058391.V373591.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. DS0000058391.V373591.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holbeche House Nursing Home Address Wolverhampton Road Wall Heath Kingswinford West Midlands DY6 7DA 01384 288924 01384 296733 holbechehouse@schealthcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross Care Homes No 2 Ltd 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) Margaret Lane Care Home 49 Category(ies) of Dementia (27), Old age, not falling within any registration, with number other category (22), Physical disability (8) of places DS0000058391.V373591.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: • Physical disability (PD) 8 • Dementia (DE) 27 • Old age, not falling within any other category (OP) 22 The maximum number of service users who can be accommodated is: 49 23rd July 2007 2. Date of last inspection Brief Description of the Service: Holbeche House Care Centre is a large Jacobean style Grade Two listed building set in extensive grounds. The home has undergone a major refurbishment programme to provide accommodation for up to forty-nine residents. The home provides accommodation on two floors; the first floor can be accessed by a passenger lift. The home has two lounges, two dining rooms and two lounge/dining rooms. The home has a separately staffed Dementia Care unit, which provides accommodation for up to twenty-two with dementia. The home has one double bedroom, all other bedrooms are single occupancy with many having en-suite facilities. There are extensive grounds and beautiful gardens for residents to enjoy. The home charges between £360 and £733 per week for residents to live there. This fee does include the Registered Nurse Care Contribution (RNCC) where appropriate. Other services available to residents at extra cost include hairdressing, chiropody, newspapers and magazines and organised outings. DS0000058391.V373591.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 Star. This means that people who use the service experience adequate outcomes. This inspection visit was unannounced. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who use the service and their views of the service provided. The inspection considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The manager for the care home was asked to complete and return an Annual Quality Assurance Assessment (AQAA). The assessment requests further information related to the quality of the service provided by the agency. Some of the information contained within this document has been used in assessing actions taken by the home to meet the care standards. The inspection focused on checking that systems and procedures are in place. Information was gathered from reviewing two staff files and a range of policies and procedures. Discussions with the Acting Manager, Deputy Manager and care staff helped to inform this report. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting, talking or observing them, discussing their care with staff, looking at their care files, and focusing on outcomes. Records relating to the care of the people using the service, training and health and safety were examined. Conversations were held with a number of residents who were able to make active contributions during the inspection visit. Information in this report is also gained from observing interaction between residents, residents and staff and visitors to the home. The manager was asked to give questionnaires to residents and their relatives. DS0000058391.V373591.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Care plans show that residents are weighed as their care needs indicate. This will make sure that resident’s needs are met in a timely manner. The kitchen duty rota has been reviewed and shows us that the number of kitchen staff on duty has been increased to provide adequate cover for a residents evening meals. This means that kitchen staff prepare evening meals and care staff numbers are not depleted and taken away from providing care for residents. Procedures in the kitchen have improved to make sure safe food hygiene practices are maintained. All opened and plated cooked food stored in the fridge were suitably covered, labelled and dated. This will protect residents from the risk of harm through cross infection. DS0000058391.V373591.R01.S.doc Version 5.2 Page 7 A heated trolley has been purchased, which means staff are not putting residents from the risk of harm by reheating meals in the microwave. What they could do better: Two requirements were made at this inspection visit related to unsafe practices in the home and twelve recommendations related to good practice. Requirements: Nurses must not leave the keys to the drug room/cupboard in the clinical room door. This will help to make sure medicines stored in the home are safe at all times and prevent nurses being at risk of harm. Resident’s bedrooms must be laid out in a way that makes sure it is safe to be used. The electrical wiring from appliances and equipment used to support care must be safely placed so that the wire is not trailed across the room, presenting a trip hazard for staff, visitors and residents. Recommendations: Nurses working in the home should make sure that practices related to the safe storage of medicines are maintained in a way that does not place them at risk from harm. Nurses should have their own tunics to wear when giving out the medicines to help prevent the risk of cross infection between staff and residents. Staff working in the home should ensure that visiting health professionals attend to residents care needs in a way that respects their privacy and maintains their dignity. A review of the activity plan for the home should include looking at suitable activities and events that residents can take part in outside of the home. This will help to vary the resident’s day-to-day life. Cleaning the home should not take place while residents are eating their meals. This will support residents eating in a pleasant environment and prevent the risk of contamination from dust particles and possible bacteria. The suitability of the bedroom on the ground floor where there are limitations on where the bed can be placed should be assessed before potential residents are offered the room. This will make sure that residents who require equipment to support their care are not placed in an environment where electrical wires are not safely placed. DS0000058391.V373591.R01.S.doc Version 5.2 Page 8 There should be sufficient staff on each shift to make sure that the lounge areas are not left unattended. This will help to make sure that people living in the home are not left at the risk of harming themselves. There should be sufficient staff on each shift to make sure that: • Residents who need help to eat their food have full support at mealtimes. This will help to make sure that residents are supported to eat a nutritious meal and staff are aware of what food residents have eaten. Laundry staff are able to carry out all procedures required in the laundry. This will help to make sure that residents have their clothes suitably laundered, decrease the risk of resident’s clothes going missing and make sure the laundry is organised. Housekeepers are able to carry out the cleaning of the home at suitable times that does not affect the well being and day-to-day life of residents. • • The duty rota should clearly show in what capacity staff are working. This will show the accountability and roles of staff on each shift. Plans should be in place to increase the number of staff with a NVQ 2 qualification in care. This will help to make sure that residents are cared for by competent and skilled staff at all times. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000058391.V373591.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 DS0000058391.V373591.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 Quality in this outcome area is good. People have information about the home available to help them make a decision about the home. Residents’ are suitably assessed before admission to the home and residents and relatives are assured that their needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and Service User Guide for the home have been updated. The documents provide information on the services and facilities provided by the home. Information in the homes AQAA tells us that copies of the Statement of Purpose are posted out to people who are interested in using the home. Statements of Terms and Conditions for moving into the home were available in resident’s files. These had been signed by the people using the service to confirm their acceptance of the conditions for living in the home. Terms and DS0000058391.V373591.R01.S.doc Version 5.2 Page 11 conditions include fees payable by individual people who decide to use the home. Three care files were examined as part of the case tracking process. One of which was for the most recent admitted person to the home. The care file for this resident showed that an assessment of their needs had been carried out before being offered a place in the home. The assessment looked at the physical, health, social care needs and the level of support needed to meet the person’s needs. Social services and nurses from the Primary Care Trust had completed other assessments of peoples needs. The completion of these supports the decision of whether the home is suitable to meet the care needs of residents. Written assessments examined show that family members had been involved in the assessment process. Family members confirmed during conversation that they had been involved in the assessment process before admission to the home. A relative said that they had been given the opportunity to visit the home before making the decision to use the home. A letter is sent out to residents and their families to confirm that they had been offered a place in the home. DS0000058391.V373591.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 and 10 Quality in this outcome area is adequate. Care plans provide staff with clear guidance on all aspects of resident’s needs. Medicines are administered to residents safely. Practices related to the safe storage of medicines are not maintained at all times. People are not always treated with respect to ensure that their privacy and dignity is maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At this inspection visit there were 41 elderly men and women living in the home. Care staff provide support to residents to help them meet their personal hygiene needs. As result people were well presented and wore warm suitable clothing. Our observation showed us that the personal care needs of people living in the home are being met. The care files of three people identified for case tracking were examined. Care files were standardised, well organised and documented. This should mean that staff have access to information about the needs of people living in the home and the actions they need to take to meet those needs. Care plans were DS0000058391.V373591.R01.S.doc Version 5.2 Page 13 person centred and should allow staff to deliver individual personal care based on the needs and wishes of people living in the home. Care files examined showed that they were written to include the individual care needs of residents based on their pre-admission assessment. The outcome of assessments carried out by social workers and PCT nurses had also been considered. Care plans identified the needs of each person based on their day to day living and gave staff the information needed to make sure resident’s needs were met safely and appropriately. A night plan of care for one resident showed their preferences for settling at night stating. “‘X’ (Resident) likes 2 pillows. ‘X’ would like her windows closed and lights turned off.” The home uses risk assessment tools to identify whether residents are at risk of developing pressure sores, poor nutrition or have an increased risk of falls. When the outcome of the assessment identifies an increased risk, care files show that a plan of care is developed to minimise the risk. For example, one person identified as a poor eater had a nutrition assessment completed and records show that daily intake of food and fluids were recorded. These were supported by a record of the person’s weight on admission to the home and then monthly weight records were maintained. Referral had also been made to the GP and a dietician. This helps to maintain the persons well being by preventing malnutrition. Care files showed other Health Care Professionals these include, an Optician, Chiropodist and the Dentist attended the residents. The Dentist was visiting the home at the time of this inspection visit. It was of concern to note that he attended to residents in the lounge areas of the home where other residents were present. This practice did not support the privacy or respect for individuals while he looked in their mouths and counted their teeth in front of everyone. A senior carer told us that she did offer the dentist a room to use where he could have seen residents in private, which he refused. We examined the systems for the management of medicines in the home. A monitored dosage (‘blister packed’) system is used. Medication is stored in locked trolleys, which are kept in a clinical room. It was of concern to see that the keys, which includes the keys for the medicine cupboards were left in the clinical room door on the outside. A medicines fridge is available in the treatment room with daily recordings of the temperature, which were within recommended limits. Controlled drugs are stored in a controlled drug cabinet. The contents of the CD cabinet were audited against the controlled drug register and the quantities were correct. Nursing staff had undertaken daily audits of the contents of the CD cupboard. Maintaining accurate records helps to ensure that medicines are maintained to comply with legislation, prevent the loss of controlled medicines and protect people from the risk of potential medicine administration errors. DS0000058391.V373591.R01.S.doc Version 5.2 Page 14 An audit of the medication prescribed for people involved in case tracking demonstrated that medicines had been accurately administered as prescribed and medicine administration records were accurately maintained. Appropriate systems for the safe disposal of medicines are in place. Unused medicines are checked and returned to the pharmacy. Observation of nurses undertaking medicine administration rounds showed that they wore tunics, which indicated to others that they were not to be disturbed while giving out the medicines. This is good practice as it gives the nurse the opportunity to concentrate on one task and promotes administering medicines to residents safely. The concern however, is that the tunics are shared between the nurses which leaves the member of staff and residents open to cross infection. Apart from the approach of the dentist towards residents when visiting the home, staff working in the home had a sensitive, kind and caring attitude residents. Residents were spoken to respectfully by staff and addressed by their preferred names. DS0000058391.V373591.R01.S.doc Version 5.2 Page 15 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 and 15 Quality in this outcome area is good. Residents are supported to maintain their independence and interests that enhances their quality of life. Residents are given a nutritious and varied diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Activity sessions were not seen to take place on the day of the inspection visit. The activity person has left and the home is currently recruiting. We were told that activities that have taken place include trips out to local pubs, music and movement and crafts. Music was playing through wall-mounted radios with speakers in the lounge areas and corridors. These were playing music suitable to the age of people living in the home. Staff were planning to help residents support the National Charity Event ‘Red Nose Day’ by staff and residents wearing an item of red clothing. One resident and relatives told us, that they would like to see more activities and visits outside the home. Information in the AQAA and staff told us that more outdoor social activities were needed. The home has an open visiting policy and people are encouraged to maintain links with their family and friends. Relatives told us that they are made welcome and the visitor’s record demonstrated that people can visit when they DS0000058391.V373591.R01.S.doc Version 5.2 Page 16 want to and showed that they visited at different times of the day. Families were visiting their relatives on the day of the inspection. We observed the lunchtime meal service in the dining room/lounge on the first floor of the home. Residents were supported to sit around the dining tables. Meals were delivered to people who chose to sit in their chairs in the lounge area or eat in their room. A two course meal was offered at lunchtime. The main meal choices for the day were Turkey casserole and cheesy vegetable bake. Sandwiches were offered as an alternative and the desert was bakewell tart and custard. Residents are offered a choice of a hot cooked meal at lunchtime. Residents and relatives made positive comments about the food provided in the home. Residents said that the food in the home was ‘Ok’. Observation at lunchtime showed that it was more of a social occasion as compared to our last key inspection visit. Residents were all eating at the same time. There were some residents who needed more time, support and encouragement with eating than staff were able to give them. When assisting residents care staff sat next residents called them by their name and used encouraging words to encourage them to eat. We also observed the home manager helping at lunchtime encouraging and helping residents to eat their meal. We observed a number of incidents at lunchtime. The cleaner for the home started to vacuum the dining area while residents were still eating. This was not good practice and was seen by the manager for the home who asked her to stop at the time. The cleaners finish their hours of work before residents have finished eating. This means that care staff would be responsible for cleaning the floors after residents have eaten, which would take them away from meeting the care needs of residents. Other incidents, which relate to staffing, are discussed under the staffing section of this report. Food in the kitchen and kitchenette was appropriately stored and cupboards in the kitchenette were cleaned at the time of the inspection. A hot trolley is now used in the evening to keep food warm while it is being served to residents. This stops the use of the microwave to heat food decreasing the risk of infection through food not being heated properly. DS0000058391.V373591.R01.S.doc Version 5.2 Page 17 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 and 18 Quality in this outcome area is good. People living in the home can be confident that their concerns will be listened to and acted upon. There are systems in place for staff to respond to suspicion or allegations of abuse to make sure people living in the home are protected from the risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A log of complaints received by the home is maintained. The home reported in their AQAA that they had received one complaint since the last inspection. Since the last inspection we received a number of concerns relating to poor staffing levels and standards of care provided in the home. Residents and relatives spoken with said that they were aware of how to complain and whom to complain to. Recording complaints received by the home will show how they are dealing with all complaints. The outcome of investigating complaints will support the home in improving the quality of service it provides. A policy, procedure and a summary of how residents or their families can make a complaint is available. We have received two complaints about the home one related to care and the other to staffing levels. The complaint about care has been resolved by social services in conjunction with the home. The complaint related to staffing was reviewed through a random inspection visit to the home. The visit showed that the manager had started to address the staffing levels with a view to DS0000058391.V373591.R01.S.doc Version 5.2 Page 18 increasing the number of staff on duty. Requirements were made following the visit, which the home has addressed. The policy and procedure detailing the action to be taken by staff to ensure the protection of vulnerable adults were examined. The homes policy takes into account the local multidisciplinary approach to managing the protection of vulnerable adults. The information guides staff on the procedures to follow if they saw or suspected evidence of abuse. The home has made one referral to Social Services regarding the allegations of abuse. This has been investigated and satisfactorily resolved under local adult protection procedures. Staff were able to confirm that they had attended training related to the protection of vulnerable adults. Training records examined shows that protection of vulnerable adults training had been offered to staff. DS0000058391.V373591.R01.S.doc Version 5.2 Page 19 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, 23 and 26 Quality in this outcome area is adequate. The standard of the environment presents a homely place for elderly people to live. Some areas do not show that a safe environment is maintained at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Holbeche House Nursing Home is a large listed building converted to provide accommodation for up to 49 older people. Elderly people who have been diagnosed with dementia live on the first floor of the home. The home is surrounded by extensive gardens, which are accessible to residents. Holbeche House was noted to be clean and fresh at this inspection visit. Bedrooms viewed looked well decorated, homely and furnished to meet the needs of people living in them. Rooms contain some of the residents own possessions such as furniture, pictures and ornaments. Electrical wiring for equipment used in one of the bedrooms was not safely placed this was mainly due to the limited positions the bed could be placed in the room. DS0000058391.V373591.R01.S.doc Version 5.2 Page 20 A maintenance man is available full time to carry out ongoing day-to-day maintenance in the home. The dementia unit has some re-decoration and we are told that this is to be further improved. Carpets are to be replaced and rooms that were rain damaged including the guttering at the last inspection have been repaired. The cats now have their own home outside where there are also fed. The kitchen shows that it is organised. Food was stored appropriately in the food store (larder), freezers and fridges. Temperatures were taken of food received into the home and cooked meals served to residents. Cleaning records in the kitchen show that they are consistently maintained. Completing the records will show when cleaning was last carried out; provide information for evidence when practices in the kitchen are monitored or an outbreak of infection is reported. The laundry is not organised, dirty linen has to go through the clean area of the laundry room. There was number of unclaimed clothing piled up on the laundry floor. There are boxes of slippers and storage is poor. A family member whose relative had been in the home for respite care was in the laundry with the housekeeper looking for items of clothing that had been lost. Systems in the management of the laundry were not working well. The number of staff working in the laundry is discussed under the staffing section of this report. DS0000058391.V373591.R01.S.doc Version 5.2 Page 21 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 and 30 Quality in this outcome area is adequate. People do not have appropriate support at all times from staff that are qualified to care for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information in the AQAA and from the manager shows us that staffing levels remain under continuous review. On some shifts agency nurses are used to make sure the home has sufficient staff on duty to meet the needs of residents. Examination of four weeks duty rotas showed that consistent staffing levels are maintained in the home. The duty rotas examined do not clearly show the qualification of staff working in the home. For example the duty rota just said ‘Trained Staff’ and it was not clear whether these were the Nurses working in the home. The night duty rotas were confusing as they showed the name of two members of staff were on the same shifts on both duty rotas for the elderly care unit and the dementia care unit. House keeping, kitchen and maintenance staff supports the home. However it was not always evident, especially in the laundry and at lunchtime that there is sufficient staff on duty to meet the needs and support people living in the home. DS0000058391.V373591.R01.S.doc Version 5.2 Page 22 The dining room was left unattended by staff for approximately ten minutes when the resident’s had finished eating. During this time two residents shut the main door to the dining room and banged on the windows. One of these residents also went through the bin in the dining room removing items. The bin contained amongst other items plastic bags. Another resident started to eat food off the floor. Our observation showed that a resident could be at the risk of harm when left unattended. The laundry is staffed by one person working between the hours of 8.00 am and 2.00 pm. This is of concern as this is a large home providing a service for 49 residents. Residents living in Holbeche House have high dependency needs, which could mean that a lot of laundry will be accumulated between the hours of 2.00 pm and 8.00 am. This would be a lot of laundry for one person to cope with over a 6-hour period. Information in the AQAA tells us that eight out of 35 (22 ) care staff permanently employed in the home have a qualification in care at NVQ (National Vocational Qualification) level two or above. Information in the AQAA told us that a further four care staff are currently working towards the award. This means that 34 of care staff in the home will be qualified at NVQ level two or above this is below the National Minimum Standard for 50 of care staff to have this qualification. This could mean that people are not continuously cared for by trained and qualified staff. The personnel files of four of the most recent employed staff were examined. Files are organised, accessible and easy to follow. The files showed that they contained evidence that satisfactory pre-employment checks such as Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (PoVA) had been carried out. Two references were obtained for all staff. Ensuring consistent and robust recruitment procedures are followed before staff start working in the home safeguard people living in the home from the risk of abuse. Training records were available for examination. These showed that staff had completed varied training, which include pressure area care, customer care and managing challenging behaviour. Staff also receive a full day training on dementia care and training is provided related to health and safety practices in the home. All staff receive mandatory training in moving and handling, infection control, abuse awareness, fire safety and food hygiene. This should mean that staff are updated in safe working practice. There is a one week training programme for new recruits and new staff receive supervision twice a month. An induction checklist is available this covers health and safety issues such as fire meeting points. Staff spoken with said that they had received an induction period when they first started in the home. DS0000058391.V373591.R01.S.doc Version 5.2 Page 23 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, 36 and 38 Quality in this outcome area is adequate. People have confidence in the way the care home is being led and managed. Safe working practices are not consistently maintained to make sure the health, safety and welfare of people are promoted and protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Care Home Manager has worked in the home for 3½ years as the manager. She has completed the NVQ 4 Registered Manager Award (RMA) qualification and is responsible for the overall day-to-day management of the care home. The manager showed us through her interaction with residents that she was knowledgeable about people in the home. DS0000058391.V373591.R01.S.doc Version 5.2 Page 24 There are clear lines of accountability within the home with the deputy manager reporting to the manager. The home has good support from an administrator who helps in the day-to-day running of the care home. The home’s Quality Assurance system showed that management reviews the service provided in the home and identifies areas for improvement. Action plans are developed for making improvements and are reviewed to monitor progress. There was evidence that the project manager for the home carries out monthly visits to monitor the running of the home. The Operations manager does monthly unannounced visits to the home to look at the service provided and obtain residents, relatives and staff views on the running of the home. The outcomes of these visits are formally shared with us by sending monthly reports to our office. The reports received have been informative providing information on how well the service is doing as well as action to be taken to improve practice and the environment. The personal monies of people living in the home are all banked. Residents are asked to sign a ‘Personal Allowance Contract’ where they sign to say that they agree or disagree to their monies being handled in this way. Accurate records of income and expenditure are maintained and audits are carried out to confirm that residents’ monies are managed safely. Residents are given monthly statements to show the balance of their accounts and any interests accrued is individually identified and applied to the person’s account. Four staff files examined showed us that they receive supervision every eight weeks and an appraisal every year. Staff supervision takes place in the home. Records available show that areas covered include: observation of care practices, nursing procedures, personal care and training. Information sent to us in the AQAA tells us that equipment is serviced or tested as recommended by the manufacturer or other regulatory body. Evidence was sampled at random to confirm this. For example, showerheads in use are flushed 3 monthly, and wheelchairs used by residents were checked on 17/02/09. A fire risk assessment and checking of fire equipment was made in September 2008 and the fire alarm is tested weekly. Some unsafe working practices were noted at this inspection. The keys to the clinical room where medicines are stored, which includes the keys for the medicine cupboard was left in the lock on the outside clinical room door. The door was shut and the nurse was in the clinical room. This is unsafe practice, which puts the nurse at risk of harm as well as the risk of medicines going missing if someone were to get hold of the keys. One of the bedrooms showed that electrical cable was trailed across the room, presenting a trip hazard for staff, visitors and residents. DS0000058391.V373591.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 3 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 2 X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 DS0000058391.V373591.R01.S.doc Version 5.2 Page 26 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 OP38 Regulation 13 Requirement Timescale for action 13/03/09 2. OP38 13 Nurses must not leave the keys to the drug room/cupboard in the clinical room door. This will help to make sure medicines stored in the home are safe at all times and help to prevent nurses being at risk of harm. Resident’s bedrooms must be 30/04/09 laid out in a way that makes sure it is safe to be used at all times. The electrical wiring from appliances and equipment used to support care must be safely placed so that the wire is not trailed across the room, presenting a trip hazard for staff, visitors and residents. DS0000058391.V373591.R01.S.doc Version 5.2 Page 27 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 OP9 Good Practice Recommendations Nurses working in the home should make sure that practices related to the safe storage of medicines are maintained in a way that does not place them at risk from harm. Nurses should have their own tunics to wear when giving out the medicines to help prevent the risk of cross infection between staff and residents. Staff working in the home should ensure that visiting health professionals attend to residents care needs in a way that respects their privacy and maintains their dignity. A review of the activity plan for the home should include looking at suitable activities and events that residents can take part in outside of the home. This will help to vary the resident’s day-to-day life. Cleaning the home should not take place while residents are eating their meals. This will support residents eating in a pleasant environment and prevent the risk of contamination from infection. The suitability of the bedroom on the ground floor where there are limitations on where the bed can be placed should be assessed before potential residents are offered the room. This will make sure that residents who require equipment to support their care are not placed in an environment where electrical wires are not safely placed. There should be sufficient staff on each shift to make sure that the lounge areas are not left unattended. This will help to make sure that people living in the home are not left at the risk of harming themselves. There should be sufficient staff on each shift to make sure that residents who need help to eat their food have full support at mealtimes. This will help to make sure that residents are supported to eat a nutritious meal and staff are aware of what food residents have eaten. There should be sufficient staff employed to carry out all procedures required in the laundry. This will help to make sure that residents have their clothes suitably laundered and decrease the risk of resident’s clothes going missing. DS0000058391.V373591.R01.S.doc Version 5.2 Page 28 2. 2. 3. OP9 OP10 OP12 5. OP15 6. OP23 7. OP27 8. OP27 9. OP27 10. OP27 11. 12. OP27 OP28 There should be sufficient housekeeping staff employed to carry out the cleaning of the home at suitable times that does not affect the well being and day to day life of residents. The duty rota should clearly show in what capacity staff are working. This will show the accountability and roles of staff on each shift. Plans should be in place to increase the number of staff with a NVQ 2 qualification in care. This will help to make sure that residents are cared for by competent and skilled staff at all times. DS0000058391.V373591.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 DS0000058391.V373591.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. 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