Inspection on 11/05/05 for Homefield Nursing Home

This inspection was carried out on 11th May 2005.

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

Homefield Nursing Home 13/06/07

Homefield Nursing Home 15/06/06

Homefield Nursing Home 04/11/05

Homefield Nursing Home 11/10/04

Homefield Nursing Home 23/04/04

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

CARE HOMES FOR OLDER PEOPLE Homefield Nursing Home 1 Lime Close Southborough Road Bickley BR1 2EF Lead Inspector Lorraine Pumford Unannounced 11 May 2005 11:20 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 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. Homefield Nursing Home G51-G01s10136Homefield UI v211885.110505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Homefield Nursing Home Address 1 Lime Close, Southborough Road, Bickley Bromley, Kent BR1 2EF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8289 7932 020 8289 7928 Mission Care Mr Moise Jennah CRH 44 Category(ies) of Dementia 44 registration, with number of places Homefield Nursing Home G51-G01s10136Homefield UI v211885.110505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Staffing Notice Issued 1 July 1994 2. Staffing Levels for the home are as follows on the basis that the manager of the home holds a RMN qualification: am: 2 RMNs or RGNs with 6 care assistants pm: 2 RMNs or RGNs with 6 care assistants Night: 2RMNs or 1 RMN and 1 RGN with 4 care assistants Date of last inspection 11/10/2004 Brief Description of the Service: Homefield was initially registered in 1981 and was a purpose built home providing nursing care for older people. The home has been increased in size with an extension to the original building providing an additional 12 bedrooms. The home is now registered to provide care to 44 service users who are over 65 years of age and suffering with dementia. The home has 12 bedrooms on the ground floor, 22 bedrooms on the first floor, and 10 bedrooms on the second floor. All bedrooms in the new extension have en-suite facilities. Some of the older bedrooms have en-suite facilities and others have a wash handbasin. The dining area and main communal lounge are on the ground floor, and a small lift gives access to all floors. The home has a garden at the back and car parking at the front. Homefield is conveniently situated for local buses and is close to Bickley rail station. Homefield Nursing Home G51-G01s10136Homefield UI v211885.110505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this unannounced visit from 11.20 am until 5pm. Parts of the premises were inspected and some documents. Three care plans were examined. During the course of the inspection one relative was spoken with and a number of staff were interviewed privately or spoken with during the tour of the home. The handover between the morning and afternoon staff was observed. The home is registered to accommodate service users who have been assessed as needing nursing care and who have also been diagnosed with dementia therefore their ability to verbally contribute to this inspection was limited. What the service does well: What has improved since the last inspection? The home has taken action to ensure the certificate of registration is displayed in a prominent place. An assessment of the premises and facilities regarding adaptations and equipment has been made. Homefield Nursing Home G51-G01s10136Homefield UI v211885.110505 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Homefield Nursing Home G51-G01s10136Homefield UI v211885.110505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Homefield Nursing Home G51-G01s10136Homefield UI v211885.110505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3. Service users or their advocates are not given all the information required to make an informed decision to live at Homefield. The home carries out initial assessments of service users needs in order to establish they can provide the required care. EVIDENCE: A draft copy of the home’s Statement of Purpose and Service User Guide were examined. The documents are not in a format that could be given to service users, their advocates or other parties requiring information about Homefield. This document once completed would enable them to have information regarding the care, facilities and services provided in order to make a valid judgement as to suitability of the home. Two Care plans seen included an initial assessment completed by Social Service Care Managers, staff said this information had been faxed to them prior to the admission of the service users. The home is now beginning a policy of visits to prospective service users to complete the assessments. A member of staff who is a qualified registered nurse had visited a service user in her own home to complete an assessment relating to her physical and psychological Homefield Nursing Home G51-G01s10136Homefield UI v211885.110505 Stage 4.doc Version 1.30 Page 9 needs prior to her admission. This information was then used to formulate the start of the care plan. This home does not provide intermediate care. Homefield Nursing Home G51-G01s10136Homefield UI v211885.110505 Stage 4.doc Version 1.30 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 standard(s) 7,9,10. Information recorded in care plans was sufficiently detailed for staff to be able to meet the assessed needs of the service users. Care plans could be enhanced for service users by input from relatives or advocates. Medication is securely stored, however, ventilation is required to maintain appropriate temperatures in the storage room. Medication records are not being adequately kept in sufficient detail. Service users are spoken to and treated respectfully by staff. The practice of service users wearing bibs at mealtimes should be revised to maximise the dignity of individuals. EVIDENCE: Staff said it was difficult to involve service users in the development of their care plan due to their level of disability. Care plans seen had been updated. Although there was evidence staff were reviewing care plans, a relative spoken with stated neither she or any member of her family had been included in the review process of her husband, who is the service user and she would have welcomed the opportunity to do this. Homefield Nursing Home G51-G01s10136Homefield UI v211885.110505 Stage 4.doc Version 1.30 Page 11 Qualified nursing staff are responsible for preparing the initial care plans. Care staff stated they were able to access the care plans for reference and to record appropriate information in relation to service users’ personal care, activities and general demeanour. Staff stated the current care plan format was due to change in the near future and this would be more user friendly for all parties involved. Shift patterns enable a 15-minute handover period between the morning, afternoon and evening shifts. Information shared was concise and included information regarding service users physical and mental health as well as their general demeanour. The GP attends the home each week; service users are able to choose whether they wish to retain their own GP upon their admission. Medication is stored in a locked room on the first floor and is housed in two locked trolleys secured to the wall and two medication refrigerators with a record kept showing regular checks to their temperatures. The sunlight was directly on the window, which made the temperature in the room extremely warm; this could adversely effect some medication being stored. There is a small extractor fan in the room and although this was activated the temperature of the room did not significantly reduce. Medication records were examined in relation to a number of service users. There were some gaps on the medication records. The record provides a code that indicated “0” as “other reason why medication had not been given”. “0” had been used in some instances, however this information in itself is not sufficient and the reason why medication was not administered must be accounted for. There is space provided to do this on the medication record, however, these had not been completed. There were hand written additions to the record that had not been signed and dated. A note on the file of one service user, which was not signed or dated, indicated a relative had requested the time of medication prescribed be altered. This had been done, however, there was no record to indicate the GP had agreed with this change. The “sharps box” which contains used needles has a sliding lid, which had been left open; this is a potentially hazardous practice. Staff spoke to and treated service users calmly and with respect. Service users seen eating lunches were wearing large bibs to protect their clothes irrespective of their ability to co-ordinate and manage the task of eating. The use of protection in varying forms i.e. napkins, aprons etc., depending on the individual service user’s ability, would enhance their dignity. Homefield Nursing Home G51-G01s10136Homefield UI v211885.110505 Stage 4.doc Version 1.30 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 standard(s) 12,13,15. Service users’ quality of life could be enhanced by providing a choice of leisure and social activities. The home does not have a designated room for private conversation. Service users receive a varied nutritional diet. EVIDENCE: Relative spoken with stated they were able to visit service users whenever they wished and were always made to feel welcome and offered refreshments. There is no room for service users to use for private conversation. Without a visitors room, service users do not have the opportunity to spend time with friends and relatives in private, other than in their bedroom which may not be easily accessible. Care plans do not indicate if service users are given a choice in relation to leisure and social activities and their preferred daily living routines. Involving service users relatives or advocates in the review process could provide information in relation to this. Homefield Nursing Home G51-G01s10136Homefield UI v211885.110505 Stage 4.doc Version 1.30 Page 13 Staff stated that the minister from a local church visits service users in the home on a regular basis and those who wish attended church services in the community. Bedrooms are individually personalised and relatives said they been able to bring in service users’ personal possessions from home. Menus were inspected and found to be balanced and interesting; there is a choice of food offered at mealtimes. A record should be kept of alternative meals provided to service users who have declined the meals on the menu to ensure that these people are also receiving a varied nutritious diet. It was evident that catering staff had spent additional time ensuring that service users requiring a soft diet also received an attractively presented meal. Homefield Nursing Home G51-G01s10136Homefield UI v211885.110505 Stage 4.doc Version 1.30 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 standard(s) 16,18. The Statement of Purpose and Service Users Guide must provide contact details for the Commission for Social Care Inspection. All staff should receive training in both the companys and Social Services’ adult protection policies to ensure service users are protected from abuse and service users and staff are confident that any allegations or concerns will be addressed. EVIDENCE: Staff were unable to locate records pertaining to any complaints the home had received and action taken by them to address the issues raised. The senior member of staff on duty stated that some relatives had brought issues to his attention and a log would be set up to record this information and the action taken to address their concerns. Information regarding the home’s complaints procedure should be included in the home’s Service Users Guide and should include contact details of the CSCI to enable service users, their relatives and advocates to contact the CSCI independently. Staff spoken with were not aware of the term “whistle blowing policy”. A member of staff stated that she had requested training in relation to adult protection issues, in particular to identifying what may constitute abusive practices. Staff were unable to locate a copy of the home’s adult protection policy. Homefield Nursing Home G51-G01s10136Homefield UI v211885.110505 Stage 4.doc Version 1.30 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 standard(s) 19,20. Service users would benefit from the input of a dementia specialist who could advise on ways of making the building more user friendly. The breakdown of the lift affects the choice and movement of service users and creates a serious hazard for staff and service users. EVIDENCE: There is a CCTV system around the outside of the building for security purposes. There is a small secure garden to the side of the building. A small number of garden chairs and tables have been recently purchased, although it is unlikely that all residents would wish to sit outside at the same time, the number of chairs and tables is at present inadequate for the number of service users accommodated. Homefield Nursing Home G51-G01s10136Homefield UI v211885.110505 Stage 4.doc Version 1.30 Page 16 There is one passenger lift; this is essential as the majority of service users are accommodated on the first and second floors of the building. Care staff stated there were occasions when the lift had broken down. This had resulted in care staff transporting service users upstairs in wheelchairs. This is a potentially dangerous practice for both service users and care staff. The addition of a second lift would ensure service users could be transported safely at all times and reduce the amount of time it takes to transport the majority of service users from upper floors to the ground floor lounge. The lounge has a rectangular glass dome ceiling to increase the light to the area, staff and relatives voiced concern that during warmer weather it was necessary for service users to be moved to other areas due to the intensity of heat generated. This is of particular concern as the service users accommodated may not be able to make a voluntarily decisions to move. Homefield is decorated well with appropriate furniture and attractive furnishings. Although the majority of service users have a pleasant attractive bedroom, service users accommodated on the second floor have veluxe windows positioned in the ceiling and are therefore unable to have a view from a window either laying in bed or sitting in a chair. A number of wheelchairs, portable hoists and laundry bags were being stored in the bathroom and shower areas. Staff stated this was due to the fact that there was no other appropriate storage in the home for these items. This is potentially hazardous as service users and staff either use the room with the items present, or alternatively leave them in the corridor outside whilst the room is in use. Although discussed at the previous inspection, the photocopier sited in the upper floor corridor has not yet been sited to a more appropriate place. Homefield Nursing Home G51-G01s10136Homefield UI v211885.110505 Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,30. All staff working in the home that have not already done so, must receive training to enable them to meet the additional needs of service users with dementia. EVIDENCE: Senior staff and a relative spoken too were highly complimentary of care staff and the dedication to the care of the people they look after. Each shift consists of a qualified nurse morning and night and additional care assistants. There are domestic staff to undertake cleaning tasks, all laundry is processed away from the premises. Catering arrangements are the responsibility of an external contractor. A care assistant spoken with stated that she had commenced her NVQ training in care. The files of three staff members were examined; these indicated some staff had been employed without experience relating to the care of people with dementia. One member of staff spoken with stated she has been waiting for a number of months for a place on a course regarding dementia and was hoping to attend a course at the end of May. Homefield Nursing Home G51-G01s10136Homefield UI v211885.110505 Stage 4.doc Version 1.30 Page 18 There was no written evidence to indicate how staff interviewing prospective members of staff had concluded candidates could meet the needs of service users when they had no qualifications or experience of working with service user who had dementia. Staff stated that they had been provided with a contract, a job description and terms and conditions of employment. Homefield Nursing Home G51-G01s10136Homefield UI v211885.110505 Stage 4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,36. A suitable qualified and competent person must manage the home on a daily basis. Staff responsible for undertaking supervision must receive appropriate training. EVIDENCE: Senior staff stated that the registered manager had vacated the post at the end of April. To date the CSCI has not being informed of this, or steps taken by Mission Care to ensure the safe running of the home on a day-to-day basis until a suitably qualified and competent manager is appointed. The new manager must be registered with the CSCI. The person in charge of the home at the time of the inspection stated that he had worked in the home for a few months as the deputy. At the time of this inspection he had held the post of acting manager for approximately two weeks, and therefore was not familiar with all of the homes policies and procedures. Homefield Nursing Home G51-G01s10136Homefield UI v211885.110505 Stage 4.doc Version 1.30 Page 20 A senior member of staff stated that she was responsible for the formal supervision of a number of care staff. She stated that although she had been provided with written guidance in relation to this task, she had received no training. A member of care staff confirmed that generally she received supervision on a regular basis, however recent staffing difficulties have meant supervision was happening less often. A staff induction programme was seen, which covers basic details of health and safety procedures. Homefield Nursing Home G51-G01s10136Homefield UI v211885.110505 Stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 x 15 3 COMPLAINTS AND PROTECTION 2 3 x x x x x x STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 2 x x x x 2 x x Homefield Nursing Home G51-G01s10136Homefield UI v211885.110505 Stage 4.doc Version 1.30 Page 22 yes 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. 1. Standard 1 Regulation 5.1 Requirement The registered person shall produce a written Guide to the care home as to the care and service provided. Make arrangements for the recording, handling, safe keeping, safe administration and disposal of medication. (Timescale of 30.05.05 not met) When possible consult with the service user or a representative when revising care plans. Ensure that all care practices promote dignity of service users. Provide suitable facilities for service users to meet with visitors in private accommodation other than their bedroom . The service users guide which is given to service users and/or their representaive contains contact details for the CSCI. Ensure that staff have training regarding adult protection issues understand the concept of whistleblowing and potential abuse of service users . Timescale for action 02.08.05 2. 9 13(2) 30.05.05 3. 4. 5. 7 10 20 15(2) 12(4)(a) 23(2)(i) 30.06.05 30.05.05 30.09.05 6. 16 5.1 30.06.05 7. 18 13(6) 30.07.05 Homefield Nursing Home G51-G01s10136Homefield UI v211885.110505 Stage 4.doc Version 1.30 Page 23 8. 9. 22 27 23(l) 18(a) 10. 19 23 Provide suitable storage for wheelchairs hoists etc when not in use. Ensure that all care staff are suitably qualified, competent and experienced to work with service users with dementia. The addition of a second lift would go futher towards the premises being suitable for the purpose of providing care to physically and mentally frail older persons. 30.09.05 30.07.05 action plan by 30.07.05 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. Refer to Standard 22 25.3 Good Practice Recommendations Re-site the photocopier to a more appropriate place. The height of bedroom windows should be such to enable service users to see out of the window when seated or in bed. Homefield Nursing Home G51-G01s10136Homefield UI v211885.110505 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection River House 1 Maidstone Road Sidcup Kent DA14 5RH 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 Homefield Nursing Home G51-G01s10136Homefield UI v211885.110505 Stage 4.doc Version 1.30 Page 25 - 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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