Inspection on 13/06/07 for Homefield Nursing Home

This inspection was carried out on 13th June 2007.

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 15/06/06

Homefield Nursing Home 04/11/05

Homefield Nursing Home 11/05/05

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 Bromley Kent BR1 2EF Lead Inspector David Lacey Unannounced Inspection 13th June 2007 09:30 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 Homefield Nursing Home DS0000010136.V335509.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. Homefield Nursing Home DS0000010136.V335509.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Homefield Nursing Home Address 1 Lime Close, Southborough Road Bickley Bromley Kent BR1 2EF 020 8289 7932 020 8289 7928 homefield@missioncare.org.uk 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) Mission Care ** Post Vacant *** Care Home 44 Category(ies) of Dementia - over 65 years of age (44) registration, with number of places Homefield Nursing Home DS0000010136.V335509.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Staffing Notice issued 1 July 1994 Staffing levels for the home are as follows on the basis that the manager of the home holds a RMN qualification: AM: 2 RMN’s or RGN’s with 6 Care Assistants PM: 2 RMN’s or RGN’s with 6 Care Assistants NIGHTS: 2 RMN’s or 1 RMN and 1 RGN with 4 Care Assistants RGN’s working in the home do so on the basis that they have substantial experience or relevant training specific to dementia. Date of last inspection 15th June 2006 (last key inspection) Brief Description of the Service: Homefield is registered to accommodate up to 44 service users who have been assessed as having dementia and requiring nursing care. The home has 12 bedrooms on the ground floor, 22 bedrooms on the first floor and 10 bedrooms on the top floor. Some bedrooms have en-suite facilities. There is a dining room and main lounge situated on the ground floor, and a smaller lounge on the upper floor. There is a small garden at the side of the building and car parking to the front. The home is situated on a local bus route and near Bickley train station. Fees for this care home (as at 1st April 2007) range from £459.49 - £792.75 per week. Homefield Nursing Home DS0000010136.V335509.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection included an unannounced visit. Two inspectors spent eight hours each in the home, beginning their inspection at 09.30. The person in charge and members of staff on duty provided assistance during the inspection visit. We provided feedback at the end of our visit to the Mission Care area director, the person in charge and a manager from another Mission Care home. During our visit, we toured the premises, observed care practices, and examined documentation. We spoke with some of the residents and staff members, and with residents’ visitors. What the service does well: What has improved since the last inspection? All members of staff were communicating with residents in a caring and respectful manner. The use of physical restraints, such as lap belts, had decreased. Where used, it was a planned intervention, carried out in the best interests of the particular resident. Pre-admission assessments give more detailed information about individual residents’ needs. Homefield Nursing Home DS0000010136.V335509.R01.S.doc Version 5.2 Page 6 The home has upgraded its only passenger lift, which should improve its reliability. 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. The summary of this inspection report can be made available in other formats on request. Homefield Nursing Home DS0000010136.V335509.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Homefield Nursing Home DS0000010136.V335509.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4 (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. Assessments to identify residents’ needs are carried out but the home does not always make it clear to prospective residents it can meet their assessed needs. Not all residents have contracts with terms and conditions. EVIDENCE: We assessed outcomes for these standards through case tracking, involving discussion where possible with residents and/or their representatives, discussion with staff, and scrutiny of relevant documentation. Five residents’ files were inspected to determine the quality of pre-admission assessment. One was of a resident who had been in the home for about eight months. The assessment conducted by Mission Cares own staff was completed. It provided personal information and the resident’s medical history, which included physical and mental health conditions. A photograph was in place, in contrast to two residents who had been admitted recently whose files did not yet contain photographs. There was a body map, which indicated a Homefield Nursing Home DS0000010136.V335509.R01.S.doc Version 5.2 Page 9 number of areas where grazes and skin tears had been identified. A FACE assessment had been provided to the home before the resident’s admission. This resident had significant dietary needs and was also a diabetic. The family had provided good information in respect of the resident’s past life, likes, hobbies and significant events. Another file seen was that of a resident admitted very recently. This resident had transferred from another care home and there was good information provide by that home. There was a nursing assessment conducted by staff at Mission Care, although this was limited in some areas on the information it provided to staff. There was no evidence of any assessment conducted under community care procedures. A relative said she and her family looked at several care homes for their mother before choosing this one. They had been given enough information to help make the choice, including a look around the home. However, on the files seen, there was no evidence of trial visits or those made by next of kin before the residents had been admitted. Details of the information provided before admission, such as the service user guide, were also not evidenced. None of the files seen contained evidence that residents had received written confirmation that the home could meet their assessed needs (requirement 1). Contracts for residents, with terms and conditions, are stored at another Mission Care home nearby (Elmwood). Examination of a sample of three Homefield residents’ files held at Elmwood showed that only one of these had a contract in place. We brought this to the attention of senior staff when we gave verbal feedback at the end of our visit (recommendation 1). Homefield Nursing Home DS0000010136.V335509.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. We received positive comments from relatives about the care provided. Care plans need improvement and regular review, and improvements are needed to the recording of care delivery. Residents have access to health care services, as they require. Medication administration was variable, with both satisfactory and unacceptable practice being observed. This needs review and, where necessary, improvement. EVIDENCE: Outcomes for these standards were explored through observation of practices, case tracking, involving discussion with residents and/or their representatives, discussion with staff, and examination of documentation. Visitors who met with us were generally positive about the care provided and the staff working at the home. For example, a regular visitor said her relative was always washed and groomed. Another said that when she visits her relative, she has noticed staff are kind and caring towards her. We were able to meet with four residents’ next of kin and the care manager for one resident. Homefield Nursing Home DS0000010136.V335509.R01.S.doc Version 5.2 Page 11 Relatives did express great concern about the lift, which is discussed elsewhere in this report (please see Environment section). The care manager was able to provide some information on the service, saying that staff had located information requested, were aware of her visit and had been helpful throughout. We saw that residents were spoken to and treated respectfully by staff members. Care plans sampled for inspection were found to be without manual handling risk assessments or those relating to nutrition. These are fundamental tools for providing care to meet individual needs. The care plans made reference to manual handling and nutrition issues, although these were not specific enough. Nutritional or mobility risk assessments need to be separate from the care plans for nutrition and mobility. Waterlow and skin integrity assessments had been completed. One resident had a MRSA ‘eradication’ chart but assessment of this need had not been written up as a care plan. The care plans were mainly reflective of physical health issues except in one where a multitude of psychiatric diagnoses had been stated under one problem heading. The actual behaviours and specific problems for that individual need to be identified and addressed with a care plan. One care plan included the following as a stated problem “Extra large pads”, which is both inappropriate and an issue for staff rather than a problem for the resident. The actual interventions section was limited in content, and the care plan was without signatures from the resident or their next of kin. Reviews were limited on the progress made in respect of the identified issues. The entries for daily events were also limited and provided little information, mainly related to physical health needs. All residents’ care plans must address each of their individual care needs, have all risk assessments in place and be kept under regular review (requirement 2). Accurate recording is an integral part of good care delivery. Our findings in this respect were mixed and it was evident improvements are needed (requirement 3). For example, records of visits by various health professionals were up to date but some other documentation was incomplete with residents’ first names only entered, staff members’ first names only, and some without dates of entries recorded. A resident with significant dietary needs and diabetes had three observation charts in place for this. These three charts were confusing and none seemed to have been updated since May 2007. The weight chart showed weight loss of approximately a stone since February 2007, and a referral had been made to the dietician for review. The dietician’s advice was provided indicating a snack between each meal. Two staff whom the inspector questioned on this resident’s dietary needs could not recall any snacks provided that morning, only those provided the night before. They were vague about this specific instruction from the dietician. Some fluid charts seen were confusing because it was difficult to establish what intake the residents had had in the 24-hour period. On the nurses’ desk on the first floor was an easily accessible book which detailed residents’ baths, showers and bowel actions. This information should Homefield Nursing Home DS0000010136.V335509.R01.S.doc Version 5.2 Page 12 be incorporated into the care plans and in any case retained in a confidential manner. The residents’ full names were written on the front of the book. (recommendation 2). An inspector witnessed the morning medication administration of four residents on the ground floor. On the first occasion, the staff member left the medication keys in the trolley door. The trolley itself was left open whilst he transported medication to a bedroom on the ground floor. For the second resident’s medication, the trolley doors were shut but the keys remained in the trolley door. On the third occasion, the medication was given to a resident’s husband to give to her and the staff member immediately returned and signed the chart although the medication was still on the dining table. For the fourth resident, the trolley was locked, the keys retained with the staff member and the medication taken to the resident. During this time there was one carer in the area although she was not always in the vicinity of the trolley nor had she been asked to observe the trolley. The blister packs were left on the dining table for the duration. (Requirement 4). Medication administration was also witnessed on the upper floor. The morning medication round was undertaken safely, in accordance with procedures. The home’s medication procedures were on file with the medicine charts. There was an up to date list of signatures and initials of those staff who give medicines, and the homely remedies protocol had been signed off by the doctor. Most medication charts we saw did not have any unexplained gaps in the administration records, had photographs in place and allergies recorded. Two charts for residents admitted the previous month did not yet have photographs in place (recommendation 3). Medications received in to the home were signed in. Hand transcriptions need to have two staff signatures to confirm the accuracy of the information recorded. This was usually though not always the case (requirement 5). The drug fridge temperatures were recorded on a monthly basis. Eye drops were generally dated on opening, except for one. Two bottles of a food supplement had been opened and partially used, and dated as dispensed February and April 2007. There were no dates of opening on the food supplement bottles, which have only a 14-day shelf life once opened (requirement 6). Homefield Nursing Home DS0000010136.V335509.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. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Residents enjoy the planned activities but these are not provided each day. The food provided is good and service users have enough to eat and drink but mealtimes could be improved by making them more relaxed affairs and ensuring items such as condiments and napkins are always available. EVIDENCE: Outcomes for these standards were assessed at our visit through observation, discussion with residents and/or their representatives, discussion with staff, and looking at documentation. We saw little in the way of activities during our visit; televisions were on and radios were playing music but little else was being made available. It was said the present lack of a lift facility was making it more difficult to provide group activities, as not all residents could be brought to the ground floor communal area. The unit was very noisy and did not have a relaxed atmosphere. There were many residents who were sleepy during the day, as was also observed at breakfast time. More activities should be provided as it is evident these have a positive impact for the residents. The home has been recommended previously to increase the activity coordinator’s working hours so this service can be Homefield Nursing Home DS0000010136.V335509.R01.S.doc Version 5.2 Page 14 provided each day. We raised this matter again during our visit and we strongly recommend it be considered, as more input from the activity coordinator would be a positive development in services for residents (recommendation 4). The part-time activities coordinator was enthusiastic about her role and was able to explain how residents may benefit from her work. Trips out had been organised, there had been more indoor events, and others were planned. One resident related to the inspector a recent trip to Brighton. She described the enormous fish she had had for lunch, which she really enjoyed. On her return she asked the staff why the fish in the home was not the same size. It was a pleasure to hear and see such a tale recollected and related in an animated manner. Visitors were seen in the home throughout the inspection, and confirmed they were encouraged to visit at any reasonable time. Residents are able to bring in small items of furniture, pictures and mementos to help personalise their bedrooms. The breakfast was observed, served in the dining area on the ground floor. The tables had cloths on them but were without cutlery, serviettes or condiments. Large cups of tea were given out. The breakfast seen consisted of porridge, toast, juice and tea. It was not a relaxed affair and the one staff member was trying to assist several residents. One relative who visits frequently was feeding his relative. Homefield Nursing Home DS0000010136.V335509.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has an appropriate complaints procedure, and people know how to raise concerns or complaints. Safeguarding procedures, including local guidelines, are in place and relevant training made available. However, staff members do not all show appropriate knowledge or understanding about safeguarding adults. EVIDENCE: We assessed these standards through case tracking, involving discussion with residents or their relatives, discussion with staff, and examining documentation. Information on how to make a complaint is available in the reception area, including relevant contact details. Relatives with whom the inspectors met during our visit had no current complaints, although felt that they could raise issues internally and it would be addressed. Staff members we spoke with were aware that complaints should be referred to the person in charge. It was not clear how the home audits or quality assures its handling of complaints in respect of timeframes and complainants’ satisfaction with the outcomes. We looked at the home’s complaints register. It was kept in the reception area office and contained fourteen entries recorded since April 2006. The register detailed the complaint, investigation, action taken, outcome and dates of responses. The information was in some cases very detailed and it is questionable how appropriate it is to include such detailed information in this Homefield Nursing Home DS0000010136.V335509.R01.S.doc Version 5.2 Page 16 publicly available register. During our feedback, we suggested the register be used to ‘signpost’ where more detailed information and correspondence about an individual complaint is filed (recommendation 5). Since the last key inspection, the commission has received one complaint about infection control that was referred to the provider for their action. Another complaint, which involved safeguarding issues, was addressed by social services under their procedures. There was a copy of the local (Bromley) multi-agency adult protection guidelines in the manager’s office. It was evident adult protection training is made available to staff but it was not clear this was having a positive outcome. For example, some staff members were asked questions during the inspection relating to adult abuse and asked to respond to a given scenario. It was not evident from their answers that they would follow adult protection procedures and adhere to the local multi-agency guidelines. Staff felt that advising and talking to the abuser would be sufficient. (Requirement 7). Since the last key inspection, the commission has been notified of two allegations, including the complaint referred to above. Social services has led investigation of these matters, in accordance with their procedures, with the cooperation of the provider. An inspector observed during some staff interviews that there was a reticence to provide information, for example, one staff member enquiring what would happen to the inspector’s notes and who would see them. Without identifying the staff members, this issue was discussed at feedback and managers agreed it is very important to maintain an open culture in the home. Homefield Nursing Home DS0000010136.V335509.R01.S.doc Version 5.2 Page 17 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, 24, 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 clean though the lack of adequate storage space means it is not tidy throughout. There are some items needing repair or refurbishment. The lift was being upgraded, which should prove to be of benefit, but the fact it was out of action for a month was causing considerable difficulty for residents, staff and visitors. EVIDENCE: We toured the premises to inspect environmental standards, including some of the residents’ bedrooms. We spoke with residents and their visitors, and with staff members. The home’s only passenger lift was being repaired and upgraded, and had been taken out of use in mid-May. Although it was positive to see that the lift is finally being upgraded, the prolonged absence of a lift facility was causing great difficulties in the home, not only for staff but also for residents and their visitors. One relative stated her mother had become more withdrawn as she Homefield Nursing Home DS0000010136.V335509.R01.S.doc Version 5.2 Page 18 was unable to go downstairs. Staff were seen to manually handle trays of food, which were heavy and potentially hazardous as they were carrying hot liquids and food. We were given verbal assurance from Mission Care’s area director that the works would be completed and the lift back in action by the end of the week. Following the inspection, we received written confirmation that the lift was available for service from 18/06/07. There were other parts of the premises that needed attention. The walls and skirting boards in the first floor corridor had suffered from wear and tear. Some blinds fitted to roof windows on the top floor needed repair or replacement to ensure they give privacy to the occupants of the rooms and also adequate shade from glare (requirement 8). The only assisted bathing facility on the upper floor was out of order, while a new part for the shower was awaited. A notice on this bathroom door stated it had been out of order since 21 May. There are some bedrooms on this floor that do not have their own en-suite bathing facilities. When questioned, staff said that residents in these rooms had to be bathed in bed until the communal shower is repaired (requirement 9). We were told that the conservatory roof leaks and puddles of water collect in this area when it rains. The weather was dry on the day of our inspection so we were not able to see this for ourselves. The provider must assess this and carry out any necessary repairs to ensure the roof is effective in wet weather (requirement 10). Individual bedrooms had clocks and calendars, all of which were correct. Bedrooms were personalised in the main, although some were either without an armchair (for example, rooms 235, 239 and 241) or had only one chair (for example, rooms 237 and 242), and it was not evident why seating for two people was not being provided in these instances (recommendation 6). In general, the home was clean and odour free. Ancillary cleaning staff were working on all of the floors. Staff were observed to follow infection control procedures when working with a resident who had tested positive for MRSA. This included using and discarding protective clothing, and washing their hands before leaving the room. The home was not tidy throughout and it was evident that a previous requirement to ensure that suitable provision is made for storage had not been met (requirement 11). The ground floor dining room was particularly congested with a number of items of furniture, including two filing cabinets, a drinks machine, water fountain, two trolleys, two linen skips, and a storage rack for trays. Residents’ wheelchairs were also in this room. In our opinion, this area could pose a hazard to staff and residents. On the first floor corridor, there were two storage rooms. One was open and seen to be very full with various items including electrical hair tongs, blankets, a duvet, several black Homefield Nursing Home DS0000010136.V335509.R01.S.doc Version 5.2 Page 19 bags, and boxes of wipes. Bathroom 154 was congested, as was the bathroom opposite bedroom 4, which had a hoist, three waste bins, yellow clinical waste bags and other items. Homefield Nursing Home DS0000010136.V335509.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A previous requirement about staffing arrangements remains outstanding. Training opportunities are made available but the outcomes of staff training need to be monitored to confirm the benefits for residents. Recruitment practices ensure that the necessary information about applicants is obtained. EVIDENCE: Outcomes for these standards were assessed by observing practice, case tracking, looking at relevant paperwork, and talking with residents, relatives and staff. At the time of our visit, there were two qualified staff on duty, with eight care staff. Ancillary staff were working throughout the home. Staff members said that at peak times there were not enough staff on duty to address residents’ care needs promptly. This was apparent during the mealtimes with several residents who required assistance either having to wait or in some cases not receiving attention. There was no evidence of a recent formal staffing review and we were unable to conclude that the previous requirement about staffing levels had been met (requirement 12). On the morning of the inspection, one of the two qualified staff members was also in charge of the home and had to spend much of the morning doing Homefield Nursing Home DS0000010136.V335509.R01.S.doc Version 5.2 Page 21 medication administration. He remained both on the rota and in charge of the home during the afternoon shift also. We raised this at feedback and were told that provision has been made for the person in charge to be supernumerary. It was not clear why this was not the case on the day of our inspection. The area director stated the normal staffing arrangements include the person in charge being supernumerary, and assured us that these arrangements would now be maintained. The home is part of the Bromley Care Home Training Consortium and supports its staff to attend the Consortium’s training events. An inspector met with three staff and spent some time with the acting (deputy) manager. Staff provided information in respect of their training and supervision. Staff said their training including NVQ preparation, health and safety, manual handling and report writing training. The staff members spoken with showed only limited knowledge in relation to dementia. Staff members’ understanding of adult protection has been discussed under a previous section. The acting manager stated that all qualified staff were trained in first aid, that there was one manual handling trainer and one health and safety representative in the home. As is the case with residents’ contracts, staff recruitment records are stored at another Mission Care home nearby (Elmwood). Examination of a sample of three staff members’ files held at Elmwood showed that the required recruitment information had been obtained. An equal opportunities monitoring form is used for recruitment and examples were seen on the staff files. Homefield Nursing Home DS0000010136.V335509.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not have a registered manager, though the provider has addressed this matter and an application to register is expected shortly. The quality assurance strategies being used are not organised well and not always based on consultation with residents or their representatives. The home ensures health and safety checks are carried out regularly. EVIDENCE: Outcomes for these standards were explored through observation while touring the premises, seeking the views of residents and/or their representatives, discussion with managers and staff, and examining documentation. At the time of the inspection visit, the home did not have a manager whose fitness to manage the home had been assessed by the commission. For some Homefield Nursing Home DS0000010136.V335509.R01.S.doc Version 5.2 Page 23 time, this has been a matter for concern about which there has been separate communication between the commission and the provider. The previous acting manager had just left and the deputy manager was acting up. The provider was recruiting to fill the vacant manager post and, shortly after our inspection, we received confirmation that an appointment had been made. The commission awaits an application for registration from the newly appointed manager. At the last inspection, it was recommended that nurse audits are recorded and made available for inspection, as part of the home’s quality assurance activities, but this recommendation had not been taken up. We raised this again, as an example of evidencing quality assurance by the home (recommendation 7). We pointed out that the home’s quality assurance systems need to be based on consultation, and readily understood by any new person taking charge of the home. For example, a ‘falls register’ was being maintained but it was not clear to any of the persons presently in charge of the home how this register is to be used for improving residents’ care. Reports of the provider’s monthly unannounced visits to the home are not being received regularly by the commission, neither were they available for inspection in the home (requirement 13). Last year, this was an aspect that had improved but that improvement has not been maintained. It was evident that the home communicates with relatives and other residents’ representatives. The most recent relatives’ meeting had been held in early June, on a Saturday so that as many people as possible could attend. Two relatives who were at the meeting said the attendance had been good and that people had been able to raise matters for discussion, such as the passenger lift refurbishment and a recent local press report that mentioned Homefield. The minutes of this meeting were not yet available, and the minutes of the previous meeting could not be located. Staff do not assist residents with their finances. A monthly account is sent to residents or their relatives or other representatives for any extra costs incurred, for example hairdressing, newspapers or toiletries. Supervision and appraisal records were seen on file for staff on unit 4 (the top floor). It was understood such records are available for all the other units in the home but these were not inspected on this occasion. Portable fans were in use both in communal areas and residents’ bedrooms. These must be risk assessed to assess their suitability and ensure residents’ safety (requirement 14). We recall this was an issue raised with the home last summer and it is disappointing to have to repeat it this year. In contrast to the last key inspection, the inspector’s request to view a selection of service records could not be met during the visit. Previously, the Homefield Nursing Home DS0000010136.V335509.R01.S.doc Version 5.2 Page 24 file of such records was well organised with information easy to access. On this occasion, the person in charge was not able either to locate certain documentation relating to health and safety or to confirm particular safety checks had been carried out. The area director agreed to ensure the relevant documentation was forwarded to the commission within one week. When received, the documentation was found to be satisfactory. The documentation sampled included Legionella testing, gas safety, environmental health (food hygiene) report, fire risk assessment review, and servicing of lifting equipment. Homefield Nursing Home DS0000010136.V335509.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 2 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X 2 X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 2 Homefield Nursing Home DS0000010136.V335509.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 OP3 Regulation 14 Requirement The registered person must confirm in writing to prospective residents that having regard to the assessment the home is suitable for meeting their assessed needs. The registered person must ensure that each residents’ care plan addresses all their individual care needs, have all supporting risk assessments in place and be kept under regular review. The registered person must ensure that documentation recording care delivered to individual residents is accurate, complete and up to date. The registered person must ensure that the practices for administering medication are always safe and follow procedures. The registered person must ensure that all handwritten medicine administration records are checked and signed by a second person to ensure accuracy. The registered person must DS0000010136.V335509.R01.S.doc Timescale for action 31/08/07 2 OP7 15 31/08/07 3 OP7 15 31/08/07 4 OP9 13(2) 31/07/07 5 OP9 13(2) 31/08/07 6 OP9 13(2) 31/07/07 Page 27 Homefield Nursing Home Version 5.2 7 OP18 13 8 OP19 23 9 OP19 23 10 OP19 23 11 OP22 23 12 OP27 18(1)(a) ensure that when medicines with a restricted shelf life are opened the date is always recorded. This will help to make sure medicines are not given beyond their expiry dates. The registered person must ensure that all staff have a clear understanding of procedures to safeguard adults. The registered person must ensure that a written programme of maintenance and renewal for the fabric and decoration of the building is produced, to include: Walls and skirtings Blinds for roof windows The registered person must ensure that the assisted bathing facility on the upper floor is repaired promptly and maintained in good working order. This is especially important for residents on this floor who do not have en-suite bathing facilities. The registered person must assess the condition of the conservatory roof and carry out any necessary repairs. The registered person must ensure that suitable provision is made for storage for the purposes of the care home. Previous requirement. The registered person must review the staffing levels on the middle and upper floors to ensure that, having regard to the size of the care home, the statement of purpose and the number and needs of service users, that at all times suitably qualified, competent and experienced persons are working in the care home in such numbers as are appropriate for the health and welfare of service DS0000010136.V335509.R01.S.doc 31/07/07 31/08/07 31/07/07 31/08/07 31/08/07 31/08/07 Homefield Nursing Home Version 5.2 Page 28 13 OP33 26 14 OP38 13 users. The outcome of this review should be made available for inspection. Previous requirement. The registered person must ensure that reports of the provider’s monthly visits are either submitted to the commission or made available for inspection. The registered person must ensure that portable fans are risk assessed to ensure their safe use. 31/07/07 31/07/07 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 OP2 OP7 Good Practice Recommendations The registered person should ensure each resident has a written contract/statement of terms and conditions with the home, provided at the point of moving into the home. The registered person should ensure that if the home is to continue using a book to detail individual residents’ baths, showers and bowel actions, it is kept away from public areas so that confidentiality is maintained. The information should ideally be incorporated into residents’ care plans. The registered person should ensure there is a photograph accompanying each resident’s medicine chart. Photographs should be labelled with the resident’s name and the date the photograph was taken. The registered person should consider increasing the activity coordinator working hours so this service, which benefits residents, can be provided each day. The registered person should consider using the complaints register to ‘signpost’ where more detailed information and correspondence about an individual complaint is filed. The registered person should provide comfortable seating for two people in each bedroom or ensure it is evident the occupant prefers not to have this provision. DS0000010136.V335509.R01.S.doc Version 5.2 Page 29 3 OP9 4 5 OP12 OP16 6 OP24 Homefield Nursing Home 7 OP33 The registered person should ensure that nurse audits are recorded and made available for inspection, as part of the home’s quality assurance activities. Homefield Nursing Home DS0000010136.V335509.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Homefield Nursing Home DS0000010136.V335509.R01.S.doc Version 5.2 Page 31 - 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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