Inspection on 15/06/06 for Homefield Nursing Home

This inspection was carried out on 15th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Homefield Nursing Home 13/06/07

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 Key Unannounced Inspection 15th June 2006 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.V298416.R02.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.V298416.R02.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 moise@mnssicare.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 Vacant Care Home 44 Category(ies) of Dementia - over 65 years of age (44) registration, with number of places Homefield Nursing Home DS0000010136.V298416.R02.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 4th November 2005 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. Homefield Nursing Home DS0000010136.V298416.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors spent seven hours in the home, beginning their inspection at 09.30. The inspectors’ visit was unannounced and the standards the Commission considers to be the key standards were inspected. The persons in charge and members of staff on duty assisted with the inspection. The inspectors provided feedback at the end of their visit to the Mission Care area director and the person in charge. During their visit, the inspectors toured the premises, observed care practices, and examined documentation. They spoke with service users, though service users’ ability to contribute verbally to the inspection was limited by their dementia, relatives and staff members. What the service does well: What has improved since the last inspection? What they could do better: The care plans sampled indicated action is required to review the content of care plans to ensure they contain the appropriate guidance to enable service users’ needs to be met. The guidance must be based on a comprehensive assessment, which has identified that the home can meet that service user’s individual needs. All members of staff must always communicate with service users in a caring and respectful manner. Improvements are needed to ensure medicines are administered effectively. The use of physical restraints, such as Homefield Nursing Home DS0000010136.V298416.R02.S.doc Version 5.2 Page 6 lap belts, is prevalent in this home and it must always be clearly evident that this is a planned intervention, carried out in the best interests of the particular service user. Service users should be able to take part in regular activities that are appropriate for their capacities and, where possible, their preferences. The home must follow its complaints procedure and respond to all complaints promptly. The acting manager needs to further develop systems to review the quality of service and nursing care provided. The home’s continued reliance on a single passenger lift is a concern and the provision of a service lift would benefit service users and staff. The provision of a small kitchen on the upper floor could also be beneficial, complementing the new lounge in making this floor more self-sufficient. 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 DS0000010136.V298416.R02.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.V298416.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 (6 is not applicable 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 both before admission and on admission need improvement to ensure needs are fully identified and that the home can meet those needs. EVIDENCE: Outcomes for these standards were explored through case tracking, involving discussion where possible with service users and/or their representatives, discussion with staff, and scrutiny of documentation. The care of a service user who wandered continually was case-tracked. The assessment contained information about next of kin and some medical information was recorded. Referral information from the social worker was limited. Other pre-admission information referred to behaviour associated with her dementia, including hallucinations, aggression and unpredictable presentation. The nursing assessment was in a ‘yes/no’ format with limited information recorded. Some of the information was confusing, for example, both “usually prefers to be on her own” and “enjoys going out with her Homefield Nursing Home DS0000010136.V298416.R02.S.doc Version 5.2 Page 9 family/friends” were ticked. Whilst both might apply there should have been a further explanation to clarify. The placing authority contract was in place. A full pre-admission assessment for a recently admitted service user whose behaviour was ‘testing’ the home’s staff could not be located. It was understood there was reliance on assessment from other health and social care professionals before admission to the home. It was not clear whether staff from the home had visited the service user before his discharge from hospital to determine that Homefield would be able to meet his needs. Arrangements were made on the day of inspection to readmit the service user to hospital. The home has a statement of purpose and a service user guide. The service user guide is available in a standard format. It was evident from a sample of three service users that either they or their representatives had been provided with service user guides. A relative said she had been given a service user guide when her husband had been admitted to the home. The inspector was told that contracts for service users, with terms and conditions, were stored at another Mission Care home nearby (Elmwood). The contracts were not inspected on this occasion. Homefield Nursing Home DS0000010136.V298416.R02.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Progress is being made in the use of the new care plan format but the content of care plans needs improvement. Service users have access to health care services, including a visiting medical officer. Medication practices need review and improvement, as some shortfalls were noted during the inspection visit. Service users are spoken to and treated respectfully by some staff members, less so by others. EVIDENCE: Outcomes for these standards were explored through case tracking, involving discussion where possible with service users and/or their representatives, discussion with staff, and scrutiny of documentation. Written comments received by the CSCI were also taken into account. Health care professionals responding to the CSCI’s survey made largely positive comments about the home and the care provided. Each service user had a written care plan. There had been progress with reformatting care plans since the previous inspection, with all newly admitted Homefield Nursing Home DS0000010136.V298416.R02.S.doc Version 5.2 Page 11 service users having the new format care plan and existing service users gradually having their care plans transferred to this. However, the content of care plans inspected was not satisfactory. One care plan inspected had six issues identified with two other specific areas, all dated six months previously. The issues were mainly physically based and very limited in the content of the intervention. Some goals were unrealistic and confusing. For example, the goal for mobility was stated as “excessive mobility”, which was actually the problem. Loss of weight was identified as a specific need, with the intervention stating the service user to be weighed every second week. The weight chart indicated monthly weighing, the last one recorded in May 2006. The Waterlow score was 10, which is ‘at risk’ and had been the same since January 2006. There was a body map with a number of bruises noted. There was a care plan for falls, which referred to the use of the lap belt. The ‘falls register’ was blank in this care plan. There was a declaration regarding bed rails although specific risk assessments for bed rails and lap belt were not in place. Another care plan looked at in detail was limited regarding specific mental health issues. The care interventions for communication included the comment “to talk loud”, even though the service user had no known hearing problems, as confirmed by the person’s spouse and by staff members. This service user was also using a lap belt and bed rails, neither of which had a risk assessment in place. There was a record of restraint on file, which had been completed poorly. On one occasion, it was recorded the service user needed the lap belt between 13.15 and 21.00, signed with two first names. Another record for a period between 7.15 and 10.30 was said to be because of “restlessness”. The record did not indicate the alternatives that staff had tried or how decisions had been reached. Reviews must be in place when lap belts are used for long periods. The pre-inspection questionnaire from the home stated that there had been no incidents in the previous 12 months when restraint had been used. The rationale for this statement is not clear. Physical restraints were seen being used and it was noted from discussions and from examining documentation that such restraint was in frequent use. The home has a GP who attends the home regularly as its ‘visiting medical officer’ (VMO). This VMO was new to the home and the inspector heard comments that it was too early to judge the outcomes for service users of the recent change in VMO. Limited records relating to health care input, for example, from chiropodist, dentist, and optician were evident in care plans sampled. Fluid charts were in operation for some service users. Those seen were incomplete. Omissions included 24-hour totals, full name of the service user, and nothing recorded during the evening/night. If the records were a true Homefield Nursing Home DS0000010136.V298416.R02.S.doc Version 5.2 Page 12 reflection of the input, some service users had been receiving less than a litre of fluid each day. A service user being nursed in bed had a turn chart in her room that had just been marked L, R or B (presumably left, right or back) but not signed, which is important to demonstrate accountability. There were no entries for the previous day between 11.00 and 22.00 hours. Two carers entered the room to turn the service user; the inspector left the room while this personal care was taking place but noted later that the chart had not been signed. Through case-tracking, medication practices were assessed to determine outcomes for service users. Some shortfalls were seen, which was disappointing as poor medication practices were highlighted in the two previous inspection reports. The medication for three service users was examined. One service user had refused all her medication on the morning of the inspection. This had been recorded and the medication disposed of appropriately, though it was not evident that any other action was to be taken, such as consulting the GP and/or other appropriate professionals for review and advice. For another service user, a medication had been recorded as given but the tablet (broken in half) remained in the MDS. For the third service user, a night time medication had not been signed as given for three consecutive nights (Friday, Saturday, Sunday), but there was no clarification for this omission. It was noted that photographs of service users on MAR sheets were not always labelled with the person’s name or dated. Recording the date is important as a person’s appearance can change, especially during a period of poor health. The home’s medication policy and procedure were available, signed as last reviewed December 2005. No service users in the home were selfadministering medication. A staff nurse stated that covert administration of medicines was not used at Homefield. The wall thermometer in the clinical room on the middle floor used for medicines storage showed 25 degrees Centigrade. The temperature of the medicines refrigerator was at the appropriate level and was being recorded regularly. The fridge appeared to need defrosting and defrosting should also be recorded. The medicines storage room had a wash hand-basin, with lotion and paper towels available. Controlled Drugs (CD’s) were stored in a metal cabinet, rawl-bolted to a solid external wall. The CD’s were checked and tallied with the home’s records. CD’s for a recently deceased service user had been retained, though for longer than would usually be necessary and the nurses agreed to check with the home’s pharmacist that this was appropriate in this case. Homefield Nursing Home DS0000010136.V298416.R02.S.doc Version 5.2 Page 13 The home had a new community pharmacist, but staff asked by the inspector did not know if the new pharmacist had carried out pharmacy audit(s) for the home. Homefield Nursing Home DS0000010136.V298416.R02.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home is not providing planned activities each day that are appropriate for its service users. Some staff support service users to exercise choice and control whenever possible but others do not. The food provided is good and service users have enough to eat. Fluids are made available but service users are not always helped to take sufficient fluids throughout the day. EVIDENCE: Outcomes for these standards were explored through case tracking, involving discussion where possible with service users and/or their representatives, observation, discussion with staff, and scrutiny of documentation. When the inspectors arrived at the home (09.30 hrs), most of the service users were up and dressed. It was not clear whether this was consistent with individual service users’ preferred daily living routines. On the ground floor, female service users’ hair was untidy and some men were not shaved. Grooming was limited and in some cases bibs applied to protect clothing remained in place for most of the morning. Homefield Nursing Home DS0000010136.V298416.R02.S.doc Version 5.2 Page 15 As service users in the home may lack capacity, it is important that their relatives or advocates are involved in the review process to provide information in relation to their choices, for example, about leisure and social activities. It was not clear this was happening routinely, although it was evident that the home encourages contact with family and friends to be maintained. An inspector spent the morning and most of the afternoon on the ground floor. Throughout this period the radio was played and no other activity noted. Staff members’ engagement with service users was limited and task orientated. One service user was pacing the area continually and others were wandering intermittently. No activities were observed on the upper floors either, apart from the radio. There was no member of staff designated to coordinate activities during the day. One service user was asking to phone his wife; the inspector was advised this is something that he does often. On approaching the nurses’ station, he again requested to phone his wife. The qualified staff member present at the nurses’ station replied, “If I don’t get my charts done, I will be behind”. No further interaction was noted from her. The same staff member told the service user “can you please go and sit down” and said that he had been told earlier that he would be able to contact his wife. The service user repeatedly approached the nurses’ station with the same request. Another carer heard this and responded in a calm manner offering a cup of tea and stating she would contact his wife .She spent time after this with the service user offering comfort and reassurance. Lunch was well presented and in good sized portions. Dining tables had cloths on them although no other condiments or table decorations. The home was short of saucers. In the corner of the lounge area there was a jug of fluid, and a few service users had glasses of drinks. Juice was offered later after lunch and afternoon tea was served with fruit and biscuits. Fluids were not offered at other times. Service users were not generally able to give their comments about the food, though one said she had enjoyed her lunch. A visitor said that her relative was being given a puree diet every day but that he did not like it. She said he needs his food minced but having it pureed was putting him off some of his meals. She said she had mentioned this to the manager the previous day and had received a helpful response. Homefield Nursing Home DS0000010136.V298416.R02.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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, though complaints have not always been responded to within relevant timescales. Adult protection procedures are in place, though not all staff members had completed training about adult protection. EVIDENCE: The provider has been noted to respond to a recent complaint about the home. The complaint concerned the use of physical restraint. The complainant had contacted CSCI as there had been no response from the provider. CSCI contacted Mission Care, which acknowledged and apologised for the delay and responded to the complainant. The home must respond to complaints within the appropriate timescales, and this should happen without the need for prompting from the CSCI. The home’s complaints file was examined, it was difficult to follow as complaints were not filed in order and there were duplicate letters in different places in the file. The organisation of complaints recording appears to need improvement, to allow effective auditing of the complaints process and monitoring of trends and outcomes. The home had adult protection policy and procedures in place. The provider arranges training for staff about adult protection, but it was evident from discussions with staff that not all had completed such training or had an Homefield Nursing Home DS0000010136.V298416.R02.S.doc Version 5.2 Page 17 appropriate level of understanding relevant to their role and function within the staff team. For example, a qualified nurse interviewed during the inspection had some knowledge about adult protection and was aware that policies were available, but had received no specific training. Another staff member interviewed had a limited knowledge about abuse of vulnerable adults. Homefield Nursing Home DS0000010136.V298416.R02.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home is clean. It is appropriately equipped with aids and adaptations, though improvement to the storage of items such as wheelchairs is needed. The lift facilities are only adequate and an upgrade would have significant benefits for service users, staff and visitors. Service users are able to bring in small items of furniture, pictures and mementos to help personalise their bedroom. EVIDENCE: Overall, the home was clean and odour free. Communal areas including corridors had suffered wear and tear. The communal areas were light and airy although could be arranged to give a more domestic/homely appearance. Chairs were positioned around the walls with the TV to the front of the room. There were two clocks in the ground floor communal area, one of which had stopped; no other domestic style reality orientation aids were present. It was Homefield Nursing Home DS0000010136.V298416.R02.S.doc Version 5.2 Page 19 pointed out at the last inspection that service users with dementia can benefit from visual prompts and domestic type signs. The home was provided with appropriate hoists and aids to assist physically frail service users. However, it was disappointing that improvements to storage arrangements seen at the last inspection had not been maintained. Some bathrooms were being used as storage areas for hoists, wheelchairs and laundry bins. As a result, these bathrooms were congested and the items presented potential hazards. This was also evident in some of the en-suite facilities. Discussion took place regarding the need to keep these areas clear and easily accessible for service users. The dining room seemed cramped at meal times, particularly with the large drinks machine in the corner. It was pleasing to see that the former manager’s office on the top floor had been changed to a small lounge for service users. Unfortunately, the photocopier on that floor was still sited in the corridor near service users’ bedrooms, despite assurances at the previous inspection that it would be moved to a more appropriate position in the home. Bedrooms were variable in the standard of personalisation. Some bedrooms had calendars although there were few clocks. It was evident that some service users had received help to personalise their rooms, benefiting from televisions, radios, photographs, pictures and other personal items. However some rooms had not been made personal to their occupants. Staff should help service users who may not have visitors to personalise their bedrooms. The inspector was told that if room doors are let go, they slam loudly and can be disturbing when lots are shut around the same time, such as in the evenings. This was evident from testing a few doors and service users may benefit if the provider can find a solution. The home continues to rely on one shaft lift for access to the upper floors. This was working satisfactorily on the day of inspection but the inspector was told of instances where the lift had been unreliable and, on occasion, not working at all. This had meant that access to the upper floors on these occasions was by stairs only. For example, a visitor said that she had had to climb stairs to the upper floor to visit her relative when the lift was not working and that this had happened about 3 times in the past six months. She suffers from particular medical problems and the climb had brought on symptoms and made her feel unwell. Staff spoke of instances when the lift had stopped between floors and when the doors had failed to open/close properly. The environmental health service had visited in May 2006 and four items needed attention, all of which the maintenance technician had in hand. A follow-up visit was due to be undertaken shortly. Homefield Nursing Home DS0000010136.V298416.R02.S.doc Version 5.2 Page 20 Please see Management and Administration section below for comments about hot water temperatures and water chlorination. Homefield Nursing Home DS0000010136.V298416.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. The home attempts to ensure that each staff shift includes at least one staff member with knowledge and experience to lead care for people with dementia, and strengthening this arrangement would benefit service users. The home was not complying fully with the additional condition of its registration that RGN’s working in the home do so on the basis that they have substantial experience or relevant training specific to dementia. Recruitment practices require improvement to ensure that all necessary information about applicants is obtained. The outcomes of staff training need to be assessed and monitored to confirm the benefits for service users. EVIDENCE: Relatives and care staff spoken with stated they felt there were occasions when there not enough staff on duty to meet service users’ care needs. Service users were not able to give their views. There were mixed comments about the staffing level reduction of a carer on the middle floor. Some carers felt it was more difficult now to meet service users’ needs promptly, but two qualified staff pointed out that nurses now give additional help with care delivery. It was not clear that this help could be maintained if the nurse was engaged elsewhere, for example, in administering medicines. The use of restraint with lap belts is discussed elsewhere in this report. It was said in relation to certain service users that such restraint was to prevent Homefield Nursing Home DS0000010136.V298416.R02.S.doc Version 5.2 Page 22 accidents to them while they were unsupervised. A care plan seen stated that the service user must have safety straps when seated in a chair whenever unsupervised. Restraints must not be used to accommodate staffing levels. Should the provider and/or manager identify that this is the case, it is expected they would take immediate steps to address the matter. The key worker for two service users had an adequate knowledge of their needs. Two staff members were asked about the needs of a service user being case-tracked by the inspector. One staff member did not relate any of the service user’s needs as identified in the care plan, whilst the other staff member referenced only some. The provider has arranged for staff at Homefield to attend training sessions in LB Bromley’s Care Home Providers Training Programme for 2006. Information provided by the home showed that nine staff members attended sessions in April 2006. Sessions attended included: equality and diversity, customer care, understanding older people, activities, introduction to dementia, report writing, and depression in older people. The assessment and monitoring of training outcomes was not evident, specifically, in restraint, adult protection, health and safety topics and dementia. For some staff, such training was yet to be undertaken. Two registered nurses were interviewed, one an RGN the other an RMN. One nurse’s knowledge about dementia was limited, although she had responsibility for leading and supervising care delivery. She had not received training in relation to dementia or specific mental health issues. This is not consistent with one of the additional conditions of registration for the home. The nurse confirmed that she had received other training in health and safety topics, person centred approach, line management, and ‘seeing it their way’. The second staff member had worked in care homes for some time and could identify signs of well being within dementia residents. She confirmed she had received training in communication, incontinence manual handling and in-house elder abuse but it was evident she had a limited knowledge in respect of COSHH, adult abuse and restraint. The inspectors sampled five staff recruitment files. They did not contain all the necessary information and the home must improve this aspect of its practice. For example, not all the files had proof of the person’s identity or contained two written references and confirmation of current, valid registration with the NMC was not present in two nurses’ files seen. Homefield Nursing Home DS0000010136.V298416.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home does not have a manager whose fitness for registration has been assessed by the CSCI in line with relevant legislation. Although there are some quality assurance mechanisms in place, these need to be fully developed to safeguard service users’ welfare. The home ensures most safety checks are carried out regularly. EVIDENCE: At the time of the visit, the CSCI had not received a completed application for registration from the acting manager, thus the relevant standard has yet to be met. The home’s response to a previous requirement stated that a registered manager would be in post by February 2006. The acting manager must obtain a CRB disclosure through the CSCI and submit this with her application for registration. Homefield Nursing Home DS0000010136.V298416.R02.S.doc Version 5.2 Page 24 Staff do not help service users with their finances and relatives/representatives receive monthly accounts for the cost of additional services such as hairdressing. In several areas, portable fans were present as it was a hot day. Service users were seen to wander close to them and these must be risk assessed in respect of service users’ safety. A selection of service records was viewed. The records seen indicated that maintenance and safety checks are regularly undertaken. Those examined included gas and electrical safety, portable appliance testing, five-year electrical installation, and lift servicing. The file was well organised with information easy to access. The records relating to inspections under the LOLER regulations were overdue, having last been addressed August 2005. The home arranged for servicing of lifting equipment following the inspectors’ visit and has provided evidence that this has been completed satisfactorily. In addition, recordings relating to hot water temperatures had lapsed. The last entry was dated 14 May 2006, and recorded within this was a temperature of 48 degrees noted in bathroom 151. Two other records indicated temperatures above the accepted 43 degrees. No action was indicated in respect of this. Weekly fire alarm records were in place however the maintenance technician does not routinely test the emergency lights. Servicing of the fire system and nurse call system had taken place in April 2006 and fire extinguishers in February 2006. The water chlorination certificate was dated February 2004 and this needs to be followed up. The home has responded to a previous requirement about quality assurance with an action plan. It is pleasing to note that Regulation 26 reports are now being received by the CSCI each month. The home provided only some of the pre-inspection information requested by the Commission. Some details, for example, names and contact details of service users’ next of kin and care managers were not supplied. This lack of full information has limited the Commission’s ability to invite those parties to contribute to the inspection. The responsible persons are reminded that it will soon become a legal requirement for registered providers of adult services to produce a quality assurance assessment each year. Until this is implemented, the Commission is asking providers to complete the pre-inspection questionnaire. Homefield Nursing Home DS0000010136.V298416.R02.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 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 2 Homefield Nursing Home DS0000010136.V298416.R02.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement The registered person must make arrangements for the recording, handling, safekeeping, safe administration and disposal of medication. (Previous timescale of 31/12/05 not met). Specifically, ensuring that all medication is given as prescribed or a written explanation given either on the MAR or in the care plan. The registered person must ensure that no service user is subject to physical restraint unless restraint of the kind employed is the only practical means of securing the welfare of that or any other service user and there are exceptional circumstances. (Previous timescale of 30/11/05 not met). The registered person must ensure that staff are provided with appropriate training regarding the work they are to perform. DS0000010136.V298416.R02.S.doc Timescale for action 31/07/06 2. OP18 13(7) 31/07/06 3. OP30 18 31/08/06 Homefield Nursing Home Version 5.2 Page 27 4. OP27 18(1)(a) The registered person must 31/08/06 review the recent change in staffing level 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 users. The outcome of this review should be made available for inspection. The registered person must ensure service users or their representatives are consulted about their social interests, and that arranged activities are offered regularly. The registered person must ensure that all staff members maintain good professional relationships with service users, treating them with respect at all times. The registered person must ensure that suitable provision is made for storage for the purposes of the care home. The registered person must ensure that the recruitment information required by legislation is obtained for every applicant. The registered person must ensure that portable fans are risk assessed in respect of service users’ safety. The registered person must DS0000010136.V298416.R02.S.doc 5. OP12 16 31/07/06 6. OP10 12 31/07/06 7. OP22 23 31/08/06 8. OP29 19 31/07/06 9. OP38 13 31/07/06 10. OP38 13 31/07/06 Version 5.2 Page 28 Homefield Nursing Home 11. OP38 13 ensure that appropriate action is taken in respect of service users’ safety when hot water temperatures exceed the accepted limit. The registered person must ensure that water chlorination meets service users’ health and safety needs. 31/07/06 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 OP7 Good Practice Recommendations The registered person should review all service users’ care plans to ensure they offer the necessary guidance to staff in meeting the needs of individual service users. The registered person should ensure that fluid charts are recorded accurately. The registered person should ensure that turn charts are signed by the person(s) carrying out this care procedure. The registered person should ensure age-appropriate activities are offered to service users each day. The registered person should consult the CSCI bulletin (June 2006) ‘Safe and Sound: checking the suitability of new care staff in regulated social care services’. This document aims to assist with improving standards of recruitment and vetting, and is available either at www.csci.org.uk or from the local CSCI office on request. The registered person should ensure the photocopier on the upper floor is sited in a more appropriate position, away from service users’ bedrooms. The registered person should consider improving the lift facilities in the home. 2. 3. 4. 5. OP8 OP8 OP12 OP29 6. OP19 7. OP22 Homefield Nursing Home DS0000010136.V298416.R02.S.doc Version 5.2 Page 29 8 OP9 The registered person should ensure that defrosting of the medicines refrigerator is recorded, to ensure this takes place regularly and can be audited. The registered person should ensure that photographs of service users on MAR charts are labelled with the person’s name and the date the photograph was taken. 9. OP9 Homefield Nursing Home DS0000010136.V298416.R02.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: 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 DS0000010136.V298416.R02.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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