Inspection on 13/05/05 for Hyde Nursing Home

This inspection was carried out on 13th May 2005.

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

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

Other inspections for this house

Hyde Nursing Home 26/09/07

Hyde Nursing Home 26/06/06

Hyde Nursing Home 24/11/05

Hyde Nursing Home 07/12/04

Hyde Nursing Home 15/06/04

Hyde Nursing Home 16/07/03

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

CARE HOMES FOR OLDER PEOPLE Hyde Nursing Home Grange Road South Gee Cross Hyde SK14 5NY Lead Inspector Fiona Bryan Unannounced 13 May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hyde Nursing Home F54 F04 s25436 Hyde NH v22530 130505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hyde Nursing Home Address Grange Road South, Gee Cross,, Hyde, Tameside SK14 5NY Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0161 367 9467 Tameside Care Limited Mrs Anne-Marie Thompson Nursing Home 100 Category(ies) of DE(E) Dementia - over 65 - 25 registration, with number TI Terminally ill - 1 of places PD(E) Physical disablity - over 65 - 50 PD Physical disability - 75 Hyde Nursing Home F54 F04 s25436 Hyde NH v22530 130505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: No service user to be admitted to the home under the age of 55 years. No more than 10 service users to be admitted to the home who just require personal care. A minimum of 4 first level registered nurses to be on duty in each 24 hour period. The manager must be supernumerary to the above staffing requirements. Date of last inspection 7th December 2004 Brief Description of the Service: Hyde Nursing Home is a purpose built home, providing accommodation for up to 100 service users requiring nursing care. The home is a two storey building, divided into four separate courts: Newton, Flowery Field, Godley and Werneth. Each court has a maximum of 25 beds, 15 on one floor and ten on the other. The courts link into a central area known as The Pavilion. Godley, Newton and Flowery Field Courts provide accommodation for service users who require general nursing care. Werneth Court provides accommodation for 25 service users with dementia who require specialised nursing care. The home is owned and operated by Tameside Care Limited and is under the control of a general manager who is also a qualified nurse. All bedrooms are single with en-suite facilities. Each of the four courts has two dining rooms, two quiet rooms, two lounges and four bathrooms. Passenger and wheelchair lifts provide access to both floors. The Pavilion overlooks the Mary Secole gardens and is the central core of the home, serving as the social and recreational focal point, equipped with a hairdressing salon and shop. The home is built on the site of Hyde Hospital. Public transport is within easy access, providing links to all towns within Tameside. Hyde Nursing Home F54 F04 s25436 Hyde NH v22530 130505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Three inspectors carried out this announced inspection, spending a total of 30 hours in the home. Time was spent talking to residents, relatives and staff. Six residents were looked at in detail, looking at their experience of the home from their admission to the present day. Comments cards were left at the home. Three residents had responded at the time of writing this report. Two residents were mainly positive although one felt that there should be more staff on duty. One resident stated that they only sometimes felt well cared for. Three relatives responded who were all positive with the exception of feeling that there were not always enough staff on duty. Two complaints were investigated during this inspection, one of which had been investigated previously by the home, however the complainant was not satisfied with the response and had referred their complaint to CSCI to consider. CSCI’s investigation of both complaints found evidence of poor care planning and insufficient monitoring and action to address the residents’ health care needs. Since the last inspection a new manager has been appointed who has been registered with the CSCI. What the service does well: What has improved since the last inspection? Improvements have been made in the presentation of the meals provided for residents requiring a soft/liquefied diet. Hyde Nursing Home F54 F04 s25436 Hyde NH v22530 130505 Stage 4.doc Version 1.30 Page 6 The provision of entertainment and activities for larger groups of residents has improved, although further work is still needed to ensure that individual residents who can’t or don’t wish to join in with group events also have their social needs met. Staff reported that the general organisation and running of the home had improved, which had resulted in them having better stocks of essential equipment to carry out their jobs, such as gloves, aprons and wipes. 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. Hyde Nursing Home F54 F04 s25436 Hyde NH v22530 130505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Hyde Nursing Home F54 F04 s25436 Hyde NH v22530 130505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4 Residents’ needs are not fully assessed before admission to the home. Some staff require training to ensure that they are able to deliver care in a way that meets residents’ needs. EVIDENCE: The care files for six residents were looked at in detail. Residents admitted under care management arrangements had social services assessments on file. However, some files did not have all the information required, particularly essential risk assessments. Staff confirmed that prior to the admission of a resident the manager would usually visit them and carry out the home’s own assessment. Even on the occasions where this had occurred shortfalls were still identified in the assessment process. Staff stated that if there was any doubt as to whether the home could meet the residents needs, this would be discussed with the nurse in charge of that unit prior to the admission and their views would be taken into account. Hyde Nursing Home F54 F04 s25436 Hyde NH v22530 130505 Stage 4.doc Version 1.30 Page 9 Staff knew the residents well and said that they got information about new residents from reading the care files, from the nurse in charge and from talking to the resident and their relatives. No staff had received training in the care of people with dementia. The nurse in charge of the Court caring for people with dementia had no experience in this field of nursing. Hyde Nursing Home F54 F04 s25436 Hyde NH v22530 130505 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and 10 Care plans do not always give full details regarding the care needs of residents. Healthcare needs of residents are not always properly met. The home’s policies and procedures for dealing with medicines are not always followed, putting residents at risk. Staff are aware of the need to promote residents’ dignity and privacy. EVIDENCE: Two complaints were investigated during this inspection. The findings of one complaint provided evidence that risk assessments had not been undertaken, relevant care plans not developed and other care plans not reviewed and updated to reflect the changing needs of the resident. Both complaint findings indicated that the residents’ health care needs had not been monitored adequately. One investigation found that appropriate pressure relieving equipment had not been provided to the resident despite being recommended by the tissue viability nurse. Six care files were looked at in detail across all four Courts. Care plans had in the majority of cases been developed from the information gained about the resident during the assessment but there remained a wide variation in the quality of the care plans and risk management plans, with some being very Hyde Nursing Home F54 F04 s25436 Hyde NH v22530 130505 Stage 4.doc Version 1.30 Page 11 good and others not providing adequate details of the interventions necessary to meet the residents’ needs. Risk assessments had not been undertaken in all cases for residents when it was clearly indicated that such an assessment was necessary. For example one resident who had a history of falling did not have an appropriate risk assessment in place. One resident who was at risk nutritionally had not been weighed on admission two weeks before the inspection, therefore no baseline record was available for staff to monitor against. Care files provided evidence that either the resident or a relative had been involved in the initial assessment and subsequent care planning, and one resident spoken to was fully aware of her on going healthcare issues and how they were being addressed. In addition two relatives stated that they were kept informed about any changes in the condition of the residents. Residents said they had been seen by their GP’s, chiropodists, dentists and opticians and had been assisted to attend hospital appointments. Records confirmed this. One resident had been seen by the tissue viability nurse who had issued instructions regarding the type of dressing to be applied. At the time of the inspection the dressing was applied incorrectly and it was confirmed by the nurse that the dressing had been in place for a week. On Flowery Fields Court morning medicines due at 10.00am were still being administered at 12.10pm. Staff on Werneth Court stated that medicines were often administered late on that Court as well and one relative confirmed this. The findings of one complaint investigation indicated that recording procedures for the administration of medicines were not satisfactory. One resident and two relatives stated that regular staff were generally very nice but staff interaction with residents appeared limited and staff said that they did not have a lot of time to sit and chat with residents. One relative said that the resident she visited was usually well presented, clean and tidy. Hyde Nursing Home F54 F04 s25436 Hyde NH v22530 130505 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15 The home does not meet all the residents’ social and recreational needs, especially the residents who are more infirm and those suffering from dementia. Residents are able to maintain contact with family and friends. Residents have some choice regarding basic areas of everyday living. A varied diet is provided which is generally acceptable to most residents. EVIDENCE: Residents said that they were able to get up and go to bed as they chose and that they were able to determine how they spent their day. An activities organiser arranges social events and entertainment such as a VE day party held just before the inspection which many residents attended and was widely enjoyed. Notice boards on each unit advertise social events. Staff said that they kept residents informed of what was happening in the home. Whilst the level of activities and entertainment that takes place in the Pavillion has increased, individual and small group activity on each of the courts was still lacking. Visitors said they were made welcome at the home and the interaction between relatives and staff appeared positive. Residents stated that they were able to choose what time to get up, what time to go to bed and were able to sit in one of the lounges or stay in their own room as they wished. Hyde Nursing Home F54 F04 s25436 Hyde NH v22530 130505 Stage 4.doc Version 1.30 Page 13 Residents were given a choice of fish and chips or quiche at lunchtime. All the residents spoken to said they liked the food provided by the home. The appearance of the meal provided for residents who required soft/liquefied diet had improved since the last inspection and looked much more appetising. Hyde Nursing Home F54 F04 s25436 Hyde NH v22530 130505 Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Residents and their representatives are not certain that their complaints are investigated properly. Staff require training to ensure that residents are protected from abuse. EVIDENCE: One of the two complaints investigated during the inspection had been investigated previously under the home’s internal complaints procedures but the complainant was not satisfied with the response. One resident stated that they would make any complaints to the nurse in charge and were happy that their concerns would be dealt with appropriately. Another resident who was quite new to the home was not aware of the complaints procedure. Two relatives stated that they had complained about issues in the past but felt that making complaints made little difference to their concerns. Of seven staff interviewed, five stated that they had received no training in adult protection. Some of these staff were very unsure about the type of instances that may constitute abuse, but most said they would inform the manager if they had any concerns. Staff had also not received training in dealing with challenging behaviour. The manager and deputy manager had recently attended training in adult protection and will be delivering training to the rest of the staff. Hyde Nursing Home F54 F04 s25436 Hyde NH v22530 130505 Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 The home is well maintained and most areas are safe for residents to use. The home is clean and pleasant to live in. EVIDENCE: Residents said they liked their rooms and had been encouraged to personalise them. All areas of the home seen on the day of the inspection were clean and tidy with appropriate, homely furnishings. Relatives of residents on Werneth Court remained concerned that the garden was not secure and was therefore unsafe to use. The manager stated that a new fence had been purchased which was due to be fitted during the week commencing 13th June 2005. Hyde Nursing Home F54 F04 s25436 Hyde NH v22530 130505 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30 The numbers of staff do not always ensure that the needs of residents can be met. Residents are not protected by the home’s recruitment practices. Further training is required to ensure that residents receive care based on current best practice. EVIDENCE: Opinion amongst staff was mixed regarding staffing levels, with some staff saying that levels were usually satisfactory, some saying levels had improved but there was still significant usage of agency staff and some staff stating that they felt staffing levels were still poor at times. Most residents spoken to felt that staffing levels had improved since the last inspection but three relatives expressed concerns about the numbers of staff provided and reported times when they had had to help staff to serve out drinks and meals and supervise residents whilst they were visiting. Investigation of one complaint indicated that on several occasions there had been no registered nurse on night duty on Godley Court. One new member of staff had commenced employment without having applied for a disclosure certificate from the CRB and without having been checked against the POVA list. An immediate requirement was made in respect of this at the time of the inspection. A nurse who had commenced employment at the home two days prior to the inspection stated that she had received some induction, but on her second day on duty, as there were staff shortages she was having to work as a carer and Hyde Nursing Home F54 F04 s25436 Hyde NH v22530 130505 Stage 4.doc Version 1.30 Page 17 was unable to work alongside the nurse as originally planned and therefore did not receive further induction into her role and duties as a nurse. Three staff said they had not received training in dementia care, including one registered general nurse on the unit for people with dementia, who had no experience in caring for this group of residents. Other training such as tissue viability, wound care, continence management and oral health had been delivered to some staff. Hyde Nursing Home F54 F04 s25436 Hyde NH v22530 130505 Stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 38 Residents need further opportunities to offer their opinion about how the home is run. Staff comply with policies and procedures in the home to ensure that the health and safety of residents is maintained. EVIDENCE: Staff stated that staff meetings were held, but the frequency of these varied between Courts. The deputy manager had held resident meetings on Flowery Fields, Godley and Newton Courts and was planning to hold these regularly. Resident meetings had not been held on Werneth Court, as many of the residents would not be able to participate. Relatives meetings had been held on this Court under the previous management, which relatives stated they felt were beneficial. However, the new manager has arranged a new system whereby individual relatives (from any Court) can see her by appointment. Relatives on Werneth Court stated that they would still like to have group meetings to discuss Hyde Nursing Home F54 F04 s25436 Hyde NH v22530 130505 Stage 4.doc Version 1.30 Page 19 general issues relating to the Court as a whole. This feedback was given to the manager. No residents spoken to could recall receiving questionnaires asking for their feedback about how the home met their needs. During the inspection staff were observed to be using safe working practices. The manager described the system in place for ensuring that all staff received mandatory training and updates in health and safety topics. Hyde Nursing Home F54 F04 s25436 Hyde NH v22530 130505 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 1 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x 2 x x 2 x x x x 3 Hyde Nursing Home F54 F04 s25436 Hyde NH v22530 130505 Stage 4.doc Version 1.30 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 4,18,30 Regulation 18 Requirement The registered person must ensure that staff receive training in dementia care, challenging behaviour and protection of vulnerable adults. The registered person must ensure that each residents care plan sets out in detail the action which needs to be taken to ensure that all aspects of the health, personal and social care needs of the resident are met. (Timescale of 28/2/05 not met). The registered person must ensure that the residents care plans are reviewed at least once a month and updated to reflect the changing needs of the residents. (Timescale of 28/2/05 not met). The registered person must ensure that relevant risk assessments are undertaken for residents and where risk is identified actions are put in place to reduce or eliminate the risk. (Timescale of 15/2/05 not met). The registered person must ensure that equipment necessary for the prevention of pressure sores is provided. F54 F04 s25436 Hyde NH v22530 130505 Stage 4.doc Timescale for action 31/12/05 2. 7 15 31/7/05 3. 7 15 31/7/05 4. 3,7 13 31/7/05 5. 8 16 31/7/05 Hyde Nursing Home Version 1.30 Page 22 6. 8 13 7. 9 13 8. 9 13 9. 12 16 10. 16 22 11. 27 18 12. 29 19 The registered person must ensure that advice given by other healthcare professionals is acted upon and necessary treatment carried out as requested. The registered person must ensure that medicines are administered to residents at the times prescribed by their doctors. The registered person must ensure that acurate records are kept of all medicines administered to residents. The registered person must ensure that the programme of activities arranged for residents takes into account the needs of the residents and suits their expectations, preferences and capacities. The registered person must ensure that complaints are fully investigated and complainants are informed about any action which is to be taken as a result of the findings. The registered person must ensure that at all times suitably qualified, competent and experienced persons are working at the home in such numbers as are appropriate for the health and welfare of residents. (Timescale of 28/2/05 not met). The registered person must ensure that no staff are employed at the home unless a disclosure certificate from the Criminal Records Bureau has been applied for and it has been confirmed that they are not on the POVA list. 31/7/05 Immediate Immediate 31/8/05 31/7/05 31/7/05 immediate Hyde Nursing Home F54 F04 s25436 Hyde NH v22530 130505 Stage 4.doc Version 1.30 Page 23 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 7 Good Practice Recommendations The registered person should consider the wide variation in the quality of care plans and risk assessments across the home and take action to ensure that all documentation is consistently detailed and accurate. The registered person should ensure that a variety of methods are used to ensure that residents have the opportunity to give feedback about how the home meets their needs. 2. 33 Hyde Nursing Home F54 F04 s25436 Hyde NH v22530 130505 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 2nd Floor, Heritage Wharf Portland Place Ashton-under-Lyne OL7 0QD 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 Hyde Nursing Home F54 F04 s25436 Hyde NH v22530 130505 Stage 4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!