Inspection on 28/03/07 for Ilsom House Residential & Nursing Home

This inspection was carried out on 28th March 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

Ilsom House Residential &... 02/02/06

Ilsom House Residential &... 16/06/05

Ilsom House Residential &... 22/11/04

Ilsom House Residential &... 26/07/04

Ilsom House Residential &... 03/12/03

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Fairfields Country Rest Home

Poldhu

Queensmount

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Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Ilsom House Residential & Nursing Home Tetbury Glos GL8 8RX Lead Inspector 586 Key Unannounced Inspection 11.10a 28 & 29th March 2007 th 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 Ilsom House Residential & Nursing Home DS0000016483.V317262.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. Ilsom House Residential & Nursing Home DS0000016483.V317262.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ilsom House Residential & Nursing Home Address Tetbury Glos GL8 8RX 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) 01666 504131 01666 504308 www.bupa.co.uk BUPA Care Homes (CFCHomes) Limited Mrs Janet Elizabeth Pitcher Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38), Physical disability (38) of places Ilsom House Residential & Nursing Home DS0000016483.V317262.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate one named service user under the age of 65 years for a single respite stay. When this respite period has ended, the service’s category will revert to that originally registered for. 2nd February 2006 Date of last inspection Brief Description of the Service: This care home provides care for the elderly person requiring predominantly nursing care, although admission for personal care only is possible. Set back off the main road overlooking the countryside, the home offers spacious accommodation with extensive gardens and ample car parking. Accommodation is over two floors and consists predominantly of single bedrooms all with en suite facilities. A few bedrooms are large enough to share if this was a particular request. This would also depend on the number of residents already living in the home. There are spacious communal rooms on the ground floor and ample communal bathing and toilet facilities. The home has a passenger lift and stair lift to aid access to the first floor. All entrances into the home are level to the ground making wheelchair access easy. This home is popular and well established in the local area. Fees range £699.49 to £886.29 (current from December 2006) The last CSCI inspection report on the home can be seen on request. Ilsom House Residential & Nursing Home DS0000016483.V317262.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Inspector carried out this inspection over two days, the first day between 11.10am and 9.35pm and the second day between 8.30am and 11.30am. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This includes comments from 13 pre inspection surveys received back from relatives, 9 from residents, 4 from care staff and 2 from visiting healthcare professionals. As part of the inspection process the arrangements to provide visitors and existing residents with adequate information about the home were inspected. This included transparency in information relating to finances. Four residents were selected and their relevant care documentation inspected in detail and compared with the actual care being delivered. Several additional residents care records and relevant care were inspected. Medications administration and relevant records were inspected. Residents’ privacy and dignity, their ability to make choices and recreational opportunities were explored. The choice, standard and delivery of food were inspected. Arrangements for dealing with complaints and for the protection of vulnerable adults were explored. The home’s environment, its maintenance and the provision of specialised equipment were all inspected. Arrangements for the control of infection were inspected. All aspects of staffing were inspected; this included the numbers of staff on duty, their training/supervision, skill mix and recruitment processes. Residents’ opinions of the general management of the home and how they are communicated with were explored. The system in place for measuring the quality of the service, the care provided and how these are improved upon was inspected. Arrangements for the safe keeping of residents’ monies were reviewed. The one previous requirement made by the CSCI was revisited to ascertain if this had been complied with. Ilsom House Residential & Nursing Home DS0000016483.V317262.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? 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. Ilsom House Residential & Nursing Home DS0000016483.V317262.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 Ilsom House Residential & Nursing Home DS0000016483.V317262.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): 1,2,3,5 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides comprehensive information for residents and families before and after admission although there is a shortfall in the information provided for those residents who are receiving funding towards their fees. Residents have their needs assessed prior to admission in order for the home to ensure they can meet those needs once the resident has been admitted. Visitors are able to visit as they choose and are made welcome prior to and after admission. EVIDENCE: This outcome has been assessed as ‘good’ overall but there are some specific shortfalls that need to be addressed. Ilsom House Residential & Nursing Home DS0000016483.V317262.R01.S.doc Version 5.2 Page 9 The home has a Statement of Purpose, which outlines what care and services the home aims to provide, this is not overly specific to the home and refers to specific BUPA policies as explanation in some areas. This was not on display as it has been in the past and neither was the last home’s inspection report. The receptionist explained that both had inadvertently been put into a drawer and she would ensure they were put back on display. Eight out of thirteen relatives commented within their surveys they did not have access to the home’s last inspection report. Visitors have access to a home brochure within the entrance area and within each bedroom is a ‘welcome pack’, which holds most of the information required by a resident or their representative once they have moved in. None of this information appeared available in any other format such as on audiotape for the visually impaired; the home may like to consider this. The administrator explained to the Inspector what information is made available to prospective residents and their families at various stages of the admission process. All of the information given meets with the Care Home Regulations and would help a prospective resident make an informed decision about their future care at the home. A copy of a new information book was seen, which is very informative and which is now given to all new residents or their families. The only shortfall in information is for residents who receive funding towards their care. These residents do not receive a copy of the home’s terms and conditions, a decision made by BUPA not the Registered Manager. They also do not receive notification of the amount they are receiving in respect of the Registered Nurse Care Contribution (RNCC), although they do receive a copy of the RNCC assessment forwarded to them by the assessor. The Care Home Regulations do now require residents to be in receipt of a copy of the homes terms and conditions and be made aware of the amount they are receiving for their RNCC, irrespective of how their fees are being met. Staff were observed taking their time to help settle a new resident into the home on the first day of this inspection. Assessments are carried out on all residents prior to their admission. If this is not possible then information relating to their needs is sought. The Deputy Manager visited a prospective resident who was in hospital to assess their care needs on the first day of this inspection. On examination of existing pre admission assessments one was dated four days prior to an individual’s admission, one several weeks before and two were dated the day of the person’s admission. Ilsom House Residential & Nursing Home DS0000016483.V317262.R01.S.doc Version 5.2 Page 10 Most relatives have confirmed that they feel welcome when they visit and say they are informed of important matters concerning their relative. Four relatives felt this was not forthcoming unless requested. One commented: “ details of relatives health are not forthcoming and when enquiries are made they are not welcomed”. One relative spoken to during this inspection said she is kept well informed of her relative’s condition by the staff. She also confirmed that she calls her relative everyday and therefore speaks to a member of staff most days. This person was also aware of who her relative’s named nurse and key worker were. Both of these act as a particular point of contact for her, although she also confirmed a recent change in this arrangement so she was hoping communication would remain good. Designated rehabilitation care is not provided within this home. Ilsom House Residential & Nursing Home DS0000016483.V317262.R01.S.doc Version 5.2 Page 11 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 good. This judgement has been made using available evidence including a visit to this service. A system is in place to plan and document most residents’ care in order to ensure each of their needs are reviewed and met. Arrangements are in place to ensure residents’ healthcare needs are met. Apart from a few shortfalls the administration of medication and its related system is safe. Residents’ privacy and dignity are generally upheld, but their ability to have privacy during visiting is being compromised. EVIDENCE: All the relative survey forms except one indicated that relatives were happy with the overall care being given. One relative visiting a very poorly resident said: “so far, the care has been everything we could expect and more”. Ilsom House Residential & Nursing Home DS0000016483.V317262.R01.S.doc Version 5.2 Page 12 The residents’ surveys indicated that many were satisfied with the care that they received. One said: “the care is superb both from nursing staff and carers”. Another said: “ I feel there are insufficient care staff at the weekends”. Care plans and additional records were inspected in detail for four residents. There was evidence in two files that suggested some of the care plans had been devised or agreed upon in one case with the resident and in the other, the next of kin. The majority of the content had been updated accordingly and gave clear instruction to staff on how to meet the individual’s needs. Shortfalls were noted in the recording and identifying of the needs of one resident. A lack of dexterity in the resident’s hands was observed to be causing real problems at lunchtime resulting in large amounts of food ending up in the resident’s lap. This resulted in the resident saying there was a feeling of ‘uselessness’ about it all. There was also no care plan relating to this person’s pressure relief, despite the resident being observed to be sitting on a basic pressure relief cushion and saying their buttocks felt sore. This resident is at risk of pressure ulcers as they are immobile. These two areas of care are significant to the resident if not adequately assessed and planned for. On talking with one of the qualified nurses about the care of one very poorly resident, all steps were being taken to ensure this resident was receiving adequate medical review. This included a visit by the Medical Consultants from a main hospital during this inspection. The family of this resident were taking a lead on decisions about their relative’s future care with the support of the home staff. Care documentation showed that the local GPs visit as required. There is access to a Physiotherapist at an extra charge, which some residents were having. Involvement with several other healthcare professionals was recorded and included the Macmillan nurse, continence advisor, mental health nurse, dietician, speech therapist, chiropodist and optician. Any loss of weight in a resident is assessed, recorded and appropriate care devised. The administration of medication was observed several times. This on the whole was carried out safely, it was noted on one occasion that a nurse signed for the medication before the resident had taken it. This is poor practice as is the drug trolley not being secured to the wall, observed at one point during the inspection. Records pertaining to administration (MAR Sheets) were inspected and had been completed in nearly all cases at each administration time. Ilsom House Residential & Nursing Home DS0000016483.V317262.R01.S.doc Version 5.2 Page 13 Several handwritten directions however did not contain two signatures and in some cases had no signature. The use of a syringe driver was commenced on one resident during this inspection and staff confirmed that they held adequate skills to maintain this. Medication stock and records pertaining to ordering and disposal of drugs was not inspected on this occasion. The privacy and dignity of residents was observed to be upheld. Care staff referred to residents by their names, knocked on doors before entering and dealt with potentially embarrassing situations quietly and skilfully. One relative stated: “the dignity of residents is respected which is very reassuring to relatives”. Another said: “ Staff always show courtesy and care”. There is a small communal lounge, which is supposed to be for residents or visitors to use if they wish to be quiet or be with visitors privately. One resident said: “ it is rarely free as staff use it”. And one relatives survey commented: “there is a private room for visiting but it is usually occupied by staff”. Ilsom House Residential & Nursing Home DS0000016483.V317262.R01.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. 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. In places residents are not having their specific choices and preferences met. Arrangements for food delivery and the standard of cooking are falling short of residents’ expectations. Family and friends including any links with the local community are viewed as integral part of the residents’ lives. EVIDENCE: This outcome has been assessed as adequate using the Commissions guidance tool however significant shortfalls in one area are making several residents very unhappy and dissatisfied. Some residents’ personal choices and preferences were seen documented within their care plans. Several spoken to said they were free to spend their day as they choose. One resident said he was very happy in the home and finds he is able to make choices, which the staff support him in. Ilsom House Residential & Nursing Home DS0000016483.V317262.R01.S.doc Version 5.2 Page 15 Several residents were seen exercising choices in whether they spent their day in their own room or not. Who they sat next to at mealtimes and whom they socialised with. Several have control over who visits them and when. Residents who are able to go outside of the home independently are free to do this as they choose, although one resident commented in their survey: “the gardens are beautiful, it’s a shame I can only get to them when my visitor takes me out in a wheelchair”. Another more independent resident commented that the gardens are beautiful and this makes a big difference to how they feel. Arrangements are in place for a regular Communion Service to be held within the home. The staff can assist in supporting alternative religious needs if requested. Residents had mixed views on the standard of cooking. Some of the comments made were: “its just edible”, “it’s appalling”, to “I enjoy the food”. One relative’s comment on behalf of her mother was: “My mother is not a lady to complain but she tells me the food is not very good”. One relative felt there was a shortfall in her relatives specific diet needs. There were several residents’ dissatisfied with the tea, served early evening. Several said it is the worst meal of the day and its delivery is extremely disorganised. They were aware that a member of staff within the kitchen had recently left and that this has caused the home considerable problems, but they were also unhappy that the routine had been altered. They said that there was no point voicing their views about it, as it would make no difference. One member of staff explained that the Registered Manager had altered the routine in order to give the residents more choice at teatime but that they were aware that several residents were very unhappy about it. Three members of staff spoken to confirmed that a particular group of residents are having to wait for their tea beyond the usual time as the upper floors and dining room have to be served first. The home’s information very much implies that the residents’ preferences and wishes are core to how the home operates. Several residents were not feeling this when it came to mealtimes, particularly teatime, and the Inspector’s concern lies with the residents’ sense of not being free to voice their views. There were also comments about the temperature of the food not being adequate at most mealtimes. It was noted that meals served in the dining room are served onto plates in the kitchen, covered and then served from a basic trolley. On the other hand food served in the lounge was served from a hot trolley. Residents who required more support to eat were offered choices and help was given in a quiet and dignified manner. One resident who is prone to wandering away from her food was sat with throughout the meal and reminded to eat her food. This was also identified as a need in her care plan. Ilsom House Residential & Nursing Home DS0000016483.V317262.R01.S.doc Version 5.2 Page 16 The home has an activities co-ordinator and it is very much up to the resident as to whether they choose to join in with these or not. One resident commented that she likes to join in most things, others preferred to do their own thing. One comment written by a relative on behalf of residents said: “activities are excellent, my mother participates unless she is unwell”. Another written on behalf of a resident said: “there are sometimes activities in the drawing room and sometimes I am moved in my chair to take part, but not always. They only happen once or twice a week”. Ilsom House Residential & Nursing Home DS0000016483.V317262.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16& 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 a complaints procedure but residents are not confident enough in the system to either raise a concern/complaint or feel any action would be taken. Several relatives remain unaware of the arrangements in place. There are significant shortfalls in the arrangements for ensuring residents are protected from abuse. However residents did not say they feel unsafe and the company clearly consider the arrangements in place to be adequate. EVIDENCE: This outcome has been assessed as adequate using the Commissions guidance tool, however there are significant practical shortfalls, which make residents very vulnerable. The home’s complaint procedure is prominently displayed within the reception area and is also found within the welcome pack in each bedroom. It was surprising then to find that 8 out of the 13 relative surveys received back said they were unaware of the Complaints Procedure. BUPA audit formal complaints on a monthly basis and each Registered Manager is expected to report any complaint to their immediate line manager. Ilsom House Residential & Nursing Home DS0000016483.V317262.R01.S.doc Version 5.2 Page 18 The home has reported within the pre inspection information the receipt of one complaint since the last inspection but information on this was not within the complaint file and the Registered Manager was not available during the inspection to discuss this. Several residents said that they did not consider it worthwhile complaining about anything as “it is always smoothed over and comments are not welcomed”. One resident’s view was that you could become very unpopular if you complained. These comments are concerning and indicate that residents do not feel empowered and safe enough to complain or express a view. Also one other resident raised some interesting points that should be taken into consideration by the home management. These were in response to the question: did the resident know who to speak to if they were unhappy? This resident commented that they could no longer distinguish between carer and nurse, as they can no longer read their name badge. An added problem for this resident was that staff rotate and this leaves the resident feeling that it is difficult to build a trusting relationship with any one person as they were able to do so in their previous care home. The other seven resident surveys received back indicated that they would usually know who to speak to if they were unhappy. The home has a corporate policy on the Protection of Vulnerable Adults (POVA). It is understood that BUPA have carried out a review of the policy and procedures, which did not satisfy the Commission and are in the process of reviewing this again, however the copy in the home file was dated 2003. Although this relates to the Department of Health’s document ‘No Secrets’ and various other leading publications, the procedures that sit within the policy do not encourage staff to share information with other agencies until well into an investigation initiated by BUPA in the event of abuse. This potentially means that anything that may need investigating by, for example the police, is not being shared until well into the commencement of BUPA’s own investigation which may well destroy valuable evidence. This potentially leaves residents very vulnerable. There was no training recorded as given to staff on elderly abuse/protection of vulnerable adults and five staff spoken to had no knowledge of the processes of adult protection or the different types of abuse. One was a senior member of staff with limited knowledge. Another staff member confirmed that they had received training in another job but nothing so far by their present employer, BUPA. Ilsom House Residential & Nursing Home DS0000016483.V317262.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a home that is safe, well maintained and which is kept clean EVIDENCE: The environment of this home is very comfortable and extremely well appointed and maintained. Records pertaining to this maintenance work were inspected and the maintenance person confirmed that there is an ongoing programme of refurbishment and redecoration, which is partly managed by the Registered Manager and ultimately organised by BUPA’s estate management team. Individual staff identify smaller day to day maintenance needs and communicate these to the maintenance person; who according to the request book deals with these as promptly as possible. Ilsom House Residential & Nursing Home DS0000016483.V317262.R01.S.doc Version 5.2 Page 20 Although residents are able to personalise their bedrooms they are not involved in the choice of décor or soft furnishings. On the days of this inspection the home was comfortably warm and well ventilated. Bedrooms and communal areas are light and airy. Precautions have been taken to protect residents from harm, such as covering radiators and fixing window restrictors. Comments from all surveys were similar:“ the environment is very warm and well ventilated as is my room”, “ the environment is excellent”. Cleaners were observed going about their work in a safe manner and residents and relatives confirmed that the home is always clean. One relative made a point of saying how she appreciates the care taken over the houseplants she has put into her relative’s bedroom. Records show that cleaning staff are provided with training relating to the products they use, the Control Of Substances Hazardous to Health (COSHH). One cleaner’s trolley was stored under the stairs halfway through a morning during this inspection but all cleaning products had been safely removed. The home has an infection control policy with numerous related procedures. Staff were observed to be practicing some of these such as wearing protective aprons and gloves when carrying out certain care tasks or when serving food. Arrangements are also in place for the correct disposal of waste. It was noted at the time of this inspection that the terrace area to the back of the home was closed off with barriers. This is extremely uneven and had some fallen roof tiles present. Ilsom House Residential & Nursing Home DS0000016483.V317262.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are not enough staff on duty to ensure all the needs and preferences of the residents are met. Although there are staff in the home adequately qualified to care for the residents, there are definite shortfalls in some areas of training, which residents would benefit from if the staffs’ knowledge were to be increased. Residents are protected through robust recruitments practices. EVIDENCE: Again this outcome has been assessed as adequate using the current guidance but there are shortfalls that need reviewing and addressing. There were several comments on the relatives, residents and staff surveys that indicate there may not be enough staff on duty to meet the needs of the home and residents. Three out of thirteen relative surveys said in their opinion there are insufficient staff on duty whilst others felt satisfied or had not commented. One resident’s survey said: “ I wish the care assistants had more time to talk to me rather than just help with my basic needs, a lot of the time I just fall to Ilsom House Residential & Nursing Home DS0000016483.V317262.R01.S.doc Version 5.2 Page 22 sleep”. Another said: “There are insufficient staff on duty at the weekend”. Another said: “the staff do not chat to us much, I cannot stress the importance of a friendly chat, they have a lot todo but what is more important is to chat to the residents”. One survey indicated that staff were available ‘sometimes’ when they are needed, others indicated that there was always or usually someone available. Two of the four care staff surveys received said that they do not have enough time to give the care they would like to give and went onto explain the high level of care some residents require compared with the short space of time to deliver this. The level of care required at present was considered high by all staff spoken to, but the staff roster did not show any increase in staff to account for this. The night staff considered the general night staff numbers to be adequate, although one said between 8pm and 11pm can be extremely busy. The off duty showed one night to be staffed with only two staff on duty, but this appeared to be a one off event, although it did result in a member of staff sustaining an injury during a moving and handling procedure. Another member of staff confirmed that correct moving and handling procedures are carried out but that this takes a great effort by the staff to maintain at times because of the ratio of high needs to numbers of staff on duty. On the day of this inspection one member of staff went off duty significantly later than her shift was supposed to be because the shift had been so busy and because records then had to be written (this member of staff had not been affected by the inspection). The teatime medication round finished at 7.15pm. The nurse explained that the shift had been very busy and problems at teatime had to be sorted out which had put her behind. On both days of this inspection staff looked very busy and were moving quickly from one task to the next. Due to this the print out connected to the call bell system was inspected. This gives the time when a resident calls for assistance and when a member of staff responding switches off the call bell. The six entries taken at random showed that it took staff between 7 & 10 minutes to respond each time. The Registered Manager has subsequently confirmed that in her opinion there are enough staff on duty in relation to the numbers of residents and the home’s ‘staffing notice’. A staffing notice dated 2000 was read during this inspection, this used to outline the home’s minimum staffing requirements before the commencement of the Care Home Regulations 2001. It is no longer recognised and homes should be staffed according to their size, layout, number and needs of the residents. The home is currently often staffed below this original minimum staffing requirement, but clearly has complex and high needs to care for currently, which may account for the comments and observations above. The home’s pre inspection information indicates that 6 staff are trained to the National Vocational Qualification (NVQ) in Care. This is below the 50 required Ilsom House Residential & Nursing Home DS0000016483.V317262.R01.S.doc Version 5.2 Page 23 in the National Minimum Standards. During the inspection it was evident that some staff have left and 4 staff hold an NVQ, but arrangements are in place for other staff to commence this training. All staff receive an induction training, which now sets the foundation for the NVQ training. After this training records indicate that the majority of care staff only receive basic updates in mandatory subjects such as fire awareness, moving and handling and food safety. Additional knowledge in dementia care, mental health disorders such as depression, bereavement and challenging behaviour to name some of the needs of the residents is not given. The recruitment process relating to 5 members of staff, one in retrospect as they had already left, were inspected. This demonstrated that robust recruitment procedures are being followed. Ilsom House Residential & Nursing Home DS0000016483.V317262.R01.S.doc Version 5.2 Page 24 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, 32, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Certain areas of the running of the home and the current methods of communication are not benefiting the residents. The company has arrangements in place to seek the views of those using the service but not all the residents in the home feel that their views or wishes are listened to on a day-to-day basis. Residents’ personal monies are safe guarded. Robust arrangements are in place to ensure residents’ health and safety. Ilsom House Residential & Nursing Home DS0000016483.V317262.R01.S.doc Version 5.2 Page 25 EVIDENCE: This outcome was assessed using the Commission’s guidance tool although again there are areas of shortfalls that need examining and addressing. The Registered Manager was on holiday at the time of this inspection so the Deputy Manager was in charge. The present Registered Manager has managed Ilsom House for many years. She is a Registered Nurse and keeps herself updated in basic mandatory trainings and the ongoing management training/development provided by the company. The qualified nurses confirmed her to be approachable and supportive, although several residents said they do not see much of her. One relative confirmed that she has always been able to speak to her when needed and finds she deals with any concerns she may have efficiently. One resident said: “the home runs more smoothly when the Manager is present” although another was quite clear that it was disorganised. A relative considered the home extremely well managed. There are however several areas within this report that suggest that there maybe certain shortfalls in the style of management adopted by the Registered Manager and some shortfalls that relate to the Registered Provider. Several residents did not feel that they were currently getting value for money. This was predominantly in relation to the staffs’ ability to meet their preferences and the quality of the food. Several residents said that the lack of a formal residents meeting/forum makes it difficult to raise issues. There were no records to indicate meetings had been held with residents or staff recently. The Registered Manager has subsequently said that the changes at teatime for example were discussed with the residents. The views of those using the service are sought by BUPA who forward a survey to relatives and residents twice a year. A report is published on the findings later in the year. BUPA also have an extensive quality assurance system, which with the findings from the survey forms the basis of the home’s future action plan to improve the service and care. Records of residents’ personal monies are kept electronically. On admission the resident is able to open an ‘in house account’ meaning they can have access to small amounts of money within the home which is deducted from a central amount kept in an external account and which is replenished by the family or Power of Attorney. This account also adds interest to the individual resident’s Ilsom House Residential & Nursing Home DS0000016483.V317262.R01.S.doc Version 5.2 Page 26 amounts. Alternatively if residents wish to they can continue to manage their own monies, as a resident spoken to preferred to do. Various arrangements are in place to ensure the health and safety of the residents and staff. Several records that demonstrate this were inspected, these included fire equipment/alarm checks and servicing, moving equipment such as hoists, servicing of all utilities/equipment such as boilers, cooker, electrical equipment and the lift/stair lifts. Regular checks on the temperature of the hot water are recorded and the emergency lighting. Arrangements are in place to reduce the risk of Legionella within the water storage system. Various risk assessments are carried out both on a general basis and an individual basis. Risk assessments were seen completed for the use of bedrails. Records show that staff are receiving updated training in fire awareness. The Inspector has requested that the level of fire training set within the home’s fire risk assessment is checked with the Fire Officer to ensure it meets with the new Fire Regulations; this is with particular reference to staffs’ individual needs in training. Records also show that staff are updated in safe moving and handling techniques. Ilsom House Residential & Nursing Home DS0000016483.V317262.R01.S.doc Version 5.2 Page 27 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 2 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 X X X X 3 3 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 2 3 X 3 X X 3 Ilsom House Residential & Nursing Home DS0000016483.V317262.R01.S.doc Version 5.2 Page 28 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 OP2 Regulation 5(1)(b) Requirement The Registered Provider/Registered Manager must provide terms and conditions for all residents irrespective of how their fees are paid. The Registered Provider/ Registered Manager must make residents aware, irrespective of how there fees are being met, the amount that they are receiving in respect of their RNCC entitlement. The Registered Manager must ensure that all residents’ needs are identified within the written care plan. The Registered Manager must ensure that the recording of medication administration and the system generally, is being run safely and that ‘good practice’ is taking place. (this is with reference to: • the correct process of recording during administration • the securing of the trolley when not in use DS0000016483.V317262.R01.S.doc Timescale for action 31/05/07 2 OP2 5B(b&c) 31/05/07 3 OP7 15(1) 15/05/07 4 OP9 13(2) 15/05/07 Ilsom House Residential & Nursing Home Version 5.2 Page 29 • the need for two signatures on handwritten instructions on the MAR sheets to prevent errors in transcription (Timescale of 01/03/06 not fully met) 15/05/07 5 OP10 23(2)(h) 6 OP12 12(2) 7 OP15 16(2)(i) 8 OP18 18(6) 9 OP27 18(1) The Registered Manager must ensure that the small communal room, designated for private use by residents and or their families is kept available to be used as such. The Registered Manager must so far as is practicable enable residents to make decisions with respect to the care they receive and their health and welfare (this is with respect to residents being involved and agreeing with changes made in the home that effect their ability to have their choices and preferences met). The Registered Manager must ensure residents receive wholesome and nutritious food, which is properly prepared and is available at such times as may reasonably be required by the residents. The Registered Provider and Registered Manager must ensure that robust arrangements are in place to adequately protect residents against abuse. The Registered Provider and Registered Manager must ensure there are enough suitably qualified and competent staff on duty to meet the residents needs and the aims and objectives stated in the homes literature. 15/05/07 15/05/07 31/05/07 15/05/07 Ilsom House Residential & Nursing Home DS0000016483.V317262.R01.S.doc Version 5.2 Page 30 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 OP1 Good Practice Recommendations Key information such as the Statement of Purpose, Service User Guide (welcome pack) and complaints procedure should be made available in an appropriate form for those that are visually impaired. Routines within the home should meet with residents’ preferences and wishes not with those of the staff and any changes in these should where practicable with the residents’ agreement. Food and drink should be served at an acceptable temperature and where practicable at a time that suits the residents. Consideration should be given to making arrangements to ensure all interested parties are aware of the complaints procedure. Specific awareness training should be given to staff on adult protection and senior staff should attend the Protection of Vulnerable Adults training provided by Gloucestershire’s Adult Protection Team. The home should aim to have 50 of its care staff trained to the recognised National Vocational Award in Level 2. Staff should receive training in dementia care and challenging behaviour and any other subject that relates to residents’ needs such as depression. The Registered Manager should consider ways to improve communication with residents, which enables them to feel comfortable to voice their views. The fire risk assessment should state how the home intends to meet the ‘individual’ training needs of staff, in relation to fire training in order to be sure each member of staff is competent in fire awareness. 2 OP12 3 4 5 OP15 OP16 OP18 6 7 8 9 OP28 OP30 OP32 OP38 Ilsom House Residential & Nursing Home DS0000016483.V317262.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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. 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