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Inspection on 16/05/05 for Ingleby Care Home

Also see our care home review for Ingleby Care Home for more information

This inspection was carried out on 16th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Resident said they were happy in the home and talked positively of the care they received and the level of choices they had. In the main, residents said, "the manager and staff are kind in every way". They said the meals were "beautiful, well cooked, always a choice and provided by an excellent cook".

What has improved since the last inspection?

There had been some improvement since the last inspection regarding the staff records and checks that needed to take place in regard to recruitment of staff. The staffing compliment had increased and the home was being staffed to a much more appropriate level. The medication systems were now much more robust.

What the care home could do better:

The environment at Ingleby Nursing Home was not as well maintained and safe as it should be and some immediate action was taken to correct some of the areas identified. It was disappointing to find that 75% of the bathrooms were out of order or not accessible for use by the residents, which meant that only one bathroom was available on the ground floor, one of the bathrooms had been out of use in excess of twelve months. A minimum of six bathing facilities are required to be available, these should be distributed throughout the home. Not all service records were in place such as an up to date fire alarms certificate; fire drills were not being appropriately recorded and it was unclear if night staff were involved in drills. Further staff training is needed for individual clients medical conditions and there was also the need to raise further awareness on respecting residents dignity needs. Progress also needs to take place regarding the quality assurance systems and staff supervisions.

CARE HOMES FOR OLDER PEOPLE Ingleby Nursing Home Lamb Lane Ingleby Barwick Stockton-on-Tees TS17 0UP Lead Inspector Jackie Herring Unannounced 16 May 2005 10:00 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. Ingleby Nursing Home B51-B01 S55360 Ingleby V227024 160505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ingleby Nursing Home Address Lamb Lane Ingleby Barwick Stockton-on-Tees TS17 0UP 01642 750909 01642 750966 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) TL Care Ltd Miss Margaret Little Care Home 50 Category(ies) of OP Old Age (50) registration, with number of places Ingleby Nursing Home B51-B01 S55360 Ingleby V227024 160505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 22/9/04 Brief Description of the Service: Ingleby Nursing Home is a 50 bedded purpose built care home which provide personal and nursing care. All 50 rooms are single rooms with ensuite facilities and there is the required number of bathing facilities and communal space. Ingleby is owned by TL Care who also operate a further four homes in the Teesside area. Ingleby Nursing Home is close to the centre of Ingleby Barwick, being in easy reach of the local church, supermarket and parade of shops. Ingleby Nursing Home B51-B01 S55360 Ingleby V227024 160505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection and took place over two inspection days, thirteen hours inspection time in total. Ten residents, four staff members of varying grades and the manager were interviewed or involved in discussions during the inspection process. A range of documentation was also examined, including resident’s records, staff rotas and staff records. What the service does well: What has improved since the last inspection? There had been some improvement since the last inspection regarding the staff records and checks that needed to take place in regard to recruitment of staff. The staffing compliment had increased and the home was being staffed to a much more appropriate level. The medication systems were now much more robust. Ingleby Nursing Home B51-B01 S55360 Ingleby V227024 160505 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ingleby Nursing Home B51-B01 S55360 Ingleby V227024 160505 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 Ingleby Nursing Home B51-B01 S55360 Ingleby V227024 160505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 The statement of purpose needs to be written and presented in a better format making it more accessible to residents. The contracts for residents need to be updated to reflect the current position. EVIDENCE: Whilst the Statement of Purpose contained the required information, it was not written in a clear and accessible way for resident, relatives and interested individual. It contained information that was not relevant to these individuals such as the staff grievance procedure. A file containing the residents terms and conditions was made available for examination, a large number were out of date, did not contain the correct fee and did not contain the individual residents room number. The manager informed the inspector that these had been updated and were in the process of being issued to individual residents. Ingleby Nursing Home B51-B01 S55360 Ingleby V227024 160505 Stage 4.doc Version 1.30 Page 9 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) 9, 10 Some additional attention is needed with the medication systems to ensure robustness. Further training to promote awareness is needed to ensure that all residents are treated with respect by all staff. EVIDENCE: The medication systems were examined during the inspection and had improved since last inspection. There were however some gaps identified within the administration records and also concern raised about some medications being refused on a regular basis without review by the GP. The majority of the residents spoken with during the inspection said they were treated with respect and the staff were pleasant and polite to them and gave examples of bedroom doors being knocked on prior to entering, personal care needs being met with privacy and ensuring dignity, with attention to gender needs. Whilst residents spoke very highly of the majority of the staff team, there was some discussion that perhaps all staff did not understand how their illnesses and disabilities effected them and how this could be changeable, as such, some resident said that some staff were overly authoritative with them rather than being understanding, encouraging and reassuring. Ingleby Nursing Home B51-B01 S55360 Ingleby V227024 160505 Stage 4.doc Version 1.30 Page 10 During the inspection a resident who needed assistance to go to the toilet was told he had to wait as it was lunchtime, which was unacceptable and did not ensure his needs were met or his rights protected and could have potentially effected his dignity. This was witnessed by the inspection who intervened and ensured that these needs were met. Ingleby Nursing Home B51-B01 S55360 Ingleby V227024 160505 Stage 4.doc Version 1.30 Page 11 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) 12,13,14,15 Lifestyle experiences and preferences are generally well met, as are links with family and friends and access to the local community. Resident would benefit further from the menu being more accessible ahead of mealtime. EVIDENCE: During discussion with residents they confirmed that there was contact with a local church and also visits from the church who provided some activities in the home as well as Holy Communion. Residents spoke of being able to go out of the home with their loved one and one lady spoke of a recent holiday she had with her family in Blackpool. On the day of the inspection, an activity afternoon was taking place and was being provided by an outside agency. Residents described being able to make decisions about their individual lives in Ingleby and gave examples of choices at mealtime, decisions about how to spend their days and where to spend their days. A couple of ladies spoken to said they preferred to stay in their bedrooms for most part of the day although they did go into one of the dining rooms for their meals. Ingleby Nursing Home B51-B01 S55360 Ingleby V227024 160505 Stage 4.doc Version 1.30 Page 12 The meals were described as “beautiful, well cooked, always a choice” although the residents had to choose at the actual mealtime, not prior to it. There was also the need to determine actual likes, dislikes and preferences of residents as the manager said this was not currently recorded. It was noted that there was no brown bread available. The dining rooms were observed to be conducive environments, it was however noted that resident who were in the last dining room to be served were waiting at the tables for approximately 45 minutes for their meals. Ingleby Nursing Home B51-B01 S55360 Ingleby V227024 160505 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 The residents are generally protected in respect of complaints, however more detail is required in the procedure. Appropriate systems were in place for protection from abuse. EVIDENCE: The complaint procedure was in need of further development, as it did not include the names, address and contact telephone number for the operations manager and directors and did not included timescales and actions for dealing with complaints. Residents said they felt confident that any concerns they had would be addressed properly. Staff who were interviewed were aware of abuse and protection of vulnerable adults and described appropriately the action they would take in the event of an incident, a copy of the Teesswide guidance on Protection of Vulnerable Adults was also available within the home. Ingleby Nursing Home B51-B01 S55360 Ingleby V227024 160505 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25, 26 Several areas at Ingleby did not provide a safe, well-maintained environment for residents and there were insufficient useable bathing facilities. The garden needs to be developed further to ensure a safe and accessible environment for all residents. EVIDENCE: During the inspection there were several areas of the home that did not ensure a safe environment for residents. These related to unregulated hot water in the residents smoking room for which immediate action was taken to address the matter; a large number of screws left lying on one of the bathroom floors, which was accessible to residents; a light shade left lying on a corridor floor and tools left unattended in one of the dining rooms. In addition, one of the bathrooms was full of other equipment such as hoists; as such the toilet was not accessible to residents. Ingleby Nursing Home B51-B01 S55360 Ingleby V227024 160505 Stage 4.doc Version 1.30 Page 15 The home has four bathrooms, and four shower rooms, one of which is now used as a hairdressing room. The toilet and additional wash hand basin should be removed from this room making it was conducive for it’s purpose. Three of the four bathroom were out of use and had been for some time. This resulted in residents from upstairs having to come downstairs for a bath, which is unacceptable. One of the residents during discussion said “you have to book a bath if you want one”. The toilet opposite the nurses station had a broken emergency call cord, contained a bar of soap, which should not be used in these areas due to cross contamination, and generally needed a good clean. The flooring in one of the upstairs bathrooms was in need of repair/replacement as an area had been taped with grey gaffer tape. There were a number of lights that required new bulbs and a number of the wall candlelight also had bulbs missing as identified at a previous inspection. Also a light fitting in one of the stairwells was in need of attention. There was odour in one of the ground floor corridors, which was coming from three of the bedrooms. Sponges were observed to be in use in personal care, this was discussed with the manager due to the potential of cross infection, and there was agreement that she would discuss the use of sponges with Public Protection. A number of hoists were observed in the home and staff confirmed they had sufficient equipment to meet the needs of the residents. The upstairs boiler room was accessible to residents as were the staff toilets, steps were being taken to address this matter. Externally, there is a large garden, which is accessible to residents via the conservatory, however, it was noted that the garden gates were broken as such this would not be safe for some of the residents use. There were some items that needed to be removed such as an old mattress, a bag of plaster and a trailing ‘sky’ cable. There was discussion with the manager about developing the garden further as there was very little area for residents to sit as no patio had been created. The manager said that there were plans to improve the garden to create a more useable space for residents, which would enhance their lives. It was also noted that the conservatory needed to have some ceiling and window blinds fitted to make the environment more conducive for use. Residents bedrooms were visited during the inspection and there was much evidence of personalisation and resident said they were comfortable in their rooms and suitable to meet their needs. Some of the bedroom furniture continues to be in need or renewal or refurbishment. Ingleby Nursing Home B51-B01 S55360 Ingleby V227024 160505 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, 28, 29, 30 Additional care staff are required to ensure resident needs are fully met. The recruitment and selection practices were robust. Additional client specific training would increase the competency of staff to meet residents changing needs. EVIDENCE: The duty rota was made available for examination during the inspection and the staffing situation had improved since the last inspection. It was however identified that that a further increase in care staff was required due to the number of residents in the home, their assessed needs and as demonstrated through observation during the inspection. Residents did say that the staff were very busy and did not always have time to spend chatting with them. It was also identified that lunchtime was very busy and it was observed that one resident’s personal care needs were not going to met until the inspector intervened. The home is committed to ensuring staff received training and this was demonstrated with 54 of the staff being qualified to NVQ Level 2 or above. A random sample of files was examined, as were some new staff files. They contained the information required and demonstrated the all checks had taken place. Staff confirmed that they had received an induction and there was evidence of TOPSS induction. Ingleby Nursing Home B51-B01 S55360 Ingleby V227024 160505 Stage 4.doc Version 1.30 Page 17 It was however identified that further client specific training such as understanding and awareness of Parkinson’s Disease would enhance their competencies further. Ingleby Nursing Home B51-B01 S55360 Ingleby V227024 160505 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) 36, 37, 38 Staff supervision needs to occur more frequently and contain more detailed information. Records do not demonstrate that health, safety and welfare of residents are fully promoted and protected. EVIDENCE: Residents and staff spoke highly of the manager of the home; she was described as supportive and approachable. Staff supervision was not taking place as frequently as needed and the system was in need of further development as there was very limited information contained within it and it was being used more as a training record. A number of service records were examined during the inspection and not all were up to date, such as an up to date fire certificate and gas landlord certificate. Ingleby Nursing Home B51-B01 S55360 Ingleby V227024 160505 Stage 4.doc Version 1.30 Page 19 The manager informed the inspector that visits were planned and she would confirm when this work had been completed, she also agreed to follow them up immediately. The water temperatures were being recorded however the records needed to contain further information as discussed with the maintenance person as well as the need to retain some past records. Fire drills were being recorded in with the weekly fire tests and there were no records to show additional fire drill such as night duty or weekend drills. The weekly fire test record needed to include more detail about the effectiveness of the fire systems. The manager informed the inspector that the quality assurance system had not change since the last inspection, however she did say that ideas had been developed and not as yet introduced. Ingleby Nursing Home B51-B01 S55360 Ingleby V227024 160505 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 2 2 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 1 2 1 3 3 3 1 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x x 1 x x 2 1 1 Ingleby Nursing Home B51-B01 S55360 Ingleby V227024 160505 Stage 4.doc Version 1.30 Page 21 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 OP2 Regulation 5 Requirement Residents must be provided with terms and conditions of residency that are up to date and containe the required information. (Previous timescale of 30 November 2004 was not met) Residents must be treated with dignity and respect at all times The complaints procedure must be updated to include additional information and contact details for the directors. (Previous timescale of 30 November 2005 was not met) The environment must be a safe and well maintained environment, staff must receive training in respect of health and safety in the workplace. Bathrooms/showers must be suitable for use, safe and accessible to residents and must be of the appropriate resident/facility ratio. (Previous timescale of 31 December 2005 was not met) Bathrooms/showers/toilets must not be used for storage. Ingleby Nursing Home B51-B01 S55360 Ingleby V227024 160505 Stage 4.doc Version 1.30 Page 22 Timescale for action 1 July 2005 2. 3. OP10 OP16 12 22 Immediate 1 July 2005 4. OP19/OP20 /OP25 23 Immediate 5. OP21 23 Immediate The boxing in of the pipework in the showers must be finished off. The toilet opposite the nurses station must have the nurse call cord repaired. The shower that is currently being used as a hairdressing salon must have the toilet and additional wash hand basin removed. The odour problem in one of the corridors must be addressed. The staffing levels must be in sufficient number as required for the number of residents and their assessed needs. The quality assurance systems continue to be developed, this must be completed and introduced. (Previous timescale of 30 January 2005 was not met) Service records must be up to date and the appropriate information should be recorded in routine maintenance records. Fire records should demonstrate that all staff are involved in fire drills. (Previous timescale of 31 December 2005 was not met) 6. 7. OP26 OP27 23 19 Immediate Immediate 8. OP33 24 1 August 2005 9. OP38 23 1 July 2005 Immediate 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 The statement of purpose should be developed into a better format making it more accessible to residents, B51-B01 S55360 Ingleby V227024 160505 Stage 4.doc Version 1.30 Page 23 Ingleby Nursing Home 2. 3. 4. 5. 6. OP9 OP15 OP20 OP30 OP36 relatives and others. The medication systems should be reviewed further to ensure no gaps in medication. Menus should be developed further and the system for giving choices should be reviewed. Residents likes, dislikes and preferences should be recorded. The garden should be developed further making it a more accessible area for residents to use. Staff should receive more client specific training. Staff supervison should to carried out more frequently and the actual system would benefit from further development. Ingleby Nursing Home B51-B01 S55360 Ingleby V227024 160505 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Unit B, Advance St Marks Court Teesdale, Stockton-on-Tees TS17 6QX 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. 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