Inspection on 24/01/08 for Ivybank

This inspection was carried out on 24th January 2008.

CSCI found this care home to be providing an Adequate service.

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.

Other inspections for this house

Ivybank 18/11/09

Ivybank 28/11/08

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Ivybank 73-75 Middleton Hall Road Kings Norton Birmingham West Midlands B30 1AG Lead Inspector Lisa Evitts Unannounced Inspection 24th January 2008 09:05 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 Ivybank DS0000071081.V358326.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. Ivybank DS0000071081.V358326.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ivybank Address 73-75 Middleton Hall Road Kings Norton Birmingham West Midlands B30 1AG 0121 624 3006 0121 624 3008 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) www.southerncrosshealthcare.co.uk Southern Cross BC OpCo Ltd Post vacant Care Home 58 Category(ies) of Old age, not falling within any other category registration, with number (58) of places Ivybank DS0000071081.V358326.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: Old Age, not falling within any other category, Code OP - maximum number of places 58 The maximum number of service users who can be accommodated is: 58 New Service 2. Date of last inspection Brief Description of the Service: Ivybank Nursing Home is a large traditional property, which has been further extended to provide accommodation for 58 older people who require nursing care. The home is located in a residential area of South Birmingham and is close to local amenities. The home is conveniently situated for public transport and off road car parking is available for several cars. The home has been established for a number of years however was acquired by Southern Cross Healthcare in November 2007. Accommodation is provided in both single and double rooms. En-suite toilets are provided in 24 rooms, and two en-suite shared rooms are available. The bedrooms are on two floors and a passenger lift is available to all floors. Sufficient communal space is provided with lounges and dining rooms and there is a large garden to the rear of the home, which is accessible to people via a ramp. A smoking room is available for people who choose to smoke. The home has a number of hoists and pressure relieving equipment available to meet the assessed needs of the people living at the home. There are assisted toilets and bathrooms available and corridors are wide and spacious and enable people to move around the home freely with any aids they require. Inside the home, there are various notice boards, which display information about forthcoming events and other articles that may be of interest. The last inspection report is available in the reception area and this enables people Ivybank DS0000071081.V358326.R01.S.doc Version 5.2 Page 5 living at the home or visitors to the home to access this information easily. The current scale of charges for the home are not included in the service user guide but can be obtained directly from the home. Additional costs include, hairdressing, toiletries, chiropody and newspapers. Ivybank DS0000071081.V358326.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Ivybank is an established nursing home, which was acquired by Southern Cross Healthcare in November 2007. There were many changes in progress to the environment and documentation, which meant that we could not fully assess all the areas on the day of our visit. The home will continue to be monitored and progress on all areas will be further reviewed at the next visit to the home. The managers were keen to make the improvements and responded well to improvements required. One inspector and one regulation manager undertook this fieldwork visit to the home, over eight hours and the manager and operations manager assisted us throughout. The home did not know that we were visiting on that day. There were 32 people living at the home on the day of the visit. Information was gathered from speaking to and observing people who lived at the home. Two people were “case tracked” and this involves discovering their experiences of living at the home by meeting or observing them, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety files were also reviewed. Random questionnaires were sent out in order to gain peoples views about the service. Four people who live at the home and four relatives returned questionnaires. These contained a mixture of positive and negative comments about the service provided and are included within this report. Five people who live at the home and six staff were spoken to. Prior to the inspection the manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us some information about the home, staff and people who live there, improvements and plans for further improvements, which was taken into consideration. Regulation 37 reports about accidents and incidents in the home were reviewed in the planning of this visit. No immediate requirements were made at the time of this visit. Ivybank DS0000071081.V358326.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: Care plans require further development so that they provide staff with specific details about how people should be assisted to have their needs met. This will ensure that people’s needs are met in a way that they prefer. Records of individual activities should be developed so that people have opportunity to participate in activities that they enjoy. The home should review how people can complain and how they are responded to, people told us “I don’t know how to make a complaint” and “Even though I approach staff first it doesn’t usually solve things”. Ivybank DS0000071081.V358326.R01.S.doc Version 5.2 Page 8 There must be enough staff available to meet the individual needs of people living at the home, in order to maintain peoples dignity. People living at the home must be appropriately supervised to ensure their safety. One relative said “At times there are not enough staff to respond to multiple residents at once”. This was observed during our visit to the home. 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. Ivybank DS0000071081.V358326.R01.S.doc Version 5.2 Page 9 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 Ivybank DS0000071081.V358326.R01.S.doc Version 5.2 Page 10 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): 1,3 & 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have sufficient information about the home to enable them to make an informed decision about whether they would like to live there. Pre admission assessments ensure that people know their needs can be met prior to moving in. EVIDENCE: The organisation has produced a comprehensive service user guide and statement of purpose. The manager was in the process of distributing these documents into all the bedrooms so that people could access this information if they wanted to. These documents are available in large print and can be made available on audiocassette upon request. This ensures that people with visual impairments can access this information. The certificate of registration and public liability insurance were not on display due to the reception area being redecorated. The certificate was reflective of Ivybank DS0000071081.V358326.R01.S.doc Version 5.2 Page 11 the previous providers and the new one issued to the home could not be located. We will issue a new certificate with details of the current providers. Comprehensive pre admission assessments are undertaken prior to people coming to live at the home. This should ensure that peoples individual needs can be met when moving into the home. Confirmation is given in writing that the home is able to meet prospective residents needs following assessment, so providing confidence to the person that their needs will be met following admission. People told us: “My daughter had all the information about the home because I was in hospital” “It’s a nice place, friendly” “I’m happy being here” Ivybank DS0000071081.V358326.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Current systems in place for care delivery do not always ensure that people’s healthcare needs and dignity are maintained. The management of medication ensures that people receive their medication safely and as prescribed. EVIDENCE: Each resident has a care plan written. This is an individualised plan about what the person is able to do independently and states what assistance is required from staff in order for the person to maintain their needs. The home were in the process of transferring the information for people at the home into the Southern Cross documentation and therefore it was not possible to fully assess the plans. This will be further reviewed at the next visit to the home once the home has had opportunity to complete them. Moving and handling risk assessments were detailed with the type of equipment that staff should use, including hoist and sling size but did not provide staff with any guidance on how to move from the floor if the person Ivybank DS0000071081.V358326.R01.S.doc Version 5.2 Page 13 should fall. Turn charts were in place for people who needed their position changing to minimise the risk of developing sore skin. Food records were detailed with what and how much food people had eaten, so that intake could be monitored. One care file, which had been written with the new documentation, was reviewed and the following was found. The assessment undertaken on admission to the home was limited with information and was not signed by the person completing it. Risk assessments had been written for risk of falls and entrapment from bed rails. A care plan for weight loss indicated that thickener was to be used in fluids to minimise the risk of choking but it did not say how thick the fluids were to be. The plan asked that weekly arm circumference recordings were taken but none had been recorded for three weeks. Care plans for incontinence said to check skin regularly but did not state what to look for or how often. The plan also said to ‘toilet regular’ however the person was bed bound and no further guidance was given. One plan said to ‘assist to do oral hygiene’ but didn’t give instructions how to do this. A care plan had been written for a mouth infection, five days after medication was prescribed. The care plan had not been evaluated. Treatment had been given for five days and there were no records of how the infection was and if the treatment was working. There were no records made as to why the treatment had been prescribed initially. Staff told us that the person used a toothbrush, toothpaste and mouth washes, however it was of concern that none of these items were in the persons room and that dentures were left wrapped in tissue on the side of the sink. There was no evidence that mouth care had been given to prevent the infection occurring. Risk assessments were written for skin sores, and there were good records of sores, including individual wound plans and photographs. We had been informed by Regulation 37 that the tissue viability nurse had been informed of this person when they were admitted to the home but there was no evidence to suggest that a referral had been made. People appeared to be supported by staff to choose clothing appropriate for the time of year which reflected individual cultural, gender and personal preferences. More attention should be provided to detail as some people’s hair did not look brushed and some people were noted to have dirty fingernails. One person was observed to have food on her hands following eating, and staff did not assist her to wash her hands and this does not promote people’s dignity. One person was taking off her clothing in the lounge and no staff were present to assist this person. This did not promote her dignity. As discussed in the staffing section of this report, communal areas were often unsupervised and people were calling out for help. People were observed to ask for the toilet but the requests were not met by staff who continued to serve meals. We did not Ivybank DS0000071081.V358326.R01.S.doc Version 5.2 Page 14 observe people being asked if they would like the toilet prior to their meals being served. One relative told us “If two staff are toileting then other residents have to wait which causes incontinence problems”. One person was calling out after lunch as she wanted to go to bed but no staff were present to assist her. One person walking around the home had been incontinent and inspectors had to inform staff of this so that she could be washed and changed. This needs to be reviewed so that staff are available to meet peoples needs and so that dignity is maintained. The management of medication was reviewed on both floors of the home and was found to be robust. All balances of medication were found to be correct. There were copies of prescriptions so that staff could check that they had received the correct medication into the home. There were no gaps on the Medication Administration Records (MAR) and two people signed handwritten MAR charts to minimise the risk of any errors with recording. Eye drops were dated when opened so that they could be disposed of at the correct time to minimise the risk of contamination. Audits of boxed medications were undertaken twice a day to ensure that medication had been given as prescribed. There were no controlled drugs in the home on the day of the visit. The fridge had temperatures recorded each day but these were recorded as between minus one and eight degrees, which means that medication is not appropriately stored. This was brought to the manager’s attention. A drug round was observed to take place at lunchtime and it is recommended that this is reconsidered so that people can eat their meals and have medication after. (Unless prescribed otherwise) people were told what their medication was for and asked if they wanted any pain relief. Ivybank DS0000071081.V358326.R01.S.doc Version 5.2 Page 15 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. People are able to choose the activities that they participate in which promotes their individuality and independence. Activities may not meet the needs of all the people who live at the home. People are offered a choice of meals to meet their dietary, cultural needs or preferences. EVIDENCE: The home has a dedicated activities coordinator for 25 hours per week. A yearly activity plan has been devised where each month an activity is undertaken to celebrate a particular day. For example, New Years Day, St Patrick’s Day, St Georges Day, Halloween, Bonfire night and Christmas. A family day, summer fete and a trip to the beach are also planned. There is a weekly rota of activities and this includes games, newspaper reading, manicures, sing a longs, movie afternoons, tabletop sales, craftwork and quizzes. External entertainers visit the home and this includes a musician once a month and exercises to music every week. People were observed joining in exercise to music on the day of the visit and appeared to be enjoying the activity. The hairdresser visits each week and Holy Communion is available once a month to Ivybank DS0000071081.V358326.R01.S.doc Version 5.2 Page 16 those residents who wish to continue to receive this. A vicar conducts a church service monthly at the home to support residents who want to continue with their religious interests. Four people have newspapers delivered to the home to enable them to carry on reading the news of their choice and the library visit the home to change people’s books. Comments received from people were varied and suggested that not all people’s needs were being met or that some people were not aware of the activities within the home and this should be addressed. People told us: “There are lots of activities going on” “I join in the ball activities when the ball person comes in” “Mom spends most of her day in her room watching TV” “Its good fun but I would like to do more” “I would like to go outside for a walk” “There are never activities to participate in” “Things go on downstairs but I don’t go, I do get bored sometimes” People can go out with their families as they choose and this encourages their independence and assists them to maintain links with the community. The home has an open visiting policy and this enables people to see their visitors as they choose, enhancing their quality of life. New documentation was being introduced for the recording of activities. The activity coordinator had a lot of knowledge about individual peoples likes and dislikes but this was not recorded so that other staff could share this information. People’s life histories are being obtained so that staff can enhance their knowledge of the individual people living at the home. The home has a three-week cyclical menu in place however this is due to be changed to the Southern Cross menu and the introduction of the NUTMEG system, which is a nutritional analysis system, which is a software package, which helps to plan a balanced meal. One inspector sampled the food on the day, which was steak pie, potatoes and vegetables. The meal was hot, and well presented. The lunchtime was observed and staff were observed to offer people a choice of meal, meals were served from a hot trolley. Adapted crockery was available so that people could maximise their independence and cold drinks were served. Staff identified that one person required a spoon to eat his meal however one was not brought and the person continued to eat with a fork. The lounge was left unsupervised while people were eating and this needs to be addressed so that people are supervised. The home is able to cater for special diets for reasons of cultural or medical needs. Smoothies are made each day with fresh fruit and cream for people who wish to have these. People told us: “He says they feed him well, too much at times and he can’t eat it all” “Meals are excellent” Ivybank DS0000071081.V358326.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. People living in the home are not always confident that their complaints are listened to and acted upon. There are systems in place, which should safeguard people from harm. EVIDENCE: The complaints procedure is displayed in the home and is included in the statement of purpose and service user guide so that people should know how to make a complaint if they need to. Some of the comments received in the questionnaires suggested that some people did know how to make a complaint or that they did not feel that their complaints were taken seriously and resolved. People told us: “If there is anything we are concerned about we have spoken to staff and have always had satisfactory answers” “I don’t know how to make a complaint” “Even though I approach staff first it doesn’t usually solve things” “Sometimes get a stonewall reception from some senior members of staff” These comments were fed back to the manager by telephone following the visit to the home, as this will need to be resolved so that people know how to make a complaint and so that they are confident that actions will be taken to resolve any concerns raised. Ivybank DS0000071081.V358326.R01.S.doc Version 5.2 Page 18 Since Southern Cross has taken over the ownership of the home, we have received one complaint regarding staff attitude, which was referred back to the providers to investigate under their own complaints procedure. The home has received one other complaint, which was still being investigated on the day of the visit. Documentation of the complaints was good and included statements taken and the outcome of the complaint, so that people knew what actions had been taken. Feedback from the questionnaires returned to us, suggested that people had concerns with the laundry. People told us that their relatives were not always wearing their own clothes and that items of clothing had gone missing. This was brought to the attention of the manager and it is recommended that the laundry system is reviewed so that peoples clothing is returned. The home has an adult protection policy, which incorporates the Department of Health’s, ‘No Secrets’ policy, and the home has copies of local Multi Agency Guidelines so that staff have guidelines to follow in the event of an allegation of abuse. This should safeguard people from harm. There had been one incident raised as an adult protection. Social workers had been involved and the home were currently investigating the concerns raised. Some staff have received training in the Protection Of Vulnerable Adults, dementia awareness and challenging behaviour, which should ensure that staff have the knowledge and skills to act appropriately to safeguard people from harm. Further training dates had been arranged to ensure that all staff receive the training and this will be reviewed at the next visit to the home. Staff spoken to during the day had an understanding of adult protection, neglect and institutional abuse. Ivybank DS0000071081.V358326.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): 19,20,22,24,25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Ivybank provides a comfortable and safe environment for people to live in. A number of improvements are in progress and are planned to further enhance the environment for the people who live there. EVIDENCE: Access to the home is via a doorbell and this ensures that people know who is accessing the building to ensure that people are safe. A partial tour of the home was completed to review areas which were relevant to the people we case tracked. The Annual Quality Assurance Assessment (AQAA) told us that a rolling programme for redecoration of bedrooms and replacement of carpet and furnishings had been developed to meet the shortfalls in the environment. Ivybank DS0000071081.V358326.R01.S.doc Version 5.2 Page 20 Since Southern Cross had taken ownership of the home, the lounge on the first floor had been redecorated. On the day of our visit decorators were on site and were working on the reception area of the home. The ground floor lounge was the next room to be decorated and this will enhance the environment for the people who live there. The manager advised us that a number of quotes had been obtained for various work to be undertaken. This included new carpets and redecoration throughout the home. Quotes had been obtained for refurbishment of all bathrooms and toilet areas, which will make the facilities more accessible and private for the people who live at the home. The smoking area was in the porch and did not have any ventilation, the operations manager advised that a kitchenette area was to become the smoking area and work to move into this room was planned within the next month. This will ensure that people have somewhere to smoke if they wish to whilst protecting people who do not wish to smoke. There was pressure-relieving equipment in use in some of the bedrooms reviewed, to meet the assessed needs of the people living at the home. The home has four hoists to assist people who have mobility problems. Corridors are wide and have handrails to assist people to mobilise freely and there is sufficient space for equipment to be used. On the day of the visit a number of beds were being replaced with ‘profiling beds’. These enable people to alter their own position or staff to assist people into alternative positions to relieve pressure in order to reduce the risk of skin sores. Bedrooms seen were personalised and reflected individual tastes, gender and cultural preferences. People are encouraged to bring in their own possessions in order to have familiar items around them to make their rooms as homely as possible. One room was noted to have an offensive odour and this was brought to the attention of the manager at the time of the visit. One person said, “I like my room” Due to the vast number of changes in progress and planned, outcomes for people living at the home will be further assessed at our next visit to the home. Ivybank DS0000071081.V358326.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. Staff are not always available to meet peoples needs. People are supported by staff who receive some training to ensure that they have the knowledge to meet individual needs. The recruitment procedure ensures that people are safeguarded from harm. EVIDENCE: The home has five care staff and two nurses on duty at all times. The home had vacancies for four care staff, which had been recruited to, and the manager was waiting for recruitment checks before allowing them to start work at the home. There was also a vacancy for a part time administrator and a kitchen assistant. In addition to nursing and care staff the home also have domestic, laundry, administration and maintenance staff. Due to staff sickness and vacancies, some agency staff have been utilised, however the manager tries to use the same agency staff where possible. The home generally maintains a core group of staff, which means that people know who will be assisting them to meet their needs. 73 of care staff have a NVQ level 2 in care and this should ensure that staff have the knowledge and skills to care for the residents individually and collectively. People told us: Ivybank DS0000071081.V358326.R01.S.doc Version 5.2 Page 22 “I feel the staff are very caring and do all they can for residents” “The staff always appear very friendly on our visits” “All staff are very nice” “The staff are good, friendly and helpful” “The staff do not appear to have the time or motivation to do more than feed and keep the residents clean” “At times there are not enough staff to respond to multiple residents at once” During the day we observed that staff did not always respond to the requests of the people living at the home in a timely manner. Examples of this were when people asked to go to the toilet at lunchtime and staff replied, “We will take you shortly”. People were then given pudding and had to wait until they had finished eating before being assisted to the toilet and this does not promote the comfort or dignity of people living there. Communal areas at times were not staffed and people were calling for assistance. It is required that a review of staffing levels and allocation is undertaken in order to ensure that adequate staff are available to met the needs of the people living in the home. Three staff files were reviewed and contained recruitment checks to ensure the safety of the people living at the home. There were no induction records available on these files to ensure that staff had been introduced into the home and had the knowledge to perform well within their roles. The manager had identified that the most recent recruit had not had an induction programme and had taken actions to address this. Since the new owners have taken over, staff have received training in a number of areas to include, safe use of bed rails, infection control, food hygiene, health and safety, nutrition, pressure area care, first aid and customer care. Further dates were booked for the remainder of staff to attend the training. A training matrix was available so that the manager could identify who required training and when and this should ensure that people receive updates as required to ensure that their knowledge is current. Qualified nurses have recently undertaken training for the use of syringe drivers (these are small pumps which deliver pain relief) and are booked to receive catheter training in April. The progress of the training will be reviewed at the next visit to the home. Ivybank DS0000071081.V358326.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered providers and manager are keen to ensure that the home is run in the best interests of the people who live there. They need time to continue with and sustain the improvements, which are in place. EVIDENCE: A new manager had been appointed who had been in post for approximately one month. She is a Registered Nurse who has a number of years experience, including working in other care homes and within management roles. The manager has worked for Southern Cross previously and therefore is aware of their policies and procedures. The manager is to submit an application to us to become the Registered Manager of the home. Ivybank DS0000071081.V358326.R01.S.doc Version 5.2 Page 24 A resident and relative meeting had been held but there were no minutes available to support this and it is recommended that any meetings are recorded. Staff meetings have been held and minutes were available for these. This gives staff an opportunity to discuss any ideas or concerns and to clarify points during the transition period. Staff spoken to told us that they were pleased with the changes in the home and were happy with the new equipment being purchased to enhance the lives of the people who live there. Staff said that the managers were approachable and that they could talk to them. External managers visit the home to monitor the quality of the service being offered and to support the manager with the changes within the home. Regulation 26 visit reports are written and are sent to us to review and this tells us about the quality of the service being provided. The organisation has a number of audits in place to monitor the service provided and had recently sent out satisfaction surveys to residents, relatives, staff and healthcare professionals in order to gain their views about the service provided. This information is collated into an annual report. Prior to the inspection the manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us some information about the home, staff and people who live there, improvements and plans for further improvements, which was taken into consideration. The home is able to hold money for people who live there. The financial records were reviewed but there was no clear audit trail to identify how much money people should have. We discussed with the manager the need to have a record, which confirms what people should be receiving, that it is checked and audited. This will ensure that people’s money is held safely. All staff had received at least one formal supervision since the organisation took over the home. These records were very brief and discussed the expectations of the organisation, for example, uniform, sickness and job description. This will be reviewed at the next visit to the home to ensure that individual needs and competence are being addressed to ensure that staff can meet the needs of the people living at the home. Accident records were reviewed and these were found to be in line with the Data Protection Act. The home informs us of incidents and injuries as per regulation 37. Health and safety and maintenance checks had been undertaken in the home to ensure that the equipment was in safe and full working order. Maintenance checks are completed on the fire system and equipment and staff receive fire training and drills so that people should be safe in the event of a fire occurring. Ivybank DS0000071081.V358326.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 2 X X X 2 2 2 STAFFING Standard No Score 27 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X 2 X X 3 Ivybank DS0000071081.V358326.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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. 2. Standard OP7 OP27 Regulation 15 18(1)(a) Requirement Care plans must reflect current needs and provide evidence of care given. Staff must be available to meet the needs of individual and collective people who live at the home, so that dignity and safety is maintained. A clear audit trail of people’s money must be available so that people are safeguarded. Timescale for action 25/04/08 07/03/08 3. OP35 17(2) Sch 4 21/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP7 OP8 OP9 Good Practice Recommendations Moving and handling assessments should detail how to move someone from the floor following a fall so that staff have guidelines to follow. A review of individual needs in relation to continence should be undertaken so that people’s needs are met. Fridge temperature should be between 2 – 8 degrees so that medication is stored within its product license. DS0000071081.V358326.R01.S.doc Version 5.2 Page 27 Ivybank 4. 5. 6. 7. 8. 9. 10. OP9 OP10 OP12 OP15 OP16 OP16 OP32 A review of the medication rounds should be undertaken so that people can eat their meals. People should be assisted to meet their needs in a dignified manner. Activities should be offered to meet all peoples needs and records should be available to show what activities people would like to participate in. Mealtimes should be supervised so that people are supported in a dignified manner at this time. People should know how to complain if they need to and know that their complaints will be taken seriously. A review of the laundry system should be undertaken to ensure that clothing is returned. Minutes of residents and relatives meetings held should be recorded so that people can access these. Ivybank DS0000071081.V358326.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ivybank DS0000071081.V358326.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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