CARE HOMES FOR OLDER PEOPLE
Leominster Residential & Nursing Home 44 Bargates Leominster Herefordshire HR6 8EY Lead Inspector
Sandra J Bromige Unannounced Inspection 19th January 2006 09:55 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 Leominster Residential & Nursing Home DS0000027682.V279585.R01.S.doc Version 5.1 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. Leominster Residential & Nursing Home DS0000027682.V279585.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Leominster Residential & Nursing Home Address 44 Bargates Leominster Herefordshire HR6 8EY 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) 01568 611800 01568 811588 www.bupa.co.uk BUPA Care Homes (CFCHomes) Limited Mrs Monica Hartley Care Home 51 Category(ies) of Dementia - over 65 years of age (51), Old age, registration, with number not falling within any other category (51), of places Physical disability over 65 years of age (51) Leominster Residential & Nursing Home DS0000027682.V279585.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th October 2005 Brief Description of the Service: Leominster Residential and Nursing Home is owned and managed by BUPA Care Homes (CFCHomes) Ltd. The Home was opened in 1996 and consists of a two-storey modern purpose built Home with a Georgian style façade offering accommodation for a maximum of 51 older people of both sexes, who may suffer with dementia, a physical disability or frailty due to old age. The Home is located in the town of Leominster, a short distance from the shops and other amenities. The Home has 45 single en-suite bedrooms and 3 double en-suite bedrooms. The double rooms are all currently used as single occupancy accommodation. A designated single bedroom is available as a respite care facility. The Home has a passenger lift. The gardens are tidy and accessible. Leominster Residential & Nursing Home DS0000027682.V279585.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place between the hours of 09.55 – 15.25 hrs on the 19th January 2006. This was a very focused inspection to follow up the requirements from the last inspection report. For standards not assessed during this visit please refer to previous inspection reports. Since the last inspection a meeting has taken place between the Commission and the responsible individual and the manager of the Home to discuss the outcome of the last inspection. The manager of the Home provided an action plan to show how they were going to improve the identified standards at the Home and the focus of this inspection was to see if the action plan had been implemented. A pharmacy inspection was carried out on the 24th October 2005 and a detailed report was sent to the Home. This report is also available to the public upon request. The requirements and recommendations from this visit have been followed up at this inspection. The Inspector looked around parts of the building and a number of records were inspected. The manager, residents, and staff were spoken to. The Commission has not received any complaints about this service since the last inspection. What the service does well: What has improved since the last inspection?
Leominster Residential & Nursing Home DS0000027682.V279585.R01.S.doc Version 5.1 Page 6 One of the registered nurses employed at the Home on a part time basis has now become the clinical co-ordinator for the Home. Her hours are in addition to the registered nurse on duty and her role is to raise and maintain the standards of care in the nursing unit, including the standard of the care records. She is also responsible for the induction of staff. A new system of care planning documentation has been put into use. Overall the quality of the information in the care plans has improved. Residents have been involved in the development and their agreement to the care plans is recorded. With the exception of one care plan they are all being reviewed each month. Residents weight is being monitored each month and recorded in the appropriate areas on the risk assessments in the care records. Bedrail risk assessments are also being reviewed each month to ensure that they are safe and suitable for use. Medication management has improved with complete and accurate records being held for receipt and disposal of medicines. The Home has updated their medicine policy since legislation and systems have changed for the disposal of medicines in nursing homes. A responsible person for BUPA has carried out audits on the Homes medicines as part of the monthly visits. Printed pharmacy labels are not being used and medicines are not being used after the expiry date stipulated by the manufacturer. A current medicine reference book is in use. The written reports of the unannounced monthly visits to the Home by a responsible person for BUPA are being sent to the Commission each month. Individual room fire risk assessments have been reviewed and updated. The induction training has been revised to ensure that staff are receiving manual handling training prior to using any equipment or being involved in the moving and handling of residents. What they could do better:
All care plans must be reviewed each month to ensure that the care being given is accurate and consistent and that staff know what to do for each resident. Medicines that are not part of the Monitored Dosage System must be dated when opened. This is so that audits can be carried by the registered manager to ensure that medicines are being given as prescribed. The Medication Administration Records must be completed accurately to show that the prescribed medicines or creams have been given or applied. The
Leominster Residential & Nursing Home DS0000027682.V279585.R01.S.doc Version 5.1 Page 7 index/key on the Medication Administration Records chart must be used appropriately to record the reason why the medicine has not been given. Senior trained staff in the Home were not familiar with the Herefordshire procedures for the Protection of Vulnerable Adults, particularly the procedures for making a referral. It is strongly recommended that the Home arrange for the Herefordshire Adult Protection Co-ordinator to come into the Home and train all staff about these procedures. 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. Leominster Residential & Nursing Home DS0000027682.V279585.R01.S.doc Version 5.1 Page 8 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 Leominster Residential & Nursing Home DS0000027682.V279585.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Leominster Residential & Nursing Home DS0000027682.V279585.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 9 Considerable progress has been made on improving arrangements to ensure that the health care needs of residents are identified and recorded in the individual care plans. The systems for the administration of medication need improving to ensure that clear and comprehensive arrangements are in place at all times to ensure that residents’ medication needs are met. EVIDENCE: The care planning documentation has been revised since the last inspection. Five care records were seen on this occasion for residents receiving nursing and residential care. The new format in use is very organised and makes it easy for nursing and care staff to see the care needs of the resident. What is particular helpful is each residents records give a summary of their past and current medical history and identified care needs, personal care needs and also a summary of the residents usual daily routine which includes information about the time that the resident chooses to get up and go to bed. Overall the quality of the recording and reviewing of the care needs and risk assessments in four of the records seen were satisfactory. This included a detailed personal/social history of each resident and their desired activity profile. The care records had been produced in consultation with the resident.
Leominster Residential & Nursing Home DS0000027682.V279585.R01.S.doc Version 5.1 Page 11 One care record showed that the standard of the recording of care and the identification of risks to the resident was not complete and all areas were not being reviewed each month. The poor quality of this care record was discussed with the manager at the time of the inspection. Residents seen appeared very comfortable and well cared. Residents spoken with confirmed that they are well cared for by the staff at the Home. Samples of medicines were looked at in line with the requirements made by the Pharmacy Inspector in November 2005. Medicine containers are not all being dated when opened. The audit carried out for one resident showed that there was an identified tablet that could not be accounted for. One box of medicine issued by the pharmacy contained different batch numbers to the one on the box of medicine and some of the tablets in the medicine strips could not be identified as the right tablet as there was none or insufficient writing legible on the medicine strip. The manager reported that she would return this medicine to the pharmacist. The operations manager for BUPA is carrying out random medicine audits during the monthly visits. The management of controlled medicines were good. The records for receipt and disposal of medicines are complete and accurate, although the records for administration are not complete and accurate. The Medication Administration Records show that the administration of prescribed creams are not being recorded consistently, the index/key is not being used correctly to denote the reason for non administration and the use of a nutritional supplement for an identified resident was not being given as per the prescribed action of care written in the care plan. Leominster Residential & Nursing Home DS0000027682.V279585.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Leominster Residential & Nursing Home DS0000027682.V279585.R01.S.doc Version 5.1 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 the following standard(s): EVIDENCE: Leominster Residential & Nursing Home DS0000027682.V279585.R01.S.doc Version 5.1 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 the following standard(s): EVIDENCE: Leominster Residential & Nursing Home DS0000027682.V279585.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 30 The deployment and number of staff on duty were sufficient to meet the resident’s needs. A comprehensive induction programme is in place to ensure that staff are trained and competent to do their jobs. EVIDENCE: At the time of the inspection there was a registered nurse and 6 care staff on the nursing unit for 27 residents and 2 care staff on the residential unit for 18 residents. Ancillary staff included the housekeeper/activity co-ordinator, 3 domestic staff, 1 laundry assistant, a chef and 2 kitchen assistants. The manager was on duty and an administrative member of staff. The Home has a formalised induction programme for new staff which takes six weeks to complete this is then followed on by further training progressing to NVQ level 2. The induction programme for staff in the Home has been revised since the last inspection to ensure that all staff on their first day of work receive training for manual handing, fire, use of hoists & bathing procedures and an introduction to the organisations policies & procedures, including residents care and health & safety. For the next 2 days they work alongside another carer who has an NVQ 2 qualification as a supernumery member of the care team. Leominster Residential & Nursing Home DS0000027682.V279585.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 & 38 Systems are in place in the Home to promote and protect the health & safety of the residents and staff. EVIDENCE: The Responsible Individual for BUPA is now sending monthly reports to the Commission each month. Notifications are being sent to the Commission in line with regulation, although they are not all being sent in without due delay. This has been addressed through separate correspondence with the manager. Newly appointed staff are receiving manual handling training prior to carrying out any care tasks at the Home. Individual room fire risk assessments have been reviewed since the last inspection.
Leominster Residential & Nursing Home DS0000027682.V279585.R01.S.doc Version 5.1 Page 17 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X 2 3 Leominster Residential & Nursing Home DS0000027682.V279585.R01.S.doc Version 5.1 Page 18 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. Standard OP7 Regulation 15 Requirement All care plans must be reviewed monthly. Brought forward amended as timescale of 30/09/05 not met. The registered manager must ensure that medicine containers are dated on opening. Brought forward amended as timescale of 30/11/05 only partly met. The registered manager must ensure that the records for administration of all medicines in the home are accurate and complete. Brought forward amended as timescale of 15/11/05 only partly met. The registered person must supply to the Commission and make a copy available for residents the report of the outcome of the Home’s review of the quality of care. Timescale of 31/08/05 not met. Brought forward, not assessed. Timescale for action 28/02/06 2 OP9 13(2) 31/01/06 3 OP9 13(2) 17(1) 31/01/06 4 OP33 24 31/01/06 Leominster Residential & Nursing Home DS0000027682.V279585.R01.S.doc Version 5.1 Page 19 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 OP18 Good Practice Recommendations It is strongly recommended that all staff in the Home receive adult protection training from the Herefordshire Adult protect Co-ordinator in relation to the Herefordshire local multi-agency procedures for the Protection of Vulnerable Adults. Leominster Residential & Nursing Home DS0000027682.V279585.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Leominster Residential & Nursing Home DS0000027682.V279585.R01.S.doc Version 5.1 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
