CARE HOMES FOR OLDER PEOPLE
Leominster Residential & Nursing Home 44 Bargates Leominster Herefordshire HR6 8EY Lead Inspector
Sandra J Bromige Unannounced Inspection 19th October 2005 10:10 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.V259619.R01.S.doc Version 5.0 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.V259619.R01.S.doc Version 5.0 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 BUPA Care Homes 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.V259619.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 6th July 2005 Brief Description of the Service: Leominster Residential and Nursing Home is owned and managed by BUPA Care Homes 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.V259619.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place between 10.10 – 17.45 hrs on the 19th October 2005. The Inspector looked around some parts of the building and a number of records were inspected. The manager, residents, staff and visitors were spoken to. An inspection will be carried out by the Pharmacy Inspector to look at the Home’s management of medicines. The findings will be made available in a separate report. The Commission has not received any complaints about this service since the last inspection. This inspection has found that the Home has not met a number of requirements related to the health care of residents. These issues have all been required in previous reports. Due to the findings of this inspection, a meeting has been arranged by the Commission to meet with the Responsible Individual and Manager of the Home. Failure of the Home to meet the requirements of this inspection may lead to enforcement action being taken by the Commission. What the service does well:
The Home is well maintained and offers a good standard of accommodation. It is very pleasant, clean with no bad smells. A range of activities is available for residents. A routine weekly list of activities takes place such as bingo, crafts, cards, board games and armchair exercises. Individual hobbies and interests are encouraged, for example one lady enjoys sewing and her machine has been accommodated in the Home and residents are taken out into the local town to meet friends or to go shopping. Visitors to the Home are made very welcome. Residents have said that it is ‘very nice here’ and the staff are ‘all kind and gentle’ and ‘will do anything we want’. A varied menu if on offer each day. Cooked breakfast is available every morning upon request. Residents have a choice of main meals each day and are able to eat in the dining room or in the privacy of their bedroom. Guests are welcome for meals and a private dining room can be arranged. The Home has recently been awarded the ‘Best BUPA care home laundry team’ for 2005 by a recognised laundry company. A newsletter is produced each month in a large print format to enable residents to be kept informed of staff coming and going, events planned, asking for suggested menus and other important and informative information. Leominster Residential & Nursing Home DS0000027682.V259619.R01.S.doc Version 5.0 Page 6 Resident’s personal allowances are well managed by the Home and residents are able to get money from within the Home instead of having to go out to the bank or rely on their relatives to do this for them. What has improved since the last inspection? What they could do better:
Care planning must improve so that staff know what to do for each resident. The residents and/or their closest relative must be shown the care plans by the nursing and care staff. They must be explained to the residents to make sure that the resident agrees with the information they contain. Residents must be weighed when they come into the Home and on a regular basis, so that the staff can make sure that they are not losing or putting on too much weight, which may affect their health. Bed rails when in use to stop residents falling out of bed and hurting themselves, must be checked every month to make sure that they are safe, suitable and still needed to be used by the individual residents. The Home reviews the quality of the service given to the residents each year. The outcome of this review and any identified areas for improvement must be sent to the Commission and also made available for residents at the Home. The Responsible Individual must do unannounced monthly visits and a written report sent to the Commission. Individual room assessments to identify if there is any risk from fire must be reviewed. All newly appointed staff must be given training on how to move and handle residents who need assistance with walking. They must also be shown how to use the equipment provided by the Home for moving residents to ensure that the resident and staff are not injured.
Leominster Residential & Nursing Home DS0000027682.V259619.R01.S.doc Version 5.0 Page 7 Registered nurses employed at the Home should be reminded of their individual responsibility and accountability under the Nursing & Midwifery Council Code of Conduct, of the requirement to maintain up to date and accurate records for the residents in their care. The Commission should be notified if the staffing levels in the Home are at any time less than those issued by the originating health authority. 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.V259619.R01.S.doc Version 5.0 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.V259619.R01.S.doc Version 5.0 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): These Standards were not assessed during this visit. EVIDENCE: Leominster Residential & Nursing Home DS0000027682.V259619.R01.S.doc Version 5.0 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 No progress has been made on improving arrangements to ensure that the health care needs of residents are identified in the individual care plans and are met. These shortfalls have the potential to place residents at risk. EVIDENCE: Three care records were looked at in depth during this visit. No progress has been made towards meeting the requirement made following the last inspection to ensure that all aspects of health and personal care are identified and planned for. Care plans are still not being kept up to date and are not being reviewed at least once a month. Two night care plans had not been reviewed since March & June 2004. Bedrail risk assessments are not being reviewed each month by the nursing staff to assess if they are still required and are safe and suitable for use with the individual resident. Moving and handling risk assessments had not been completed for a resident who was admitted to the Home two months ago, neither had the identified resident been assessed for falls, continence problems, nutritional needs, skin care and dependency. This identified resident is known to have a history of falls prior to admission to the Home. Resident’s weights are not being checked on a regular basis even though they are identified as being at very high risk nutritionally. The residents or their representative’s agreement to the care plan is not being obtained.
Leominster Residential & Nursing Home DS0000027682.V259619.R01.S.doc Version 5.0 Page 11 The manager reported that it has been arranged for a senior nurse in the Home to carry out care planning reviews and training to address these identified shortfalls. All residents seen appeared comfortable, were nicely dressed and their clothes were nicely laundered. Throughout the day ladies were having their hair cut and set by the hairdresser. Residents spoken with were happy with the care and felt that there care needs were being met by the Home. An inspection will be carried out by the Pharmacy Inspector to look at the Home’s management of medicines. The findings will be made available in a separate report. Leominster Residential & Nursing Home DS0000027682.V259619.R01.S.doc Version 5.0 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): 12, 13, 14 & 15 Social activities are well organised, and provide stimulation and interest for people living at the Home. Links with the community are good and support and enrich resident’s social opportunities. Dietary needs of residents are well catered for with a balanced and varied selection of food available that meets resident’s tastes and choice. EVIDENCE: The Home employs a part time activity co-ordinator. Routine weekly activities are programme for each day of the week and are on display for residents in the Home. There are also posters showing other activities planned such singers and an ’Old Time Music Hall’ show. On the afternoon of the inspection a large group of residents were seen enjoying a game of bingo, with tea and homemade cakes being served during the interval. Prizes are purchased by the Home for residents to win at the bingo. Community links are good. Holy Communion is held in the Home each month. All visitors to the Home sign in and out and this shows that residents receive many visitors throughout the day. Partners and family of some previous residents continue to visit and be involved with the Home. This is encouraged. One afternoon each week is programmed for residents to be taken into the local town by the Activity Co-ordinator, to see friends, go shopping or to have afternoon tea. Leominster Residential & Nursing Home DS0000027682.V259619.R01.S.doc Version 5.0 Page 13 A good choice of menu is provided. Residents are consulted about the type of food they would like and this is taken into to consideration when revising the menus in the Home. Residents said the food is ‘very good’ and they ‘have a choice of meals’. Residents choose to eat in their rooms or in the dining room. Guests can be entertained for lunch in a separate dining area upon request. Leominster Residential & Nursing Home DS0000027682.V259619.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these Standards were assessed during this visit. EVIDENCE: Leominster Residential & Nursing Home DS0000027682.V259619.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these Standards were assessed during this visit. EVIDENCE: Leominster Residential & Nursing Home DS0000027682.V259619.R01.S.doc Version 5.0 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 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. Recently recruited staff are not receiving fire or moving and handling training prior to commencing work or on their first day of work, this has the potential to leave residents and staff at risk of injury. EVIDENCE: The numbers of staff on duty at the time of the inspection were satisfactory for the numbers of residents being cared for in each unit of the Home. The manager confirmed that they had experienced problems with staff shortages the previous week due to sickness. The staff rotas continue to show regular use of agency staff, both trained nurses and care staff. New trained and care staff have very recently started work at the Home. Residents spoken with said that the staff are ‘polite and friendly and they have a joke with you and smile’, ‘they are very good, they always come when you ring the bell’, and ‘they will do anything we want, they are very good at night’. Residents and staff said that the staffing situation ‘is improving’ and on the residential side two staff are being provided throughout the daytime and evening. 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. At the time of the inspection a newly recruited care assistant was working their third shift. They were working alongside another more experienced carer which is good practice. The new employee had not received any training on the action to take in the event of a fire or any instructions on
Leominster Residential & Nursing Home DS0000027682.V259619.R01.S.doc Version 5.0 Page 17 how to move and handle residents in order to ensure that the residents and themselves are not injured and the use of lifting equipment. Leominster Residential & Nursing Home DS0000027682.V259619.R01.S.doc Version 5.0 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 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): 33, 35, 37 & 38 The Home regularly reviews aspects of its performance through a programme of self-review. A good system is in place for the management of resident’s personal allowances to ensure that their financial interests are safeguarded. The timing of health & safety training for new staff needs to be improved to promote and protect the health & safety of the residents and staff. EVIDENCE: The manager carries out a review of the quality of the service each year. The Home has recently been in consultation with residents about the menus provided by the Home. The outcome of the review needs to be supplied to the Commission and made available to residents at the Home. The Commission has not received monthly written reports from the Responsible Individual as the last report was dated July 2005. Leominster Residential & Nursing Home DS0000027682.V259619.R01.S.doc Version 5.0 Page 19 Records of the Home’s management of resident’s personal allowances were seen. Records are computerised and paper copies are maintained. Monthly statements are produced for these accounts showing any deposits or any expenditure. Receipts are available for all expenditure and interest is added to each account on a monthly basis. Notifications are being sent to the Commission in line with regulation. Guidance was given that a notification should be made if staffing levels fall below those of the originating health authority. Bedrails have been checked each month by the maintenance person to ensure that they are still fitted correctly and are not loose. Individual room fire risk assessments have not been reviewed for over 2 years and some as long as 5 years. New staff are using moving and handling equipment and caring for residents without receiving any moving and handling training. Leominster Residential & Nursing Home DS0000027682.V259619.R01.S.doc Version 5.0 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 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 2 8 2 9 x 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 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 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X 2 2 Leominster Residential & Nursing Home DS0000027682.V259619.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The care plan must set out in detail the action which needs to be taken by the care team to ensure that all aspects of the health, personal and social care needs of the residents are met. Timescale of 30/09/05 not met. Care plans must be reviewed monthly in consultation with the resident and/or their representative. Timescale of 30/09/05 not met. Residents weight must be monitored periodically according to the individual residents risk assessment and agreed care plan. Timescale of 30/09/05 not met. Bedrail risk assessments must be reviewed each month to ensure that they are safe, suitable and still required to be used for the individual residents. 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
DS0000027682.V259619.R01.S.doc Timescale for action 31/12/05 2 OP7 15 31/12/05 3 OP8 14 31/12/05 4 OP7 13 31/10/05 5 OP33 24 31/01/05 Leominster Residential & Nursing Home Version 5.0 Page 22 6 OP33 26 7 OP38 13 8 OP38 13 the quality of care. Timescale of 31/08/05 not met. Unannounced monthly visits must be carried out by the Provider in accordance with Regulation 26 and a written report submitted to the Commission. Individual room fire risk assessments must be reviewed on an annual basis or more often if any changes take place. Timescale of Immediate & Ongoing not met. All care staff must receive moving and handling training prior to using any equipment or be involved in the moving and handling of residents. 31/10/05 31/10/05 31/10/05 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 Refer to Standard OP7 OP27 Good Practice Recommendations All qualified staff should refer to the guidance from the Nursing & Midwifery Council entitled ‘Guidelines for record and record keeping’. The Commission should be notified if staffing levels fall below those issued by the originating health authority. Leominster Residential & Nursing Home DS0000027682.V259619.R01.S.doc Version 5.0 Page 23 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
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