CARE HOMES FOR OLDER PEOPLE
Leominster Residential & Nursing Home Bargates Leominster Herefordshire HR6 8EY Lead Inspector
Sandra Bromige Unannounced 6 July 2005 09:50 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Leominster Residential & Nursing Home E52-E02 S 27682 Leominster Residential Nursing Home V237094 060705 Stage 0.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Leominster Residential & Nusring Home Address Bargates Leominster Herefordshire HR6 8EY 01568 611800 01568 611588 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Care Homes Ltd Mrs Monica Hartley Care Home with Nursing 51 Category(ies) of Old Age 51 registration, with number Physical disability over 65 years of places Dementia over 65 years 51 51 Leominster Residential & Nursing Home E52-E02 S 27682 Leominster Residential Nursing Home V237094 060705 Stage 0.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: There are no conditions of registration in place. Date of last inspection 22 February 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 E52-E02 S 27682 Leominster Residential Nursing Home V237094 060705 Stage 0.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over 6 hours. The Inspector looked around some parts of the building and a number of records were inspected. Seven residents, three visitors and six staff were spoken to. There have not been any complaints received by the Commission about this service in the last twelve months. The Home’s manager was not on duty at the time of the visit as she was away on annual leave. What the service does well: 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. Two staff must be made available on the residential side at all times during the morning, afternoon and evening as 15 residents are too many for one carer to look after on their own. 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 still
Leominster Residential & Nursing Home E52-E02 S 27682 Leominster Residential Nursing Home V237094 060705 Stage 0.doc Version 1.40 Page 6 fitted correctly onto the bed and are safe for the resident and staff to use. Individual room assessments to identify if there is any risk from fire must be reviewed. Staff should write the date on bottles and packets of medicines when they start to be used. When the trained staff in the Home handwrites medicine records they should sign the record and another nurse should check this. Information about the dietary needs of residents should not be made public by putting the information on the outside of the resident’s bedroom door. Open packets of incontinence pads should not be stored in the bathroom as they may absorb moisture created by the hot water. 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 E52-E02 S 27682 Leominster Residential Nursing Home V237094 060705 Stage 0.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Leominster Residential & Nursing Home E52-E02 S 27682 Leominster Residential Nursing Home V237094 060705 Stage 0.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Assessments are done by the Home prior to admission to ensure that care needs can be met. EVIDENCE: The records of the most recently admitted resident show that the Home Manager visited the prospective resident and carried out a detailed assessment of this persons care needs. Leominster Residential & Nursing Home E52-E02 S 27682 Leominster Residential Nursing Home V237094 060705 Stage 0.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 & 10 Limited 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. Small improvements to the management of the medicines in the Home are needed to prevent any potential risk to residents. Personal care is given by staff in a manner that respects the resident’s privacy and dignity. EVIDENCE: Little progress has been made on the requirement to ensure that all aspects of health, personal and social care needs are identified and planned for. Care plans are not being kept up to date and are not always being reviewed at least once a month. The residents or their representative’s agreement to the content of the care plan is not being obtained. All residents seen were nicely dressed. Relatives spoken with were happy with the care provided. Medication Administration Records are at times being handwritten and are not being checked by a second nurse to ensure that the medication has been written up properly. When tablets are received by the Home they are not
Leominster Residential & Nursing Home E52-E02 S 27682 Leominster Residential Nursing Home V237094 060705 Stage 0.doc Version 1.40 Page 10 always being recorded on the medication chart. The room where the tablets are stored is an internal room and the temperature was not being checked each day. Some of the bedroom doors had notices on the outside, which showed if the resident had any special food needs. This may be helpful for staff, but it is the Inspector’s opinion that it is not very respectful of the individual residents privacy as the information is there for all visitors of the Home to read. Leominster Residential & Nursing Home E52-E02 S 27682 Leominster Residential Nursing Home V237094 060705 Stage 0.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: Leominster Residential & Nursing Home E52-E02 S 27682 Leominster Residential Nursing Home V237094 060705 Stage 0.doc Version 1.40 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 Complaints are handled properly to provide residents with confidence that their concerns will be listened to, taken seriously and acted upon. Procedures are in place to ensure that the people living in the Home are protected from abuse. EVIDENCE: The Home has a complaints procedure, and complaints and suggestions forms are on display at the entrance to the Home. Complaints are recorded and outcomes from any complaints are checked each month to see if any changes can be made to improve the service provided. A resident told the Inspector “if s/he had any concerns s/he would speak to any member of staff”. No complaints have been received by the Commission about this service in the last twelve months. Protection of Vulnerable Adult checks are carried out on staff before they are employed by the Home. Staff are aware of the need to report any suspected abuse. Leominster Residential & Nursing Home E52-E02 S 27682 Leominster Residential Nursing Home V237094 060705 Stage 0.doc Version 1.40 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26 The Home is well maintained to ensure that the residents live in a pleasant, clean and safe environment. EVIDENCE: Since the last inspection a new washing machine has been installed in the laundry. The Home continues to be very well maintained with ongoing routine maintenance and decoration. Fire risk assessments need updating. All areas of the Home were clean and tidy and there were no unpleasant smells. Hand washing facilities are provided throughout the Home and plenty of disposable aprons, gloves and incontinence pads are available. Opened packets of incontinence pads are still being stored in a bathroom. The laundry is very well organised, well maintained and the clothes are nicely laundered.
Leominster Residential & Nursing Home E52-E02 S 27682 Leominster Residential Nursing Home V237094 060705 Stage 0.doc Version 1.40 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29 The deployment and number of staff in the afternoon is not always sufficient to meet the residents’ needs. The procedures for the recruitment of staff are robust offering protection for the residents living in the Home. EVIDENCE: The numbers of staff on duty at the time of the inspection were satisfactory for the number of residents in the Home. The staff rotas show that agency staff continues to be used on a regular basis during the day and night, but the numbers of shifts covered by agency staff are greatly reduced from the findings at the last inspection. Residents, relatives and staff all confirm that “staffing levels are improving”, they “have been short, due to problems recruiting, but it is now much better”, but there are “still times when there is only 1 member of staff on duty in the residential side between 3 – 7pm”. Residents and relative spoken to said that the “staff are kind and considerate”, but on the residential side they “would like to see 2 staff on duty between 3-7pm”. Staff confirmed that on these occasions when there is only 1 carer, when they are bathing a resident the carers from the nursing unit have to answer the call bells. On the day of the inspection the residential side had 15 residents. The staff files of 2 staff employed since the last inspection indicated that the Home has carried out all the necessary recruitment checks to ensure the protection of the residents. Leominster Residential & Nursing Home E52-E02 S 27682 Leominster Residential Nursing Home V237094 060705 Stage 0.doc Version 1.40 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 & 38 Systems are in place to promote and protect the health & safety of residents and staff. Incidents that have taken place in the Home have not all been reported to the Commission. EVIDENCE: There were 2 incidents seen recorded in the Home, although neither of the incidents had been reported to the Commission. Regular tests and checks are recorded as being carried out by the maintenance person in respect of water temperatures, wheelchairs, and fire systems and equipment. A representative of the organisation has recently looked into the use of bed rails in the Home. Forms are in place for regular maintenance checks to be carried out on bed rails in use, although none had been completed. Fire risk assessments for individual rooms need to be reviewed.
Leominster Residential & Nursing Home E52-E02 S 27682 Leominster Residential Nursing Home V237094 060705 Stage 0.doc Version 1.40 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x 2 3 Leominster Residential & Nursing Home E52-E02 S 27682 Leominster Residential Nursing Home V237094 060705 Stage 0.doc Version 1.40 Page 17 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 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 20/04/05 NOT MET Care plans must be reviewed monthly in consultaion with the resident and/or their representative. TIMESCALE OF 30/04/05 NOT MET Residents weight must be monitored periodically according to the individual residents risk assessment and agreed care plan. TIMESCALE OF 30/04/05 NOT MET There must be 2 staff rostered to work on the residential unit during the morning, afternoon and evening each day. Bed rails must be checked for safety and the findings recorded on a monthly basis. Individual room fire risk assessments must be reviewed on an annual basis or more often if any changes take place,
E52-E02 S 27682 Leominster Residential Nursing Home V237094 060705 Stage 0.doc Timescale for action 30/09/05 2. 7 15 30/09/05 3. 8 14 30/09/05 4. 27 18 Immediate & Ongoing Immediate & Ongoing Immediate & Ongoing 5. 6. 38 38 13 13 Leominster Residential & Nursing Home Version 1.40 Page 18 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 9 Good Practice Recommendations All non- monitored dosage system containers of medicines should be dated when first opened for use to assist with the monitoring of stock and the correct use of the medicines. It is strongly recommended that hand-written entries on the Medicine Administration Records are signed by the designated person making the entry with a signed check by a second person. Information about residents dietary needs should not be displayed on the outside of their bedroom door for all visitors to the Home to read. Opened packets of pads should not be stored in the bathroom. 2. 9 3. 4. 10 26 Leominster Residential & Nursing Home E52-E02 S 27682 Leominster Residential Nursing Home V237094 060705 Stage 0.doc Version 1.40 Page 19 Commission for Social Care Inspection Hereford Area Office 178 Widemarsh Street Hereford HR4 9HN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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