Inspection on 22/05/07 for Leopold Nursing Home

This inspection was carried out on 22nd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Leopold Nursing Home 20/11/07

Leopold Nursing Home 06/07/06

Leopold Nursing Home 16/02/06

Leopold Nursing Home 12/10/05

Leopold Nursing Home 24/03/05

Leopold Nursing Home 17/02/05

Leopold Nursing Home 16/02/04

Similar services:

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

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

CARE HOMES FOR OLDER PEOPLE Leopold Nursing Home 17 Leopold Road Felixstowe Suffolk IP11 7NP Lead Inspector Kevin Dally Unannounced Inspection 22nd May 2007 09:00 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 Leopold Nursing Home DS0000024433.V340798.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. Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Leopold Nursing Home Address 17 Leopold Road Felixstowe Suffolk IP11 7NP 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) 01394 670196 01394 279059 leopoldnursinghome@hotmail.com Mrs Rema Jayarajan Post Vacant Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to a maximum of 5 places may be used to provide respite care to persons aged between 55 and 65 years of age. 6th July 2006 Date of last inspection Brief Description of the Service: Leopold Nursing Home offers accommodation for a total of thirty-six older people. A condition of registration is that within the thirty-six residents the home can offer respite care to up to five people between the ages of fifty-five and sixty-five. The home is in the coastal town of Felixstowe, close to local shops, amenities and the beach. There are frequent bus and train links to nearby Ipswich. The house is large and has been adapted to offer the accommodation over three of the four floors. There are seventeen single rooms and nine double bedrooms each with a washbasin in the room. Each floor has toilets and assisted bathrooms. There is a passenger lift to all floors. There is a large communal lounge and dining area on the ground floor that has a conservatory at one end. Externally there is a small seating area and off road parking but no garden. Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken on the 22nd May 2007, between 9am and 5pm. This was a key inspection that assessed the core standards that related to the nursing care provided to elderly service users. The report has been written using all the information gathered prior to and during the inspection. During the inspection, the acting manager assisted me by providing relevant information about the service. During the inspection, a number of serious concerns were raised; particularly the impact that the vacant managers post was having on the service. Since the inspection, the owners have notified me that a full time manager has been appointed from October 2007. In the meantime, the home will be run by an experienced manager who will work part time at the home each day, to ensure that the home is adequately supervised during this period. The focus of this inspection centred on the provision and management of the nursing care service. Further, a selection of residents’ care plans, risk assessments, needs assessments were checked, as were accident and incident reports for evidence of adequate care and management monitoring. The environment and the meal provision were also checked. Staff recruitment procedures, rosters and the numbers of staff on each shift were checked. The way the home responded to complaints and quality assurance, were assessed. In addition, a CSCI pharmacist inspector undertook an inspection of the medicines of the home on the 25th May 2007, in order to assess the previous concerns that related to medication issues. A copy of their report is available on request from the CSCI, and the key points from their report are summarised under standard 9. Comment cards were received from residents (16) and relatives/advocates (11), and via direct interviews with residents, relatives and the staff group. A selection of the views and comments received has been included throughout this report. Three staff members’ records were checked, including the staff training and the supervision practises of the home. This inspection showed that of the 26 National Minimum Standards inspected, 12 were assessed as good, 9 as adequate and 5 as poor. Twenty-one of these standards checked are considered by the CSCI as key standards, of which the home met 9. What the service does well: Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 6 Feedback received from residents, and relatives confirmed they appreciated the efforts of the staff, their kindness and their hard work within the home, and many examples of their appreciation are provided within this report. On arrival at the home the atmosphere was calm and relaxed, and staff were welcoming. Residents were observed to be well groomed, neat and tidy, with the staff group in attendance and assisting residents when required. The meal selection was to good standards, which residents said they enjoyed. The recruitment procedures checked would ensure that the most suitable staff are employed by the home. Staff records checked evidenced that these ‘carers’, who were in fact nurses but were employed as carers, were very well trained and experienced, and would be an asset to the home. The cleanliness of the home including the lounge, dining room, and residents’ individual rooms was to good standards. What has improved since the last inspection? What they could do better: Currently the manager’s position has been vacant for nearly a year, and this situation is having a direct impact on the effective operation of the service. During the inspection, a number of key concerns were raised that needed urgent attention. These are No manager, so some loss of in house leadership and direction for the home. A new manager must be urgently appointed to provide direction and leadership for the home. • Some poor care practices have developed, for example, continence care, and issues around lack of dignity and responsiveness towards some residents in the provision of this care. Due to the concerns raised, it was a requirement that the staff group be retrained in continence care practices and adult protection procedures, including how to maintain residents dignity and provide care in a responsive way. • Medication concerns, as identified by the pharmacist inspector, these must be addressed as per their report. • Inconsistent monitoring of accidents / incidents / bruises. The home must ensure that a consistent approach and appropriate monitoring systems are in place to ensure residents safety. • Staff rostering must to be reviewed to ensure that staff are not working excessive hours, and which may be having an impact on the quality of the care provision. • Quality assurance and monitoring systems failed to identify some serious care practice concerns, medication concerns, and monitoring of accidents and incidents. These systems need to be fully reviewed to ensure that problems are identified and resolved by the home. Please contact the provider for advice of actions taken in response to this Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 7 • 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. Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 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 Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4. Standard 6 was not inspected on this occasion. The quality in this outcome area is adequate. While people can expect to receive appropriate information about the service, people cannot always be assured that the home could meet residents’ care needs due to lack of experienced management direction. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Feedback received from the majority of residents (13 of 14) and relatives (11 of 11) confirmed that they had received sufficient information to help them make decisions about the home. This information had enabled them to consider if this was the right home for them. Two relatives commented, “We receive very prompt information that effects our relative” and, “The staff always contact my sister or myself when my relative is unwell or being taken to hospital”. Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 10 Three residents’ care records checked, evidenced that a basic pre-admission needs assessment had been undertaken for them which included information around mental status, communication, behaviour, mobility, use of aids, personal care requirements, sensory problems, continence issues, dietary issues, if feeding was required and skin integrity. Their admission weight was also recorded. The assessment was completed by staff, who had access to a choice of appropriate key words to tick. For example, under the heading, ‘communication’, staff could select that there ‘were/or not’ communication problems, and if these were ‘minor’ or ‘major’. Although pre admission assessments provided a summary of a resident’s pre-assessed care needs, it did lack detail. However, care plans and additional assessments did provide more detailed information. It is therefore recommended that the home review the needs assessment form to ensure that it provides sufficient pre-admission information around a resident’s care needs. Additional assessments included a ‘problem orientated approach’ where key medical problems were identified, and one resident’s records checked included notes around poor mobility, continence, pressure sores, heart & lung problems, appetite, and a small broken area. Specialised assessments were also provided including a dependency profile, pressure area risk assessment, moving and handling risk assessment, daily observations and nursing records. Leopold provides nursing care services for up to 36 elderly residents. The staff group comprises of around 14 first level registered nurses and 11 care staff, although only 6 nurses were appointed as registered staff for the home. Staff records checked evidenced that these nurses were a skilled and experienced group of staff. For example, 1 ‘care’ staff member had achieved a BSC in Nursing, while another had wide hospital experience. While this evidence shows that staff have the individual skills and training, and would be able to meet the nursing care needs of the residents, further evidence (Please refer to standard 8) shows that collectively, the home were failing to meet some peoples’ care needs in a responsive and dignified way. (Please refer to standards 8, 9 and 10, 14) This included the use of some care practices that were unacceptable, for example, poor continence care practices. The home has now been without a manager for some considerable time, and this has had a direct impact on the management and direction of the home. While the deputy manager has maintained some direction and support for staff, this situation was unsustainable long term. It was therefore an immediate requirement from this inspection that the registered person/s ensure appropriate management support for the home’s acting manager, while the manager’s position was recruited to. Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 11 Residents (16) who had completed the CSCI surveys, stated from their prospective that they ‘always or usually received the care and support they needed. One resident and two relatives spoken with raised concerns about the care they or there relative received. This is discussed under standard 8. From the relatives/visitors (11) who had completed the CSCI comment cards, 7 stated that the care home ‘always’ met the needs of their relative, and 4 stated, ‘usually’. One relative provided the following feedback about the care provision. “Care staff definitely have the right skills and experience to look after people properly. The carers are highly skilled”. Leopold Nursing Home DS0000024433.V340798.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 The quality in this outcome area is poor. Residents could not always expect to receive appropriate nursing care in a responsive and dignified manner, due to lack of suitable management monitoring and direction. Medication practices had become unsafe, and may put residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans for 3 vulnerable residents, including one who was prone to falls and skin problems, and one with mobility difficulties, were checked. Time was spent with these residents to check the level of support written in the care plan, reflected the level of care given. Various assessments of individual need had been undertaken including a basic assessment on admission (Please refer to Standard 3) from which a care plan would be produced. The care plan for one vulnerable adult prone to falls and bruising was checked. Their records were divided into 3 key sections, which were, ‘The problem orientated nursing approach’, risk assessments, and the nursing care plan. Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 13 The problem oriented approach identified relevant medical issues, of which 7 had been recorded. These included mobility difficulties, continence care issues, pressure sores, dietary issues, and 2 medical conditions. Risk assessments included a dependency profile, pressure sore risks, a nutritional risk assessment, and moving and handling risks. Assessments were signed, dated and current. The nursing care plan profile was a pre-printed sheet, which uses the nursing problem solving approach for each problem identified. Each assessment includes naming the problem, identifying the aim of the care, the actions needed to resolve the problem, and the evaluation of the nursing intervention. Three care plans checked showed that evaluations of the care provided were assessed each month, were signed and dated. The care plan for one resident identified 9 areas of assessed need and included key information around medical problems, personal hygiene, mobility, a safe environment, communication, nutrition, elimination, sleep, and skin integrity. Records stated that the resident was “prone to falls” and that their “skin was at risk”. Records of skin and soft tissue abnormalities (bruise charts) checked recorded 3 instances of bruising, the last being in April 2007. I therefore met with the resident and noted that they had sustained substantial bruising to their elbow. A check of the records showed that this particular injury had not been recorded, or any reason given for the bruising for example, a fall or a knock. Further, there was no evidence of ongoing monitoring, so this was of concern. This was raised with the acting manager, but they were unable to explain how or when this problem may have occurred. The home was therefore required to ensure that all causes of bruising/accidents/incidents are fully reported, recorded, investigated, and monitored, and when necessary, are referred to appropriate medical personnel for after care. Accident records for the home were checked for the period June 2006 to April 2007. Accident records counted showed there were 72-recorded accidents for this period. Positively, accident monitoring was undertaken by the home to try to access any trends and identify if any resident was more prone to falls. However the accident monitoring record showed that 7 accidents from the accident book had not been included within the monitoring information so was not quite accurate. The remaining accidents had been charted on a graph, and were divided into the part of the day they had occurred. Also monthly trends could be seen. Individual accident records were maintained for each resident in their folder, and these records identified the date of the fall, what time of the day and what had occurred that was of relevance to the accident. Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 14 One resident who was more prone to falls (8 falls during a 3 month period) their accident records checked provided good notes around the fall including the date and time, and what the concern was. However, there was no record of the measures the home had taken to try to prevent these falls occurring again. The resident’s records showed that they were on a tranquiliser, and it was not clear if this had been considered as a possible cause of their falls. The moving and handling practices of the home were observed and on the day of the inspection I watched staff mobilising 4 residents to the day room after breakfast. The hoist was used for 3 of these residents and the hoisting techniques were seen as adequate, although one resident’s legs were jammed for a short period against the hoist frame. Care must be taken at all times to ensure that this does not occur to avoid injury or bruising. Further some of the chairs in the day room were positioned too close together, and partially obstructed the hoist feet. Hoist access was therefore difficult but staff did manage to work around these problems. One resident was assisted to stand and sit by the use of a hoisting belt with assistance from 3 staff. This was seen as good practice. On arrival at the home I spent sometime within the day room to observe the support and assistance being received by the residents. Residents were being positively supported by good numbers of staff, were well groomed and looked well cared for. All the residents present had access to drinks on their tables, and staff were seen assisting residents with drinks throughout the morning. Some more vulnerable residents received special build-up milkshakes. Records checked for 3 residents evidenced that all 3 had gained weight since their admission. The day room had a calm atmosphere, and was noted to be clean and well kept. The radio was playing and one resident commented that they enjoyed this. One relative spoken with confirmed to me that their relative and the residents’ generally were “well dressed, well fed with some meals better than others”. However discussion led to one instance (1 year ago) where their relative had had a fall from bed, and when they asked staff how this had occurred, no one knew about this. Two months ago the relative noticed a blister and once again staff did not know how this had occurred. Further discussion led to the relative stating, ‘People ask to go to the toilet, and sometimes wait all morning or all afternoon’. They had heard staff say, ‘you have a pad just go’ or ‘wait for the person who does your floor’. This was upsetting to the relative to hear this. Another relative was spoken with and they stated that ‘sometimes 2 or 3 residents are caught short and have to wait long periods to go to the toilet’. One resident spoken with stated that ‘they get caught short and want the toilet, and often have to wait’. Further, they had heard staff say, ‘You have pads on just go. We are too busy’. Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 15 However, in discussion with a group of 4 staff it was stated, “Residents would never be told to use the pad to go to the toilet”. These issues were discussed with the acting manager, and due to the serious nature of these concerns the home was required to immediately review all continence care practices to ensure that staff maintain the residents’ dignity and meet their care needs. Further, it was a requirement of this inspection that the home immediately provides retraining around continence care practices for all staff members, and that this must be completed by 1st July 2007. At the previous inspection in November 2006, a number of concerns around the medication practices of the home were raised, and as a consequence 4 requirements were made to be addressed. In conjunction with this key inspection, and in order to assess the progress made by the home, a CSCI pharmacy inspector, undertook an unannounced inspection of the medication processes on the 25th May 2007. Nine requirements were made, which include the following points. 1. 2. 3. 4. 5. 6. 7. 8. 9. Clarification of the use of PRN medicines Prescribed medicines must be available at all times Accurate medicine records must be maintained Accurate medicine records of their disposal must be maintained Accurate MARS chart dose directions must be maintained Medicines must be given in line with prescribed instructions Authorised medicine dosage changes must be accurately recorded Records must be maintained when medicines are not administrated Discretionary medicines must only be given when authorised by the home’s policy The following Judgment relating to standard 9 was made by Mr Andrews as follows: - “The overall outcome relating to the medication standard for people who use the service is poor because the home’s medication practices place people at risk”. Complete findings are provided in a separate report dated the 30th May 2007, and are available from the CSCI on request. During the inspection, the home was found to be calm and relaxed with adequate time provided to meet the residents’ needs. Residents were observed being treated kindly. However, one visiting Doctor had to ask staff to take a resident to their room in order that he could complete an examination in the privacy of their room, and not in the corridor. Staff were observed to knock on doors, and promptly answer call bells, and meet care needs. However, the findings provided around continence care (Please refer to standard 8) evidenced that staff did not always consider residents dignity, and relatives and a resident confirmed this. Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 16 For example, “you have a pad just go’ or ‘wait for the person who does your floor’. This is not meeting care needs in a dignified and responsive way, therefore the home was required to review the manner in which they provide care to residents. Residents and relatives feedback was received around the care provided by the home, as follows. Residents (16) Do you receive the care and support you need? Do staff listen and act on what you say? (1 did not say) Are staff available when you need them? Do you receive the medical support you need? Relatives (11) Does the care home meet the needs of your relative? Are you kept up to date with important issues affecting your relative? Eg hospital admissions, accidents etc? Does the care home give the support or care to your relative that you expect or agreed? (One did not say) Do the care staff have the right skills and experience to look after people properly? Yes/ Always 7 Usually 4 Sometimes No Yes/ Always 14 15 12 4 Usually 2 Sometimes No 15 1 10 1 7 3 7 4 A selection of views and comments received from residents and relatives about their care included the following views. Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 17 “My relative does not converse with me”. “My relative has no speech so difficult to understand them. Sometimes I feel the nursing staff give up rather than persevere to find out what they want”. “We could not ask for better smiling nurses with greater efficiency”. “The home provides excellent care and the staff are very caring”. “Staff definitely have the right skills and experience to look after people properly. The carers are highly skilled”. “I don’t feel it appropriate that male members of staff attend to my relative. However, she is resigned to this”. “I receive prompt information that effect our relative, if they go to hospital”. “There has never been an occasion where I have had to raise any concerns with the home”. “Nursing staff are not always careful when hoisting/moving residents, who may be in pain”. “I would like to say how good the care assistants are. The nurses are generally good but because they are young sometimes forget that these elderly people had a life too”. “They could improve by looking after the small things which are important. My relative does not always have glasses on because no one remembered, so they cannot watch television”. “They always treat my relative with care and respect and help them retain their dignity. They are always clean and tidy and although they choose to stay in their room they often pop in for a quick word”. Residents and relatives views on the home were quite varied and it was apparent that while some residents were satisfied with their care, others felt there was room for improvement. Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 18 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 The quality in this outcome area is adequate. The staff group would provide adequate lifestyle opportunities for residents at the home, including social opportunities, adequate meals, and contact with families and friends. Residents may not be able to exercise control in all circumstances. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection, some time was set aside to talk with residents and staff, and observe the care received. On the day of the inspection the home atmosphere was calm and relaxed, and staff were welcoming. Residents were observed to be well groomed, neat and tidy, and most had completed their breakfast. Staff were observed positively supporting some residents who needed assistance with feeding, and this was completed in an unhurried manner. The radio provided popular music for the first part of the morning, which some residents enjoyed. Feedback from residents (15) were asked, ‘Are there activities organised by the home in which you can participate in?’ 13 replied, ‘always or usually’, 2 stated ‘sometimes’. Residents’ comments included ‘Activities are available but I choose not to take part’, or ‘I prefer to stay in my bedroom as I have other things to do’. One relative stated, ‘I was pleased to see that my relative will now be able to take Communion’. Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 19 A record was maintained of the activities provided for residents, which was usually provided between 4pm to quarter to 5 each day. These included opportunities with music and exercise, songs of praise, film watching, drawing and painting, reminiscence therapy, quizzes, skittles or bowls. A number of residents were found up and dressed in their own rooms, and they confirmed it was their choice to be there. Two residents were seen with their families outside and enjoying the afternoon sun. Several relatives spoken with confirmed they visited their relative frequently, and that there were no restrictions placed on visiting. Feedback from residents and relatives confirmed that the standards of meals and food were sufficient. The home provided a sample of their rotating menu, and the menu board in the dining room showed the menus choices available. The daily menu ‘choice sheets’, which gives information on the menu choices, were not checked on this occasion. Dinner on the day of the inspection was a choice of beef stew dumpling or fish cake served with creamed potatoes, Swedes, and runner beans. Dessert was fresh fruit salad or ice cream and custard. Residents seen in the lounge or their bedrooms had access to drinks, and good practice was seen with residents being encouraged to take drinks throughout the day. Some meals had been blended and were served as a puree diet to those more vulnerable residents with chewing difficulties. Food was separated into individual components, which looked good and smelt appetising. A range of main menu courses offered over a week included steak and mushroom pie or pork pie, cold ham or minced beef pie, toad in the hole or poached haddock, cottage pie, or tuna onion quiche, fried haddock or grilled sausages, pork goulash with apple dumplings or ham cheese quiche, roast lamb or roast chicken. A range of deserts included Lemon cord tart with custard, syrup sponge with custard, bakewell tart, backed rice pudding, cherry cheese cake, apple crumble and Viennetta ice-cream. Residents’ records showed that an assessment had been undertaken at admission around their dietary needs, and this had been used to produce information on their nutritional needs. This included information about the resident’s dietary requirements, the necessity for monthly weight monitoring and a nutritional risk assessment. Three residents’ weight records checked showed evidence of weight monitoring, and that these residents had all gained weight since admission. It was evidenced that staff have had the Malnutrition Universal Screening Tool (MUST) training, and direct referral from staff to the Dietician would take place when necessary. The three residents’ records checked did not have (MUST) assessments in place, and which is strongly recommended for all residents, to provide evidenced based nutritional information on the status of a resident’s nutritional needs. Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 20 A selection of comments received from residents and relatives included the following feedback. “The kitchen staff are good and there are a variety of meals. They seem to have enough to eat and drink and the portions are adequate”. “I don’t like greens”. “Residents are well fed. Some meals are better than others”. Comment cards received from residents (16) asked, ‘Do you like the meals?’, 12 stated ‘always’ 2 stated ‘usually’, while 2 stated ‘sometimes’. Due to the outcomes identified in standards 8 and 10, (please refer) it was apparent that some residents were not always able to maintain control and exercise choices over some aspects of their lives. For example, when they could go to the toilet. However, there were other practices seen, for example meal times, and the choice to remain in your room or participate in activities, which demonstrated good practice. These concerns have already been addressed under standards 8 and 10. One relative stated, ‘The home supports people to live their life as they choose, as far as they are able. The home lives up to its name – Caring’. Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 21 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 and 18. The quality in this outcome area is adequate. Residents could usually expect to be kept safe by access to the complaints procedures, but may not always be protected by the home’s adult protection procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the complaints policy is contained within the home’s policy manual. Dr Jayarajan, one of the home’s owners, would normally investigate any complaints received and provide written feedback at the conclusion of any complaint investigation. Feedback received from 16 residents said they ‘knew who to talk to if they were unhappy’ and 15 of 16 residents confirmed they ‘knew how to make a complaint to the home’. One stated ‘No’. Eleven of 11 relatives confirmed they were aware of the complaints procedures. Since the previous inspection the acting manager stated that there had not been any complaints. However, I was aware that there had been one complaint made to Social Care Services. A relative of a short stay resident had made a complaint, and Social Care had requested that Dr Jayarajan investigate this matter. Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 22 The issues raised were mostly around the care practices of the home and a misunderstanding around the food selection. Social Care responded by stating that this complaint has been ‘very thoroughly investigated’. However, the home was required to ensure that a record of all complaints received by the home, are maintained on the records, and are available for inspection. A selection of feedback received from some relatives included the following comments. ‘There has never been an occasion where I have had to raise any concerns with the home’. ‘I think most of the nurses are very caring people towards the people living in the home. If I have any concerns they are always dealt with straightaway’. The home had policies on Adult Protection Procedures and the prevention of abuse, which had been updated in January 2007. The records checked for 3 staff members evidenced that 1 of 3 staff members had received training in the home’s adult protection policy. Three staff members’ recruitment records checked showed that the home had obtained a Criminal Records Bureau check (CRB) for each staff member. Due to the serious care concerns raised (Please refer to standard 8) around the way in which some residents had been inadequately cared for, it is a requirement of this inspection that all staff are retrained or provided with Adult Protection training, to ensure staff understand what do, should they suspect or evidence abuse. This must include training in physical, emotional, sexual, physical neglect and intuitional abuse. Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 23 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, 23, 26 The quality in this outcome area is good. People could expect to live in a home that was odour free, clean and hygienic. Although basic home maintenance is undertaken, some improvements would be required to ensure a well-maintained and safe environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The house is large and has been adapted to offer the accommodation over three of the four floors. There are seventeen single rooms and nine double bedrooms each with a washbasin in the room. Each floor has toilets and assisted bathrooms. There is a passenger lift to all floors. There is a large communal lounge and dining area on the ground floor that has a conservatory at one end. Externally there is a small seating area and off road parking but no garden area. A tour of the premises was undertaken including checking the lounge area, the dining room, office areas, hallways, stairwells, and 4 residents’ rooms. Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 24 The lounge area provided seating for most residents with chairs well positioned on one side of the lounge to allow easy hoist access. The other side was quite cramped, and seats were ‘arm to arm’, and hoisting was more difficult, although staff did manage to work with this problem. It is recommended that the management consider alternative ways of placing the lounge chairs to ensure maximum access for staff, and the comfort of the residents. The home does show signs of ageing, with some areas, for example, the carpet in the stairwells, in need of replacement within the next few years. The carpet in room 27 was torn and was a tripping hazard, and must be replaced. Residents’ rooms checked were clean and tidy and suitable for their purpose. One resident spoken with confirmed that their room met their needs, and they could enjoy the views from their window. One double room checked was adequate in size, and screening had been provided to ensure care could be provided in privacy. Generally the paintwork in the hallway areas was adequate but some areas may need repainting in the future. The laundry area provided washing and drying facilities, and hot washes were delivered at 73 degrees Celsius. The home did seem to lack storage areas for equipment, but this will be looked at in more detail during the next inspection. Feedback from relatives and observation of the home, confirmed that the cleanliness of the home was to good standards, with no unpleasant odours noted. The lounge and dining areas were clean, tidy and fresh smelling. Domestic staff were seen cleaning and working throughout the home during the inspection. Residents (16) completing the feedback card in answer to the question, ‘Is the home fresh and clean?’ 14 stated ‘Always’ while 2 stated ‘usually’. A selection of residents and relatives’ comments included the following views. ‘The home is clean including the bedrooms and toilets. Staff are always available and they are quite good with their standard of hygiene I have observed’. ‘Over the years our relative has been in the home it has continued to instigate changes and improvement so we feel they are doing a good job.’ ‘I think some of the views from the windows [on the ground floor] are limited and could be better improved by cutting the hedge shorter to allow residents see people or traffic going by’. ‘Get rid of double rooms, as they are very small with no personal space’. Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 25 ‘It would be nice if the residents had a bigger garden to sit in but the residents are cared for and made comfortable’ Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 26 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 The quality in this outcome area is adequate. People using the service can expect sufficient staffing levels, but work shift patterns for some care staff may be too exhausting. Recruitment and staff training is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Leopold provides nursing care services for up to 36 elderly residents. The staff group comprises of around 14 first level registered nurses and 11 care staff, although only 6 nurses were appointed as registered staff for the home. Staff records checked evidenced that these nurses were a skilled and experienced group of staff who should have the skills and experience to meet the resident’s needs. For example, 1 ‘care’ staff member had achieved a BSC in Nursing, while another had wide hospital experience. Copies of the staffing rotas for the period 29th April to 26th May 2007 were sent to me for checking. This showed that planned staffing levels in the morning were maintained at around 1 registered nurse, 6 ‘carers’, and occasionally 1 support carer. This provided a ratio of 1 ‘care staff’ to 6 residents. The average staffing levels in the afternoon (1pm – 9pm) was 1 registered nurse, 6 ‘carers’ giving a ratio of 1 member of care staff to 6 residents. Staffing levels at night were, 1 registered nurse with 3 care staff. The staff group confirmed this. Observation during the inspection showed that care staff time was mainly spent managing the care needs of the residents. Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 27 The acting manager usually worked Monday to Friday but was scheduled on duty, one in every 4 Sundays. The rotas showed that the home provided one fulltime and one part time chief, with 2 kitchen assistants. The home also appointed a ‘supper’ helper between the hours of 3pm to 7pm. There were 2 full and 1 part time domestics. The home provided a maintenance person. During the course of the inspection it was evidenced that there were some serious concerns around the way in which continence care practice was managed by staff, including taking people to the toilet. (Please refer to standard 8) Staff had sometimes been overheard saying, ‘We are too busy’ or ‘you will have to wait for the carer on your floor to assist you’. These comments could mean that staff numbers may be insufficient. However, the evidence checked including the rotas and feedback from people did not support a view that there were serious staff shortages. However, checking the rota schedules, I noted that one staff member had worked up to 57 hours in one week. Further 9 of 16-day staff were rostered through night duties, up to a maximum of 2 nights per week (11 hours shifts), and 14 of 16 staff undertook up to 3 long days (13 hours) per week. Some of these shift patterns of work may be exhausting for staff and may mean that staff are unable to fully meet the needs of the residents. It was therefore a requirement of this inspection that the home review the care staff rotas to ensure that the shift patterns of work are not onerous or exhausting for staff, to ensure that staff can safely meet the needs of the residents. Feedback received from residents, relatives and the staff group confirmed that they believed there were adequate staff numbers at the home to meet the needs of the residents. Information supplied by the home showed that 7 of 11 carers currently hold a National Vocational Qualification (NVQ) level 2 award or above, which represents 63 of care staff having achieved an NVQ award. Three staff members’ recruitment records checked showed that the home had obtained a Criminal Records Bureau check (CRB) for each staff member. Employees’ records checked also included 2 written references for each staff member, identity checks, and an application form with their former work history and experience. Two applications checked evidenced that the staff members were nurses and were very well trained. The home had also undertaken a Professional Identification Number (PIN) check for each nurse. Copies of relevant training certificates were held on file, and there was evidence that 3 of 3 employees had been given comprehensive ‘in-house’ induction. Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 28 Three staff members’ records checked evidenced that these staff members were very well trained, and were also nurses. Records included that training had been undertaken around moving and handling training, fire, health and safety, pressure relief, personal care training, diversity, sensory training, Osteoporosis, optical training, infection control, dementia awareness, risk assessment, wound care, constipation, food hygiene, and more. As already stated (Standard 18) Adult protection training was required for 2 of 3 staff members. Due to the concerns raised in Standard 8, the staff group were required to be retrained in continence care practices. Feedback received from staff members all thought they received sufficient training to assist the residents, and meet their needs. Feedback received from relatives (11) stated they thought that care staff ‘always or usually’, ‘have the right skills and experience to look after residents properly’. A selection of comments received from residents and relatives about the staff included the following views. “Staff are very kind and attentive”. “The staff have happy smiling faces and are friendly and caring. They give the care and attention to those who need it”. “The general care is good. Staff are pleasant and kind to all, and look after my relatives needs well. They have a hard job to do with so many people in here.” “The care assistants are particularly good and seem to know the residents really well”. Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 29 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): The quality in this outcome area is poor. Due to the vacant managers position, residents could not expect the home to be well managed, which could put more vulnerable residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Currently the manager’s position has been vacant for nearly a year, and this situation is having an adverse effect on the operation of the service. Mrs Mathews, the deputy manager, has been acting manager during this time, but does not want to take on this role long term. The staff group expressed concern that a permanent manager had not yet been found, and recognised the need for this to be resolved. During this time, a number of key concerns have arisen as a result of no permanent manager. These are • No manager, so some loss of in house leadership and direction for the home DS0000024433.V340798.R01.S.doc Version 5.2 Page 30 Leopold Nursing Home • • • • • Some poor care practices have developed, for example, continence care, and issues around lack of dignity and responsiveness towards some residents in the provision of this care Medication concerns as identified by the pharmacist inspector Inconsistent monitoring of accidents / incidents / bruises Staff rostering issues, which need to be reviewed to ensure that staff are not working excessive hours, and which may be having an impact on the quality of the care provision. Quality assurance and monitoring systems failed to identify some serious care practice concerns, medication concerns, and monitoring of accidents and incidents. These systems need to be totally reviewed to ensure that problems are identified at an earlier stage and resolved. The acting manager and staff have maintained the home during this difficult period, but were aware that they personally may not have the skills required to resolve some of these issues. This is a matter for the owners to address with some urgency. Feedback received from residents and relatives do however praise the efforts and care of the staff team. Quality assurance monitoring (QA) was in operation, including receiving customer surveys, accident and incident monitoring and complaints and concerns. However, as stated above, the quality assurance system failed to identify some developing poor care practices. It was therefore a requirement that the home redevelop its QA monitoring systems to ensure that problems are identified at an early stage. Feedback received from residents (16) state that staff were ‘always’ or ‘usually’ available to them when they needed them. Further, relatives (11) expressed the view that the home give the support or care to their relative that they expected. This report also identifies considerable feedback in various sections, where there is expressed satisfaction with the service provided. The home does maintain some residents’ personal money, so a selection of residents’ personal finance records was checked. This evidenced that the cash counted matched the book balance. There were no concerns about the way in which the home managed these personal finances. Records checked and feedback received from staff confirmed they received supervision from the home and supervision records were maintained. Three of 3 staff members’ records identified that they had received supervision and support on a regular basis. Staff records checked showed that staff had received health and safety training, including moving and handling training, fire, food hygiene and infection control. A tour of the premises evidenced that the home was adequately maintained. Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 31 The COSHH cupboard was found unsecured, and which may allow some more vulnerable residents access to harmful substances. This was required to be secured. Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 32 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 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X 3 X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 x 3 3 x 2 Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 33 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 OP4 Regulation 10 Requirement The registered person/s must ensure that appropriate management support is provided for the home’s acting manager, while the manager’s position remains vacant. This is to ensure that appropriate management guidance is provided, and that the home can meet its stated purpose, and meet residents’ care needs. This is an immediate requirement. Timescale for action 22/06/07 2. OP7 OP8 12(1)(a) The registered persons must 22/06/07 ensure that all causes of bruising, accidents, incidents are fully reported, recorded, investigated, and monitored, and when necessary, are referred to appropriate medical personnel for after care. This is to ensure the safety, prevention, and appropriate monitoring of individuals prone to falls and/or bruising. This is an immediate requirement. 22/07/07 3. OP8 13(4)(b)(c The registered person/s must ) evidence that residents identified 13(5) as at ‘higher risk of falls’, what DS0000024433.V340798.R01.S.doc Leopold Nursing Home Version 5.2 Page 34 4. OP8 13(5) 5. OP16 17(2) Sch 4(11) 6. OP18 18(1)(c)(i ) actions and measures they have taken to reduce or eliminate falls occurring again. This is to prevent residents suffering harm, and are kept safe. The registered person/s must 22/07/07 ensure that resident’s who are being hoisted are correctly positioned to prevent them being injured. Further that all obstructions, for example chairs positioned closely together are better placed to ensure good hoisting techniques are used, for resident’s safety. The registered person/s must 22/07/07 ensure that a record of all complaints is maintained at the home, and available for inspection. The registered person/s must 22/07/07 provide retraining for all staff in adult protection procedures to ensure they can identify various forms of abuse, and keep residents safe from harm. 7. OP18 18(a)(c)(i ) 8. OP19 9. OP27 The registered person/s must 22/06/07 provide re-training for all staff around all aspects of meeting residents’ continence care needs. This is to ensure that staff can meet residents care needs in a responsive and dignified manner. This is an immediate requirement. 16(2)(c) The registered person/s must 22/06/07 13(4)(a)(c repair or renew the carpet to ) room 27 to avoid a tripping hazard and so ensure residents’ safety. This is an immediate requirement. 18(1)(a) The registered person/s must 22/07/07 review the care staff rotas to ensure that the shift patterns of work are not exhausting for staff. This is to ensure that staff can safely meet the needs of the DS0000024433.V340798.R01.S.doc Version 5.2 Page 35 Leopold Nursing Home residents, in responsive way. 10. OP31 8 The registered person/s must 22/06/07 take steps to appoint a competent person to the position of registered manager and keep CSCI informed of changes in management arrangements. This is to ensure that the home can meet residents’ overall nursing care needs, by direction from an appropriately qualified and experienced person. This is a repeat requirement, and is immediate. The registered person/s must 22/07/07 redevelop their quality monitoring systems to ensure that any problems identified, are fully addressed. This is to ensure appropriate management monitoring to keep residents’ safe. The registered person/s must 22/06/07 keep the COSHH cupboard secure at all times to ensure residents’ safety. The timescale is immediate. 11. OP33 24(1) 12. OP38 13(4)(a) (c). RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 Leopold Nursing Home DS0000024433.V340798.R01.S.doc Version 5.2 Page 37 - 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!