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Inspection on 13/08/08 for Lickey Hills Nursing Home (2 Units)

Also see our care home review for Lickey Hills Nursing Home (2 Units) for more information

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Staff address residents by their preferred name and in a kind and sensitive way. Regular visits are made to the home by two general practitioners from the local practice. Varied and well-balanced menus are provided each day for residents to choose from and specialist diets are provided as required. The home provides transport for residents to get out and about in the community, which is suitable for residents in wheelchairs. A daily programme of activities is provided which includes group activities for residents to choose from. Multi-denominational church services take place in the home once a week. One to one social care is provided for residents who are frail and spend a lot of time in bed. A monthly newsletter is written by one of the residents to keep everyone informed about what is going on in the home. Regular meetings are held with residents in the home to make sure they `have a say` in the running of the home. A resident from the home represents this and other homes for older people owned by the provider at national meetings to make sure residents contribute and have `a voice` in how they wish to see the service improved. Visitors are made welcome in the home and are able to see residents in the privacy of their room. The home has a complaints procedure and the manager records complaints received and the outcomes so that the information can be used as part of the quality review of the home. Criminal Records Bureau checks are carried out for all new staff prior to appointment to ensure residents are protected from harm. Satisfactory numbers of staff are employed to provide the care for the residents. The home employ male and female staff from a multi-cultural background. Staff undertake an induction programme upon employment and ongoing mandatory and other training including the opportunity to study for a National Vocational Qualification. Residents are able to manage their own monies and the home also holds monies for residents and are able to act as appointee, which they do for one resident. This is managed very well and the records are well maintained.

What has improved since the last inspection?

CARE HOMES FOR OLDER PEOPLE Lickey Hills Nursing Home (2 Units) Warren Lane Rednal Birmingham West Midlands B45 8ER Lead Inspector Sandra J Bromige Key Unannounced Inspection 13th August 2008 08:45 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 Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.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. Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lickey Hills Nursing Home (2 Units) Address Warren Lane Rednal Birmingham West Midlands B45 8ER 0121 445 5532 0121 447 7835 lickey.hills@craegmoor.co.uk www.craegmoor.co.uk Parkcare Homes Ltd 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) Mrs Christine Alexander Care Home 97 Category(ies) of Dementia - over 65 years of age (47), Learning registration, with number disability (4), Old age, not falling within any of places other category (97), Physical disability (3), Physical disability over 65 years of age (97) Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Category LD is restricted to persons over 50 years of age. Date of last inspection 27th February 2008 Brief Description of the Service: Lickey Hills Nursing Home is situated in a picturesque area of Barnt Green close to the Lickey Hills visitors centre. It comprises of two units, one catering for the elderly physically frail (Cofton Unit) and the other for people who have care needs arising from dementia related illnesses (Rednal Unit). Both units offer facilities for male & female residents who require nursing care. Both units are on two floors and all rooms, single and shared have en-suite facilities. This report reflects inspections of both of the units in the home as it is registered as one service. Up-to-date information relating to the fess charged for this service is available on request from the home. Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Since the last Key Inspection in February 2008 we, the commission carried out a random unannounced inspection of the service on 28th May 2008 to check compliance with four requirements made at the Key Inspection relating to care records and healthcare of residents. The findings of the inspection showed poor quality of care and care records. One requirement had been met relating to the use of risk assessments for bedrails. We issued two Statutory Requirement Notices relating to the health and welfare of residents and residents care records. A random unannounced inspection took place on the 25th July 2008 to check if the home had complied with the Statutory Requirement Notices. The findings of the inspection showed action had been taken by the service to reduce the potential risk for residents and they had complied with the Notices. We carried out an unannounced Key Inspection on 13th August 2008. Due to the short timescale between the inspections in July and August the findings from the inspection in July have been included in this report. The Key Inspection took place over one day by an Inspector and a Pharmacist Inspector. A Key Inspection is where we look at a wide range of areas. To help us plan the inspection we looked at information we have received since the last Key Inspection from any notifications sent to us by the home, information from other health and social care professionals and the improvement plan submitted by the provider. During the visit to the home care records, staff records and other records and documents were inspected. There was a tour of parts of the accommodation and interviews with staff, including the manager and other senior staff. Time was spent speaking privately with residents in their rooms as well as spending time out and about in the home observing what was happening and talking to residents and their relatives. We have not received any concerns or complaints about the home since the last Key Inspection. There has been one safeguarding referral since the last Key Inspection, relating to care of an identified resident. This is being investigated by Worcestershire County Council, who are the lead agency for safeguarding people. Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.R01.S.doc Version 5.2 Page 6 What the service does well: Staff address residents by their preferred name and in a kind and sensitive way. Regular visits are made to the home by two general practitioners from the local practice. Varied and well-balanced menus are provided each day for residents to choose from and specialist diets are provided as required. The home provides transport for residents to get out and about in the community, which is suitable for residents in wheelchairs. A daily programme of activities is provided which includes group activities for residents to choose from. Multi-denominational church services take place in the home once a week. One to one social care is provided for residents who are frail and spend a lot of time in bed. A monthly newsletter is written by one of the residents to keep everyone informed about what is going on in the home. Regular meetings are held with residents in the home to make sure they ‘have a say’ in the running of the home. A resident from the home represents this and other homes for older people owned by the provider at national meetings to make sure residents contribute and have ‘a voice’ in how they wish to see the service improved. Visitors are made welcome in the home and are able to see residents in the privacy of their room. The home has a complaints procedure and the manager records complaints received and the outcomes so that the information can be used as part of the quality review of the home. Criminal Records Bureau checks are carried out for all new staff prior to appointment to ensure residents are protected from harm. Satisfactory numbers of staff are employed to provide the care for the residents. The home employ male and female staff from a multi-cultural background. Staff undertake an induction programme upon employment and ongoing mandatory and other training including the opportunity to study for a National Vocational Qualification. Residents are able to manage their own monies and the home also holds monies for residents and are able to act as appointee, which they do for one resident. This is managed very well and the records are well maintained. Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? Residents’ contracts have been reviewed to include information about the nursing care contributions and how these affect the fee paid by the resident. Pre-admission assessments carried out before residents are admitted are more comprehensive to make sure the home are able to meet the residents care needs. Care records have improved to make sure they include details of care to be provided so that staff understand what is required and residents can be sure their needs are met. Care records are being reviewed and updated when there is any change in care needs so residents can be sure their needs are met. Nutritional risk assessments are being done when residents move into the home and the outcome is being used to inform care planning to make sure their dietary needs are provided and they are not at risk of harm. If residents cannot manage their medicine, the home supports them with it in a safe way. Records show medication is being stored at temperatures between 24-27°C, which is just within the safe storage limit for medication. This means that people who use the service are no longer at risk of being given medication that has been stored incorrectly. The service was undertaking regular checks on resident’s medication. We saw that medication was counted daily using a running stock balance. This was commended as good practice. The home has increased the numbers of staff employed to provide activities for residents from two to three staff so that there is more opportunity for residents to engage in their hobbies and interests. Money has been provided for extra flowers in the gardens to make them more pleasant. The home’s menus have been reviewed following consultation with residents. Eleven new specialist beds and 14 low beds have been purchased to provide more comfort for residents and to reduce the risk of harm. New weighing scales have been purchased which fit onto the hoist so that staff can monitor more accurately the weight of residents who are very frail and may be at risk of malnutrition. More staff are being recruited to reduce the use of agency staff. Residents are starting to become involved in interviewing and selecting staff to work in the home so they are involved in the choice of who they want to care for them. The communication between staff has improved through daily meetings between the manager and nurses in charge of each unit and weekly staff meetings. More frequent and robust audits of care plans and medication is taking place. This has improved the care provided to the residents in the home. Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Comprehensive pre-admission assessments are being carried out by the staff to make sure that they can safely meet the resident’s needs and to enable them to formulate a clear and accurate care plan prior to admission. The organisation has reviewed their contract to make sure residents are aware of how nursing contribution payments are managed. The service does not provide intermediate care. EVIDENCE: The contract has been reviewed to give information to new residents about the nursing care contributions and how these payments are managed as part of the weekly fees. The provider has written to existing residents to make sure they are aware of how the nursing contribution payments are incorporated as part of their current fees. Pre-admission assessments were seen for residents’ case tracked. A preadmission assessment carried out for a resident who had been admitted to the Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.R01.S.doc Version 5.2 Page 11 home seven days before the inspection visit was seen. This assessment was comprehensive enabling the staff at the home to formulate a care plan prior to admission of the resident. Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been considerable improvement in the care records, which ensures residents health, and social care needs are being provided consistently and safely by the staff caring for them. If residents cannot manage their medicine, the home supports them with it in a safe way. Some improvement is needed to ensure all residents privacy and dignity is maintained at all times. EVIDENCE: Positive outcomes were seen for the two residents case tracked, for example they were well dressed and nicely presented. They were very chatty when spoken with and one resident told us they ‘like it here and do not wish to leave’. The four staff spoken with had a much more comprehensive understanding of the needs of the residents and we were told ‘care plans have improved, we are able to understand the care needs of the residents’. Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.R01.S.doc Version 5.2 Page 13 Some further improvement is needed. For example, pressure area care charts for one resident are not always showing they are moving the resident at the frequency that is stated in the care plan. The eating and drinking care plan for the resident lists food the resident dislikes, although the food chart shows these foods have been given to the resident. Two staff spoken with were not aware of all of the food likes and dislikes of this resident. The moving and handling risk assessment did not state the equipment needed to assist the resident to mobilise, although it was in the care plan. A resident had been readmitted to the home and a number of the care plans had not been reviewed until seven days after readmission. Residents and relatives spoken with expressed their satisfaction with the care provided. They told us they were ‘quite happy’, staff are ‘very good to the patients, look after them’. ‘Always very nice and clean’, ‘wash her hair twice a week’. ‘They ring me if anything happens’. ‘X had been losing weight, now on nutritious drinks’. ‘Marvellous’, ‘could not do better’. At the last Key Inspection, we had noted that the medication room in Rednal unit had been too hot for the safe storage of medication. We looked at the current daily records for the temperature of the room, which stated that the temperature ranged from between 24-27°C, which is just within the safe storage limit for medication. We also saw that an extractor fan was in operation, which may help in keeping the temperature at safe levels. This means that people who use the service are no longer at risk of being given medication that has been stored incorrectly. We looked at the medicine records, which were documented either with a signature for administration or with a code to explain why the medication was not administered. Overall the recording and documentation of the medicine charts was clear. This means that the medicine records were kept up to date and current and therefore the health and welfare of people who use the service were safeguarded. There was evidence that the service was undertaking regular checks on resident’s medication. We saw that medication was counted daily using a running stock balance. This was commended as good practice. The manager also informed us that spot checks were also done to ensure that residents were being given their medication. The dates of opening of medication were recorded and balances of medication were recorded and carried forward onto a new medicine record chart. This means that it was possible to check if medication had been given as prescribed by a medical practitioner and is seen as good practice. We looked at four individual care plans relating to medication. Two of the care plans did contain up to date information relating to medication. For example, we saw one care plan with an entry dated 22/7/08, ‘seen by Dr X as new admission and has prescribed movicol sachet as X complains of constipation’. Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.R01.S.doc Version 5.2 Page 14 It was therefore disappointing that two of the care plans contained very little recorded information relating to the individual residents medication details. For example, we saw one resident had been prescribed a medicine to calm and control their behaviour, which was written as ‘Take one 5ml spoonful twice a day when required’. The medicine record documented that it was being administered twice a day on a regular basis. The care plan seen did not document or provide information on when it should be administered for the benefit of the resident’s health and well-being. We spoke to the manager on the unit who agreed that there should be information relating to medication in a care plan. A second example of a lack of information in a resident’s care plan related to an alternative medication that had been provided by a relative. The manager on the unit told us that the general practitioner had been informed about the tablets and had agreed that it was all right to give, however this information was not recorded in the care plan. Overall the care plans seen did not always contain specific written information relating to medication and the specific healthcare needs of the residents. We observed staff speaking to residents in a kind and respectful manner and doors were closed when staff were assisting with personal care. A resident told us staff ‘never enter the room until they knock and wait to be invited in’. A resident told us they have not been asked if they prefer a male or female carer to assist them with their personal care. The resident told us they would prefer the same gender carer as them to help them with their personal care. In Rednal unit a list of all the residents’ names and the type of incontinence products used is on display in the communal toilet, this does not maintain the privacy and dignity of the residents. Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are treated as individuals and the home supports residents to follow personal interests and activities within their individual disabilities. Residents are able to keep in touch with their family, friends and representatives. Residents are consulted about the meals and are able to choose meals from a varied and nutritionally balanced menu. EVIDENCE: The home has increased the number of staff employed for the provision of social care and activities since the last Key Inspection. There is now three staff actively involved in the arrangement, support and delivery of activities to the residents. Social care plans have improved since the last inspection and they contain activity programmes, although these programmes are not currently person centred and this needs developing so that they show the planned one to one social care for each resident. The day’s activities are on display in both units. A resident told us they ‘can do anything I want’. The home has a resident who represents ‘the voice’ of older people from 46 care homes for older people owned by the provider. This resident is supported to communicate with residents from other homes via Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.R01.S.doc Version 5.2 Page 16 email and the home has provided a mobile telephone so residents can contact him directly. On the day of the inspection the resident attended a national ‘Your Voice’ forum meeting with a member of staff from the home. The resident told us some of the changes that have taken place in the home and nationally due to consultation with residents through this forum. For example, they have been given extra money for flowers in the garden, menus have been changed, prospective staff whose first language is not English have to undertake an English language test and residents will start becoming involved in the recruitment and selection of staff for the home. Relatives told us it’s ‘part of the care plan to get X in the garden’ and they confirmed their relative has the opportunity to attend religious services. The day’s menu was displayed at the entrance to the home and in each unit. This showed a choice of meals. We observed the service of meals in two units. Staff were observed offering choice and supporting and assisting residents to eat in a discreet and sensitive manner. Relatives told us the food is ‘very good’ and they ‘had a meal with X yesterday’. Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives are able to express their concerns, have access to a robust, effective complaints procedure and are protected from abuse. EVIDENCE: The home’s complaints records show they have received two complaints since the last Key Inspection in February 2008 and these have been investigated and resolved to the satisfaction of the complainants. It is recommended the home enter the date the action and outcome of complaints are resolved. The home’s complaints procedure is on display in the home. Relatives told us the staff are ‘all approachable’ and they are ‘able to voice concerns’ and the home ‘would listen’. We have not received any concerns or complaints about the home since the last Key Inspection in February 2008. The training records show there are some staff who have not received any training about safeguarding residents, although some of these staff have NVQ level two which includes this subject and the training plan on display in the home shows training is planned for later this month and in September. Staff spoken with were clear about the home’s policies on reporting suspected abuse and felt bale to raise concerns. They told us ‘you can talk to the manager about anything’. Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.R01.S.doc Version 5.2 Page 18 There has been one safeguarding referral since the last Key Inspection, relating to care of an identified resident. This is being investigated by Worcestershire County Council who is the lead agency for safeguarding people with the co-operation of the home. Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment is safe, comfortable and generally well maintained. Parts of the home are in need of re-decoration to make a more pleasant environment for the residents. The laundry room is small for the numbers of residents in the home and is located in a room in the middle of the dementia care unit which increases the risk of fire for those residents and the amount of ‘human traffic’ using that corridor of the Unit. EVIDENCE: The manager told us there has been no progress with the re-decoration programme since the last inspection with the exception of bedrooms being ‘tidied up’ before new residents are admitted. From observation it is evident some parts of the home are looking very tired and are in need of refurbishment. On the dementia unit (Rednal) there is a Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.R01.S.doc Version 5.2 Page 20 strong smell of urine when you enter and some bedrooms have bad odours. The dining room and lounge areas lack space and the lounge carpet is badly stained. Some communal facilities for residents seen at the last inspection that were badly in need of decoration remain in the same condition, such as the toilets on Cofton unit downstairs by the dayroom and the sluice and toilets by the dayroom on Rednal unit. These have been identified on the redecoration programme as being in “desperate need of redecoration”. These areas increase the risk regarding the potential for cross infection and due to their current state of repair e.g. tiles broken and missing, coving coming away from the wall need to be addressed as soon as possible. A clinical waste bin is situated adjacent to a communal toilet on Rednal unit, this needs to be moved to another location as it is unpleasant for residents. A recent internal Clinical Governance audit carried out in May 2008 highlighted ‘dining facilities on Rednal were very cramped’ and recommended this is reviewed and ‘the facilities downstairs are quite crowded’. More pictures are needed in some rooms particularly on Rednal. A relative told us the carpet in the lounge on Rednal unit ‘needs a major clean’. There have been no changes to the laundry since the last inspection. The laundry room is situated within the dementia care unit. The access to this facility is in constant use and leads out onto the corridor where residents are walking up and down most of the day. This has the potential to place residents at risk of harm. Despite the continued lack of space in the laundry for this 97 bedded home the staff do a good job. It is strongly recommended that this facility is relocated elsewhere on the site and will enable the development of further communal space for the residents in this specialised dementia unit. Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, and in sufficient numbers to support the people who us the service. Recruitment practices need to be more thorough to ensure residents can be confident staff are suitable to care for them. EVIDENCE: The home employs male and female staff from a multi-cultural background. On the day of the inspection the staffing levels were satisfactory with a good ratio of male and female staff on duty in both units. The manager told us a new clinical manager for the dementia unit who is a registered mental health nurse is starting work at the home full time next week. There is some use of agency staff at the time of the inspection. Discussion with relatives confirmed there is ‘enough’ staff on duty. A resident told us the ‘majority of staff are very good’ and communication with staff has been discussed due to staff being employed from a multi-cultural background. The provider has addressed this, as new staff are required to carry out an English literacy test. They told us the home ‘have been recruiting new staff’ and residents ‘will be involved in interviews in the future’ as they ‘should have a choice of staff’. Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.R01.S.doc Version 5.2 Page 22 The manager told us, and the training statistics confirm that 40 of the care staff have completed NVQ level two. It is evident from information on a notice board in the dementia unit, person centred care planning and dementia awareness training is planned for a date later this month. Three staff recruitment files were seen. They contained all the information required with the exception of a file which showed the employment reference was not received by the provider until two days after the employee started work at the home and gaps in the employment history for another employee had not been explored at interview. This needs addressing as it has the potential to place residents at risk of harm. Written evidence of induction training was seen for care staff although there was no written evidence seen of induction training for a nurse. The area manager told us they did not have a written induction programme for nurses but this has been addressed since this person started work at the home. The nurse told us they received a two-week induction when they started work at the home and the staff rota for that period confirms this. The manager told us the provider revised the induction programme for staff in January 2008. They showed us the new induction programme. This does not include any information for staff about the Mental Capacity Act. The area manager told us managers are receiving training about the Mental Capacity Act in September and this will then be ‘rolled out’ to staff in the home. Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has the necessary qualifications and experience to manage the home. The management and training of staff has been addressed to ensure care records are being written and reviewed and person centred care planning and delivery is put into practice throughout the home to ensure that the health, safety and welfare of residents is promoted and protected. If residents are unable to manage their money, it is managed by the home in their best interests. EVIDENCE: The manager has been in post for seven years. She is a registered nurse and has successfully undertaken her Registered Managers Award (RMA). Since the last inspection she has undertaken an update on nationally recognised health Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.R01.S.doc Version 5.2 Page 24 and safety training and wound care, but has not received any training on the Mental Capacity Act. The area manager told us this is being addressed in September. A resident told us the ‘manager is very good, listens, absorbs and acts’. Since the last Key Inspection action has been taken by the provider and home manager which has improved the communication between staff and they have increased the frequency of internal audits for care plans and medication which has achieved positive outcomes for the residents living in the home. Nurses meet with the manager on a daily basis and weekly staff meetings are taking place with minutes maintained. The area manager told us she is currently visiting the home each week to support the manager and assess the home’s progress in improving standards for the residents. As part of their quality audit process the provider has carried out a thorough audit of the home in May 2008 and it is evident from the action plan seen the home have completed two thirds of the action points to date. Staff and relatives told us questionnaires have just been sent out to relatives and residents. A sample of the questionnaire for relatives and residents were seen. The area manager told us the policies and procedures identified as being in need of review or development at the last Key Inspection have been addressed with the exception of one policy which is overdue review. Administration staff told us they continue to act as appointee for one identified resident and no changes have been made to their process for managing this resident’s money since the last inspection. The last Key Inspection in February showed this ‘account was well managed and receipts were available for purchases made’. Records for the management of fire were seen and weekly and monthly checks were recorded. Records show an external contractor monitors the home’s management of Legionella. A copy of the current staff training matrix was seen. have not received all of the core mandatory training. display in the entrance of the home shows training is and safety and moving and handling later this month This shows some staff The training plan on planned for fire, health and in September. Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 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 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP9 Good Practice Recommendations It is recommended that there is a documented protocol available which describes the care to be given to residents who could become agitated or aggressive. This must include details for the administration of medication prescribed ‘when required’ for behaviour management. Residents should be consulted regarding their preference of gender of care staff. It is strongly recommended that the home review the laundry provision with particular regard to its location and size. Thorough and robust recruitment records should be kept in the staff file to demonstrate that any employment gaps or issues that arise through the recruitment process are explored at interview to ensure that residents are fully protected. Information about the Mental Capacity Act should be included in the induction programme for all staff to ensure DS0000004122.V370144.R01.S.doc Version 5.2 Page 27 2 3 4 OP10 OP19 OP29 5 OP30 Lickey Hills Nursing Home (2 Units) 6 OP38 that residents’ rights are maintained and respected. The home should ensure all staff receive training appropriate to their role at regular intervals to ensure residents and staff working in the home are not placed at risk of harm. Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Lickey Hills Nursing Home (2 Units) DS0000004122.V370144.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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