Inspection on 20/07/09 for Lickey Hills Nursing Home (2 Units)

This inspection was carried out on 20th July 2009.

CQC found this care home to be providing an Poor service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lickey Hills Nursing Home (2... 04/03/10

Lickey Hills Nursing Home (2... 01/12/09

Lickey Hills Nursing Home (2... 13/08/08

Lickey Hills Nursing Home (2... 27/02/08

Lickey Hills Nursing Home (2... 30/05/07

Lickey Hills Nursing Home (2... 20/06/06

Lickey Hills Nursing Home (2... 02/09/05

Lickey Hills Nursing Home (2... 26/07/05

Lickey Hills Nursing Home (2... 10/02/05

Lickey Hills Nursing Home (2... 08/09/04

Lickey Hills Nursing Home (2... 22/01/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Lickey Hills Nursing Home (2 Units) Warren Lane Rednal Birmingham West Midlands B45 8ER Lead Inspector Sandra Bromige Key Unannounced Inspection 20th July 2009 08:55 DS0000004122.V376602.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.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) Manager post vacant Care Home 97 Category(ies) of Dementia (47), Old age, not falling within any registration, with number other category (97), Physical disability over 65 of places years of age (47) Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability - over 65 years of age (PD(E)) 47 Old age, not falling within any other category (OP) 97 Dementia (DE) 47 The maximum number of service users who can be accommodated is: 97 Age: Dementia (DE) age 55 and above. 2. 3. Date of last inspection 13th August 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 fees charged for this service is available on request from the home. Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.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 zero star. This means the people who use this service experience poor quality outcomes. This was an unannounced inspection. Two inspectors spent one day at the home and a second day by one inspector, talking to people who use the service and the staff, and looking at the records which must be kept by the home to show that it is being run properly. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. We looked in detail at the care provided by the home for four people. This included spending time observing the care they receive, discussing their care with staff, looking at care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. The service had previously completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. Some of the services comments have been included within this inspection report. We also received completed survey forms from people who use the service, their relatives, staff working at the home and health professionals who work with the home. The information from these sources helps us understand how well the home is meeting the needs of the people using the service. Some of the comments from the surveys have been included within this inspection report. We have not received any complaints about the service since the last inspection. There have been six safeguarding incidents since the last inspection which have been referred to Worcestershire County Council who are the lead agency for co-ordinating allegations of abuse. The outcome of two incidences have not been upheld and the outcome of another found shortfalls in care. Three safeguarding investigations are not concluded. At the time of the inspection the interim manager advised us of a recent referral they had made to Worcestershire County Council. Two days following the inspection we received a notification from the home regarding an incident of physical abuse between two people who use the service, which took place in early July 2009. This had not been referred to safeguarding by the home. Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.R01.S.doc Version 5.2 Page 6 What the service does well: The home provides comprehensive information for people to look at before they decide to begin using the service. This information is available in different formats to meet the diverse needs of the people they provide a service for, for example, large print, easy read and audio versions. Peoples needs are assessed before they move into the home to enable the home to find out all about them, and the support they will need. Staff address people who use the service 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. A choice of menus is provided each day for people to choose from. The home provides transport for people to get out and about in the community, which is suitable for people in wheelchairs. Multi-denominational church services take place in the home once a week. A person who uses the service represents this and other homes for older people owned by the provider at national meetings to make sure people are able to 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 people in the privacy of their room. The home has a complaints procedure and the manager records complaints received. Criminal Records Bureau checks are carried out for all new staff prior to appointment to ensure people are protected from harm. The home employs 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. People who use the service are able to manage their own monies and the home also holds monies for people and is able to act as appointee, which they do for one person. This is managed very well and the records are well maintained. What has improved since the last inspection? The service have reviewed and evaluated their person centred care planning documentation and included care specific care plan documentation to allow for Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.R01.S.doc Version 5.2 Page 7 more specific assessment. New privacy curtains have been put into bedrooms to increase the privacy for people who share a bedroom. Some bedrooms have been redecorated; ventilation fans have been installed to help maintain a fresh and odour free environment. The car park has been resurfaced. What they could do better: Care plans need to be improved to make sure they have enough information for staff to understand the care people require. They need to be reviewed as peoples needs change so that people can be sure their needs will be met. The health and social care needs of the people who use the service need to be promoted and staff need to act upon outcomes of assessments and instructions from health professionals to ensure people are not placed at risk of harm through neglect of care. Improvement is needed to the storage and management of medication to ensure medicines are being stored safely and securely and they do not deteriorate which can make the medication ineffective and possibly harmful to the people who use the service. They should review the adequacy of the size of the laundry and the safety of its location in the home, including consideration to the health and safety of the people who work in the laundry. They need to provide the correct numbers and skill mix of qualified and unqualified staff to meet the needs of the people who use the service; so that people can be confident their health and social care needs will be met. More thorough records should be kept for the recruitment of staff for example showing in the records of interviews that the home has explored any gaps in employment history to ensure people are fully protected from any potential harm. Staff should receive training about new legislation which impacts on the care of people who lack mental capacity to ensure they have a clear understanding of how this impacts on the care of the people who use the service. Where the home is holding larger sums of money for people, they should transfer this money to an individual higher interest bearing account so that they ensure they are acting in the best interests of people at all times. Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.R01.S.doc Version 5.2 Page 8 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.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.V376602.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed before they move into the home to enable the home to find out all about them, and the support they will need. The service does not provide intermediate care EVIDENCE: Pre-admission assessments were seen for the people whose care we case tracked. One person had moved into the home two weeks prior to the inspection. The pre-admission assessment had been carried out before the person moved into the home. Overall this was well completed and the current medication for this person was listed on the assessment form, but the frequency that it was given had not been completed. Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.R01.S.doc Version 5.2 Page 11 The Annual Quality Assurance Assessment (AQAA) submitted by the service prior to the inspection states prospective service users aspirations and needs are assessed using the company assessment tool. The home provides comprehensive information for people to look at before they decide to begin using the service. This information is available in different formats to meet the diverse needs of the people they provide a service for, for example, large print, easy read and audio versions. Surveys completed by people who use the service told us they received enough information before they started using the service. Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples healthcare needs are not being met and medication is not being stored safely which places people who use the service at risk of harm. Peoples dignity is not being maintained at all times. EVIDENCE: We tracked the care of four people who use the service and we found some poor outcomes of care for these people. For example, the skin care plan for one person had not been completed until six days after they started using the service. The care plan stated the person needed to sit on a special cushion to prevent them from developing pressure sores. This person was not sitting on a pressure relieving cushion. We spoke to care staff who told us they were not aware this person needed any special equipment to relieve pressure when sitting and they told us they only move them for meals. Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.R01.S.doc Version 5.2 Page 13 The appearance of some people was poor. For example, one person we spoke with kept pushing their hair away from their eyes and face as it was too long. Glasses were smeared and cloudy. Some ladies hair appeared not to be styled and completely flat at the back, they had facial hair and dirty fingernails. Surveys completed by relatives of people using the service told us the cleaning of spectacles is not always done. Hair sometimes needs attention. People were not receiving regular baths or showers. Trained and care staff told us they record the baths and showers in a book which we looked at. There was no information to show that one person we tracked had received a bath or shower since they moved into the home two weeks ago and for another person their last recorded bath or shower was 14th March 2009. There were no recorded baths or showers since 16th July 2009, four days before the inspection. We spoke to trained and care staff who told us they are not able to do baths especially at weekends, but also in the week, and they had to cancel baths and showers due to shortage of staff at weekends. There are no baths when short staffed and unable to give nail care. The care plan for one person showed they were losing weight and staff needed to weigh them every week. The persons last recorded weight was 1st July 2009. This person was prescribed food supplements by the general practitioner due to weight loss. We looked at the medication records for this person and could see the one food supplement was being given as prescribed, although the other food supplement called fortisip was not on the medication records and there was only one entry on the persons food/fluid intake records dated 20th July 2009 showing this had been given. We asked for the records of this persons food and fluid intake prior to the 19th July 2009, but the nurse was unable to locate them. We asked the trained nurse if this person was having a diet high in protein including snacks between meals. The nurse told us this person was having a normal diet the same as the other residents, they are given biscuits between meals, but is not on a high protein diet. We asked the chef if they were providing any high protein diets for Rednal unit and they told us they were providing none at the moment. The communication care plan for one person stated the staff needed to check their eye sight each day using a board with vertical lines on it. If the person saw wavy lines for three consecutive days the staff needed to make an urgent appointment with the eye surgeon. There was no recorded information to show this eye test had been carried out by the staff since March 2009. We saw a document in a care plan called a depression assessment. The last entry on the assessment was dated April 2009 and recorded an outcome of mildly depressed. The record showed an assessment on 28th January 2009 and 28th March 2009 also showed the outcome as mildly depressed. The record states as an action point, referral to General Practitioner and complete care plan. We could see no information to indicate this person had been referred to the General Practitioner and there was no care plan for the management of depression. Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.R01.S.doc Version 5.2 Page 14 We saw a skin care plan for a person which showed they had a dressing on their bottom which needed changing every two to three days. This care plan had last been reviewed on 13th June 2009. A pressure sore care plan had an entry dated 17th July 2009 with an action plan prescribing the dressing in use and the frequency they were to be changed. There was an entry dated 19th July 2009 stating this person had no broken areas and sudocrem was being applied, but the skin care and pressure sore care plan had not been reviewed and updated following these findings. We looked at how medication is being managed for the people whose care we tracked. One person was prescribed tablets for pain to be given when required. There was no care plan for the management of pain for this person providing information on when it should be administered for the benefit of the persons health and well-being. The management of medication prescribed as when required was highlighted in the last inspection report dated 13th August 2009. We saw a list of this persons medication which had been sent to the pharmacy by the home. The list stated this person was taking Fortisip 200ml twice a day. This was not on the medication chart. We asked one of the trained nurses and they told us this person was being given the Fortisip. Another trained nurse told us the person was not being given the Fortisip. We asked to see the previous weeks medication charts, but we were told they could not be located. We saw the code O used on a medication chart for not giving the medication, which means other but there was no reason recorded for not giving the medication. We carried out an audit of this medication. The staff had recorded the amount of medication received on the medication chart and there were 14 times recorded when the medication was refused. There were 12 more tablets remaining than there should have been. The trained nurse told us this is because they ask the person if they want their medication. This is poor practice and is not in line with the homes medication procedures. The medication should be dispensed and shown to the person as they have dementia as they would not be able to make a meaningful decision whether to take it or not if they were just asked. We observed two trained nurses giving out medication on Rednal unit at lunchtime. One nurse was dispensing the medication and the second nurse was administering to each person and they changed roles at times. The nurse dispensing the medication was not always able to see and witness the medication being given to the person, but they were signing the medication chart to indicate it had been given to the person it was prescribed for. This is poor practice. We looked at the storage of medication on Rednal unit as previous inspections had raised concern about the temperature of the rooms where medication was being stored. The records of the temperature of these two rooms showed recorded temperatures of 29 degrees Celsius over a number of consecutive days in March and April 2009. This is four degrees above the maximum temperature recommended by the manufacturers, which means medication can be harmed at these temperatures. We saw a medication audit carried out by the home in April 2009, which highlighted the temperature of the rooms being above 25 degrees Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.R01.S.doc Version 5.2 Page 15 Celsius. There was no action plan from this audit. Records showed that medication which needed refrigeration was being stored within the correct range of temperatures. We saw some cream and eye drops which were in use but there was no date of opening on the packaging. There was an empty oxygen cylinder in the medication room. The nurse told us it belonged to a person who no longer lives at the home. This needs to be returned. We looked at the management of controlled medication. The records were correct. The controlled drug cabinet does not meet the Regulations as it is screwed to a partition wall. We observed staff speaking to people respectfully. Staff knocked on bedroom doors before entering and doors were closed whilst carrying out personal care. The AQAA states gender preference for personal care tasks documented in care plans, which we saw in some but not all care plans for the people tracked. The AQAA also stated shared rooms have new privacy curtains. We saw the privacy curtains in the shared rooms for people we tracked. There was one room where the curtains did not fully enclose both beds. A survey completed by two health professionals stated staff usually or sometimes respect the privacy and dignity of the people who use the service. Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The social and nutritional care is not based on a person centred approach to care to ensure people receive the stimulation and nutrition they require in order to meet their care needs and protect them from harm. EVIDENCE: The home has reduced the number of staff employed for the provision of social care and activities since the last key inspection in August 2008. We saw social care plans and activity programmes for the people we tracked. The social care plans and life histories are informative. The activity programmes as stated in the last inspection report are not currently person centred and this needs developing so that they show the planned one to one social care for each person. One persons care plan clearly indicated the persons personal preferences where they like to entertain their visitors. It lists this persons hobbies and interests and the activity programme indicates this persons preference for activities, but it was clear from reading the care plan this was not up-to-date and needs reviewing. We spoke to the activity co-ordinator on Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.R01.S.doc Version 5.2 Page 17 duty. She told us she was providing activities on Cofton unit in the morning and Rednal unit in the afternoon. She told us they try to focus on people as individuals and ensure activities also focus on specific interests for male and females. In the afternoon, we spoke to three people sitting in the lounge on Cofton unit. One person said they hadnt done much all day when asked. They said they had been sat in the chair all the time and it was boring. Two other people told us they had been sitting in the lounge most of the day. We spent two hours in the afternoon on Rednal unit observing four people in the lounge and recording what we observed. The activity co-ordinator had put a CD of music on to play and left the room. The music stopped and there was no music playing for 20 minutes until the activity co-ordinator came back into the lounge and changed the CD. We observed the activity co-ordinator engaging with three people on a one to one basis with activities. None of the care staff tried to engage in any social activities with the people in the lounge. One person went out into the garden for a period of 20 minutes and the patio doors were closed behind them. No one appeared to check to see if this person was alright whilst in the garden and a visitor got up and let them back into the lounge. Afternoon tea and biscuits were served during this period. One person was slumped in their chair and was drifting in and out of sleep. We saw a trained nurse sit next to this person and feed them a fortified mousse. They did not attempt to sit this person up prior to giving them food and did not engage in any conversation with them as they were engaging in conversation periodically with staff in the dining area. Two people we observed were not offered an afternoon drink. Care staff told us they do not do any social activities with the people who use the service. A staff survey told us they need more staff to do activities with residents as the carers that are on havent got the time with all the duties they do. The care plan for one person we tracked stated they like to eat alone. We observed this person sitting at a dining table with other people at lunchtime. Staff told us on Rednal unit two carers give out the breakfast. The residents do not have a choice to eat breakfast in their bedroom, they all have to be washed and dressed and brought to the day room. Breakfast is not completed until 11.30hrs; it starts at 09:15am. Lunch is served at 12:30hrs. We observed staff serving lunch on Rednal unit. The menu had been changed to bubble and squeak instead of cauliflower cheese. There was vegetable soup and a choice of sandwiches, although the sandwiches were all made with white bread. People were sitting at the dining tables and in the lounge. We saw staff giving people a choice of meals and deserts. Staff were assisting people to eat on a one to one basis in a sociable manner. Staff told us they have 21 people on this unit who need assistance with meals; there were eight staff available during lunchtime, as two trained staff were giving out medication. Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.R01.S.doc Version 5.2 Page 18 A high protein diet was not being provided for one person we tracked who was losing weight. The chef told us they are not providing any high protein diets for Rednal unit at the time of the inspection. Staff told us they offer people biscuits between meals, which we observed, although no one was offered any high protein snacks or other finger foods between meals. People told us the food has improved a little and the home are currently consulting people about the menus provided. One person told us they were concerned about carers chatting to each other whilst assisting people with meals and intended to raise this at the meeting with the interim manager this week. We spoke to one person who told us about not being able to swallow food easily. We noticed they did not have any teeth. Staff told us this person likes to have soup and often asks for it. There was no reference to food consistency in this persons care plan to indicate there may be a need for softer food due to not having any teeth. There did not seem to be any acknowledgement by staff that this person asks for soup because it might be easier for them to eat. Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns with their care, they or people close to them know how to complain. Outcomes of complaints are not being recorded so people cannot be confident they are fully addressed by the home. Staff need training about safeguarding people and procedures to follow when incidences of abuse occur in the home to ensure people are being protected from harm and neglect. EVIDENCE: The AQAA submitted by the service states they had received nine complaints in the last 12 months. The outcome of the complaints was not given. We looked at the complaints records held in the home. It was evident there had been considerably more than nine complaints in the last 12 months. The outcomes of complaints are not being recorded, which does not enable the home to use this information as part of the internal quality assurance monitoring. This was discussed with the Clinical Governance manager at the time of the inspection and she agreed the format for recording outcomes needed to be reviewed. Surveys from people who use the service told us two out of the three received knew how to complain. All staff spoken with were aware of the homes complaints procedures. The complaint procedure is available in various formats suitable for the people they provide a service for, for example, easy read, large print and audio versions. Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.R01.S.doc Version 5.2 Page 20 We have not received any complaints about the service since the last key inspection in August 2008. There have been six safeguarding referrals since the last key inspection. The outcome of two has not been upheld and the outcome of one found shortfalls in care. Three safeguarding investigations are not concluded. At the time of the inspection the interim manager advised us of a recent referral they had made to Worcestershire County Council, who coordinate safeguarding investigations. Two days following the inspection we received a notification from the home regarding an incident of physical abuse between two people who use the service, which took place in early July 2009. This had not been referred to safeguarding by the home. Staff spoken with had received training about safeguarding people in the last twelve months. The training matrix shows there are six staff who have not received any safeguarding training in the last 12 months. This includes a person who started work in the home in the last two months. We looked at the recruitment of two new staff. We saw that references and a Criminal Records Bureau check had been undertaken before they started work in the home. We saw that the home had checked the Nursing and Midwifery Council Personal Identification Number of a newly recruited trained nurse to see if they were registered, but this check was not done until the day after they started work in the home. Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Parts of the home are in need of refurbishment to make it a more pleasant and a safer environment for the staff and people who use the service. EVIDENCE: The last inspection report dated 13th August 2008 stated 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 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 Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.R01.S.doc Version 5.2 Page 22 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. This remains the current situation at the home. In addition, the corridor carpet on Rednal unit is badly worn and the bathroom adjacent to the communal toilets is in need of refurbishment. The last inspection report stated, 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. This remains the current situation at the home. The AQAA told us they have improved the home through decoration of bedrooms and installation of ventilation fans to maintain a fresh and odour free environment. We observed when entering the dementia unit some strong and unpleasant odours. We saw a copy of the homes action plan for the planned refurbishment of the home and staff told us a meeting is planned for later this month to discuss the action plan. The action plan includes relocating the laundry and replacement flooring for the lounge, dining room and corridors on the dementia unit. The action plan did not include the toilet and sluice areas identified in their previous refurbishment programme as being in “desperate need of redecoration”. The home notified us about a problem they were having with the storage temperature of the cold water tanks. This problem is still trying to be resolved by the contractor as the temperature of the cold water storage remains too high. Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are not enough staff to meet the health and social care needs of the people who use the service which places them at risk of harm through neglect. Recruitment practices need to be more thorough to ensure people can be confident staff are suitable to care for them. EVIDENCE: On the first day of the inspection there were 10 staff on each unit, this included at least two trained nurses. On the second day there were 10 staff on Rednal and nine staff on Cofton unit as two staff were absent and a carer had been moved across to Rednal to work. We looked at the staff rotas over a four week period and these showed the staffing levels to be 10 staff on each unit, although there were some days where they were down to eight staff on duty. These numbers include the use of agency staff. The numerical information in the AQAA told us in the last three months they have covered 13 nursing and 63 care staff shifts with temporary or agency staff. 31 staff left employment at the home in last 12 months. The home employs a multi-cultural team of male and female staff. The interim manager told us there is a high use of agency staff at present and they are currently recruiting new care staff. Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.R01.S.doc Version 5.2 Page 24 The AQAA told us, staff attendance is well managed and this reduces the need for agency use ensuring continuity of care. Staffing levels are based on the needs of service users dependencies. The inspection found poor outcomes of care for the people who use the service (refer to health and personal care and daily life and social activities sections). Surveys from people who use the service told us they need more staff always short, uses lot of bank people. Surveys from staff told us, the care staff try their best with the amount of staff they have but more staff would be able to cope more with the residents changing needs. Need to employ the right number of staff (carers) in line with the needs and the number of residents and their state of dependence (and not by other criteria). We need more seniors. More staff to do activities with residents as the carers that are on havent got the time with all the duties they do. A survey from a health professional told us the home could improve through providing continuity of care between staff on different shifts. A person who uses the service told us they intended to raise a concern with the interim manager about the lack of care staff on duty. We spoke to staff about the training they had received over the last 12 months; we looked at the training and induction of two new staff and at the records of mandatory training for all staff. The trained nurses have not received any training about the Mental Capacity Act or the Deprivation of Liberty safeguards (DoLs), although they are completing DoLs assessments as part of the care records. Six staff have not received any safeguarding training in the last 12 months. This includes a person who started work in the home in the last two months. 21 staff have not received any infection control training in the last 12 months and three staff need fire safety training. The AQAA told us, staff complete a three month induction in line with skills in care requirements. We looked at the recruitment files for two new staff which showed they had both received induction training. Pre-employment checks had been carried out prior to employment, for example Criminal Record Bureau checks and two written references. One person had a gap in their employment history and there was no evidence to show the reason for this had been discussed at interview. This concern has been raised at previous inspections. We saw that the home had checked the Nursing and Midwifery Council Personal Identification Number of a newly recruited trained nurse to see if they were registered, but this check was not done until the day after they started work in the home. The AQAA told us they currently have 15 staff with NVQ 2 or above. Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home needs improvement to ensure it is run safely and in the best interests of the people who use the service. EVIDENCE: The registered manager resigned in January 2009 and the home has been without a full time manager since that time. A new area manager for the organisation has recently started. A full time interim manager was appointed through an agency and started work at the home four days prior to the inspection. A new manager has been appointed and is due to start work at the home in August 2009. Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.R01.S.doc Version 5.2 Page 26 There has not been any continuity of leadership of the home since the registered manager left and systems and practices which had been put into place to ensure good communication amongst senior nursing staff had lapsed. This appears to have had a detrimental impact on the quality of care received by the people who use the service. The interim manager had highlighted these shortfalls and has recommenced the daily meetings with the head of each unit and arranged meetings to consult staff, people who use the service and their relatives. Surveys from people who use the service told us, we now have a new area manager who seems to be very efficient and also a new home manager has been appointed so things should improve tremendously. A person told us the new interim manager is on the ball. We looked at the homes internal quality monitoring audits in relation to medication and care planning as the quality and management in these areas is poor. We saw a medication audit carried out by the home in April 2009, which highlighted the temperature of the rooms being above 25 degrees Celsius. There was no action plan from this audit. The last managers audit dated May 2009 did not assess either of these areas. The information in the AQAA told us, all policies are reviewed as required but with a minimum 3 yearly interval. The numerical information in the AQAA shows the following policies have not been reviewed for over three years; recruitment (2003), sexuality & relationships (2002), induction (May 2006), moving and handling (June 2006), working with volunteers (2003). Administration staff told us they continue to act as appointee for one person. Monies for people are held in an interest bearing client account and interest is applied according to their individual balance. We saw a number of people had over a £1,000 in this account, in the best interests of these people; this money should be moved to an individual higher interest bearing account. The information in the AQAA told us the fire extinguishers had not been serviced since 14/02/08. The fire records confirmed this information, although the fire extinguishers seen had an entry on the service label stating they had been last serviced in May 2009. It appears the certificate for this service has not been filed. The last recorded check for the window restrictors was June 2009. The home has an ongoing problem with the storage temperature of the cold water tanks which is being investigated by the contractor. Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 3 Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1)(2) Requirement Timescale for action 31/08/09 2 OP8 OP12 12 (1) 3 OP9 13(2) 4 OP9 13(2) Care plans must be in place and sufficiently detailed and care needs reviewed as peoples needs change to ensure staff understand what is required and people can be sure their needs will be met. The health and social care needs 31/08/09 of the people who use the service must be promoted and provided to ensure they are not placed at risk of harm through neglect of care. To make arrangements to ensure 31/08/09 that care plans include detailed information and instructions for staff in respect of the administration and management of medicines, including the reasons to give medicines on a when required basis and what constitutes needed for a named person. To make arrangements to ensure 30/09/09 that medication is stored securely and at the correct temperature recommended by the manufacture to ensure medication does not deteriorate DS0000004122.V376602.R01.S.doc Version 5.2 Lickey Hills Nursing Home (2 Units) Page 29 5 OP9 13(2) 6 OP27 12(1) which can make the medication ineffective and possibly harmful to people living in the home. To make arrangements to ensure 30/09/09 that controlled drugs are stored securely in accordance with the requirements of the Misuse of Drugs Act (Safe Custody) Regulations 1973 and in accordance with the guidelines from the Royal Pharmaceutical Society of Great Britain to ensure controlled drugs are being stored safely and securely to prevent misuse. You must ensure that the 31/08/09 numbers and skill mix of qualified/unqualified staff are appropriate to the assessed needs of people living at the home, taking into account the size, layout and purpose of the home, at all times. This is so that people can be confident that their needs will be met in a timely manner. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP19 OP29 Good Practice Recommendations 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 people are fully protected. Staff should receive training about the Mental Capacity Act and the Deprivation of Liberty safeguards to ensure they DS0000004122.V376602.R01.S.doc Version 5.2 Page 30 3. OP30 Lickey Hills Nursing Home (2 Units) 4. OP35 have a clear understanding of how this impacts on the care of people who live in the home who lack mental capacity. Large sums of peoples monies held in the joint client account should be moved to individual high interest bearing accounts to ensure the home is acting in their best interest with regard to their savings. Lickey Hills Nursing Home (2 Units) DS0000004122.V376602.R01.S.doc Version 5.2 Page 31 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Fax: 03000 616171 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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