Inspection on 27/02/08 for Lickey Hills Nursing Home (2 Units)

This inspection was carried out on 27th February 2008.

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

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

Other inspections for this house

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

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

Lickey Hills Nursing Home (2... 20/07/09

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

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 09/07/2008.

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 27th February 2008 08:05 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.V362832.R02.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.V362832.R02.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.V362832.R02.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 30th May 2007 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. The fees are not published in the home’s statement of purpose, they are provided by the home manager. Lickey Hills Nursing Home (2 Units) DS0000004122.V362832.R02.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 0 star. This means the people who use this service experience poor quality outcomes. This was an unannounced inspection that took place over two days by an Inspector and a Pharmacist Inspector for one of the two days. This was a key inspection – this is an inspection where we look at a wide range of areas. To help us plan the inspection we looked at pre-inspection information in the form of an Annual Quality Assurance Assessment requested from the home some weeks earlier, and an improvement plan submitted by the provider in December 2007. 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 received two complaints about this service since the last inspection relating to care of residents in the home. Due to the seriousness of the complaints they were referred to Worcestershire County Council, who are the lead agency for safeguarding people. Both complaints are currently being investigated. We received further information from the home regarding a theft of money; this was also referred to safeguarding for investigation. A number of requirements in this report that have not been met have been amended to reflect new Commission for Social Care Inspection guidance. What the service does well: The home provides information for prospective residents to enable them to make an informed decision about coming into the home. Residents and their relatives are able to visit the home prior to admission. Residents are treated with respect by staff and their privacy and dignity is maintained at all times. 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. A resident said they have “enough to eat” and there is a “choice”. Two activity co-ordinators are employed by the home and they work hard to maintain the hobbies and interests of residents and to provide entertainment in and outside the home. Monthly “Your Voice” meetings are held in groups or one to one with more frail Lickey Hills Nursing Home (2 Units) DS0000004122.V362832.R02.S.doc Version 5.2 Page 6 residents to enable people to express opinions on the service and how it could be 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. Staff receive training about ‘safeguarding adults’ and staff spoken with were clear of the action they would take to protect the people living in the home. Criminal Records Bureau checks are carried out for all new staff prior to appointment. The environment is safe, comfortable and generally well maintained. Residents are able to choose the colour scheme of their bedroom and to bring in personal items and possessions. Residents’ clothes are nicely laundered. 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. A female resident said they do “not mind male staff” looking after them. 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. Equipment and systems in the home are maintained and serviced regularly. What has improved since the last inspection? The recording system for care has been changed to enable a person centred approach to care. New privacy curtains have been provided in all of the shared rooms to ensure complete privacy for both residents occupying the room. Meetings are now taking place each month with residents either on a group or individual basis to enable them to have a say in the running of the home and how it can be improved. A newsletter is produced by one of the residents so that all residents and relatives get to know what is going on. This resident represents the home at a national meeting within the organisation so that senior people within the organisation get ‘first hand’ information about what the people who use the service think and how they feel it could be improved. A substantial grant has been obtained to enable the home to buy more leisure equipment for residents and to purchase some portable sensory equipment for the more frail residents. Lickey Hills Nursing Home (2 Units) DS0000004122.V362832.R02.S.doc Version 5.2 Page 7 The layout of the lounge and dining room and the service of meals in the dementia unit have improved. Protected mealtimes have been introduced to ensure that staff are not disturbed and called away to the telephone whilst assisting residents to eat. They have started a redecoration programme of the home internally. The driveway has been resurfaced. What they could do better: The organisation need to review the residents contract to include information about the nursing care contribution and how this affects their individual fees. More comprehensive pre-admission assessments need to be done before a resident is admitted to the home and this needs to include the social care needs of residents. Care plans need to be written at the point of admission for all identified care needs of the individual residents. They need to be reviewed and updated when the residents needs change. They need to be assessable to care staff and used as a point of reference when they are giving care to the residents each day, to ensure that the standard of care is consistent and they know what to do for that resident. Residents and their relatives need to be consulted about their care and seek agreement to their care plan. Risk assessments need doing for all residents upon admission and reviewed as their needs change. Bedrails must not be used without first having undertaken a risk assessment and consent should be sought from the resident or their relative. Medication records must be maintained accurately to show what has been given or the reason for not giving the medication. The senior managers need to introduce a system to enable them to audit the medication to make sure it is being given as prescribed by the general practitioner and to ensure that it is being stored at a safe temperature. A clear written protocol needs to be written as a guideline for staff when administering ‘when required’ medication for residents who could become agitated or aggressive. The home should review the adequacy of the size of the laundry and the safety of its location in the home, including consideration of the health and safety of the people who work in the laundry. They need to check all the doors in the home to make sure they do not have holes in them as this may compromise safety in the event of fire. More thorough records should be kept for the recruitment of staff for example records of interviews and what was discussed. The induction programme should be revised to include information for staff on the Mental Capacity Act and the manager and existing staff would benefit from this training as they offer a specialised dementia care service. Lickey Hills Nursing Home (2 Units) DS0000004122.V362832.R02.S.doc Version 5.2 Page 8 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.V362832.R02.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.V362832.R02.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): 1, 2 & 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who may use the service and their representatives have the information needed to choose a home that will meet their needs. Contracts need to be reviewed to make sure that residents’ are fully aware of how the ‘free nursing care’ payment is taken into account regarding their individual fees. Comprehensive pre-admission assessments are not 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. This service does not offer intermediate care. EVIDENCE: The service user guide was on display at the entrance to the home, although it did not include the most recent key inspection report, which took place in May 2007. The service user guide has just been reviewed and a copy will be put in all bedrooms for reference. The home intends to produce a service user guide in a pictorial format. Lickey Hills Nursing Home (2 Units) DS0000004122.V362832.R02.S.doc Version 5.2 Page 11 A copy of the statement of purpose is sent to the resident and their relatives along with the contract. This was confirmed through discussion with a visitor. Contracts were seen for the residents’ case tracked. The home’s contract does not provide clear information about the ‘free nursing care’ contributions. It states that the fees exclude the ‘free nursing care’ contributions, but does not give any information to indicate if this is paid in addition to the stated fee and if so how this is paid to the home. Pre-admission assessments were seen for the residents’ case tracked. They had not been thoroughly completed and contained conflicting information. The assessment for one resident stated they had a history of medical problems, but no medical problems were noted, there was no medication listed and no social history obtained. Another stated under the safety section “Risk of falling out of bed – No was ticked and then “bedrails” was written. A third assessment stated under the current medication section “allergic to penicillin” and under the section “Clinical Background”, Allergies, “none known”. All three preadmission assessments had been carried out by a unit manager. Lickey Hills Nursing Home (2 Units) DS0000004122.V362832.R02.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 poor. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments are not in place for all individual residents assessed care needs to ensure that their health and social care needs are being provided consistently and safely by the staff caring for them. This has the potential to place residents at risk of harm. Improvement is needed to the way the home manages medication records and procedures, and staff require further training in respect of these areas to ensure that medication is managed safely in the home and residents are not placed at risk of harm. Residents’ privacy and dignity is being maintained at all times. EVIDENCE: The information seen in the care plans for the residents case tracked lacked detail to enable staff to deliver a consistent standard of care. The type and size of incontinence pads are not stated in the care plan. There were two types of pressure relieving mattress stated in an identified care plan. A resident developed a wound on the 5th December 2007 and the care plan was not revised until the 24th December 2007. There were no photographs of the wound and it was not graded to enable staff to review in a consistent manner Lickey Hills Nursing Home (2 Units) DS0000004122.V362832.R02.S.doc Version 5.2 Page 13 any improvement or decline of the wound. The daily records had an entry indicating that a resident had developed an infection in their gums, which was being treated with antibiotics. There was no acute care plan for this problem. The resident had their own teeth and the care plan stated “own teeth, brush after every meal”. The identified resident at 10.30 hrs was up and dressed in the day room, their tooth brush was dry and staff when asked stated they “clean teeth every day when X gets up and put to bed”, “teeth not cleaned yet”. This lack of attention to the resident’s oral hygiene is poor and shows that staff are not following the care prescribed in the care plan. The same residents care plan had seven bowel actions recorded over a 19-day period. There was no evidence to show that this had been followed up. The care assistant when asked reported that they had “checked the pad and it was OK and put a clean pad on”, they stated the “night staff may have put X on the commode”. This is a poor outcome. The resident was not given the opportunity to open their bowels on the toilet or a commode. A resident had been admitted to the home 11 days previously and did not have a care plan for social care, keeping active, safety, hygiene, eating and drinking, urinary incontinence or mobility. This identified resident was immobile, diabetic and had urinary incontinence and the lack of care plans places this resident at risk of neglect or harm. A resident had bedrails in use and a risk assessment had not been done to ensure that it was safe to use the bedrails. This and another resident case tracked had bedrails in use but the staff had not sought any written consent to use them. A resident’s dietary care plan stated they needed to be weighed weekly and required fortified drinks to maintain/increase their weight. The nutritional risk assessment had not been completed and the care plan had not been reviewed despite evidence that this resident was losing weight. There were records to show that staff were recording the resident’s fluid and food intake, but this was not included in the action plan in the care plan. Discussion with a resident and their next of kin confirmed they had not seen their care plan, and they stated “No one tells us how X is getting on”. It is evident from discussion with care staff that they are mostly reliant upon verbal communication regarding the information they need to provide the care for the residents case tracked. Staff when asked how they obtain the information about the residents care needs stated, “spoke to X’s husband, resident tells you”, “when we have time we read care plan”, “saw X green folder on day of admission”, “are allowed to read care plan – do not get chance as so busy, not read X’s care plan”, “not had time to read file, too busy”. The lack of information in the care plans and staff not referring to them when delivering care places residents at risk. Lickey Hills Nursing Home (2 Units) DS0000004122.V362832.R02.S.doc Version 5.2 Page 14 A medication procedure was available, produced by Craegmoor Healthcare, which was specific to the medication management within the service. It was dated September 2006 and was due for a review in September 2008. This means that people who use the service are safeguarded by a working medication policy. A household or ‘homely’ remedy list was available for the treatment of minor ailments such as a headache. This had been checked and agreed by a healthcare professional to ensure the safety of the people who use the service. We saw secure storage of medication in the two units, which were tidy and organised. Clear warning signs for the storage of oxygen cylinders were displayed for safety reasons. This ensured that medication was safe and secure and it was easy to locate individual peoples medication. The medication storage in the Rednal Unit was too hot for the safe storage of medication. We saw the daily records for the temperature of the room, which stated that the temperature ranged from between 26 to 29°C, which is above the safe storage limit for medication (25°C). This means that people who use the service are at risk of being given medication that has been stored incorrectly and they are therefore at an increased risk of harm. We saw documented evidence for the receipt and disposal of medication from the pharmacy, which meant that the service ensured that levels of medication were kept at a safe level. We saw good practice relating to changes made to medication received in a telephone call, for example from a hospital or a special clinic. We saw evidence that two members of staff signed the record to ensure accurate information was recorded. This means that there is a safe system for recording information and helps to ensure accuracy of medication information. At lunchtime, we saw medication being administered patiently and with care to people in the Cofton unit. The medicine records seen were usually documented either with a signature for administration or with a code to explain why the medication was not administered. We did see one chart for a prescribed cream, which had not been signed by a member of staff. A ‘tick’ had been documented instead, which meant it was not possible to identify who had applied the cream. It was also disappointing that one medicine chart was not complete and there were some omissions in the records. The medicine record for the administration of one medication showed that it had not been signed for administration on three occasions on the 18th February 2008. We checked the blister pack containing the tablets, which showed the medication, had been removed from the container but there was no record of it being administered. A further discrepancy was seen on 21st February 2008 for the teatime administration, which showed that the tablet had been signed for administration, however the tablet was still packed in the blister pack and had Lickey Hills Nursing Home (2 Units) DS0000004122.V362832.R02.S.doc Version 5.2 Page 15 not been administered. This means that some of the medicine records were not accurate and people who use the service were not safeguarded and were at an increased risk of harm. We saw evidence to suggest that the service could undertake some checks on peoples medication particularly for medication supplied in a blister pack marked with the days of the week. However, for medication supplied in boxes a full check on people’s medication could not be undertaken. For example, the dates of opening of some medication were not recorded and any balances of medication were not recorded and carried forward onto a new medicine record chart. This means that it was not always possible to check if medication had been given as prescribed by a medical practitioner. Some people were prescribed medication to be given when required. We saw two examples of people prescribed a medicine to calm and control their behaviour when required. In one example, the medicine records documented that the doctor had reduced the amount to be administered when needed. We saw good documented evidence that staff had not been administering the medication because it was not required, which meant that staff were ensuring that the healthcare needs of the person were being monitored and reviewed. The second medicine record showed that staff were administering the medication every evening. The daily notes seen for the resident did not reflect the reason why the medicine had been administered routinely. We spoke to a member of staff who said that the medication was administered routinely as it ‘takes the edge off her as she gets abusive’. We saw the care plan, which did not contain specific written information to inform staff under what circumstances this medicine should be administered to ensure that the health and welfare of people are safeguarded. Residents privacy and dignity was seen being maintained when delivery personal care. Staff were observed addressing the residents in a respectful manner. Lickey Hills Nursing Home (2 Units) DS0000004122.V362832.R02.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. 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. Social care plans need to be improved to demonstrate that the home are offering the choice of a diverse range of activities for male & female residents who have physical and mental healthcare needs. Residents are able to choose meals from a varied & nutritionally balanced menu. The layout of the dining room and the service of meals in Rednal Unit has been reviewed providing a more spacious, pleasant and sociable experience for residents at mealtimes. EVIDENCE: The social care needs of all the residents’ case tracked had not been assessed as part of the pre-admission assessment. Only one of the residents had a good social care plan. One resident did not have a social care plan. The home employs two activity co-ordinators who currently provide activities Monday to Friday each week. They are looking to expand this provision to seven days per week. The activity co-ordinator explained how she had been met with a recently admitted resident and their family to discuss their hobbies and interests and she is in the process of reviewing the success of the social programme for this resident. This resident had a good social care plan. Lickey Hills Nursing Home (2 Units) DS0000004122.V362832.R02.S.doc Version 5.2 Page 17 Monthly ‘Your Voice’ discussions take place in the home on a group or individual basis to gather ideas for improvement and feedback from the residents. A resident takes this information forward to a national meeting within the organisation from the home. Minutes from a recent meeting indicate that recent issues raised include a possible language barrier between residents and staff whose first language is not English, they have asked for an increased gardening and activities budget. A resident is supported by the activity co-ordinator to produce a monthly newsletter keeping all the residents and relatives informed about what is going on in the home and outcomes from the national meetings within the organisation. The activity co-ordinator has recently obtained a substantial grant from Worcestershire County Council which has enabled them to purchase three wide screen televisions, DVD players with video & surround sound, and Snoozelan equipment which will be portable and can be used in the residents bedrooms. A four-week rotating menu is provided which offers a choice of meals including a cooked breakfast. The menu is on display at the entrance to the home and within each unit. On the day of the inspection lunch consisted of a choice of mushroom soup, cauliflower cheese, sandwiches, salad and cheesecake for dessert. Supper was lamb’s liver/onions, turkey burger in bun, potatoes, cabbage, swede and rice pudding. Choices of ‘finger’ foods are also available each day. Lunch was observed in Rednal unit. Most of the residents were sitting at round tables in the dining room with room between for residents to walk about. Plain white cotton aprons have been made for residents to wear to protect their cloths from becoming soiled at mealtimes. Staff were sitting adjacent residents communicating and encouraging the resident to eat. Mealtimes are now protected on the unit and no telephone calls are taken by staff to ensure that the focus is on providing the residents dietary needs. Lickey Hills Nursing Home (2 Units) DS0000004122.V362832.R02.S.doc Version 5.2 Page 18 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 has a complaints procedure on display at the entrance to the home. This needs to be reviewed to remove the name of the inspector. The complaints procedure is published in the service user guide. The home’s complaint’s records show that they have received four verbal complaints/concerns and these were all addressed within 24 hours. A written complaint relating concerns about the care of an identified resident has been acknowledged by the home and is currently being investigated by the area manager. Two care staff spoken with were both aware of the home’s complaint’s procedure and stated they felt able to complain. One carer indicated that the manager and senior staff are “very good and deal with issues straight away”. All staff spoken with had received training about the recognition and reporting of any suspected abuse. The Inspector was invited into the home by staff who did not know her without asking for evidence of their identification. This has the potential to place residents and staff in the home at risk. Staff need to be reminded of the need to ask for identification of any ‘official persons’ visiting the home. Lickey Hills Nursing Home (2 Units) DS0000004122.V362832.R02.S.doc Version 5.2 Page 19 Staff records show that criminal records bureau checks are carried out on staff prior to appointment. Lickey Hills Nursing Home (2 Units) DS0000004122.V362832.R02.S.doc Version 5.2 Page 20 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 layout of the communal area on Rednal unit has been altered to make it look more homely. The home have reviewed the décor and state of repair of the home and have drawn up a redecoration programme. 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 Lickey Hills Nursing Home (2 Units) DS0000004122.V362832.R02.S.doc Version 5.2 Page 21 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. There is a hole in the staff room door on Rednal unit, which may have the potential to compromise the fire safety in the home. The holes in the bedroom doors seen at the last inspection have been filled. A wheelchair was seen blocking a fire exit to the laundry despite a sign on the door stating, “keep clear”. This was raised with the manager. The grounds were tidy and the driveway was being resurfaced at the time of the inspection. A recent fire risk assessment undertaken by an external contractor had highlighted two areas of work needed deemed as ‘high’ risk priority. The fire brigade were conducting a visit to the home at the time of the inspection. The home has had a recent visit from the Environmental Health officer, who considered the standard of cleaning in the kitchen as good. Three requirements were made at this visit and the manager confirmed that these have been addressed. 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. The home was generally clean and tidy. There was a strong smell of urine upon entering the dementia unit and there was a used glove left on the table by the signing in book at the entrance to the home. Staff have received training in the management of infection control. Lickey Hills Nursing Home (2 Units) DS0000004122.V362832.R02.S.doc Version 5.2 Page 22 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. More robust records need to be kept of the content of interviews for staff to demonstrate that issues highlighted on application forms and in references are thoroughly explored ensuring the protection of the people living in the home. EVIDENCE: There were satisfactory numbers of staff on duty during both days of the inspection and discussion with staff and staffing rotas confirm that these numbers are consistently being maintained. There is a high ratio of trained staff to care staff on the dementia unit. The manager is full time and her hours are supernumery. The deputy manager’s hours were previously totally supernumery but she is now working four days per week as part of the numbers on Cofton unit. A team of ancillary staff support the care team. The Annual Quality Assurance Assessment shows that the home employ a multicultural team of male and female staff, ranging from aged 18-65 . In the past three months one shift has been covered by an agency carer. The Annual Quality Assurance Assessment shows 15 permanent care staff have achieved “NVQ level 2 or above” and 13 of care staff are working towards NVQ level 2 or above. Two staff files were seen. There was no evidence on file to show that one person had been interviewed. Certificates were seen for Lickey Hills Nursing Home (2 Units) DS0000004122.V362832.R02.S.doc Version 5.2 Page 23 induction and most of the mandatory training required except abuse and infection control. The carer confirmed that they had received this training, although they have not received any training on dementia care and is working in the dementia unit in the home. The second staff file did not evidence that the manager explored at interview the gaps in employment history and comments in a reference, although the manager stated she had done this. The training officer confirmed that the induction training does not include information about the Mental Capacity Act. This should be included as the home offers specialised dementia care. Lickey Hills Nursing Home (2 Units) DS0000004122.V362832.R02.S.doc Version 5.2 Page 24 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, 37 & 38 Quality in this outcome area is adequate. 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. Management and training systems need to be put into place to ensure that care records are being written and reviewed and that 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. 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 mandatory training, but has not received any training on the Mental Capacity Act. This needs to be addressed as a matter of priority as they have a specialised dementia unit within the home and she needs to ensure that residents’ rights are maintained and respected. Lickey Hills Nursing Home (2 Units) DS0000004122.V362832.R02.S.doc Version 5.2 Page 25 An Annual Quality Assurance Assessment was completed by the home prior to the inspection. This document is very brief and gives very little information about the service and minimal evidence to support the claims made within it or to demonstrate how the home intends to improve in the next 12 months. Relatives questionnaires were received in November 2007 as part of the quality assurance programme, but the information in these questionnaires have not been collated and an action plan developed. The records of care are of a poor quality and care staff are not using them to enable them to deliver consistent standards of care. Management and training systems need to be put in place to ensure this is addressed and residents are not placed at risk. This needs to be closely monitored through the home’s quality monitoring systems. The data supplied by the home within the Annual Quality Assurance Assessment regarding the homes policies and documents indicate that they do not have a policy for clinical procedures, referral and admission and sexuality and relationships. Other policies are in need of review such as the code of conduct, death of a service user, and physical intervention and restraint. The management of resident’s monies were looked for an identified resident. The account was well managed and receipts were available for purchases made. The data supplied by the home within the Annual Quality Assurance Assessment indicates that with the exception of the emergency call system all equipment has been maintained/tested within the recommended timescales. External contractors have carried out Legionella checks and work needed was carried out without delay. The home has had recent fire and environmental health visits. See environment section. Staff spoken with have received mandatory training and a training programme is in place for this year. It is evident from minutes of staff meetings that the manager has held meetings with Heads of Units and trained staff regarding the systems for the recording, monitoring and follow up of accidents such as skin tears and bruising to residents in the home and the importance of communication and protected mealtimes for residents. Lickey Hills Nursing Home (2 Units) DS0000004122.V362832.R02.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 1 3 Lickey Hills Nursing Home (2 Units) DS0000004122.V362832.R02.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5A, 5B Requirement Timescale for action 27/02/08 2. OP7 15(1) 3. OP7 14(2) 4. OP7 13(4)(7) The contract must contain information as to whether a nursing contribution is to be paid by residents as detailed within the Regulations so that prospective and existing residents are fully aware of how this affects their individual fees. (Timescale of 31/08/07 not met. The date given is the date of the inspection) Care plans must be developed to 27/02/08 include details of care to be provided so that staff understand what is required and residents can be sure their needs will be met. (Timescale of 14/07/06 & 31/08/07 not met. The date given is the date of the inspection) 27/02/08 Care plans’ must be reviewed and updated in light of any change in care needs so that residents can be sure their needs will be met. (Timescale of 14/07/06 not met. The date given is the date of the inspection) Prior to the use of bedrails a risk 28/02/08 DS0000004122.V362832.R02.S.doc Version 5.2 Lickey Hills Nursing Home (2 Units) Page 28 (8) 5. OP8 14(1)(2), 6. OP9 13(2) assessment must be done and consent must be obtained to ensure residents are not at risk of harm. An immediate requirement was made. Detailed nutritional assessments must be undertaken as soon as possible after admission certainly within the first week, and the outcome used to inform care planning to ensure that their dietary needs are provided and they are not at risk of harm. (Timescale of 20/06/06 & 31/07/07 not met. The date given is the date of the inspection) Medicine records for the administration of medication must document what has been administered or record a reason why it was not administered in order to ensure that the people who use the service are safeguarded. 27/02/08 30/04/08 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 OP3 OP7 Good Practice Recommendations The pre-admission assessment carried out prior to admission should assess all areas of need listed within this Standard. Care plans should be formally agreed either with the resident, or with their representative when the resident is unable to provide informed agreement to ensure that they consent to the care and the care is person centred. A system should be introduced to ensure that accurate medicine audits can be done and check that people who use the service have been administered medication according to the directions of a General Practitioner. DS0000004122.V362832.R02.S.doc Version 5.2 Page 29 3. OP9 Lickey Hills Nursing Home (2 Units) 4. OP9 5. OP9 6. 7. 8. 9. OP10 OP19 OP19 OP29 10. OP30 A system should be introduced which demonstrates that medication is stored at a safe temperature in order to ensure that people who use the service are protected from harm. 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. All doors should be checked to ensure that they do not have holes in them so that it does not compromise the safety of the people living and working in the home. 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 that residents’ rights are maintained and respected. Lickey Hills Nursing Home (2 Units) DS0000004122.V362832.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands 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.V362832.R02.S.doc Version 5.2 Page 31 - 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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