Inspection on 30/05/07 for Lickey Hills Nursing Home (2 Units)

This inspection was carried out on 30th May 2007.

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

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

Other inspections for this house

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... 27/02/08

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 Unannounced Inspection 30th May 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lickey Hills Nursing Home (2 Units) DS0000004122.V336496.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lickey Hills Nursing Home (2 Units) DS0000004122.V336496.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 Limited 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.V336496.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Category LD is restricted to persons over 50 years of age. Date of last inspection 20th June 2006 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 current fees for the home range from £373-588 pw plus any nursing care contribution that is paid by the Primary Care Trust. Lickey Hills Nursing Home (2 Units) DS0000004122.V336496.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over 2 days. One Inspector spent 17.5 hrs in the home and a second Inspector spent 9.5 hrs in the home. 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 requested from the home some weeks earlier, survey forms received from residents (1), relatives (5) and health care professionals (2). 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. The Commission has received one complaint about the service since the last inspection which was looked into by the Primary Healthcare Team. 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. Staff from the home visit prospective residents to establish their needs prior to admission. A healthcare professional confirmed that staff ‘always visit wards & gather information about the patient and their needs’. Contracts are given to new residents to ensure that they are aware of the terms and conditions of their stay. Comments received from relatives about the care in the home include; ‘Since X has been at the home I have noticed a considerable change in X as well as being more alert X is also very contented and happy’, and they ‘provide good appropriate care to X, ‘pleased with all aspects of care that X has received’. Varied and well-balanced menus are provided each day for residents to choose from. A relative commented ‘X has a very good appetite as the food is very good’. 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. Lickey Hills Nursing Home (2 Units) DS0000004122.V336496.R01.S.doc Version 5.2 Page 6 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. Staff undertake an induction programme upon employment and ongoing mandatory and other training including the opportunity to study for a National Vocational Qualification. A training officer is employed by the home. Comments from relatives about the staff in the home include; ‘I have found them very helpful to all X needs, and think that they are deserving of praise for what they do’. ‘ The staff make all the residents feel at home and very secure’. Residents are able to live in a home which is appropriately managed, providing care in a safe environment. What has improved since the last inspection? What they could do better: The residents contract must be reviewed to include information about the nursing care contribution and how this affects their individual fees. The care plans on Cofton Unit are of a better quality than those on Rednal Unit, although on both units there are shortfalls in the standard required. Care plans need to be improved so that they include all of the care required by that resident and need to be discussed with the resident and/or their representative. The care prescribed needs to be reviewed on a regular basis or more often if needs change to ensure residents are receiving the correct care. Care plans need to be written clearly so that all staff can understand the care that needs to be provided so that residents receive a consistent standard of care and staff know what they are to do for that resident. Nutritional risk assessments must be done for all residents upon admission and reviewed regularly. Medication must be managed in accordance with the homes medicine policy. Lickey Hills Nursing Home (2 Units) DS0000004122.V336496.R01.S.doc Version 5.2 Page 7 The home must review the adequacy of the privacy curtains in the shared rooms to ensure that complete privacy is obtainable whilst giving personal care. The home must ensure that staff are respectful at all times when communicating about residents. Social care plans must be provided to ensure that all residents’ recreational needs are identified and met. The service of the meals on the dementia care unit and how residents are assisted with their meals must be reviewed to ensure that it is always a pleasant and social occasion. The size and layout of the communal areas on the dementia care unit must be further reviewed to ensure that it has a more homely appearance. All parts of the home must be reviewed to ensure that all areas are clean, in a good state of repair and the décor is fresh so that it is a clean and pleasant environment for the people living, working and visiting the home. 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.V336496.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lickey Hills Nursing Home (2 Units) DS0000004122.V336496.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective people to use the service and their representatives are provided with information needed to choose a home that will meet their needs. Preadmission assessments are done for each resident prior to admission to ensure that the home is able to meet their individual needs. A contract is provided which tells them about the service they will receive. EVIDENCE: The Home’s Statement of Purpose is on display in the entrance to the home and a copy is given to residents with their contract & terms & conditions of stay. Completed contracts were seen and a sample contract was provided dated 2002. This contract needs revising as it does not include the information required by Regulation 5A & 5B about the nursing care contributions. The contract also refers to NCSC & not CSCI. Written feedback from a resident confirms that they have received a contract and enough information prior to admission. Lickey Hills Nursing Home (2 Units) DS0000004122.V336496.R01.S.doc Version 5.2 Page 10 A representative from the home prior to admission carries out pre-admission assessments. Two types of assessment were seen; one version did not provide sufficient information to enable the home to formulate a care plan. Another format had been used for 2 residents admitted this year. This format required more comprehensive information and enabled the home to formulate a care plan for the resident. There was also information to show that an overview of the prospective residents care needs had been discussed with the care team in the Unit. The pre-admission assessment for two residents did not cover all aspects of care within the relevant Standard (S3.3) as there was no information about the resident’s diet, sight, foot care, social interests, hobbies & religious needs & family links. Lickey Hills Nursing Home (2 Units) DS0000004122.V336496.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The standard of the care plans vary between the two units. Care plans are not in place for all individual residents care needs, are not being reviewed accurately to enable care to be provided in a consistent manner which has the potential to place residents at risk. All medication is not being stored and administered in accordance with the homes medicine policy & procedures, placing residents at risk. The privacy & dignity of residents is not being maintained at all times. EVIDENCE: The home is in the process of implementing a new ‘person centred’ care planning system. Six residents were case tracked. The care records of the 3 residents on Cofton Unit were of a much better quality than those on Rednal Unit, although improvements are needed. There were no photographs or grid outlines of the wounds to enable the home to monitor the improvement or decline of the wound. Bedrail risk assessments were not in place for two residents. This was highlighted at the time of the inspection and was put into place by the home. Some of the forms were not dated and there was little or no evidence of the resident or their representative being involved in the care Lickey Hills Nursing Home (2 Units) DS0000004122.V336496.R01.S.doc Version 5.2 Page 12 planning process. End of life care wishes had not been followed up or assessed for some residents. Care plans are not in place for all of the individual residents identified needs e.g. a stroke, speech difficulties. On Rednal Unit the care plans had serious shortfalls. 3 residents were case tracked. Risk assessments and care plans are not being reviewed each month or more often as changes take place. Some documents had a date of review but no written comments to show or support the outcome of the review. An identified resident had bedrails in use. There was no evidence of any written consent to the use of these bedrails. There was evidence of two incidents involving bedrails for this resident, and no evidence that the risk assessment had been reviewed or any action taken following these incidents, despite the records containing an entry stating ‘Found on floor at 04.30hrs, taken off the right side rail’, ‘would need another type of side rail’. These findings were highlighted at the time of the inspection and were addressed. An identified resident had developed a pressure sore and a care plan was in place. The wound was not being assessed and the dressings were not being done at the frequency prescribed in the care plan. There were no photographs of the pressure sore. A second resident’s skin assessment in April 2007 showed that the risk of developing a pressure sore was increasing and had a score of 20. The skin assessment form states ‘If score 10 or above, develop a care plan for preventative measures’. There was no care plan put into place for the prevention of pressure sores until the 10/06/07 as the resident had developed a pressure sore. The skin assessment care plan had an entry dated 27/05/07 that stated ‘Waterlow score remains low’, which is inaccurate according to the skin assessment carried out in April 2007. ‘Weekly’ weights were prescribed, although there is no evidence of this. This resident did not have a pressure-relieving mattress provided and this was confirmed in discussion with a trained nurse on the unit. The trained nurse was asked if this resident had any pressure sores and responded ‘not that I know of’. A second trained nurse spoken with was not aware that this resident had a pressure sore. The manager was advised of these findings and arranged for an appropriate mattress to be provided the same day. There was no nutritional risk assessment for an identified resident whose care plan had recorded evidence that they were losing weight. This was brought to the attention of the manager who reviewed this information and advised the Inspector following the inspection that these entries were a mistake. This raises further concern about the quality and accuracy of the care records. Another resident had a weight recorded on the 01/04/07. The care plan stated that the resident was to be weighed monthly and a review on the 21/05/07 stated weight ‘stable’. How can this statement of review be supported when there is only one weight for the resident? There was no nutritional risk assessment for a second identified resident whose care records showed evidence of weight loss each month. A malnutrition Lickey Hills Nursing Home (2 Units) DS0000004122.V336496.R01.S.doc Version 5.2 Page 13 assessment had not been completed & the skin assessment stated weigh weekly, but there was no evidence that this was being done or of any action being taken due to the weight loss. Good life histories were seen in care records, although the information is not being used to formulate a care plan for social care. The homely remedies policy on Cofton Unit was signed by the visiting General Practitioner and dated 21/09/04. There was no evidence of review since which is not in line with the homes policy which states ‘The written authorisation must be reviewed with the General Practitioner at least annually’. A code is being used when medication is being omitted but the reason for omitting the medicine is not being recorded each time. The dosage of a controlled drug had been altered by the General Practitioner on the Medication Administration Records but had not been signed. The staff had been administering this medication. This was addressed by the home after the Inspector highlighted it. An identified resident’s medication is being ‘disguised’ in their food. There was no written evidence of consent to this being done and the home’s practice is not in line with their medicine policy and procedures and the Nursing & Midwifery Council statement on the covert administration of medicines. Oxygen was seen in one of the treatment rooms, but the warning notices are not sufficient and are not in line with the guidance provided by the Royal Pharmaceutical Society of Great Britain (2003) ‘The administration and control of Medicines in Care Homes and Children’s Services’ as referenced to in the home’s medicine policy and procedures. The treatment and clinic rooms on Rednal Unit are internal rooms. The temperature of the rooms is being monitored and recorded each day and records show that at times the temperature is exceeding 25˚C in both rooms. There is no evidence to show that any action has been taken to remedy the situation in accordance with the home’s medicine policy and procedures. In the clinic room there are topical and internal preparations being stored above the recommended temperature. This could compromise the effectiveness of the preparations. In both Units privacy curtains were seen in shared rooms. The complete privacy of the residents in these rooms is not obtainable due to the fixed location of the privacy curtains. Whilst observing residents on Rednal Unit a carer was overheard referring to residents as ‘heavies’ and residents who require assistance with eating were referred to as ‘feeders’ when speaking to the Inspector. This is evidence of poor practice Lickey Hills Nursing Home (2 Units) DS0000004122.V336496.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Social care plans and activities provided in the home need to be improved to demonstrate that the home are offering 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 service of meals in Rednal Unit is task orientated and is not a pleasant & sociable experience for residents. EVIDENCE: A church service was taking place on the first day of the inspection. The home accommodates the needs of residents of various religious beliefs. The preadmission assessment for all residents is not identifying the recreational needs, hobbies & interests prior to admission to enable the home to ensure that they are able to meet their individual social care needs. The activities and interests of some residents are well recorded. For other residents case tracked their individual social care plans are not fully completed and do not identify their needs or any planned outcome. Good life histories are available but the information is not being used to formulate a social care plan. Comments received from surveys include; ‘X wanted to sit outside on a sunny day. X was told no because they couldn’t spare the staff being as X was the only one who wanted to sit out’ and there are ‘more social activities for ones who are Ok and Lickey Hills Nursing Home (2 Units) DS0000004122.V336496.R01.S.doc Version 5.2 Page 15 only physical disabilities’. A carer was observed in the lounge on Cofton Unit who was based in there to supervise the residents in the dayroom. The carer was not attempting to communicate with the residents as they were reading a leaflet. The Inspector observed lunch being served on Rednal Unit (dementia care). The dining tables are quite close together and do not leave much space for residents to move around freely. Lunch was observed for a period of 40 minutes and staff confirmed that there were still 3 residents who had not received their lunch, as they needed assistance with eating. A good choice of meals is available and the menus are displayed at the entrance to the home and within the unit. A lighter lunch of soup & sandwiches with another choice is served each day at lunchtime and the main meal of the day is in the evening. A comment received stated ‘X has a very good appetite as the food is very good’. The service of lunch to the residents with dementia was ‘task orientated’. Soup was left on a table to get cold whilst staff continued to go around the residents putting blue aprons on them. When the Inspector asked who the soup was for, they were told it was the ‘feeders’ table. The Inspector observed a member of staff sitting between 2 residents feeding both of them, they were not talking to either of these residents as they were holding a conversation with one of their colleagues who was feeding another resident on the same table. The staff member left these two residents and went to assist another resident on an adjacent table. Meanwhile these two residents were left sitting with their food in front of them and it was going cold. Another staff member came and sat between the two residents and started to feed one of the resident’s. That person then proceeded to leave the table and answer the telephone and return 3 minutes later to finish assisting the same resident to eat lunch. The Inspector also observed a bowl of soup & bread pushed in front of a resident, left there for a few minutes and then taken away and given to another resident on the table. This is evidence of poor practice. A resident was sitting in the lounge area being assisted with lunch. The staff member approached the resident quietly, explained what they had come to do, told the resident what was for lunch and talk to the resident on a 1:1 basis whilst assisting the resident to eat. This is good practice. Lickey Hills Nursing Home (2 Units) DS0000004122.V336496.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaint procedure and are protected from abuse. EVIDENCE: The home’s complaints procedure in on display at the entrance to the home. The home’s complaints records contain information about a recent complaint that had been investigated by the manager. There was one element of the complaint where there was no information to show that the concern had been addressed. Another concern was recorded in a resident’s records. This should be recorded in the concern/complaints records so that the information can be audited as part of the homes quality review systems. Written information from relatives and residents confirm that they know how to make a complaint and who to speak to. A General Practitioner confirmed that they had not received any complaints about the home. The Inspector (who had not visited the home before) was invited into the home by staff without asking for evidence of their identification. This has the potential to place residents at risk and staff need to be reminded of the need to ask for identification of any ‘official persons’ visiting the home. All staff spoken with have received training in ‘safeguarding adults’ and were clear of the action they would take. Lickey Hills Nursing Home (2 Units) DS0000004122.V336496.R01.S.doc Version 5.2 Page 17 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): 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 home is divided into two Units, which are both on two storeys with accessibility via passenger lifts which are suitable for residents in a wheelchair. A call system, hand rails, a variety of grab rails and hoists are provided for residents with physical disabilities. Comfortable armchairs are provided in the communal lounge areas, they are well lit and the décor and pictures are age and gender appropriate. Residents’ rooms seen were mainly in good repair have a variety of colour schemes which residents can choose from and are personalised. Lickey Hills Nursing Home (2 Units) DS0000004122.V336496.R01.S.doc Version 5.2 Page 18 The hoists and equipment seen around the home had all been recently serviced. Low surface temperature radiators are in use or the radiators were covered. Window restraints were seen on second floor windows during the visit. Some areas of the home are in need of redecoration/repair and refurbishment. The extractor was not working in the staff toilet on Cofton Unit on both days of the inspection. The complete privacy of residents in the shared rooms seen is not obtainable due to the fixed location of the privacy curtains. A ceiling panel was missing in a shower room. A communal toilet had holes in the wall and broken and missing wall tiles. The carpet in the nurses office was threadbare by the desk. The carpet was also threadbare and not held in place by carpet gripper in the doorway to the office & doorway to corridor outside office. This was brought to the attention of the home manager at the time of the inspection. Some of the radiator covers in the en-suites in Rednal Unit were rusting at the bottom. Edges of washable floors throughout the home needed sealing or coving to prevent a build up of dirt and for ease of cleaning. One en-suite had part of the skirting board missing. Part of the intumescent strip on the corridor fire door was missing. This was brought to the attention of the nurse in charge of the Unit at the time of the inspection. A number of bedroom doors had partial thickness holes where previous locks had been fitted and removed. The one side of the lounge area on the dementia care unit gives the appearance of a ’waiting room’, as the chairs are in a line up both sides and the dining area for that Unit is overcrowded. 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. The laundry has 3 washing machines and two new tumble dryers. It is the Inspectors opinion that the space is very cramped for the staff working in the laundry particularly as they are laundering clothes for up to 97 residents. There is no room in the laundry for the roller iron and this is situated in a room off the laundry that is also being used by the Domestic Supervisor as her office. The floor is tiled. There was a build up of dirt behind the machines. Despite the lack of space the laundry staff do a good job of laundering the residents clothes. It is the Inspectors opinion that the home should consider building a new laundry and convert the existing laundry space into further communal facilities for the residents on the dementia care unit. The home was generally clean. There were some areas that needed attention. There was a strong smell of urine upon entering the home on both days and a shared room has a very bad smell. A sluice area was dirty behind the sluice machine and where the laundry skip was standing. A used glove had been left in a shower room and on the floor in a communal toilet. Some of the waste bins in communal areas did not have a lid. Corners of communal toilets were Lickey Hills Nursing Home (2 Units) DS0000004122.V336496.R01.S.doc Version 5.2 Page 19 dirty. A clinical waste bin was situated next to the toilet in a communal toilet area which is unpleasant for anyone using the toilet. Written comments received include; the home is ‘usually’ fresh & clean. ‘The only concern I have is that nurses don’t wash hands between each resident contact’. The home has had a recent outbreak of diarrhoea and vomiting and prompt and appropriate action was taken by the home to contain the infection. Lickey Hills Nursing Home (2 Units) DS0000004122.V336496.R01.S.doc Version 5.2 Page 20 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): 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, skilled and in sufficient numbers to support the people who us the service. EVIDENCE: There were satisfactory numbers of staff on duty during both days of the inspection and staffing rotas show that these numbers are consistently being maintained. The manager and deputy manager also both work full time and their hours are totally supernumery. A team of ancillary staff supports the care team. Information provided by the home indicates that a multi-cultural team of male & female staff are employed, ranging from aged 18-65 . No temporary or agency staff have been used to cover shifts in the last 3 months. Written comments from residents confirm staff are ‘usually’ available when needed. Relatives have commented that staff ‘ always welcome us as visitors’ and are ‘friendly & polite’. Information provided by the home indicates that 23 of the care staff, including bank & agency staff have NVQ level 2 or above. 3 staff files were seen and in the main provided all the information required to be obtained prior to recruitment with the exception of one staff file. This file contained two references but neither of them were employment references. They were both personal references. Lickey Hills Nursing Home (2 Units) DS0000004122.V336496.R01.S.doc Version 5.2 Page 21 Staff files and discussion with staff confirmed that they receive a programme of induction upon employment. The home employs a training officer at present, but this person is leaving at the end of August 2007 and is not being replaced. Lickey Hills Nursing Home (2 Units) DS0000004122.V336496.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are able to live in a home that is appropriately managed, providing care in a safe environment. EVIDENCE: The home has systems in place for monitoring the quality of the service. This includes monthly audits. The most recent audit was seen and it is evident that the information relating to the numbers of residents who have pressure sores is inaccurate. It is the Inspectors opinion that this is due to a lack of communication amongst the trained & senior staff in the home. A representative for the Provider carries out monthly visits and reports are sent to the manager. Action plans are produced following all audits and the home are also now producing a quality improvement plan. Lickey Hills Nursing Home (2 Units) DS0000004122.V336496.R01.S.doc Version 5.2 Page 23 The homes management of resident’s monies was seen and records are in place. Receipts are issued when money is brought in for identified residents during the week but not at weekends as the money is given to the staff within the Units. It is strongly recommended that a receipt book is available on each Unit to enable staff to issue a receipt. Notifications are being sent by the home to the Commission of any significant events in the home. More information needs to be provided about the circumstances leading to the death of residents. Records for water temperatures, window restrictors and bedrail maintenance checks were recorded. Advice was given to the manager during feedback to ensure that the bedrooms are identified on the bedrail maintenance records. An external contractor had done a fire risk assessment in April 2005 and this identified the need for a fire emergency plan to be implemented. Wheelchairs were seen in use without footrests in place. This was reported to the manager during feedback after the inspection. Information provided by the home indicates that equipment is being checked on a regular basis. The gas certificate was seen which was dated December 2006. An annual training programme is displayed in the home covering all of the mandatory topics and staff confirmed that they are receiving their ‘core’ training upon employment and updates as required. Lickey Hills Nursing Home (2 Units) DS0000004122.V336496.R01.S.doc Version 5.2 Page 24 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 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 2 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 1 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Lickey Hills Nursing Home (2 Units) DS0000004122.V336496.R01.S.doc Version 5.2 Page 25 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 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. Care plans must be developed to include the care required to meet the assessed needs of residents. Timescale of 14/07/06 not met. Care plans must be formally agreed either with the resident, or with their representative when the resident is unable to provide informed agreement. Timescale of 14/07/06 not met. Care plans’ effectiveness must be reviewed in accordance with the changing needs of each resident by a registered nurse. Timescale of 14/07/06 not met. Care plans must be written to ensure staff understand the care to be provided, and to ensure DS0000004122.V336496.R01.S.doc Timescale for action 31/08/07 2 OP7 15(1) 31/08/07 3 OP7 15(1) 31/08/07 4 OP7 15(2) 31/08/07 5 OP7 15(1) 31/08/07 Lickey Hills Nursing Home (2 Units) Version 5.2 Page 26 6 OP8 14 17(1)(a) 7 OP9 13(2) 8 OP10 16(2)(c) 9 OP10 12(4)(a) 10 OP12 16 11 OP15 12(1)(a) & (b) 12 OP20 23(2)(a)(f) that care is provided in a consistent manner. Timescale of 14/07/06 not met. Nutritional assessments must be undertaken in depth as soon as possible after admission certainly within the first week, and a care plan formed if necessary. Timescale of 20/06/06 not met. The registered person must ensure that medication is received, administered and stored according to the medicine policy to ensure the safety of the residents. The adequacy of the privacy curtains in shared room must be reviewed to ensure that residents privacy & dignity is maintained at all times. The registered person must ensure that any communication/reference by staff relating to residents is respectful at all times to ensure that the dignity of the residents is maintained. Residents’ interests must be recorded, and they must be given opportunities for stimulation through leisure, social, occupational and recreational activities, which suit their individual needs, preferences and capabilities. Brought forward, partly met. The service of meals on the dementia care unit must be reviewed to ensure that it is a pleasant & social experience for the residents. The size, design, furnishing and layout of the communal area on Rednal Unit must be reviewed to make the area more homely, and minimise the institutional impression the area generates. DS0000004122.V336496.R01.S.doc 31/07/07 31/07/07 31/07/07 20/07/07 31/08/07 31/07/07 30/09/07 Lickey Hills Nursing Home (2 Units) Version 5.2 Page 27 13 OP19 13(4)(a) & (c) 23(2)(b) & (d) Brought forward, timescale of 30/09/06 partly met. The registered person must 31/08/07 review all parts of the home with regard to the state of repair, décor and cleanliness to ensure that the environment is clean and safe for people living in the home. 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 3 4 Refer to Standard OP3 OP9 OP19 OP29 Good Practice Recommendations The pre-admission assessment should cover all areas of need listed within this Standard. All rooms where oxygen is stored or in use should display the statutory warning notices: Compressed Gas. Oxygen: No Smoking, No Naked Lights. It is strongly recommended that the home review the laundry provision with particular regard to its location and size. A reference should be obtained from the applicant’s most recent employer and the home need to check the authenticity of the reference to ensure that residents are fully protected. Lickey Hills Nursing Home (2 Units) DS0000004122.V336496.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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. 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