Inspection on 07/10/08 for Lickhill Manor Nursing Home

This inspection was carried out on 7th October 2008.

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

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

Other inspections for this house

Lickhill Manor Nursing Home 14/06/10

Lickhill Manor Nursing Home 09/02/10

Lickhill Manor Nursing Home 07/04/09

Lickhill Manor Nursing Home 25/01/08

Lickhill Manor Nursing Home 04/05/07

Lickhill Manor Nursing Home 25/01/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

CARE HOMES FOR OLDER PEOPLE Lickhill Manor Nursing Home Lower Lickhill Road Stourport on Severn Worcs DY13 8RL Lead Inspector Chris Potter Unannounced Inspection 7th October 2008 09:15 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 Lickhill Manor Nursing Home DS0000064419.V372276.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. Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lickhill Manor Nursing Home Address Lower Lickhill Road Stourport on Severn Worcs DY13 8RL 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) 01299 827789 01299 878065 Gentle Care Services Limited Mrs Lynda Ann Mason Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (40) of places Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 40 Physical Disability (PD) 40 The maximum number of service users to accommodated is 40 2. Date of last inspection 25th January 2008 Brief Description of the Service: Lickhill Manor Nursing Home is a large grade II listed building, which has recently been tastefully extended to provide nursing and personal care for 40 people. The majority of people in the home are older people, but the home accommodates some younger people with debilitating illness’s for example multiple sclerosis. The home is located on the outskirts of Stourport–on-Severn next to Lickhill caravan park. It is situated in over an acre of landscaped gardens providing pleasant views from the rooms. The home is difficult to access on public transport given its location, but is within short distance of the town with the shops and the river Severn. The home provides plenty of car parking for visitors within the grounds. Accommodation is provided on three floors in both single and shared rooms. The home provides a range of aids and equipment to assist them in meeting the needs of people using the service. A passenger lift is available to assist people using the service to access all three floors of the home. Communal areas are available with three lounges and a separate dining area, so that people have a choice of where they wish to spend their day. A limited range of activities are provided for the people. The home is owned by Gentle care services limited. Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 5 The registered manager for the home is Lyn Mason who is a first level registered nurse with many years experience having worked at the home for 15 years. Lyn is responsible for the day to day running of the home. Information regarding the home can be obtained from the statement of purpose and the service users’ guide which are available from the home. A copy of our most recent inspection report can be viewed at the home. Information about the fees is available on request from the home. Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience poor outcomes. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. We, the commission, spent a day at the home when they did not know we were going. This was a key inspection – which is an inspection where we look at a wide range of areas. including care records for people using the service. Information was gathered from speaking to and observing people who lived at the home, X people were “case tracked”, and this involved discovering their experiences of living at the home by meeting and observing them, looking at medication and care files, and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Ten surveys were sent out, and returned by five residents and three staff. We looked at some parts of the accommodation and interviewed some 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. Before the inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the service for completion. The AQAA is a selfassessment document that focuses on how well the service sees that outcomes are being met for people using the service. An immediate requirement notice was issued following the visit. This was for the home to increase the staffing levels on the late shift and increase the number of trained staff on days so that there are enough people on duty to meet the needs of the people living there. What the service does well: The home provides a warm and friendly environment for people to live in and to visit. Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 7 Written information is available to help people decide if they wish to move to Lickhill Manor. Residents are able to bring some of their own personal possessions into the home so that they are able to create a more homely room. The residents told us that all the staff are kind and respectful in the way they care for them. The grounds are well maintained and provide pleasant areas for the residents to use when the weather permits. What has improved since the last inspection? What they could do better: People’s needs should be planned for in a more consistent way so that people can be confident that all their needs will be met Staffing levels need to be increased especially in the evenings so that there are enough staff on duty to meet the needs of people living there.” Available activities do not meet the needs, expectations and preferences of people living at the home so that residents are not able to experience a meaningful lifestyle. The home does not consistently follow robust recruitment practices to assist in minimising the potential risk of employing an unsuitable person. The systems are not in place so that people feel confident that their views are listened to help develop the service provided Staff do not receive formal supervision so that staff do not have the opportunity to voice their opinions on a one to one basis. It would also provide staff with recognition of their work and would help identify training and career opportunities. Ensure that all staff receive the training they need in a timely way so that staff are trained in the areas necessary to enable them to meet the needs of the residents. Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 8 Systems need to be implemented so that all areas of the home are safe and any risk to residents are reduced so that they are safe . 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. Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2 and 3 (standard 6 is not applicable for this service as they do not provide respite care) Quality in this outcome area is poor. Residents have limited information about the service before moving in so that they don’t receive all the information they need to make an informed choice. Failure to consistently assess people’s needs prior to admission may mean that the care they receive does not meet the resident’s needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We received five completed survey forms from people who use the service. They told us that they had been provided with enough information to help decide whether or not they wished to move into Lickhill Manor but their experiences of the service failed to meet those expectations. Comments Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 11 included: “I was given a lot of information only verbally and have found since my arrival much of this information is incorrect” We the not not looked at the statement of purpose which had not been updated following homes extension and so the information was incorrect. The document was available in the home for residents and relatives to view. The information is available in alternative formats to assist people to understand it easily. Four residents said that they had not been provided with a contract on admission to the home. So people moving into the home do not know the terms and conditions of their stay and what they can expect. The administrator confirmed that during her maternity leave no one had been in a position to complete the paperwork for the people. The administrator showed us copies of contracts to confirm that people moving into the home normally receive one. The administrator confirmed that she would address this. Comments received included: “I do feel that I should have been given a copy of a written contract” We looked at three people’s care records who had recently moved into the home. A pre – admission assessment had only been completed for one resident. We were told that they had been admitted as an emergency from the hospital and they had been unable to assess them. We were told by the deputy manager that the homes procedure in an emergency would be to assess the person within 24 hours of admission to the home. This had not been completed, and the nurses’ on duty told us this was because there was only one nurse on duty at the time of their arrival. To assist in ensuring residents receive care to meet their assessed needs and supply any aids and equipment all admissions should be assessed prior to admission to the home. The Annual Quality Assurance Assessment completed by the manager failed to demonstrate how the home were meeting these standards, but did state that contracts should be made available. Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10 Quality in this outcome area is poor. The lack of information in the care records may result in a failure to meet the person’s health and personal care needs consistently. Arrangements for the administration & recording of medication does not ensure that people living at the home receive their medication as prescribed which may harm their health Residents’ right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. This judgement has been made using available evidence including a visit to this service. Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 13 EVIDENCE: We looked at the care records for three people using the service. These records showed that each person has an individual care plan. A care plan consists of detailed assessments of the person’s, health, social and psychological needs. The care plan includes the person’s views and wishes about their care delivery. The care plan provides directives for the staff delivering the care. We looked at the care records at Lickhill Manor and these failed to provide enough detail for staff delivering the care. For example, on a care plan was recorded “Osteoporosis” there was nothing else completed on the plan of care for that health care need. There was no risk assessment to direct staff in how to assist the resident mobilising. We saw from the daily records that the person had a pressure sore, but there was no care plan in place to show what staff might have been providing to try and reduce the risk of further skin damage. The staff had not recorded if pressure relieving equipment was being provided. The person told us that they had not been consulted about their care preferences, and because of the short numbers of staff, they did not like to bother them. A nurse confirmed that they were providing dressings, but had failed to complete the care records because of the staffing levels. The nurse also told us that they were still waiting for pressure relieving equipment to arrive for that person. For a diabetic resident the care plan stated to record the blood sugar weekly. This had been followed until the 21st July 2008, and no record entered following that date, however the evaluation for August 2008 recorded that the person’s blood sugar remains stable. We looked at the care records for a resident admitted for “nursing care” and a list of their health needs were recorded. The nurses had not completed a plan of care for those problems. The person was in bed and no written record was available on how their health needs were being met. Without up to date comprehensive information staff do not have the information they need to meet residents’ health care needs consistently in a way they prefer. We were told by the nurses that they do not have sufficient time to complete the paperwork. “I was the only nurse on duty with two emergency admissions, medication and dressings, so the care plans are not prioritised”. We looked at the resident’s personal records which are completed by the carer. There were several days where nothing had been recorded, which appears that no care was given on those days. All staff spoken with confirmed that all Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 14 residents receive the care, but this is difficult with the staffing levels, and staff are coming in early and leaving late to care for the residents. We were told by two residents that they are offered a choice of personal care, at their preferred time. We looked at the medication records for the three residents which show how medication is administered to the people who use the service. There were some discrepancies between what had been prescribed and what had actually been given. One resident’s prescribed medication had not been signed for by the nurse for three days. The nurse did not know for what reason the medication had not been given. It is good practise for handwritten entries on the medication administration records to be countersigned to reduce the potential for mistakes in people’s medication being incorrectly administered. We saw handwritten entries on the resident’s medication record which had not been countersigned. By failing to record the number of tablets administered for medication prescribed “as needed” could result in the person exceeding the recommended dose or not having enough medication to control, for example, pain. The storage of medication is inadequate. The medication trolley is not secured to a wall and the room is being used for storing food and the freezer from the kitchen. This could result in medication being mixed up or tampered with and the person not receiving the correct medication. We saw that the people were dressed appropriately for the weather their age and gender. Staff were observed being kind and respectful to the residents. Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15 Quality in this outcome area is adequate. The home provides a limited range of activities for the people to take part in, that do not meet their needs or expectations. Food preferences and choices are not the preferred option for all the people’ so they do not receive their food preferences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides a limited range of activities for the residents. During the afternoon, we saw a singer entertaining the residents and the majority of people were participating with this and some relatives had visited to participate. Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 16 Information from the surveys and comments from residents and staff during the inspection indicated that the activities should be more suited for the residents needs. There is no assessment that the current activities are suitable for people with short term memory loss, people who are confined to their bedroom and younger people using the service. The service is failing to gather information about people’s likes and dislikes when they are admitted to the home. The staff told us that the person designated was part time (16 hours) and felt that more hours were needed to develop more suitable activities. Other comments received included: “very few activities arranged by the home” “more activities required” “would like to go out” and “we have no transport to take the residents out”. We were told by the manager at the last inspection that when the extension was completed and more residents had moved into the home the activities hours were to be increased. However this has not happened. The designated person told us that they do what they can, but find it difficult engaging the residents. A record is maintained of any activity which they participate in for example if they attended the entertainment. During the day we saw residents sat in the lounges and their bedrooms with the televisions on. Some programs were not the residents preferred choice and they stated “staff just put them on”. The home organises religious services for people who are Church of England and Roman Catholic if they wish to participate. We saw visitor’s coming and going during the day, and they were made welcome by staff. One relative told us “I visit every day and they always make me welcome”. Visitors can visit the home at any time, and can request a meal to have at the home. We received various comments about the food, from the residents and staff. Generally the view was that the quantity of food was sufficient, but the choices were limited. We were told that the cook knows the residents and is aware of their dietary likes and dislikes. From talking to the residents this was not so. The general opinion was that breakfast, and lunch were fine, but the tea was boring and repetitive. Comments received included: “the food is good” “food in abundance spoiled by poor cooking” “we are given jam sandwiches for tea every day”. We were told by a resident that they were having problems swallowing food and had requested that they have a trial of different foods to assist them, this had not been implemented. The meals are appropriate for the culture of people living in the home. The home caters for special diets required by people including diabetic diets. Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 17 We saw resident’s having breakfast and this varied from a full cooked breakfast, bacon sandwich, cereals, toast and marmalade. Staff were assisting residents where required. The residents told us that they were enjoying their breakfast and the food appeared appetising. The home was awarded an excellent rating from the environmental health at their last visit. Lickhill Manor Nursing Home DS0000064419.V372276.R01.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): Standards 16 and 18 Quality in this outcome area is adequate. People living in the home have access to a complaints procedure but can not be confident that their views will be listened to. Arrangements in place do not ensure that people living there are safeguarded from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a standard printed copy of the home’s complaint procedure in the service user’s guide. People who are able to express themselves confirmed that they were aware of the complaints procedure and who to talk to. Copies of the complaints procedure were not displayed around the home, and the format should be reviewed for a format accessible for all the people living in the home. Lickhill Manor provide a suggestion box in the reception area of the home, for visitors to make comments about the home, but staff were unsure if this was being used. Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 19 A resident told us that they were happy to talk to staff, but were not sure anything would change from this an example of this was the staffing levels. Staff told us that they raised concerns with the manager about staffing levels, but things had not improved. We looked at the records which the home is required to keep, showing how they had managed complaints since the last inspection. The records showed that the home had received two complaints in that period. The one was about the temperature of their relatives bedrooms and the second was about the care being provided for their resident. The outcome of the homes’ investigation was included and the temperature of the room was addressed. The one about care was upheld and included action taken by the home to prevent a reoccurrence. We have received no complaints about the home since the last inspection. We were unable to identify how many staff had received training in the protection of vulnerable adults, no training record was available, only a record with a date and a few names on it. We were told that the next training in protection of vulnerable adults was planned for the 24th October 2008. Staff we spoke to confirmed that they would have no hesitation in reporting concerns and poor practise and responded appropriately to scenarios. A member of staff confirmed that they had received training, but not at Lickhill Manor. Lickhill Manor Nursing Home DS0000064419.V372276.R01.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): Standard 19, 24, 25 and 26 Quality in this outcome area is adequate. Some areas of the home require improvement to provide the residents with a home that is suitable to meet their needs and safe for them to live in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the building work has been completed. Lickhill Manor are now able to offer more single en suite bedrooms for people who chose to live there. We looked around the home and saw that some of the bedrooms are personalised for the person using the room, and this gives a homely Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 21 atmosphere. The new extension leaves the main house looking tired, walls looking marked and damaged, carpets stained in some areas, and the furniture is well used. There was no refurbishment programme in place, so no effort had been made to introduce an improvement in furnishings and fittings. The home has not been adapted to suit the needs of all the residents. No alterations have been made to the home to assist residents with memory and sensory impairments. The home provides a small selection of specialist beds, pressure relieving equipment and chairs for some residents, but not in sufficient numbers to meet the needs of all people who use the service. A resident told us that they were concerned about people wandering into their bedroom and going through their personal items. The individual had not been provided with a key to secure their room. There are three lounges, and a large dining room for the residents to use. This means that people have some choice over where they want to spend their day. The lounges have a television for the residents to watch, and these were all on during the visit. A Passenger lift is available to assist residents with mobility problems to access all areas of the home. We observed that light shades had not been provided to the ceiling lights in the new extension to reduce the glare for residents and provide a more homely appearance. The deputy manager told us about a recent incident where an intruder had accessed the grounds of the home and the police had been called. We were concerned that the home had not notified us about this incident and had failed to complete a risk assessment about the security of the grounds and the home. We were notified about a resident leaving the home unnoticed. A risk had been highlighted about the fire doors not being alarmed, and this has not been addressed. On looking around parts of the home, we saw that the bathrooms were fitted with a normal domestic bath, which we were told was waiting for a hoist so that people would be able to use it. Given the dependency of some of the residents, a specialist bath would have been advantageous and offered all the residents a choice of bath. A damp patch was noted on the ceiling in the new bathroom – the cause of which had not been investigated. The home stands in extensive grounds and outdoor furniture is provided for the residents to use when the weather permits. Several residents and relatives were sitting in the gazebos after lunch, which they use for smoking, as the home has a no smoking policy in accordance with current legislation. Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 22 The home is situated in an isolated location but no risk assessment of the grounds had been undertaken or actioned to minimise any possible risk of unauthorised entry or access. Given the earlier incident where a resident left the home unnoticed, and the potential for someone to gain entry into the home, we were concerned to see that the fire doors on the extension had not been alarmed. We were advised by the central registration team that the fire authority advised that only low dependency residents should be admitted to the extension. The home had failed to incorporate this into the individual’s risk assessment when they are admitted to the home. Only one washing machine was provided for 35 residents. The operative was also only provided with a domestic iron. Comments from residents included: “the washing machine is going all night, I can hear it”, “my washing comes back clean, but not ironed, and “I used to iron everything, but I suppose with all the washing they have to do what can you expect” Comments received about the cleanliness of the home varied from: “It is sometimes clean and fresh”, “usually clean and fresh”, “always clean and fresh”. We were told that the home has employed extra domestic cover to provide cover for the seven days, and that the standard had improved form this. At the time of our visit the home was clean and free from offensive odours. Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is poor. Staffing levels are not adequate to consistently meet the needs of the people living there. Failing to complete appropriate checks on new staff may place residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We received surveys from residents that advised us that the staffing levels for the home were down especially at weekends. On some occasions, there are two registered nurses on a morning shift and one registered nurse on an afternoon shift but, on several occasions the duty rotas showed that there was only one registered nurse on duty during the morning period. The rotas also showed that during the weekends, the same nurse was covering both the morning and afternoon shifts. Usually, there were seven carers on duty in the morning but, during the afternoon, this fell to just four carers. On some occasions, levels were as low as three carers for 35 residents. During the inspection, residents and staff told us that there were not enough staff covering the home. Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 24 We observed that the lounges were not being supervised during the tour of the home, but we were advised that the staffing levels for that day were “good”. Comments received included: “Staffing levels are poor especially on a late, and we could do with two nurses on the early. I was working on my own last week, and received two emergency admissions, I had the medication to do, dressings, telephone calls it was horrendous”, “we are too busy to complete the paperwork”, “staff moral is low at the moment due to the staffing levels”, “we come in on our own time to try and get things done”, “the staff are very good, but they are overworked, and we have to wait sometimes up to one hour for the toilet”. Given the size of the home and the number of residents we made an immediate requirement notice for the home to increase their staffing levels. We received confirmation on the 17th October 2008 that this had been addressed. We were unable to evidence what training individual staff had completed, because no record was on their individual file and the home had not completed a training matrix. A new member of staff told us that they had received induction training when they commenced. A list of forthcoming training dates were provided which included “First Aid”, “Infection Control”, “Health and Safety”, “Fire Safety”, “Protection of Vulnerable Adults” and “Moving and Handling” training. Care staff told us that they felt that they were appropriately trained to meet the needs of the residents. Residents told us that the staff were kind and were more than able to meet their care needs. The Annual Quality Assurance Assessment completed by the manager stated that more than 50 of the care staff have completed National Vocational Qualification level 2 or above in care, and this assists them in delivering the care for the residents. We looked at three staff records and these showed us that the home’s recruitment procedures do not protect the people who use the service from harm or risk. The home had failed to confirm with the nursing midwifery council that any of the nurse’s registration were still in date. We found evidence that two references had not been received before people started working in the home, and that they were not from the most recent employer. This means that unsuitable staff could be employed. We were told by staff recently appointed that they had not been provided with a contract of their terms and conditions of employment. Staff confirmed that they had received induction training and shadowed a senior person when they commenced. Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 25 At present the home employs all female staff, from a diverse cultural background. This means that male residents can not receive gender specific care if they wish. We were told that no resident had requested a male staff member, but we were unclear if they had been asked whether they would like the option of having staff of the same gender to help them with their personal care needs. Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 26 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): Standards 31,33,35,36 and 38. Quality in this outcome area is poor. Given the scores from the above outcome areas, the home is not adequately managed as it is up to the manager to ensure that an appropriate service is available for people living there. The manager is qualified and has the skills and experience to run the home. But, by failing to improve some areas of the home residents and staff could be placed at potential risk. The home is not being run in the best interest of residents so that their wellbeing is not promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 27 All staff and residents we spoke to confirmed that the manager is approachable and appears to listen to what is being said, however some things do not change, an example of this being the poor staffing levels. The manager is suitably qualified to manage Lickhill Manor having been in post for many years. The manager has been without administration support for several months and, with the shortfall in staffing levels, has been working directly with the residents. This may have assisted in the number of requirements and recommendations identified at this inspection. The manager completed our Annual Quality Assurance Assessment (AQAA), and this failed to provide an accurate assessment of all areas of the service provision. The information was brief and failed to provide us with how the home were monitoring themselves against the standards. It also failed to demonstrate if the requirement from the last inspection had been addressed. The service was unable to provide us with the results of audits to demonstrate how they are monitoring the service as audits had not been undertaken. We were not shown regulation 26 reports which should be completed by the providers to monitor their performance. No system was in place for auditing accidents, care plans, environment and medication, all of which assist the home in monitoring their progress. Failing to monitor the service may result in risks to the residents not being identified, which may result in their health and safety not being protected. Record keeping for the staff and residents is inconsistent. Residents and staff spoken with raised concerns about the shortfall in staffing levels, which raises the risk of harm, due to staffing shortages, failing to reduce identified risks to the environment and grounds, staff training and inadequate staffing levels. Equipment in the home is serviced regularly, and a maintenance person is employed to carry out minor repairs. However when they are not there safety checks are not undertaken, an example of this being the failure to maintain weekly fire tests which could place people at risk in the event of a fire occurring within the home as staff may not be familiar with the correct procedure to follow. We were told by the administrator that the residents’ relatives tend to manage their finances. The administrator sends the relatives an invoice for any charges for example hairdressing. We looked at the accident records for the residents in the home. The forms were being completed appropriately, but the information was not being transferred onto the residents’ care plans. Fall risk assessments were not in place for residents highlighted at high risk of falls from the accident records. This means that people may not be receiving the appropriate care to keep them from injuring themselves through slips and trips. Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 28 We were told by staff that they were not receiving formal supervision. Supervision can assist in monitoring the person’s performance and identify training needs. Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 29 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 2 1 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X 2 2 2 STAFFING Standard No Score 27 1 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 1 X 2 Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP3 OP7 Regulation 14 (1) (a) 14 (2) 15 (1) and (2) Requirement Systems must be in place to ensure that residents needs can be met prior to them moving in. Residents and/or their representative must be consulted about their care plan. The care plan must be kept under continual review and revised at any time when it is necessary to ensure that their care needs are identified, and a clear action plan is put into place for staff to follow and protect residents from harm. Systems must be in place to record all medication administered so that residents receive their prescribed medication safely and in accordance with prescribed instructions. Timescale for action 31/10/08 30/12/08 3. OP9 13 (2) 31/10/08 Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 31 4. OP12 18(1) Systems must be in place to 31/10/08 ensure that the recreational, social, occupational and educational needs of residents are met and wellbeing promoted. 5. OP27 18 (1) (a) Suitably qualified and competent staff in sufficient numbers must be available to ensure that the health and welfare needs of the residents are met. Immediate requirement notice issued 07/10/08 31/10/08 6. OP29 19 (1) (a) 7. OP38 13 (4) (c) To ensure that residents are protected from potential harm the home must ensure that their recruitment procedure is robust so suitable people are recruited. Arrangements must be in place to ensure that unauthorised people can not gain entry into the building thereby protecting people who use the service. 31/10/08 31/10/08 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. Refer to Standard OP1 Good Practice Recommendations The home reviews and updates the information it provides to prospective residents so that it accurately reflects the services and facilities available. The home should provide the information in other formats to make it easier for residents and their representatives to understand the information provided. All residents should be provided with a statement of terms and conditions on moving into the home or a contract to DS0000064419.V372276.R01.S.doc Version 5.2 Page 32 2. OP2 Lickhill Manor Nursing Home 3. 4. 5. 6. 7. OP15 OP19 OP25 OP26 OP30 8. OP33 assist them in ensuring that their rights are protected, and so that they know what they can expect from the service. Systems should be developed to evidence that the residents’ food preferences and choices are being respected. The home should ensure that suitable equipment is provided in sufficient numbers to meet the needs of people using the service. To assist the residents and reduce the glare from the uncovered light bulbs, appropriate light shades should be fitted. To improve the laundry service for the residents the laundry equipment should be reviewed to ensure it is adequate to meet the amount of laundry being created. To assist in monitoring and ensuring that the staff have the relevant training and skills to meet the needs of the residents, a system to monitor individuals should be developed. To assist the service in meeting the needs of the residents, it is recommended that the home develop effective quality assurance audits and include the views of the residents and other professionals. To assist in monitoring staff performance and ensuring that they have the opportunity to voice their opinions, it is recommended that the service formalise their supervision program for the staff. 9. OP36 Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 33 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 Lickhill Manor Nursing Home DS0000064419.V372276.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!