Inspecting for better lives Random inspection report
Care homes for older people
Name: Address: Lound Hall Nursing Home Town Street Lound Retford Nottinghamshire DN22 8RS two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Frances Shillito Date: 1 5 1 0 2 0 0 8 Information about the care home
Name of care home: Address: Lound Hall Nursing Home Town Street Lound Retford Nottinghamshire DN22 8RS 01777818082 01777818084 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : MPS Care Homes Ltd care home 30 Number of places (if applicable): Under 65 Over 65 0 30 0 dementia old age, not falling within any other category physical disability Conditions of registration: 30 0 30 The registered person may provide the following categories 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 - Code OP Dementia - Code DE Physical Disability Code PD The maximum number of service users who can be accommodated is 30. Date of last inspection Brief description of the care home Lound Hall Care Home is situated in the village of Lound close to Retford. The home provides Nursing and Residential Care for up to 30 older people or people who have a Care Homes for Older People
Page 2 of 16 Brief description of the care home physical disability. The accommodation comprises two lounges and a dining room and both single and double rooms are available, all with ensuite facilities. The home is suitable for people with mobility problems, provides a passenger lift and level access. The gardens are accessible to wheelchairs and provide a range of seating within a mature well-maintained garden. The range of fees is: 315.00 pounds to 748.00 pounds per week, and these do not include hairdressing, chiropody or toiletries. If a staff escort is required for Hospital appointments a charge of 25 pounds is applied. A copy of the last report is available on the wall in the reception area, and every service user is given an admission pack which contains the service user guide. Care Homes for Older People Page 3 of 16 What we found:
The case files of three people who live at the home were read during the visit, It was noted that the care plans had originally been written in 2005. Whilst there was a record for the manager to complete to show that the care plans have been reviewed and updated, it was not clear whether this had taken place, and the care plans seen were long out of date. There was evidence in the daily notes made by staff that one person who lives at the home had experienced irritated skin since May 2008, which staff treated with ointments. However there was no record made to confirm that the persons doctor had visited the home and prescribed medication. Staff spoken with were not aware of whether this had happened. The manager added that this individual has also been diagnosed with scabies, and as a result everyone who lives and works at the home were treated for this in December 2006. The home did not inform CSCI (Commission for Social Care Inspection) of these events. The manager explained that she was not aware of the need to share this information with the Commission. In addition this person had been admitted to hospital and discharged in October 2008. Staff had also noted in the records that the hospital had not sent them any information about the care to be provided, and this had not been followed up by the management of the home. There was also no up to date care plan in place for staff to follow. It was also noted from what staff had written in the daily records, that this individual was being treated with drops for the MRSA infection. However there was again no care plan in place for staff to follow, setting out their care needs and how these should be managed at the home. A nurse had made a note that this individual should see the doctor the following day, yet there was no evidence to confirm that this had been acted upon. Staff spoken with said that all the staff team have an awareness of MRSA and they explained in detail how they would care for people with this condition. However in the absence of a care plan to follow, the management of MRSA is very difficult. We saw that staff had made a record of a visit made by a social worker to assess this persons wellbeing and happiness, but there was no evidence of the outcome of this visit. It was not clear who was involved in this meeting and there was no care plan developed as a result. There was also no evidence to suggest that relatives or supporters had been consulted about this persons care needs and how best they could be met. Staff spoken with said that there is not always enough time to read care plans whilst they are on duty. This means that they lack guidance and direction about the care they give to people who live at the home, and have to draw on their own knowledge of good practise. However they added that thorough hand overs take place at the end of every shift to ensure there is good communication and continuity of care. The case file of a person was seen who has been living at the home since July 2008. A detailed care plan was in place which had been promptly completed when they moved into the home. We saw that they had signed to show that they had been involved Care Homes for Older People Page 4 of 16 when their care plan was developed. It contained useful guidance for staff to follow to ensure that their dietary, health and personal care needs are met. Staff had also noted in the daily records that the persons nutritional intake remains good in line with the care plan. Following admission staff had also undertaken a risk assessment with this person including a focus on pressure area care and mobility. A Monthly Health Screening Tool had also been used by staff to record this persons weight. Staff had also noted in the daily records that on one occasion that they had been encouraged and reassured in their best interest, of the need to see their doctor. This resulted in a hospital admission. During the visit the storage room for medication was seen. We saw that the room is small and very warm. There was no thermometer in place to record the temperature of the room and there was no extractor fan fitted. The sink for hand washing was dirty, and the casing around it was old and dirty. In the room there was no worktop to allow staff to remove the medications, including controlled medicines from the cabinet, and record what they were doing in a safe way. During the visit to the medication storage room the manager had to balance the controlled medication record book on the sink and hold bottles in her other hand. The medication administration records and the controlled medicines were also checked. There was evidence that one person had been prescribed oral morphine in January 2008, yet had received only two to three doses. The manager explained that this medication had been prescribed for shoulder pain and that there had been no need for it to be given since that time. However the written instructions clearly showed that this oral morphine should have been disposed of thirty days after it was opended, yet it was still stored in the controlled drugs cupboard. Another person living at the home was also taking oral morphine and amoxicillin, however there were gaps in records made by staff in the medication administration records. For example staff had not signed to confirm that medications had been given. Another person had been prescribed temazepam. The records showed that staff had not made a note of the new stock received in the controlled medicine register in the correct area. Instead a record had been made in the section where records are made of medicines which have been disposed of. The records of visits from the pharmacist were seen. This indicated that there had been a shortfall in a fentanyl patch, and it was understood at the home that the manufacturer had not inserted the correct amount into the dispensing box. However there was no record at the home of how this had been investigated. CSCI had not been informed of this and the manager explained that she was not aware of her responsibility in sharing this information with the commission. We also saw that there is no medication stock balance check taking place at shift changeovers. This was confirmed in discussion with qualified staff. Given that shortfalls had been noted by staff in relation to fentanyl patches, there is a significant risk that staff would not be alerted within a reasonable time frame, if there was medication missing, or more importantly if people had received more than their prescribed dose. In addition there was no evidence to show that the home is carrying out medication audits as part of its quality assurance activities. Had regular audits been taking place Care Homes for Older People
Page 5 of 16 controlled medicines identified as no longer in use would have been returned. During discussion the manager confirmed that the qualified nurses and level three care staff at the home received medication training recently. The complaints records contained in a book were read. The manager had recorded the details of conversations which had taken place with people who had raised concerns. However there was no written evidence of the investigations which took place, any action taken and the outcome of complaints. This indicates that concerns do not appear to be addressed or taken seriously at the home. During discussion the manager confirmed that the complaints procedure is made available to people who live at the home and their relatives. They added that a copy of the procedure is generally displayed on the wall in the reception area of the home, but it had recently been taken down. The complaints record of a person living at the home was seen. It was noted that a record of a telephone call from a relative had been recorded by the manager. Concerns had been raised in relation to the management of the persons finances, including concerns that their personal finances were not being safeguarded. The manager confirmed that she had not informed CSCI of this or alerted the local authority Adult Social Care Service, in line with protocols on safeguarding vulnerable adults. The training records seen indicated that staff have received some training in the safeguarding of adults, yet during discussion it was evident that they are not clear on their responsibilities for reporting any suspicions of abuse. Staff spoken with said that people who live at the home are assessed for the use of keys to their bedroom doors. They added that not everyone has a key to their room, and that the manager holds all the keys to the home and a master key in safekeeping. The home does not use the Department of Health Essential Steps guidance, to help them to assess current infection control management. During discussion the manager said that she was not familiar with this guidance, despite reflecting in the AQAA, the paperwork completed by the manager on the running of the home, (Annual Quality Assurance Assessment) that this is in place. The homes infection control policy was seen, however shortfalls were noted, in that it did not describe to staff how they should respond to specific issues. There was also no date on the policy to confirm that it had been recently reviewed and that the contents are up to date. The manager explained that the policy is reviewed and updated annually by her line manager, and that she would ensure that the policy is dated as from 2009. There was no risk assessment in place for infection control at the home. We also saw that the home has no guidance for staff to follow in relation to caring for people with MRSA and Chlostridium Difficile and infection control. However the home does have guidance in place in respect of the safe disposal of needles, the treatment of scabies and the action to take in case of a heat wave. Protective equipment was seen at the home and staff confirmed that this is readily available. The manager stated that there is always a good supply of anti-bacterial hand wash at every sink, as well as a generous supply of gloves and aprons for staff to use. Care Homes for Older People
Page 6 of 16 The manager confirmed that a contract for the removal and disposal of clinical waste is in place. As a result of the last key inspection in October 2007, the management of the home were required to review staffing arrangements and put contingency plans in place, to ensure there are enough staff to meet the dependency levels of the people who live at the home, in the event of staff holiday and sickness. During discussion with the manager she reported that they have twenty supernumerary hours each week, which are used up to 8pm for effective use of time. She added that the home benefits from the input of an administrator, who undertakes specific work, to enable the manager to have more time to undertake activities relating to the oversight and management of the home. Despite this, discussion with staff indicated that staffing levels do not allow sufficient time for staff to read or review care plans to inform the care to be delivered. Further indications of staffing level deficits were noted when the manager confirmed that there is no link nurse for infection control, due to insufficient supernumerary hours. The manager reported that three qualified bank nurses work over four days between 08:00 and 20:00. She added that this shift arrangement is in the interest of consistency and continuity of care, in that it allows opportunities for liaison with doctors and other professionals. The manager added that the nursing staff see people right through the day and are able to monitor their nutrition, dietary intake and medication. Bank staff spoken with explained that given the pattern of their working hours, they do not often have an opportunity to attend or contribute to staff team meetings to inform practise within the home. Following the last key inspection, the management of the home was required to ensure that all the information and documentation required by Regulation 19 and Schedule 2 is available in the staff files. The management of the home was also reminded that they must not employ anyone to work at the care home until these documents and this information is obtained, so that the people who live there are properly protected from harm. Three staff recruitment files were checked. One staff member is a qualified nurse who works bank shifts at the home. We saw that their file did not contain a CRB (Criminal Records Bureau) Enhanced Disclosure or two satisfactory references. During discussion the manager stated that she was not aware of whether the nurse was employed directly by the home or by an agency. Attempts to contact the head office for confirmation were made, but the manager did not receive a response during the inspection visit. Later in discussion, the staff member explained that their salary is paid directly by the home. They also confirmed that a CRB Enhanced Disclosure had been received in June 2007, when they started work at the home, together with two employment references from the hospital where they are employed. The recruitment file of another worker was read. There were details of their previous employment, paperwork confirming her identity, two satisfactory references, a satisfactory CRB Enhanced Disclosure and a POVA (Protection of Vulnerable Adults) first check. Finally a third recruitment file was examined. For this worker there was no up to date CRB Enhanced Disclosure on file, with the last Disclosure having been obtained in 2002. The manager explained that the staff member had been employed at the home eleven years earlier, and that this was prior to her taking up the role as Care Homes for Older People
Page 7 of 16 manager at the home. During discussion the manager explained that the home has its own budget allocation for staff training, which means that training courses and DVDs can be bought in, in addition to in house training being provided. The training records of three staff working at the home were read. We saw that there was evidence to confirm that staff received training in infection control practise in 2007. In addition the manager said that the PCT (Primary Care Trust) initiative has meant that community infection control nurses visit the home to offer training to the staff team. Staff received general training recently from the community nurses in areas such as infection control, incontinence, moving & handling, MRSA and Chlostridium Difficile. She added that infection control training is planned for mid November 2008, to be delivered byTraining Futures, who have previously provided dementia awareness training to staff. The manager explained that generally she works on their own, but is able to attend training events, to update herself on good practice in the care field and to maintain her professional development. Through discussion with the manager and examining the paperwork at the home, it is evident that the manager is not aware of her responsibilities in relation to significant matters. These include care planning and review, the reporting of significant occurrences at the home to CSCI in line with Regulation 37, alerting both CSCI and the local authority Adult Social Care service of safeguarding concerns, and safe recruitment practises. Little evidence was seen in relation to quality assurance activities within the home, to identify areas for improvement and inform future practise. Shortfalls in the management of medications within the home have not led to change of practise or improvement. There is currently no monitoring of compliance with safe administration, recording and storage of medications. The manager confirmed that Regulation 26 visits to the home take place on a monthly basis. What the care home does well:
The manager told us that some staff have worked at the home for a long time. This helps provide consistency and continuity of care for those who live at the home. We looked at staffing rotas and also spoke to management and staff. We found that the shift patterns worked by qualified nursing staff allow for continuity of care, as staff can monitor peoples nutrition, medication and well-being over a longer period of time. Staff said that thorough hand overs takes place at the end of every shift, and that this communication helps them to provide consistency and continuity of care to the people in their care. An administrator is employed at the home and this gives the manager more time to focus on the running of the service. On the day of the visit we saw that the home was clean, tidy and in good order. Care Homes for Older People Page 8 of 16 What they could do better:
Care plans need to be reviewed and updated regularly with the involvement of the person concerned and their relatives or supporters, to take account of preference, choice and changing need. Staff should be allocated time to read these care plans to inform the care they provide. Medical advice and assistance must be obtained to ensure that the health needs of people who live at the home are met, and that their care plans are updated in the light of this. Improvements need to be made to the medication storage room to make it a clean and functional space for staff to handle medication safely. Medication should be stored in appropriate conditions and accurate records made when medication is received into the home, given to people and disposed of. In addition medication stock balance checks at the close of each shift need to be implemented, along with monthly medication audits, as part of the quality assurance activity at the home. A formal approach needs to be adopted in relation to complaints handling and resolution. Every complaint received should be fully investigated, and the person making the complaint informed of any action taken within twenty-eight days. Notifications of significant incidents or occurrences must be made to CSCI as required under Regulation 37. Any concern relating to the safeguarding of vulnerable adults should be shared with CSCI, and the local authority Adult Social Care Service should also be alerted as lead agency, in line with agreed safeguarding protocols. Arrangements should be made to ensure that staff receive training in the safeguarding of vulnerable adults and that they are competent in following agreed protocols. The Department of Health Essential Steps guidance should be obtained to enable an assessment of the homes current approach to infection control management to be carried out. The Infection Control policy should be reviewed and dated to include guidance for staff to follow in response to MRSA and Chlostridium Difficile. A risk assessment in relation to infection control should be undertaken at the home as soon as possible. Staffing arrangements need to be brought under review to determine that there are enough staff to meet the dependency levels of the people who live at the home, that there is sufficient time for staff to consult care plans and other important documentation, as well as contribute to team meetings to inform practise at the home. Despite the findings of the previous key inspection, when the home was required to ensure that those who are resident at the home are protected by robust recruitment practises, there are still deficits in the documentation required to be held on staff files in line with Regulation 19 and Schedule 2. No staff should be employed at the home until a POVA First check, two satisfactory references and a satisfactory CRB Enhanced Disclosure are received and placed on file at the home. Quality assurance activity within the service needs to be implemented to ensure that areas for improvement are identified as quickly as possible, and that action taken as a result leads to service improvement. Consultation and involvement with people who Care Homes for Older People
Page 9 of 16 live at the home, with their relatives and supporters, professionals and other stakeholders should be formalised, so that the views of all those involved inform plans for the future running of the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 10 of 16 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set.
No. Standard Regulation Requirement Timescale for action 1 27 18(1)(a) You must review the staffing 20/01/2008 arrangements, and put contingency plans in place to ensure there are enough staff to meet the dependency levels of the residents in the event of staff holidays and sickness. You must ensure that all of 20/12/2007 the information and documentation required by Regulation 19 and Schedule 2 is available in the staff files and you must not employ anyone to work at the care home until these documents and this information is obtained so that residents are properly protected from harm. 2 29 19, Sch 2 Care Homes for Older People Page 11 of 16 Requirements and recommendations from this inspection
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 15 The care plan of each person 11/03/2009 must be reviewed and updated on a monthly basis in consultation with them, and take into account the views of involved professionals. This will ensure that people agree their care plans, and that such plans set out in clear terms how the health and social care needs of each individual are to be met. 2 8 13 Arrangements must be made 11/03/2009 to ensure that where necessary, people living at the home receive appropriate medical advice and treatment. This will ensure that each individual has access to health care services so that their health needs are met. 3 9 13 Accurate records must be kept when medicines are recieved into the home, administered and disposed of. All medication must be 11/03/2009 Care Homes for Older People Page 12 of 16 stored in appropriate conditions. This will help to safeguard the health and wellbeing of the people who live at the home. 4 16 22 Complaints made must be 11/03/2009 fully investigated and any action taken as a result, communicated to the person raising the concerns within 28 days. This will help the management of the home to ensure that peoples right to complain is respected, and that the outcome of complaints lead to service improvement. 5 18 37 Prompt notification to CSCI must be made in the event of death, ilness or other significant occurences at the home. Where safeguarding concerns arise the local authority Adult Social Care Service and CSCI must be promptly alerted. 11/03/2009 This will ensure that the people living at the home are protected from abuse and Care Homes for Older People
Page 13 of 16 neglect. 6 26 13 The Infection Control policy and procedure must be reviewed and a risk assessment undertaken, to take account of national guidance. This will help staff tp prevent the spread of infections amongst people living at the home. 7 26 23 Improvements must be 11/03/2009 made to the medication storage room, to ensure it is kept clean, well equipped, ventilated and maintained. This will help to prevent the spread of infection and safeguard the health and well-being of people who live at the home. 8 30 18 Safeguarding training must 11/03/2009 be provided to all staff at the home. This will help staff in following agreed protocols for reporting safeguarding concerns and to ensure that the people who live at the home are protected from abuse. 9 33 24 Quality assurance and 11/03/2009 monitoring activity at the home needs to take account of the views of people who use the service, their relatives, supporters and any involved professionals. This will help to ensure that the running of the home is kept under review and this leads to service improvement. 11/03/2009 Care Homes for Older People Page 14 of 16 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 15 of 16 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 16 of 16 - 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!
