Inspection on 16/05/06 for Moorwood Cottage Care Centre

This inspection was carried out on 16th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Moorwood Cottage Care Centre 17/07/07

Moorwood Cottage Care Centre 19/09/06

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Immanuel Nursing Home 9 Valley Road Chandlers Ford Eastleigh Hampshire SO53 1GQ Lead Inspector Annie Billings Unannounced Inspection 16th May 2006 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 Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 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. Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Immanuel Nursing Home Address 9 Valley Road Chandlers Ford Eastleigh Hampshire SO53 1GQ 01325 351100 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) Ashbourne (Eton) Limited To be confirmed Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (47) of places Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3 Service users must be at least 50 years of age. A maximum of 9 service users may be accommodated between 50-64 years of age. Bedroom 39 can only be used by a service user, over the age of 65 years, who requires personal care only 25th October 2005 Date of last inspection Brief Description of the Service: Immanuel is one of a national group of care homes owned by Southern Cross Healthcare Limited, currently trading as Ashbourne (Eton) Limited, and is registered to accommodate up to forty-seven older people. The home can admit up to forty-six service users for nursing care and one for personal care only. Of the forty-seven service users that the home can admit, nine may be between the ages of fifty and sixty-four. The home is situated in a residential area in Chandlers Ford and is near to the local shops and amenities. The home has been extended and accommodation is on two floors offering thirty-seven single, five shared bedrooms and three communal rooms. There is a stair/chair lift to the first floor. The home has a large garden which is uneven in some areas and an accessible pond, although steps to this area are currently fenced off for safety purposes. A raised patio area is accessible to the residents from the sitting room and there is a large car park at the front of the home. The acting manager advised that each service user is provided with a copy of the statement of purpose and service user guide, although following amendments these are currently being printed. The pre-inspection questionnaire states the current scale of charges per week as £500 - £600, with additional charges made for hairdressing and chiropody. Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors undertook this unannounced inspection on the 16th May and the 19th May 2006. During the two days, all of the key standards were assessed and twenty-four issues identified at the last inspection were followed up. A tour of the premises was undertaken, including all communal areas and the majority of bedrooms. The inspectors toured the home, speaking to residents, their visitors and members of staff. Staff files, resident’s personal care plans and other records were examined as part of the inspection process. Additional information was supplied within a pre-inspection questionnaire completed by the service. The home is currently without a registered manager, although the commission have since been advised that an appointment has been made, with an expected start date of the 26th June. The acting manager appointed attends the home three days each week, and was able to assist with most of the inspection. Following the last full inspection in October 2005, the providers were invited to attend a meeting with the Commission for Social Care Inspection (CSCI) on the 27th October, to discuss the serious concerns identified. In the absence of a registered manager interim management arrangements were discussed and agreed. A statutory notice was subsequently issued to the home in respect of one long outstanding issue relating to care planning. A follow up visit to the home in December 2005 assessed the issue as fully addressed. The home was taken over by Ashbourne Healthcare in April 2005, but has since been purchased by Southern Cross Healthcare. New paperwork systems are currently being introduced to the home. What the service does well: Service users spoken with said they are well cared for, and felt happy with the service. Two visiting relatives also advised they were happy with the service provided. Communal rooms are bright, spacious and comfortable. Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: It is disappointing that the service does not appear to have taken steps to ensure that previous issues raised have been appropriately addressed in line with the action plan submitted by the organisation. During this period, an acting manager has been attending the home three days each week, and not on a full time basis, as indicated at the meeting with the providers on the 25th October 2005. During this time the home has not been managed effectively. Fourteen issues raised at the last inspection remain outstanding, and four have only been partially addressed. Further concerns were identified during this visit. The responsible person must ensure that the serious concerns set out in this report are put right and that management arrangements ensure the home is managed effectively. The home has been asked to ensure that: - all new residents are admitted only after a full assessment of their needs is undertaken; this assessment must only be carried out by people trained to do so, and to which the prospective service user, his/her representatives (if any) and relevant professionals have been party - each resident has a service users plan of care, which is generated from a comprehensive assessment of their health, welfare and social needs. These plans must give staff detailed guidance on how to support people’s needs. Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 Page 7 Recording systems to be fully and accurately completed to demonstrate peoples’ needs are being met. - three nursing staff receive further training in the administration of medication with regular audits undertaken to ensure that policies and procedures are adhered to - nutritional assessments are completed for all frail or bed-bound residents by someone who is proficient in this type of assessment - risk assessments must be fully completed, to support the judgements made and appropriate measures put in place to minimise the risks identified - all staff must receive training in the protection of vulnerable adults - the home is clean, safe and well maintained. In particular, improvements must be made to first floor bathroom facilities, the ground floor bathroom facilities are fully accessible, the “wet room” is improved to ensure the dignity of users, and hot water pipes are covered to reduce any risk of burns - beds are assessed for their suitability so that nursing care can be provided without risk to staff - commodes, commode pots and sluice areas are kept clean, hygienic and free from offensive odours - all staff must receive training in adult protection and awareness of abuse - there are systems in place to control the spread of infection, in accordance with relevant legislation and published professional guidance - the staffing numbers are appropriate for the assessed needs of the service users - a thorough recruitment procedure is followed to ensure the protection of service users - the staff induction, training and supervision arrangements are put into practice - the home is managed effectively - products hazardous to health are appropriately stored - potential risks are identified and prompt action taken to eliminate or minimise the risk to ensure the health, safety and welfare of service users or staff - monitoring visits by the providers are undertaken regularly, to ensure the service is being run in the interests of service users - Regulation 37 notices are completed and sent to the commission following any accidents or incidents in the home Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 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 Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 The quality rating of this outcome section is poor. This judgement has been made using available evidence including a visit to the service. Service users cannot be assured that all their care needs have been assessed and would be met. The home does not offer an intermediate care service. EVIDENCE: Although standards 1 and 2 were not fully assessed, the manager advised that following amendments by the new owners, information about the service were currently being printed, although a copy was made available to the commission. It was noted and discussed with the manager that these and newly implemented paperwork systems are all in the name of Southern Cross Healthcare, and not the registered provider, Ashbourne (Eton) Limited. The manager agreed to discuss this with their line manager, as the relationship between companies needs to be made clear to service users, to ensure they are aware who is providing the service. New contracts are also being issued as Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 Page 11 a result of the change of ownership, and the manager gave assurances that these would be in place the following week. Standard 3 was examined at the last inspection and a requirement was made to ensure that each new resident had a pre-admission assessment which assessed, identified and documented all personal, health and social needs. Since the last inspection, the new owners of the service have introduced new systems of paperwork. Evidence seen suggests these have not been properly understood or implemented. Although it is recognised that this is the second change of systems in a twelve month period, which inevitably involves staff in a lot of work during the transition period, several assessments sampled were not signed and dated and assessment tools have not been fully completed for three new service users sampled. Risk assessments do not always identify any evidence to support the judgement made, or the control measures put in place, and conflicting information was found within files i.e. bed rails were in use with one resident, although the risk assessment states the risk is slight and very unlikely. No evidence of consent to the use of rails was available. A service user who was assessed as ‘nil by mouth’ had clearly just eaten breakfast. Discussions held with the manager and nursing staff identified that no training had been provided in the use of these new systems. Little evidence was available to support the involvement of relatives or residents in the assessment process, although the manager gave assurances that this was available on previous assessments, and was working towards updating the evidence at planned care reviews. One relative told the inspectors they had not been involved in the assessment or care planning process of their relative, despite visiting the home nearly every day. Improvements were however identified in some areas, as social and recreational interests are now being documented, and a personal history developed for each service user, although it was unclear where this information had been obtained. Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The care planning process is inconsistent, and does not ensure that staff have sufficient guidance to support service user’s needs. Systems are in place to ensure health care needs are addressed but many incomplete records do not demonstrate that needs are met. Although some improvement has been noted, arrangements for dealing with medication do not protect the residents. The resident’s privacy and dignity is seriously compromised by the structure and layout of the home, and the staff’s lack of attention to detail in personal care. EVIDENCE: A statutory notice was served on the home in December, following inaction in meeting a long outstanding requirement to develop detailed care plans. A further visit in December 2005 assessed care plans as appropriate in meeting people’s needs. The new owners have since introduced new systems of care planning. Individual care plans were available in each of five files sampled, but these were inconsistent, and did not always provide staff with detailed guidance. Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 Page 13 Information within one file identified the need for a specialised diet due to religious beliefs. This conflicts with information on the eating and drinking care plan, and amended information within the assessment. Difficulty in communication had been assessed and the family were noted as offering to interpret, but no attempt had been made to translate the care plan or to involve the service user. Alternative methods of communication had not been investigated, although two members of the staff team were able to speak the same language. A communication care plan in another file was excellent, and provided staff with detailed guidance on how to communicate with the resident. Information contained in other care plans viewed are not specific i.e. requires assistance with feeding, but does not specify the assistance needed; ensure adequate fluid intake; needs assistance of one or two carers and may use stand aid. This does not ensure that staff are aware of how to support service user’s needs. This was borne out by observation of moving and handling practice that was inappropriate for the service user, and could potentially put them and staff at risk. Systems are in place to ensure that health care needs are met, but are not completed consistently. Daily food and fluid charts were in place in each room visited, but were not properly completed, and where a need to record monthly weights had been assessed, no records were available. Records seen indicate that residents receive regular visits from GP’s, dentist and chiropodist when necessary. A number of shortfalls in medication practice were identified at the last inspection. Procedures in the home have been improved and current professional reference material has been made available, although a number of instances were found where medication was not identified as “as and when required”. This resulted in omissions being identified in recording where medication was not required. Two instances of unclear instructions on dosage of Warfarin were identified for two service users, which could lead to an overdose. A number of other omissions of signature were found. The requirement has therefore been repeated. The manager and qualified nursing staff advised that weekly audits of stock and records are undertaken internally, although no evidence was available. The manager advised that three of the six qualified nursing staff undertaking medication administration had been registered on a ‘safe handling of medication’ training course. Due to a change of pharmacist registration had been delayed for the other three staff. The requirement will remain in place until all staff have completed the training. The senior nurse on duty advised that agency nurses do undertake the administration of medication. There was no system in place to assess the competency of these staff, but the manager had developed a system of assessment by the second day of inspection. Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 Page 14 A number of residents spoken with said they are well looked after, and relatives confirmed they always look clean and tidy, although a number of male residents observed in the dining room at lunchtime were unshaven, a pair of glasses worn by one resident were unclean and another resident who had just finished lunch had no dentures in place. The staff member nearby indicated they had been left in their room, although was unable to communicate if this was the resident’s choice. The need for staff to pay attention to detail was discussed with the manager, having found dentures in one room that belonged to a previous resident, and the occupant’s hearing aid found under their bed. Staff and the manager were observed knocking on doors. Bedroom doors are fitted with locks, and screens are available in shared rooms, although due to the room layout in some, the privacy and dignity of residents would be compromised. Staff advised of the difficulties using the “wet room”, as due to its’ size and layout, the shower and WC cannot be used with the door closed. The room is currently used, leaving the door open and a screen utilised to provide an amount of privacy. This seriously compromises residents’ privacy and dignity. Information within the client enquiry form provides details of funding and has been included as part of the care plan file. This information should not be provided to staff, and should remain private between the resident and the home. The citing of a facsimile machine in the reception, that is rarely manned is inappropriate. A more suitable setting must be established to ensure that information remains confidential. Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Although activities appear to be more in line with resident’s preference, further development is necessary to ensure that the diverse needs of service users are met. Contact with families is encouraged and choice promoted in the provision of a balanced diet, but the home must ensure this meets the dietary preference of the residents. EVIDENCE: A number of residents spoken with confirmed they determine their own daily routines, getting up and going to bed when they wish. Choice was promoted within a number of care plans viewed, and relatives were observed visiting the home at various times of the day. A number of residents spoken with showed little interest in planned activities, although one said their interest in gardening was well promoted, and residents were observed participating in an exercise session in the afternoon. Since the last inspection, residents’ interests have been documented, although much more could be done to encourage and promote the documented interests. One file documented the resident’s interest in music and watching Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 Page 16 the activity within the home. On both visits, no music was playing in their room and the room was at the end of a corridor. An activities recording sheet has been developed for each service user, but these regularly record “one to ones”, without explanation as to the activity. Following consultation with residents the activities programme has become more varied although the list of weekly activities is not well publicised and is inaccessible to many of the residents. A video player available in the home had been placed in a drawer, and it was suggested that by making this more accessible in the communal lounge, residents could choose to make use of it. An activities co-ordinator is employed for 18 hours per week in the afternoons. On both days of the inspection they were seen to take time to sit and talk to residents both in communal areas and in their rooms. The manager has previously advised they were accessing a training course for the co-ordinator to further promote more diverse activities, but this has yet to happen. The home employs contract caterers and there is always at least one cook in the kitchen at meal times. Lunch was observed on both days, and food was well presented, plentiful and hot. Staff were available to assist if necessary. There is a planned menu, which is varied, and offers choices although some evidence seen indicates that the differing and specific needs of the residents are not always met. As indicated earlier in the report, conflicting evidence was available within files, and a recent quality assurance questionnaire stated that their needs were not being met. The manager agreed to look into this further, as the comment related not only to diet but religious needs not being met. Nine of the current residents receive a pureed diet, although there is not always sufficient evidence to support the reasoning behind this. Other comments made by residents included “Food is nicely served”, but suggested that menus are repetitive, and they get “lots of baked beans – I don’t like them”. One of the previous requirements made was to ensure that nutritional assessments are undertaken for all frail and bed-bound residents, by someone proficient to do so. Screening tools have been introduced, but those seen were either partially completed or not completed at all. Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 Page 17 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. An appropriate complaints procedure has been developed that residents and relatives feel able to use. Some staff have received training and have an awareness of abuse and the appropriate reporting procedures, which ensures that residents are protected. EVIDENCE: The home has developed an appropriate complaints policy and procedure, which was displayed by the front door. Residents spoken with said they felt able to talk to staff and the acting manager if they were unhappy, and felt confident that something would be done. One of two visitors said they were aware of the procedure. One complaint has been made to the home since the last inspection. This had been dealt with appropriately and a satisfactory outcome achieved. Two other issues have been brought to the attention of the commission. These have been referred to Social Services for investigation under the protection of vulnerable adults policy. Outcomes have yet to be achieved. Staff training includes ‘Resident welfare’, which covers all aspects of adult protection and provides definitions of abuse and what to do if abuse is suspected. Staff spoken with had a good awareness of abuse issues and the reporting procedures, although one of the qualified staff was unaware of the Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 Page 18 role of Social Services. Training records confirm that some staff have received training in this area, although one member of staff said they had missed the last three sessions, due to a lack of staff. It was advised at the inspection in May 2005 that all staff would have completed this training by the end of the year. Training records show this has not been achieved, and a requirement has therefore been made. Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Systems in place to ensure the environment remains clean, hygienic and well maintained are ineffective, as serious health & safety issues identified could put residents at serious risk of harm. Despite improvements in one bathroom, facilities remain inadequate and do not meet the needs of residents. EVIDENCE: During the inspection it was noted that the front door is now secured during the day to ensure that residents remain safe, although from comments made this has only recently been introduced. Visitors now sign in and out for each visit. Ongoing problems with the central heating and hot water systems have recently been resolved, although on the first visit some parts of the home were colder than others, although service users had no complaints. Other Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 Page 20 improvements to the home have been made since the last inspection. The ventilation system in the laundry is now in operation, although on the first day of inspection the washing machine was out of action. Dirty washing had accumulated since the breakdown on Sunday, and since the laundry is sited close to the front door, an odour had permeated throughout the home. The faulty drainage had been fixed by the second visit, and the odour was less obvious. The laundry contains only one washer and dryer, and a recommendation has been made for the home to develop a contingency plan in the event of future breakdowns. Improvements have been made to one of the ground floor bathrooms with the installation of a new bath, taps replaced and tiles repaired, although a shower attachment has not been fitted to allow for hair washing and the one handrail that is fitted is not in a usable position. The main bathroom on the ground floor was inaccessible, due to the storage of three hoists and two laundry trolleys. One member of staff was under the impression the bath had not worked in over eight years, although this was later found to be working. Staff therefore use the wet room in this part of the home, which provides an additional WC and shower facility. Although no views were expressed by the residents, staff advised that due its’ layout and design, it was impossible to utilise the facilities when using moving and handling equipment, or with the door closed. The door is therefore left open when in use, and a screen provided to give an amount of privacy. This is unacceptable, as this does not protect the dignity or privacy of users. The bathrooms upstairs remain unfit for use. In one room the side is only partly attached to the bath, the toilet is leaking and there are a number of mattresses stored in the room. The bathroom adjacent to room 39 is dirty, with old, worn, rippled and loose carpet. Uncovered hot water pipes were identified in one WC and all washing facilities were unwelcoming and institutional in décor. In several bedrooms the commode pots were found to be dirty and stained, and many of the taps dripping. The sluice room on the ground floor was reasonably clean, although no bin liner was in place. The first floor sluice contained several used bedpans, with dried on faeces. These were identified at the previous inspection, and looked liked they had been there since the October visit. . Most of the bedrooms in the older part of the home have only one electric socket. In several rooms it was found that there were air mattresses, lights and televisions plugged into one socket or a series of extension cables. The safety aspect of this practice was discussed with the regional manager at the October inspection, but no action has been taken. Four new adjustable beds have been supplied since the last inspection, although a number are still too low, divans too high and a number on wheels and could not be used safely by staff or in conjunction with a hoist. One staff member advised they had recently sustained a back injury due to the inappropriate height of the bed. One bed fell apart when moved, and a variety of tissues, bread crusts, biscuits, a glass, a mug, dust, a pair of shoes apparently not belonging to the occupant and the resident’s hearing aid were found underneath. Bed covers generally Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 Page 21 were thin, stained and threadbare and a number of pillows were lumpy through over-washing. Several rooms were uninhabitable due to poor access, lack of appropriate facilities or their state of repair. Room 39, which is deemed only appropriate for someone with personal care needs, is currently used as an ironing room. Room 25, currently used as a staff room, has a badly stained and broken basin, held together with tape. Rooms 33, 34, 35 and 36 do not have appropriate bathroom facilities and rooms 27, 28 and 29 have sustained water damage due to a leak in the flat roof. Notices had been attached to the doors of these rooms to identify a danger if lights were switched on, but the rooms remained unlocked, and no action had been taken to have the electrics checked for safety, despite the leak happening the previous week. An immediate requirement was made in relation to this issue. Structural cracks were seen in a number of rooms, particularly on the first floor. A number of vanity units in the older part of the home are in a poor state of repair, and décor looks tired and worn. One room currently occupied by a wheelchair user had four chairs blocking movement around the bed and access to the basin. A number of fire doors, which should be kept locked, were found unlocked. One of these areas contained rat poison. All areas posing a potential risk to the health and safety of residents were brought to the attention of the acting manager, who took prompt action to address the issues where possible. Communal areas were tidy, well furnished and clean, although much of the paintwork is badly scuffed and worn. The gardens are partially accessible, as one area has an unguarded pond, and access to this area has been secured. Exterior windows in the older part of the building need repainting and two tiles are missing on the roof. The garage is currently used as a storage area, and contains a variety of furniture, mobility aids, decorating and other substances that may be hazardous to health (COSHH), incontinence pads and oxygen tanks. This area was left unsecured, with doors wide open. An immediate requirement was made to ensure this area remains inaccessible to service users. An improvement programme had been developed on the 7th May 2006 to cosmetically enhance the premises and garden, but this does not address the structural deficiencies of the property. Infection control procedures had been implemented in the home on the second day of inspection, following diagnosis of an infectious disease. This information was not brought to the attention of the inspectors until much later in the day, which could have put other service users at risk. Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Staffing arrangements do not ensure that staffing levels or skill mix are appropriate to meet the needs of service users. Recruitment procedures are not robust in the protection of service users. EVIDENCE: The rosters sampled indicate that two qualified staff are on shift 8am to 8pm plus four care staff, with one qualified nursing staff member between 8pm and 8am with two care staff. Some staff, including qualified staff, are still working up to 60 hours a week, although signed agreements to work more than 48 hours as indicated in the DTI Working Times Directive (Department of Trade and Industry) are now in place. The manager told the inspectors that staffing levels are determined by the numbers of service users, rather than their care needs, and was under the impression that historically agreed minimum staffing levels still applied. It was also identified that the manager was only managing the home three days per week, leaving the service responsibility in the hands of the qualified nursing staff four days per week. No additional staff had been supplied to ensure the senior staff have supernumerary hours to manage the home appropriately. Discussions with nursing and care staff identified that staffing levels had improved recently, although there are only twenty-six residents accommodated at the moment. Staff felt there were times when they worked Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 Page 23 under pressure, and there were clear signs that certain staff members are stressed due to staffing arrangements. One staff member advised they had missed three training sessions as there were not enough staff to cover. Some conflicts exist between the staff team, with care staff feeling their opinions were not valued and qualified staff not giving support when required; and qualified staff feeling care staff need regular prompting, although the manager was unaware of this. Staff said that meetings are held regularly, although no documented evidence was available to support this. Comments made by service users were mixed, and included, “money is to be spent on the garden which could be spent on more staff”; “care staff are kind and helpful”; “staff are hardworking and caring”. Two relatives said that staffing levels were generally adequate, although one said there could be more at weekends. Two other residents had made comments on quality assurance questionnaires that indicate there were language barriers with some staff, stating “feels unable to communicate with some staff, as language is a barrier. Sometimes feels unwanted”, and “becomes cross when I can’t understand staff”. The training matrix sampled does not indicate that overseas staff are supplied with training in English language. Four staff files were sampled. One contained two references, although neither were from a previous employer; another contained one blank reference, while a third contained four, although none of these were appropriate. Photocopies of employment visas were available, but did not confirm the originals had been seen, and none of the files contained interview notes to identify that gaps in employment histories had been followed up. The pre-inspection questionnaire confirms that only one of fifteen care staff has completed a National Vocational Qualification to level II, although a further seven are underway. The staff training matrix supplied identified a number of shortfalls in training, including two trained bank staff without current moving and handling certificates, food hygiene, protection of vulnerable adults or recent fire safety training although they have worked recently. Two members of the domestic staff have received no training at all, and in some instances where training had been given this is not always facilitated by someone appropriately trained. As stated earlier in the report, moving and handling practice observed was inappropriate, and a senior carer said they had received no additional training or job description to support their senior role. Induction training records seen within files were not signed, and according to the dates given had been completed within one shift. The manager agreed these would not meet the standard of the Sector Skills Council induction, although she understood that the new providers would be implementing a new induction and foundation training programme. Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 Page 24 Some evidence was available to support staff receiving formal supervision. The manager agreed these were not up to date, although a plan has now been developed to ensure that all staff receive supervision every six weeks. From records seen, and from discussion with a qualified member of staff undertaking supervision these appear to be client focused or used for training purposes, and do not provide opportunities to raise concerns. Although the staff felt the manager was approachable, they felt unable to address their concerns directly because “she is so busy”. No evidence was available to support that staff undertaking the supervision sessions had received training in supervisory skills. A requirement made at the last inspection for qualified staff to undergo additional training in medication administration has been partially met, as three members of staff are registered on a course. The manager advised that due to a change in pharmacy, the training for three staff members had been delayed. The requirement has therefore been repeated. Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Management of the home is poor and ineffective in ensuring the health, safety and welfare of service users and staff are protected. Service users’ finance is well managed. EVIDENCE: The home has been without a registered manager for nine months, although the commission have now been advised of a recent appointment. In the interim, an acting manager had been appointed, although this has been on a part time basis, and not as agreed with the commission. At other times qualified nursing staff, including agency staff, have been left to manage the home, although without supernumerary hours. There are clear indications that the home is not being managed effectively. An immediate requirement was Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 Page 26 issued to increase the hours or review management arrangements in the home. The acting manager is registered with the commission in respect of another service within the group, and agreed that the prolonged joint management of two homes had been difficult, although line management support was readily available. Care staff and service users confirmed the acting manager is accessible and approachable, although a number of staff felt unable to address their concerns because she was so busy. Delegation of tasks to other members of staff had been necessary, but there was little evidence of monitoring to ensure these tasks were completed adequately to ensure that service users’ needs were being met. Service users confirmed that they were informed of changes to the service, although there was no documented evidence of this. The manager advised they had written to all relatives recently, with a view to involving them in the quality assurance process, but had received little response. An annual questionnaire had been given to the residents recently, but the results had yet to be collated and acted upon. These were sampled and a number of issues identified to the manager were responded to quickly. The previous survey mainly raised issues about activities, which have been addressed to some degree, although training for the activities organiser has yet to be accessed. The home is required to audit the service on a monthly basis, to ensure the service being run in the best interests of service users. These have not been completed regularly to ensure that service quality is monitored. The pre-inspection questionnaire confirms that service users finances are largely managed with the support of their families, although personal allowances are looked after and stored securely by the home. Three records were sampled, and were found to be accurate and well maintained. Records indicate that systems and equipment are tested and serviced regularly, and a record of accidents kept. The home is required to report any significant accidents or incidents to the commission, although there have been occasions when this has only been complied with after prompting or not at all, as in the instance of the roof leak. Systems for monitoring health and safety in the home are clearly ineffective, as proven by the serious issues identified earlier in the report, although once identified, the manager took prompt action to address them. Shortfalls identified earlier in this report in the assessment and care planning process and staff training do not ensure the health, safety and welfare of service users and staff. A current fire risk assessment has been undertaken by the Estates department, and the manager advised that evacuation procedures have been Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 Page 27 put in place, although discussion with a qualified member of staff indicated they were not aware of these procedures. Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 1 X X X X X 1 STAFFING Standard No Score 27 1 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 X X 1 Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 Page 29 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 OP3 Regulation 14 Requirement The responsible person must ensure that new residents are admitted only after a full assessment of their needs is undertaken; this must include risk assessments of any area of identified risk, with detailed evidence to support any action taken to minimise the risk; this assessment must only be carried out by people trained to do so, and to which the prospective service user, his/her representatives (if any) and relevant professionals have been party. This is a repeated requirement from the inspection on the 25th October 2005 2 OP7 15 and Schedule 3 The registered person must ensure that each resident has a service users plan of care, which is generated from a comprehensive assessment of his or her health, welfare and social needs. Care plans must demonstrate the daily care to be provided for DS0000066927.V292770.R01.S.doc Timescale for action 01/07/06 01/07/06 Immanuel Nursing Home Version 5.1 Page 30 each service user and give staff detailed guidance on how to support peoples’ needs, in consultation with the resident (or their representative) included in the planning or revision of the care plan. 3 OP9 13(2) Schedule 3(i) The responsible person must ensure that staff adhere to the procedures for the receipt, recording, storage, handling, administration and disposal of medicines This is a repeated requirement from the inspection on the 25th October2005 4 OP9 13(6) The responsible person must ensure that nursing staff receive further training in the administration of medication This is a repeated requirement from the inspection on the 25th October 2005 5 OP10 12(4)(a) The responsible person must ensure that the staff maintain the dignity of the residents at all times This is a repeated requirement from the inspection on the 25th October 2005 6 OP15 Schedule 3 (3)(m) The responsible person must ensure that nutritional assessments are completed for all frail or bed-bound residents by someone who is proficient in this type of assessment This is a repeated requirement from the inspection on the 25th October 2005 01/07/06 01/07/06 01/08/06 01/07/06 Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 Page 31 7 OP15 Schedule 4(13) The responsible person must ensure that the fluid and food intake output is recorded accurately for all residents who require these observations This is a repeated requirement from the inspection on the 25th October 2005 01/07/06 8 OP18 13(6) 9 OP19 23 The responsible person must ensure that all staff receive training in the protection of vulnerable adults The responsible person must ensure that the home is clean, safe and well maintained; a risk assessment of the whole home including areas of working practice must be completed by a competent person This is a repeated requirement from the inspection on the 25th October 2005 01/07/06 01/07/06 10 OP21 23(j) The responsible person must ensure that a shower facility is provided in one of the first floor bathrooms to meet the needs of service users; and other bathroom facilities are accessible, well maintained and meet the needs of service users. Improvements must be made to the wet room to ensure service users privacy, and hot water pipes covered in the ground floor WC’s. This is repeated requirement of inspection of 25th January 2005 and 12th/25th May and the 25th October 2005 01/08/06 11 OP24 16(1) & (2)(c) 23(2)(n) The responsible person must 01/07/06 ensure that all beds are assessed regarding their suitability for use DS0000066927.V292770.R01.S.doc Version 5.1 Page 32 Immanuel Nursing Home when providing nursing care for the residents accommodated in the home This is a repeated requirement from the inspection on the 25th October 2005 12 OP26 13(3) The responsible person must ensure that all bathrooms, toilets, commodes, commode pots and sluice areas are kept clean, hygienic and free from offensive odours This is a repeated requirement from the inspection on the 25th October 2005 13 OP27 18(1)(a) The responsible person must ensure that staffing levels are appropriate to meet the assessed needs of the service users This is a repeated requirement from the inspection on the 25th October 2005 14 OP29 19 Schedules 2 and 4.6 The responsible person must operate a thorough recruitment procedure for new staff and maintain all staff records as required in Schedule 2 This is a repeated requirement from the inspection on the 25th October 2005 15 OP30 18(1)(c) The registered person must ensure that a staff training and development plan is implemented for the home. The plan must demonstrate that all new staff undertake induction and foundation training that meets the specifications of the Sector Skills Council DS0000066927.V292770.R01.S.doc 01/08/06 01/07/06 01/07/06 01/07/06 Immanuel Nursing Home Version 5.1 Page 33 This is a repeated requirement from inspection of 12th/25thMay and the 25th October 2005 16 OP30 18(1)(c) The registered person must 01/08/06 demonstrate that all staff receive the required statutory training, and any necessary additional training, to ensure that they are proficient in their duties This is a repeated requirement from inspection of 12th/25thMay and the 25th October 2005 17 OP33 26 The registered person or their 01/07/06 representative must visit the home monthly to monitor the service, and ensure it is being run in the best interests of service users The registered person must 16/05/06 increase the hours or review the management arrangements in the home, to ensure they are effective The registered person must 01/07/06 demonstrate that all staff receive regular documented supervision to ensure that they are proficient in their duties This is a repeated requirement from inspection of 12th/25thMay and the 25th October 2005 20 OP36 18(2) The registered person must ensure that senior staff undertake training in supervisory skills before supervision sessions are undertaken This is a repeated requirement from the inspection on the 25th October 2005 21 OP38 13(4) The registered person must DS0000066927.V292770.R01.S.doc 18 OP31 38 19 OP36 18(2) 01/07/06 16/05/06 Version 5.1 Page 34 Immanuel Nursing Home 22 OP38 13(4) 23 OP38 37 ensure that products hazardous to health are appropriately stored The registered person must ensure that unnecessary risks to service users and staff are identified and prompt action taken to eliminate or minimise the risk The responsible person must ensure that Regulation 37 notices are completed and always sent to the commission following any accidents or incidents in the home that may affect the welfare of residents This is a repeated requirement from the inspection on the 25th October 2005 16/05/06 01/07/06 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 OP19 Good Practice Recommendations Contingency arrangements should be developed in the event of future breakdowns of laundry equipment. Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 Page 35 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 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 Immanuel Nursing Home DS0000066927.V292770.R01.S.doc Version 5.1 Page 36 - 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!