Inspection on 04/12/06 for Mother Redcaps Nursing Home

This inspection was carried out on 4th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Mother Redcaps Nursing Home 27/10/09

Mother Redcaps Nursing Home 29/06/08

Mother Redcaps Nursing Home 24/05/07

Mother Redcaps Nursing Home 19/05/06

Mother Redcaps Nursing Home 21/12/05

Mother Redcaps Nursing Home 16/05/05

Mother Redcaps Nursing Home 21/10/04

Mother Redcaps Nursing Home 19/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Mother Redcaps Nursing Home Lincoln Drive Egremont Promenade Wallasey Wirral CH45 7PL Lead Inspector Les Smith Key Unannounced Inspection 09:00 4th December 2006 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 Mother Redcaps Nursing Home DS0000020940.V323944.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. Mother Redcaps Nursing Home DS0000020940.V323944.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mother Redcaps Nursing Home Address Lincoln Drive Egremont Promenade Wallasey Wirral CH45 7PL 0151 639 5886 0151 630 1730 glenn.bulloch@tiscali.co.uk 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) Business & Marketing Consultants Limited *** Post Vacant *** Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (51), Physical disability (2) of places Mother Redcaps Nursing Home DS0000020940.V323944.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. A maximum of 51 older persons may be accommodated of whom no more than 2 adults shall be in the category PD and two named adult under 65 years of age. Provide accommodation for two named service users for personal care OP (PC). One named service user under age of 65 years. Three named adults in Category OP (N) under the age of 65. Date of last inspection 19th May 2006 Brief Description of the Service: This care home is a three-storey purpose built nursing home, situated on Egremont Promenade overlooking the river Mersey, and offers nursing care for 51 older persons. A lounge/dining room is provided on each floor with televisions, videos, piano, and music centres available. The home is double glazed throughout and ramp access is available at the front entrance. A lift serves all floors. All accommodation offered is in single rooms and the majority have the benefit of en-suite facilities. A selection of bathrooms, showers and toilets are provided on each floor and assisted bathing facilities are available. The small front and side gardens are well maintained and car parking is provided at the front of the building. Fees range from local social service rates to £481. Mother Redcaps Nursing Home DS0000020940.V323944.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place on 23rd of November for a period of eight hours to initially check compliance with requirements made at the previous visit in May 2006. The visit was extended to review all standards as a result of the concerns expressed by residents, relatives and staff. A second unannounced visit was made on 4th December when the inspector was accompanied by a regulation manager and a specialist pharmacy inspector. A total of 26 hours time in total was spent at the home over the two days. During the visit time was spent examining records, policies and procedures and a tour of the home was undertaken. Discussions took place with residents, relatives, members of staff, and the registered manager. Relatives spoken to were unanimous in expressing their concerns in relation to both nursing and social care. Comments included ‘her skin is very dry and the cream prescribed is not being applied’, There are no mid-morning or afternoon drinks served’, ‘they are always short-staffed’, ‘the best staff have left’, ‘you can never find any staff’, ‘they lost her new glasses in the first twenty-four hours here’, ‘it is very poor value for money’, ‘there are no standards here anymore’. Examination of files including care and personnel files showed that record keeping is poor in all areas. Medication management is poor and residents or their representatives cannot be confident that health needs will be met. Recruitment procedures are not as robust as they need to be to support and protect the residents. Recent thefts at the home have not been dealt with appropriately or reported to the Commission or the Adult Protection service. Staffing levels are not sufficient to meet the assessed needs of the residents and continuity of care is severely compromised by the excessive use of agency staff. Staff have not received the required mandatory training in fire awareness, first aid, manual handling or health and safety. A lack of storage facilities at the home has resulted in bathrooms and ensuite facilities being used for inappropriate storage limiting the facilities available to residents. Maintenance at the home is poor and needs to improve to ensure that the environment both internally and externally is safe and comfortable for residents. The home has deteriorated significantly due to a lack of effective management, leadership and guidance. Discussions with the manager showed a lack of knowledge and interpersonal skills ranging from dealing with adult protection issues to accepting residents outside of the homes registration category. Mother Redcaps Nursing Home DS0000020940.V323944.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: 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. Mother Redcaps Nursing Home DS0000020940.V323944.R01.S.doc Version 5.2 Page 7 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 Mother Redcaps Nursing Home DS0000020940.V323944.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives have sufficient information to make an informed decision about where they wish to live but cannot be confident that their needs will be fully assessed or able to be met. EVIDENCE: The Statement of Purpose contains all the required information and is available on request. A copy of the document is also available in the reception area and includes a copy of the previous report. The manager gave assurances that a copy of the Service Users Guide is available in all rooms. Residents’ spoken to could not recall if they had ever received a written contract or statement of terms and conditions or any information prior to coming to the home ‘my daughter deals with those things’, ‘my visit was arranged by the CPN’. Mother Redcaps Nursing Home DS0000020940.V323944.R01.S.doc Version 5.2 Page 9 Examination of a selection of residents care files demonstrated that an appropriate assessment of needs had been carried out prior to admission. The pre-admission assessments seen lacked the comprehensiveness required in order to construct an initial plan of care. The identification of needs is essential to enable any required aids or facilities to be put in place prior to admission and to enable the prospective resident to be assured that their needs can be met. One file was seen that identified the need for an air cell mattress and the prospective resident was assured that this was available at the home. The resident was admitted without an appropriate mattress being available resulting in discomfort for the resident for three days until one was brought into the home by the resident’s spouse. The home must be able to demonstrate that appropriate aids and equipment are in place in order to assure prospective residents or their representatives that the home has the ability to meet assessed needs. Additionally, it is also essential that the home have a competent workforce equipped with the knowledge and skills to deliver the care required. The lack of appropriate training for staff limits and compromises the care service at Mother Redcaps. Serious concerns have been expressed by a visiting GP and two specialist nurses to the home and to the CSCI (Commission for Social Care Inspection) in relation to the care service at the home. Visitors and prospective residents are welcome to visit the home at any time and as often as they wish when deciding whether to request or accept a place at the home. The home also offers trial stays with a view to permanent residency subject to availability. The home is not registered for and does not provide intermediate care. Mother Redcaps Nursing Home DS0000020940.V323944.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lack of comprehensive and consistent care planning, risk assessment, review and poor medication management places residents at risk of harm or injury EVIDENCE: A range of care plans and associated documentation were examined during this visit. These included residents with differing needs such as sensory impairment, specialist nursing needs and varying levels of cognitive ability. All care plans and associated documentation examined lacked accurate completion and one file was seen where no care plans had been completed for a resident who had been admitted to the home some 2 weeks earlier. It is a serious concern that the resident with no care plan in place had complex needs. The lack of required and accurate care plans fails to demonstrate that the interventions to meet known needs have been put in place. The risk of required care not being given due to lack of appropriate care plans is not acceptable. Mother Redcaps Nursing Home DS0000020940.V323944.R01.S.doc Version 5.2 Page 11 The standard of regular care plan review was poor with inadequate statements such as ‘continue with plan’ with no justification as to why the care plan is to continue. The regular evaluation of care plans is essential to monitor the effectiveness of the care delivered and therefore the evaluation must detail the effectiveness or otherwise of care delivered thereby justifying any changes or no change to the plan. Daily report sheets were completed in variable amounts of detail. Some members of staff record a good level of detail whilst others record non-specific comments such as “settled and slept well”. Statements such as these give no indication as to the actual care delivered, the outcome of that care or how the resident has spent their day. The promotion of independence invariably involves an element of risk, which is managed via the completion of relevant risk assessments. The required risk assessments were not always present in the care files examined. Where risk assessments were present and reviewed, examination showed that the assessments were not always accurate and any reviews did not always reflect changes, which were evidenced in other parts of the care file. Risk assessments for the use of bed rails and appropriate consent for use had not been completed for several residents who had bed rails in use. Wound records were not always present in the detail required. Full mapping of wounds or sores must be undertaken to ensure that improvements and deteriorations can be identified in the early stages to further plan the treatment to be given. Residents identified as having sensory or cognitive impairment had no plans in place to address their special needs and plans in relation to their activities of daily living failed to reflect the additional input and care required due to their sensory impairment. Care files showed that GPs, specialist nurses and other health care professionals such as dieticians and chiropodists saw residents. However, referrals are not always made in a timely manner. Treatments and recommended interventions are not acted upon resulting in a failure to meet residents’ health needs. The tissue viability nurse who prescribed dressings and requested that dressings be changed on alternate days for a resident in respect of a wound that was not healing. On the day of this visit the resident complained that the dressings had not been changed for five days. The resident concerned had requested on two days that the dressings be changed but had been told on both occasions that the staff did not have time. On asking for the dressing to be changed it was discovered that the relevant dressings were not available. The tissue viability nurse was requested by an agency nurse on another visit to review another resident who should have been referred several days earlier. Mother Redcaps Nursing Home DS0000020940.V323944.R01.S.doc Version 5.2 Page 12 The overall standard of recording and administration of medication was poorer than at the last inspection. Policies and procedures for handling and recording medication were in place, but findings on the day showed that these were not reflected by current practice. Records such as the ‘Administration of when required medication’, ‘Audit of potentially abusable medication’ and ‘Reasons for omission of medication’ had not been fully and accurately maintained. This meant that it was not always possible to see why medication had been given or missed out. Medication that had been refused could not always be accounted for and not all medication had been recorded when coming into or destroyed by the home. This meant that it was impossible to audit medication for some residents. Some handwritten entries on MARs were found to be incorrect. These entries had not always been checked and signed by a second member of staff. Poor record keeping places the health and wellbeing of residents at risk of harm. A sample audit of Medication Administration Record charts (MARs) and current stocks, showed nine examples where medicines had been signed for but not administered, two medicines that could not be accounted for and two examples of medication that had been signed as given even though no stock was present. All these examples show poor practice within the home. Residents are at serious risk of harm if nurses do not follow Royal Pharmaceutical Society of Great Britain and Nursing and Midwifery Council guidelines for the safe administration and recording of medication. Four residents had a total of six current medications present that were not listed on the MARs. A list of residents taking nutritional supplements was not complete and in one case recorded incorrect information. Residents are at risk of not receiving the correct treatment if MARs are not accurate. A carer stated that she made sure nutritional supplements were always present in one resident’s room, because if she didn’t, then they were not given. Twelve residents had been given medication at the incorrect dose. One resident prescribed a liquid medicine three times a day had only been given it twice daily for over a week Residents did not always get their medication at the correct time. The morning medication round for the lower floor was only started at 11:10 am. This meant that residents who needed medication with or before breakfast were not given it on time. One resident, prescribed regular pain relief, had to ask for painkillers as none had been given since 10pm the previous evening. Another resident had not been given diabetic medication before breakfast as prescribed. Lunchtime medication for the same floor was completed by 2:30pm meaning that doses were given too close together. This is particularly dangerous for residents taking Paracetamol, strong painkillers or medication Mother Redcaps Nursing Home DS0000020940.V323944.R01.S.doc Version 5.2 Page 13 that causes drowsiness. The health and wellbeing of residents is at serious risk of harm when medication is not given at the correct time. One resident often spent short periods of time away from the home. There was no record of medication being made available for him to take during this time, or offered when he came back. Residents are at risk of not receiving their medication when away from the home. There was no evidence to suggest that residents who were asleep were offered it again later. This means that residents who chose to rest at certain times of the day were at risk of not getting their medicines properly. Some residents refused their medication and again there was no evidence that it was reoffered later. Whilst all residents have the right to choose whether or not to take their medicines, some may refuse because they are confused. These residents are at risk of not getting their medicines correctly. The clinical room was not kept locked at all times. Staff members other than nurses were seen going in and out of the room. A large quantity of waste medication was stored in open containers meaning that medication was easily available to unauthorised people. Medicines were also found in residents’ rooms. This is not safe: medication must be stored securely at all times. Staff left the fridge door open twice during the visit. This meant that medication was stored at the incorrect temperature. The fridge temperatures had not been recorded daily, however thermometer recorded a recent range between 0°C and 28°C. Blood glucose test strips were stored in the fridge, despite the label stating that they must be refrigerated. Failure to store medication at the correct temperature places the health and wellbeing of residents at risk. Nurses did not always check the medication of new residents. This meant that they did not know whether residents had brought all their medication with them, or whether medication was still current. There must be a system in place to confirm medication with residents’ GPs in order to ensure that it is given correctly. Staff did not always have enough information to make sure those medicines with variable doses e.g. warfarin, or those prescribed for use ‘when required’ was given correctly. Control of medication stocks within the home was very poor. Even when residents had enough medication to last the next month, new supplies would be ordered and either disposed of or allowed to build up. This meant that the home created far more waste medication than necessary. The audit system in place had not been used properly. This meant that administration and recording errors had not been spotted and poor practice had gone unchecked. Mother Redcaps Nursing Home DS0000020940.V323944.R01.S.doc Version 5.2 Page 14 Observation of care during the course of this visit showed that resident’s privacy was maintained in relation to personal care. Residents must at all times be treated with respect and dignity and many aspects of care fail to do this. Mealtimes clearly demonstrated the lack of care and poor practice that exists at the home. The breakfast trolley was delivered to the dining room at 0905 with uncovered toast and bowls of porridge. By the time some residents were being served the food was cold but still given to residents. Lunchtime further demonstrated the lack of respect and dignity for residents with the following occurrences noted: One resident was given a plate on their knee in an easy chair rather than be assisted to sit at the table One resident struggled for five minutes to try and eat their meal before any assistance was offered One resident refused the meal and sweet and the refusal was accepted without any form of intervention or alternative being offered The lack of assistance for residents at mealtimes is not acceptable and severely compromises respect for and dignity of the individual. A lack of respect and dignity is a major concern of relatives with all those spoken to expressing serious concerns at the standards of care at the home. Comments made included ‘I asked for mum to go the toilet at 1000 and when I had to leave at 1200 she had still not been taken despite several requests’, ‘I have complained several times about mum being dressed with no underwear on’, ‘her hair is not washed for weeks on end’, ‘I am very worried about my husband but he is too frail now to move elsewhere’, ‘she was not mobilised as she should have been and is now chair bound’, ‘he is just sat in a chair and left’, ‘nails are always filthy’, ‘it takes far too long to get someone to take her to the toilet’. Care files examined lacked relevant information in relation to terminal illness and end of life wishes. It is important that residents’ wishes are documented and respected. Mother Redcaps Nursing Home DS0000020940.V323944.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): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. As far as possible residents have choice and flexibility in how they spend their day in the home, but limited social and recreational activities do not promote independence and individuality for each resident. Meals at Mother Redcaps are good, offering choice and variety whilst catering for residents dietary needs or cultural preferences. EVIDENCE: The home employs an activities co-ordinator for 20 hours per week who also works as a care assistant for 18 hours per week. The staffing situation at the home is such that the activities co-ordinator frequently becomes involved in carrying out care duties. This reduces the time available for activities to between 6 and 10 hours per week, which is clearly inadequate. In view of the size of the home and the differing requirements there is a need to establish the likes and preferences of individual residents to provide a fully inclusive activity programme. It is recommended that consideration be given to increasing the hours of the activities co-ordinator to full-time and arrange appropriate training in activities for elderly. This would enable more to be done to provide stimulus for those residents who cannot participate in-group activities. Whilst the co-ordinator keeps records of activities it is strongly recommended that Mother Redcaps Nursing Home DS0000020940.V323944.R01.S.doc Version 5.2 Page 16 participation in activities be recorded in the daily reports. This would help to develop a profile of likes and dislikes of individual residents. The home has a policy of open visiting with friends and family welcome at any reasonable time and to stay as long as they and the resident wished. Visitors were observed to be arriving at the home throughout the day and residents were able to see their guests in one of the communal areas or in their own rooms as they wished. However, one relative comments that ‘we would like to see our relative in their own room but it is so malodorous we cannot’. There is little opportunity for the promotion of autonomy and independence at Mother Redcaps. All the staff members spoken to said that morale could not be any lower and made comments in relation to care including ‘we are far too rushed to give quality care’, ‘care is limited by the shortage of staff’ and ‘privacy and dignity are compromised’. Meals at mother Redcaps are varied and include a large proportion of homemade dishes and pastries. The kitchen is well equipped and organised and the stores are well stocked. Meals are taken either in individual rooms or one of two communal dining areas. It is the practice for a large numbers of residents to remain seated in easy chairs using over bed tables, which is not best practice. Mealtimes and the midday meal in particular is an opportunity for mobilisation and social interaction and every encouragement should be given to residents to participate. Mother Redcaps Nursing Home DS0000020940.V323944.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents and their representatives cannot be sure that their complaints will be taken seriously or acted upon in an appropriate manner and residents are not protected from abuse, which places them at risk of harm or injury. EVIDENCE: There is a record of complaints and actions taken at the home but it is clear that many complaints are not documented. Discussions with relatives clearly showed that complaints had been made that were not recorded and relevant actions had not been taken. Only four complaints had been documented since the previous visit. The complaints had been resolved but the documentation did not give appropriate information in relation to either investigations carried out or outcome and there was no formal correspondence on file. The home must ensure that all complaints verbal or written are documented together with details of appropriate investigations and outcomes to promote openness and transparency. It is recommended that the complaints procedure be reviewed and distributed to all residents or their representatives. During this visit it became apparent that there had been three alleged incidents of theft during November. Two incidents involved the removal of jewellery from residents whilst they slept and one involved the theft of cash. None of these incidents had been documented, reported to the CSCI or the adult protection unit as required. The police were only informed following the second theft. One of the rings involved has since been found in an area that had been previously searched. It is a major concern that there has been a total Mother Redcaps Nursing Home DS0000020940.V323944.R01.S.doc Version 5.2 Page 18 failure of all procedures. A relative involved has of their own volition put notices up in the home advising other residents and relatives of the thefts. The protection of residents from abuse of any sort must always be paramount and the home must ensure that all staff members are trained in abuse recognition and the actions to take should abuse be discovered or suspected. The home has failed to provide this training and must address this as a priority. Mother Redcaps Nursing Home DS0000020940.V323944.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The environment at Mother Redcaps requires significant improvements in order to promote a homely, safe and comfortable place to live for the residents. EVIDENCE: A tour of the home accompanied by the administrator was made. There had recently been new carpeting fitted in several rooms and old carpet was left on the fire exit landing. Space under the stairwells was being used inappropriately for storage. Resident’s rooms are personalised to varying degrees depending upon individual wishes and those seen were mainly clean and tidy. Several rooms were noted to be malodorous and it is recommended that if regular cleaning is failing to control the odour then the home should look at alternative flooring. Rooms with ensuite facilities frequently had inappropriate items stored in them such as protective bumpers for bed rails. Such practice not only limits the use of the facilities but also compromises effective infection control. Other rooms Mother Redcaps Nursing Home DS0000020940.V323944.R01.S.doc Version 5.2 Page 20 had wardrobes, wheelchairs and other items stored within the ensuite. Storage facilities at the home are minimal and the resultant inappropriate storage prohibits the use of facilities that residents need to use. One bathroom contained a commode that had been placed there without being emptied. A cupboard containing electrical switch mechanisms and cabling was left open presenting a clear hazard to residents. Furnishings are of an adequate standard in most parts of the home. Residents complained that some of the easy chairs were uncomfortable, “chairs are hard, not a comfortable chair in the house”. On examination the chair bases have been repaired with solid plywood sheets rather than the correct sprung construction. The plywood on one chair was badly stained and was still damp from a previous occupant. These chairs must be replaced. Maintenance in the home is poor with large cracks in the walls in several places and Dado rail missing in one corridor. The garden areas are in a very poor state being heavily overgrown. One relative asked the manager on the day of this visit if he could clear some overgrowth away so that his relative could see the river from the window. Bed rails are being used incorrectly with only one rail being fitted to some beds. Bathrooms and toilets are sufficient in number but inappropriate storage again limits their suitability for use. Two communal toilets had no toilet rolls in place and one had no toilet roll holder. The upper lounge and dining area carpet is very badly stained and needs a minimum of deep cleaning and replacement if necessary. All of these observations present a clear risk to the health, safety and welfare of residents. Mother Redcaps Nursing Home DS0000020940.V323944.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are insufficient numbers of care staff employed to meet the assessed needs of the residents and recruitment policies and procedures are not robust and fail to support and protect the residents. EVIDENCE: Examination of the off duty records shows that there appears to be insufficient staff to meet residents’ needs. The off-duty for one week was examined in detail and showed that against the target staffing level of 1176 hours there were 15 shifts short which amounts to 90 hours. Additionally, the home used a total of 138 hours agency staff in the same week making a total of 228 hours shortfall, which is almost 20 . This level of staff shortage inevitably has serious consequences for the care of residents and this is supported by the findings in other areas of this report. The lack of continuity of care is effecting the wellbeing of residents “I am unsettled because staff are leaving”, “there is more agency than permanent staff on some days”, “they are all young kids”. The home is reminded that the level of care required and dependency of residents must be based on comprehensive assessments of need and that the needs of residents with dementia increases over the course of the day and staff must be available to meet those increased needs. The assessment carried out by the Long Term Care Team to establish the level of NHS contribution to fees is not relevant when considering workload and staffing levels. Mother Redcaps Nursing Home DS0000020940.V323944.R01.S.doc Version 5.2 Page 22 The home does not meet the 50 target for staff with a minimum of NVQ2 and staff members need to be supported and facilitated to gain the qualification. The staff personnel files for six staff showed the following: One file showed employment commenced before PovaFirst clearance obtained. One file had no CRB check One file had only one reference Four files had no proof of identity Four files had no photograph of employee Five files had no job description Five files had no contract of employment One file showed PIN expiry date of 07/06 – renewal not verified Six files had no appropriate induction documents. One file related to an under eighteen employee and no risk assessment as required for the employment of young persons had been completed. The home must review staff personnel files and ensure that all the required information and documents are obtained. The home could not evidence that training in either the mandatory topics or other areas has been carried out. The home needs to carry out a training needs analysis and provide appropriate training to all staff in order to provide a trained and competent workforce. Mother Redcaps Nursing Home DS0000020940.V323944.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is a lack of effective management, guidance and leadership at Mother Redcaps compromising the health, safety and welfare of residents. EVIDENCE: The manager at Mother Redcaps is a first level nurse in the process of registration with the CSCI and planning to commence study for the registered managers award in the near future. As detailed in earlier sections of this report there are serious deficiencies in the management of records including care and personnel files, training, health and safety and all aspects of medication management. Requirements made at the last visit have not been met and there has been an overall significant deterioration in the management of Mother Redcaps. Mother Redcaps Nursing Home DS0000020940.V323944.R01.S.doc Version 5.2 Page 24 There is no comprehensive quality assurance system in place at the home. The limited amount of quality assurance that was present at the previous visit has not been taken forward and in some areas has lapsed. There is no formal supervision of care staff in place. This is a serious concern as staff supervision is a key integral component of effective staff management and has an important part to play in Quality Assurance. Records are securely stored and held in accordance with the Data Protection Act. There has been no training in the mandatory training for fire awareness, first aid, manual handling and health and safety. Training in these areas must be put in place as a priority. The fire alarm system and emergency lighting system inspection was due in February 2006 but has not been carried out and the public liability insurance certificate on display expired on 30th November 2006. The records seen show that the weekly fire alarm checks and monthly checks on the emergency lighting system have not been carried out since May 2006. There have been no fire drills carried out. A valid gas safety certificate was seen that expires on 21st December 2006 and a electrical safety certificate was valid until August 2008. The required inspection and Loler certificates for the lift were not available at the time of this visit. The previous report recommended that the relevant Legionella checks be carried out on the water supply as the last testing was in 2002 but this has not been carried out. Valid servicing and Loler certificates were seen for the hoists. Mother Redcaps Nursing Home DS0000020940.V323944.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 2 2 2 2 2 2 2 STAFFING Standard No Score 27 1 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X 3 1 2 1 Mother Redcaps Nursing Home DS0000020940.V323944.R01.S.doc Version 5.2 Page 26 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 registered person shall ensure that a comprehensive pre-admission assessment by a suitably qualified person is carried out to make sure that required aids and facilities are in place to meet the assessed needs The registered person shall ensure that the care home is conducted so as – (a) to promote and make proper provision for the health and welfare of service users; (b) to make proper provision for the care and, where appropriate, treatment, education and supervision of service users The registered person must produce a care plan for each service user that must be kept relevant and updated on a regular basis to ensure that staff have the information required to provide appropriate care DS0000020940.V323944.R01.S.doc Timescale for action 31/01/07 2 OP4 12 31/01/07 3 OP7 15 31/01/07 Mother Redcaps Nursing Home Version 5.2 Page 27 (Previous timescales of 28/02/06 and 30/07/06 not met) 4 OP8 13(1)(b) The registered person shall make 31/01/07 arrangements to receive where necessary, treatment, advice and other services from any health care professional by making sure that referrals are made in a timely manner and that directions from such professionals are followed The registered person must ensure that full and accurate records are kept of all medicines received, administered and leaving the care of the home. There must be a full record of all medication currently prescribed for each resident. The registered person must ensure that all medication is only administered in accordance with the General Practitioners instructions. Care must be taken to ensure medication is offered at the appropriate time e.g. before food, in order for it to work properly. The registered person must ensure that there is an effective system in place to audit medicines management within the service. Errors or discrepancies involving Controlled Drugs must be notified to the Commission 31/12/06 5 OP9 13(2) Sch 3 (i) 6 OP9 13(2) 15/12/06 7 OP9 24(1) 31/01/07 8 OP9 13(2) The registered person must 15/12/06 ensure that medication (including waste medication) is stored securely at all times. Medication (including creams and other external products) must DS0000020940.V323944.R01.S.doc Version 5.2 Page 28 Mother Redcaps Nursing Home not be kept in residents’ rooms, unless appropriate risk assessments are in place 9 OP9 13(2) The registered person must ensure that medication requiring refrigerated storage is kept within the correct temperature range (2-8°C). Appropriate action must be taken if the temperature falls outside this range. 15/12/06 10 OP10 18(c)(1) 11 OP12 16(2)(n) The registered person shall 31/01/07 ensure that all staff are instructed on how to treat service users with respect at all times to ensure that privacy and dignity is maintained. 31/01/07 The registered person shall having regard to the size of the care home and the number and needs of service users consult service users about the programme of activities arranged by or on behalf of the care home and provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation, fitness and training (Previous timescales of 31/01/06 and 30/06/06 not met) The registered person shall having regard to the size of the care home and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home to ensure that service users have the opportunity to maximise their capacity to exercise personal autonomy and choice The registered person shall DS0000020940.V323944.R01.S.doc 12 OP14 18(1)(a) 31/01/07 13 OP15 162)(i) 31/01/07 Page 29 Mother Redcaps Nursing Home Version 5.2 14 OP16 17(2) Sch.4 (11) 15 OP18 13(6) 16 OP19 23(2)(b) having regard to the size of the care home and the number and needs of service users ensure that hot and cold drinks are available at all times and offered regularly The registered person shall 31/01/07 maintain a record of all complaints made by service users or their representatives or relatives of service users or by any persons working at the care home about the operation of the care home, and the action taken by the registered person in respect of any such complaint The registered person shall make 31/01/07 arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse The registered person must 31/03/07 ensure that the care home is in a good state of repair and reasonably decorated at all times, including the external grounds. (Previous timescale of 31/08/06 not met) The registered person must 31/01/07 ensure that the furnishings are of a suitable and adequate standard in all areas of the care home in order ensure comfort for service users (Previous timescales of 31/08/06 not met) The registered person shall having regard to the size of the care home and the number and needs of service users ensure that suitable provision is made for storage for the purposes of the care home to make sure that DS0000020940.V323944.R01.S.doc 17 OP19 16(c) 18 OP21 23(2)(m) 31/03/07 Mother Redcaps Nursing Home Version 5.2 Page 30 19 OP26 16(k) 20 OP27 18(a) 21 OP29 19(1)(a) bathing and toilet facilities incl. ensuite facilities are available for use at all times. The registered person shall 31/01/07 having regard to the size of the care home and the number and needs of service users keep the care home free from offensive odours to ensure that service users and their visitors can be comfortable in all accessible parts of the home incl. individual rooms The registered person shall 31/01/07 having regard to the size of the care home and the number and needs of service users (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users (b) ensure that the employment of any persons on a temporary basis at the care home will not prevent service users from receiving continuity of care in order to make sure that service users assessed needs are met. (Previous timescale of 19/05/06 not met) The registered person shall not 31/01/07 employ a person to work at the home unless – (a) the person is fit to work at the care home (b) he has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of DS0000020940.V323944.R01.S.doc Version 5.2 Page 31 Mother Redcaps Nursing Home 22 OP30 23 OP31 Schedule 2 of the Care Homes Regulations 2001 (c) he is satisfied on reasonable grounds as to the authenticity of the references referred to in paragraph 5 of Schedule 2 in respect of that person 18(1)(c) The registered person shall having regard to the size of the care home and the number and needs of service users ensure that a staff training programme is put in place and implemented which meets the Skills for Care criteria and includes structured induction training to ensure that staff are able to meet the assessed and changing needs of service users 9(2)(b)(1) A person shall not manage a care home unless he has the qualifications, skills and experience necessary for managing the care home. 12 The registered person shall ensure that the care home is managed in an open and transparent manner with clear direction and leadership that promotes an open, positive and inclusive atmosphere for the benefit of service users The registered person shall establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home including the quality of nursing where nursing is provided at the care home. (Previous timescales of 31/01/06 and 31/08/06 not met) 31/03/07 31/01/07 24 OP32 31/01/07 25 OP33 24(10 31/03/07 Mother Redcaps Nursing Home DS0000020940.V323944.R01.S.doc Version 5.2 Page 32 26 OP36 18 The registered person must ensure that all staff are appropriately supervised, and records of this are kept. (Previous timescales of 31/03/06 and 30/07/06 not met) The registered person shall maintain all the records specified in schedules 3 and 4 of the Care Homes Regulations 2001 and (a) ensure records are kept up to date (b) are at all times available for inspection in the care home by any person authorised by the Commission to enter and inspect the home The registered person shall make suitable arrangements for the training of staff in first aid to ensure that a qualified first aider is on duty at the care home at all times The registered person shall make suitable arrangements to provide a safe system for moving and handling service users in order to minimise risk to service users and staff The registered person shall ensure that (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety (b) any activities in which service users participate are so far as reasonably practicable free from avoidable risks and (c) unnecessary risks to the health and safety of DS0000020940.V323944.R01.S.doc 31/03/07 27 OP37 17(1)(2)(3) 31/01/07 28 OP38 13(4) 31/03/07 29 OP38 13(5) 31/03/07 30 OP38 (c) 13(4)(a)(b) 31/01/07 Mother Redcaps Nursing Home Version 5.2 Page 33 (d) service users are identified and so far as possible eliminated RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard OP8 Good Practice Recommendations It is strongly recommended that all accidents, falls and untoward incidents are clearly audited and recorded by the homes management at least monthly. There should be clear, personalised directions for the use and administration of when required and variable dose medication for all service users prescribed such items. A second member of staff should witness and countersign all hand written entries on Medication Administration Record charts Verbal dose changes and new medication should be accurately entered onto Medication Administration Record charts with staff signature, date and authority where appropriate. Verbal dose changes should be confirmed in writing by the prescriber Staff should familiarise themselves with the homes policies and procedures for medicines management. Warfarin books should be kept with the MARs so staff can check doses before administering this medicine Medication should only be ordered when necessary in order to avoid wastage The maximum and minimum temperatures of the medication fridge should be recorded daily OP9 Mother Redcaps Nursing Home DS0000020940.V323944.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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