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Inspection on 07/02/08 for Mowbray Nursing Home

Also see our care home review for Mowbray Nursing Home for more information

This inspection was carried out on 7th February 2008.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Mowbray has a core of stable staff many of which have worked at the home for many years. The staff spoken with during the inspection-raised concerns about the lack of management and organisation and the inadequate staffing levels, which have an effect on their ability to provide quality care for the residents.

What has improved since the last inspection?

Some improvements have been made to the environment including new curtains in the small lounge. The respite unit has improved since the last inspection with dedicated staff and nursing input. However, given the number of issues raised through complaints since the last inspection, and the issues identified during this inspection, we consider there has been an overall deterioration in the service since the last inspection.

What the care home could do better:

Given the concerns raised at the inspection, it would appear that the home is lacking management and leadership. The home has been without a registered manager for seven months. The area manager has been spending time at the home to assist with management cover. This also reflects on the company for failing to recognise the shortfalls with the service provision. Staffing levels should be appropriate to meet the numbers and dependencies of the residents. The home should also ensure that domestic, catering and laundry staff are employed in adequate numbers, and not take care staff away from undertaking direct care duties. There was a breakdown in communication from the provider to staff working at the home, leaving the staff feeling very devalued, wondering what was happening, and the reason why a manager had not been appointed. Internal communication amongst staff also appeared to be lacking. Examples being; poor handover`s, carers not being given clear directives about the residents` care needs etcetera. A robust and comprehensive needs assessment should be carried out for residents prior to them being accepted into the home. This should ensure that the home can meet their needs and that they have the appropriate equipment and suitably skilled staff to meet those needs appropriately. Care plans and risk assessments need to be completed for the residents with the majority of assessments being completed on the day of admission. Thereason for delays with this process should be recorded. Nurses should ensure that they maintain their professional accountability and date and sign all entries. Staff employed at the home must possess the competencies and skills necessary to provide the care required, and must be provided with the training in relation to the home`s policies to ensure that residents are protected from harm. The home should ensure that their complaints policy is followed and record all complaints. This record should evidence the investigation, length of time to resolve and the outcome of the complaint, including any action taken in response.

CARE HOMES FOR OLDER PEOPLE Mowbray Nursing Home Victoria Road Malvern Worcestershire WR14 2TF Lead Inspector Chris Potter Key Unannounced Inspection 7th February 2008 09:30 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 Mowbray Nursing Home DS0000063032.V357613.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. Mowbray Nursing Home DS0000063032.V357613.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mowbray Nursing Home Address Victoria Road Malvern Worcestershire WR14 2TF 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) 01684 572946 Minster Care Management Limited Vacant Care Home 39 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (39), of places Physical disability (1), Physical disability over 65 years of age (39) Mowbray Nursing Home DS0000063032.V357613.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th June 2007 Brief Description of the Service: Mowbray Care home is situated in Malvern, being convenient for local amenities and public transport. The home is a large converted house set in spacious grounds with views of the open countryside. Minster Care Management Limited owns the home. The Home is currently without a registered manager following the resignation 7 months ago by the previous manager. The home is registered to accommodate 39 residents with both nursing and residential needs. Residents have a choice of either single or double bedrooms, many benefiting from having en-suite facilities. Other facilities provided for residents include lounges and a dining room. Currently, 6 beds are used to provide intermediate care. Passenger lifts are available to enable residents who possess mobility problems access to the first floor of the home. The fees for this home are between £525.00 and £600.00 per week depending on the size of the room and whether it is shared or single accommodation. Hairdressing, chiropody, newspapers and the cost towards some outings are additional to the fees. These charges were correct at the time of the inspection for more accurate information please contact the home direct. Mowbray Nursing Home DS0000063032.V357613.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was an unannounced key inspection – this is an inspection where we look at a wide range of areas. The inspection took place over two days on the 7th and 11th of February 2008. This inspection was undertaken as a result of the number of complaints received following the previous inspection, and these being considered under multi-agency “safeguarding” procedures. This is a procedure whereby health and social workers review the people using the service to ensure that their health and welfare is being protected. The home has been without a manager for seven months following the resignation of the previous manager. To help plan for the inspection we reviewed the home’s Annual Quality Assurance Assessment (AQAA), which was received within the last 9 months for the previous unannounced key inspection in June 2007. The complaints and the provider’s responses were also reviewed. At the time of this inspection the home was accommodating 33 residents in the main home and 3 residents on the intermediate unit. Since the last inspection we have received seven complaints about the service three of which were anonymous. The complaints cover a range of issues, the main ones being lack of management and organisation, inadequate staffing levels, and environmental issues. The provider has investigated these complaints through their own complaints procedure (See the complaints section). A large percentage of time was spent talking to all grades of staff, which confirmed that they felt devalued and were working under severe pressure to try and care for the residents to the best of their ability with the current staffing levels. We issued an immediate requirement for adequate staffing levels to be provided, based on the numbers and dependencies of the residents in the home. Another area of concern was the poor quality of the residents’ care plans, specifically around wound management. We issued an immediate requirement for the nurses to review the care plans, prioritising the more dependent residents with skin damage. What the service does well: Mowbray Nursing Home DS0000063032.V357613.R01.S.doc Version 5.2 Page 6 Mowbray has a core of stable staff many of which have worked at the home for many years. The staff spoken with during the inspection-raised concerns about the lack of management and organisation and the inadequate staffing levels, which have an effect on their ability to provide quality care for the residents. What has improved since the last inspection? What they could do better: Given the concerns raised at the inspection, it would appear that the home is lacking management and leadership. The home has been without a registered manager for seven months. The area manager has been spending time at the home to assist with management cover. This also reflects on the company for failing to recognise the shortfalls with the service provision. Staffing levels should be appropriate to meet the numbers and dependencies of the residents. The home should also ensure that domestic, catering and laundry staff are employed in adequate numbers, and not take care staff away from undertaking direct care duties. There was a breakdown in communication from the provider to staff working at the home, leaving the staff feeling very devalued, wondering what was happening, and the reason why a manager had not been appointed. Internal communication amongst staff also appeared to be lacking. Examples being; poor handover’s, carers not being given clear directives about the residents’ care needs etcetera. A robust and comprehensive needs assessment should be carried out for residents prior to them being accepted into the home. This should ensure that the home can meet their needs and that they have the appropriate equipment and suitably skilled staff to meet those needs appropriately. Care plans and risk assessments need to be completed for the residents with the majority of assessments being completed on the day of admission. The Mowbray Nursing Home DS0000063032.V357613.R01.S.doc Version 5.2 Page 7 reason for delays with this process should be recorded. Nurses should ensure that they maintain their professional accountability and date and sign all entries. Staff employed at the home must possess the competencies and skills necessary to provide the care required, and must be provided with the training in relation to the home’s policies to ensure that residents are protected from harm. The home should ensure that their complaints policy is followed and record all complaints. This record should evidence the investigation, length of time to resolve and the outcome of the complaint, including any action taken in response. 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. Mowbray Nursing Home DS0000063032.V357613.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mowbray Nursing Home DS0000063032.V357613.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 and 6 Quality in this outcome area is poor. The pre-admission assessments are not consistently being completed which places residents at potential risk because the home may not have the relevant skills to meet their health and physical care needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Six residents’ pre-admission assessments were reviewed at the inspection. The quality of these assessments varied according to which registered nurse had completed the assessment. The quality of some assessments was so poor it raised concerns about the competency of the nurse in question. The preadmission assessment goes through the activities of daily living, providing - in some scenarios - little or no information at all. The assessment fails to identify the nursing needs and why the person is requiring 24-hour nursing care. The assessment also fails to identify the specialist equipment required to meet the Mowbray Nursing Home DS0000063032.V357613.R01.S.doc Version 5.2 Page 10 residents’ needs - for example pressure relieving equipment. Another problem identified by a carer was that the nurses failed to advise the care team about the new residents. An example of this was they were not aware that one resident had diabetes. The assessments also failed to record if the resident or relative had assisted with the information. A recently bereaved resident, having gone through major surgery, was assessed as having “no anxieties”. On speaking to the resident, they were clearly anxious and upset about the changes in their life. This had not been identified on admission or in the care plan. Since the last inspection, which raised concerns about the staffing levels on the intermediate unit, the home had allocated two members of staff to cover. However, this appears to have left the main home even shorter. Staff working on the unit stated that they felt guilty given the pressure on the rest of the staff. Mowbray Nursing Home DS0000063032.V357613.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. The care records are not accurately identifying all residents’ care needs and are not providing a clear action plan to ensure that the residents receive adequate care at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Complaints have been received since the last inspection in respect of named individuals and alleging that the home was not fully meeting their health and personal care needs. Elements of the complaints included the times in which the residents were getting up in the morning. It was evident on both days of the inspection that some residents were not getting up until 12:30pm. Staff confirmed that this was so, and this was not the residents’ choice to get up at this time. This is considered institutionalised care, and not person-centred. All grades of staff stated that they were short-staffed, and felt pressured in trying to care for the residents. The home currently caters for people with high Mowbray Nursing Home DS0000063032.V357613.R01.S.doc Version 5.2 Page 12 dependency needs, with 100 of the residents having continence problems, 33 of the residents requiring direct assistance with meals, and the majority of residents requiring two staff and a mechanical hoist to mobilise. Other elements of complaint were in respect of buzzers not being answered. Again, buzzers were activated for at least 15 minutes before being silenced. Staff also confirmed that some residents are left on the toilet/commode for up to 15 minutes because they can’t get back to them. Staff stated that nails are not being cared for properly and they could not always offer a total immersion bath or a shower to residents when staff ‘phone in sick at short notice. On reviewing one care plan, a resident recently admitted into the home had stated that they were unhappy with the care. This appeared not to have been followed up and was not recorded in the home’s complaints register. Staff confirmed that some relatives were complaining about the times that individuals were getting up, and also that incontinence pads were not being changed frequently enough to ensure hygiene and dignity issues were being promoted and addressed. Given the last report identified that nurses other than the manager and area manager were failing with the care plan recording, it was disappointing that this had not been addressed. Six care plans were reviewed during the inspection. These failed to provide sufficient detail and guidance for the staff to meet those needs. The nurses were consistently failing to sign and date entries. Additional information was being added to the care record and the nurse was not dating or signing this. The quality of the record keeping was poor and not in accordance with the Nursing and Midwifery Council’s guidance for professional accountability. A nurse advised the inspector it was because they were so short-staffed, and did not have sufficient time to do the care plans properly. The home uses a pre–printed care plan for the residents’ needs, and for some residents, a name only had been added to this sheet. The plan was not being individualised for the resident. For one resident the care plan failed to provide sufficient detail about the management of diabetes. A care plan had not been developed for the blood thinning medication they were prescribed and associated risks from this. Psychological needs had not been assessed. This was of significant concern given that the resident had been recently bereaved, and had received major surgery resulting in body disfigurement. The type of pressure-relieving equipment had not been recorded. The resident had lost weight and the nutritional risk assessment had not been updated. Another resident’s care plan cited within the daily entry that the individual had “loose bowels”. This had not been developed into a care plan. The resident was also wandering and a care plan for this had not been developed. For a high dependency resident at high risk of developing pressure skin damage, the plan failed to record intervention and equipment being used. The care plan did not state how and what type of hoist the staff should use. The Mowbray Nursing Home DS0000063032.V357613.R01.S.doc Version 5.2 Page 13 resident was admitted on the 18th and the assessments were not dated until the 19th. Under “hygiene” the nurse had recorded “being bedridden”, which made no sense. A doctor had made an entry in the care file for pain relief but a care plan had not been developed for this. The resident was also on blood thinning medication but, again, a plan of care had not been developed. Daily notes for this resident referred to the bedroom - “Room is very smelly” – but identified no action in response. A care entry recorded “Small sore”. No care plan had been developed for this. A resident who had recently returned from hospital had not had their care plan and risk assessments updated. Another resident admitted with a pressure sore was reviewed during the inspection. The care records were poor, and failed to identify the progress of the wound and the frequency of the dressings being renewed. Following the last inspection the home has changed their pharmacy supplier and reported a better service. The area manager also completes a monthly audit on medication and the last one scored a 92 compliance rating. The only issue identified at this inspection was that the nurses are not double signing handwritten entries on the medication administration chart. Staff were observed being polite to the residents, and knocking doors before entering. Comments received from some residents were that they felt that the staff were very caring and did their best. Mowbray Nursing Home DS0000063032.V357613.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is poor. Residents’ choices are being restricted due to the staffing levels. Activities are suited for some of the residents they need to be further developed for the more dependant residents. Food in the home is of a satisfactory quality, due to staffing levels the meals are not always served to residents in a sensitive manner, This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs an activities co-ordinator who informally arranges some activities that are suited to some residents’ abilities, capabilities and choice. The social needs of the residents should be formally assessed and developed/structured into a care management plan. Staff commented that it was always the same residents who went out on visits – thereby confirming that many residents were not included within social, recreational and occupational activities. This has a direct and negative impact on quality of life. Mowbray Nursing Home DS0000063032.V357613.R01.S.doc Version 5.2 Page 15 From discussions with the staff and recent complaints, the home is actively failing to provide individualised, person-centred care, and failing to respect residents’ wishes and choices due to inadequate staffing levels – thereby compromising individuality. This raises significant concern as the issues identified within this section of the report could be prevented if the provider diligently discharged their legislative responsibilities. Staff disclosed the following areas of concern: • • • • • • • • • • • • • “Not always enough staff to allow carers to do jobs properly”, “Not coping - it is 12:20pm and we still have residents to get up”, “12:35pm - still have a resident to get up”, “95 of residents require full care and things get forgotten”, “Residents not getting what they need”, “Do not have time to talk to the residents”, “Not able to offer resident a big bath if staff phone in sick”, “Teeth not being done daily”, “Residents suffering due to not having time to answer the buzzer”, “Residents being left on toilet for 15 minutes”, “Residents being put back to bed at 7 o’clock (pm) and not being got up until 12.30” (pm the following day)”. This equates to people being left in bed for 17½ hours in every 24-hour period. (Residents) “Missing their morning drinks due to catering staff taking the drinks around and not telling carers that the drinks are there”, “Nails not being cleaned”. Staff do not assist all residents who require assistance with their meals as staff do not have the time to provide discrete and sensitive help to people who are vulnerable and reliant on others to meet their basic care needs. The home is short of catering staff – resulting in a carer having to undertake catering duties at alternate weekends. Staff expressed their opinion that the chef was unreliable and had poor timekeeping skills This impacted on care delivery when other staff had to cover. To summarise, residents’ quality of life is adversely affected by inadequate resources and a failure by the registered provider to effectively protect and promote a good standard of living for vulnerable people entrusted into the their care. Mowbray Nursing Home DS0000063032.V357613.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. The home has a complaints procedure in place. However, staff and relatives do not feel that they are being listened to. The home has a safeguarding policy in place and staff understand their responsibilities in reporting poor practise. However, they do not feel that their concerns are being actioned by the service provider. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the Commission has received several complaints from staff, professionals and relatives. It was concerning that the complainants wished to remain anonymous for fear of repercussions. The complaints were referred to the service provider to investigate, and the Commission received a copy of their response. The complaints were around; • • • • • The specific care of named individuals, Basic care needs not being met, Staffing levels, lack of catering, domestic and laundry staff at weekends, Lack of management and organisation in the home, Cleanliness, DS0000063032.V357613.R01.S.doc Version 5.2 Page 17 Mowbray Nursing Home • • • • The decoration of the home, The night RGN leaving the home with only carers on duty, Carer being sent home drunk and Infection control. The response from the service provider’s representative advised that many of these concerns did not exist and that action had been taken to address other issues. However, at the time of the inspection, some of the issues identified by complainants were confirmed and an immediate requirement notice was issued in respect of staffing levels. Whilst talking to staff they confirmed that residents and relatives were complaining about the time that residents were getting up and because incontinence pads were not being changed frequently enough. These complaints were not recorded in the home’s complaints register. Staff also confirmed that they had complained about the staffing levels. This was not recorded in the complaints register. An entry was recorded in a resident’s care plan that they were not happy with the care. This was not recorded in the complaints register. Staff also reported that a resident had left the home because they did not like it there. Again, this had not been entered into the complaint register. The home must ensure that all complaints are recorded and provide details of the investigation with the outcome. There is little evidence of the service using complaints as an opportunity to improve outcomes for people who use the service. Some of the concerns have been referred to the lead agency for safeguarding adults. An investigation is currently in progress with the assistance of other agencies that commission care from the home. All staff spoken to were aware of safeguarding, and confirmed that they had voiced their concerns about staffing levels and the impact on the delivery of care for the residents, but felt nothing was being done about this. One relative informed the Commission that their relative did not feel safe at the home anymore, and they were afraid to complain directly for fear of repercussions. Mowbray Nursing Home DS0000063032.V357613.R01.S.doc Version 5.2 Page 18 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 and 26 Quality in this outcome area is poor. The home’s appearance would be improved by more re-decoration, better cleaning and maintenance and the provision of new furniture and furnishings. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection there has been investment in some areas of the home. New curtains and carpets have been purchased for the new lounge. Two bedrooms were in the process of being redecorated, and some bedroom carpets had been replaced. Some of the bedrooms are personalised by the resident and appear quite homely. The home is generally dark and the decoration does not assist this. A recent admission to the home was advised that they would have to pay to decorate their room to meet their wishes. The Mowbray Nursing Home DS0000063032.V357613.R01.S.doc Version 5.2 Page 19 furniture in many areas of the home appeared well worn and reflects on the general fatigued appearance of the home. One complaint received was in respect of the poor decoration in the home. Some radiators were very hot to touch. At the inspection it was reported that they were low surface temperature radiators. It was recommended that these are reviewed to reduce the possible risk of injury to residents through accidental contact burn. Complaints have been received by the Commission about the odours and general cleanliness of the home. Some odours were evident in areas on the days of the inspection. Only one domestic was rostered for cleaning. Given the size of the home and the level of incontinence this is not adequate. The laundry is also not appropriately staffed and the laundry person arrived at work on Monday with a large backlog of laundry due to no designated laundry person working over the weekend period. The maintenance of hoists should be reviewed. The accident records recorded that a resident slipped from the hoist. Staff also reported that some residents had to stay in bed when the hoist broke, and they were instructed to manually lift residents. Mowbray Nursing Home DS0000063032.V357613.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. The care needs of the residents are being compromised due to inadequate staffing levels. By failing to provide staff with the relevant training, skills and competency is adversely affected - which may place residents at risk of receiving poor care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Prior to the inspection we wrote to the provider about the management cover, and complaints alleging poor staffing levels. A response was provided on the first day of the inspection. On the first day of the inspection the home appeared poorly organised, and staff advised that the administrator was the nurse in charge. A call bell was heard and was not silenced for at least 10 minutes. The atmosphere in the home was tense, and staff presence was not observed in the communal areas during the tour of the home. Mowbray Nursing Home DS0000063032.V357613.R01.S.doc Version 5.2 Page 21 On the second day of the inspection the majority of time was spent talking with all grades of staff. Staff reported that they were very unhappy working at the home and, with the staffing levels, felt pressured in delivering care to the residents. It was of concern to hear that staff have voiced their concerns through staff meetings, and to senior staff members but they feel like they have not been listened to. I spoke to 10 members of staff over the two days and all expressed how they felt devalued and receive no thanks only criticism for the work that they do. All staff reported that they have not received a pay rise for over three years and only continue to work there for the residents. Staff became upset when they reported that they do not have sufficient time to provide a good quality service, are rushing to do things and things get missed. All staff reported that it is not possible with the staffing levels to get residents up before midday, and management are not listening to this. Staff stated that (they) “find the work really stressful” and (they) “don’t have time to answer call bells” when attending to a resident. Some residents miss the morning drinks because the catering staff do the drinks and don’t advise the carers that the drink is left. Staff continued by saying; “95 of residents are full care and somethings get left”, (we) “do not have the time to talk to the residents”. When asked if additional staff were rostered for very ill residents, the response was “no” (residents are) “not receiving frequent supervision” and there were “delays when reporting concerns to the nurses i.e. a resident with a sore developing - the nurse in charge failed to check”. The inspector was advised that the home has 8 – 10 residents with skin damage. Carers confirmed that they do not have confidence in all the nurses. Staff also reported that they were not always provided with a handover and never see the care plans, this resulted in a carer not knowing that a resident was diabetic for 3 days. Another resident missed breakfast because their needs had changed and staff were not advised. Provision and availability of supplies was also criticised by staff who said; “we never have enough pads, wipes, gloves and residents run out of toiletries”. Relatives spoken with during the inspection stated that the staff were caring and kind but very busy. Care staff confirmed that they receive mandatory training and many are in the process of completing NVQ Level 2 in Care. The home should ensure that all the nurses are clinically updated, and have the appropriate skills to meet the needs of the residents. No one is up to date with syringe drivers, not all staff are up to date with wound care management, diabetes and dementia care. Given the poor standard of care plans training should be provided for a more person-centred care approach. Two staff files were reviewed at the inspection and these showed that the home had recruited appropriately. Mowbray Nursing Home DS0000063032.V357613.R01.S.doc Version 5.2 Page 22 The home employs three male staff and respects the wishes of the residents as to their preferences for male or female staff. Mowbray Nursing Home DS0000063032.V357613.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, 33, 35 and 38 Quality in this outcome area is poor. Due to the lack of management and leadership, the health, safety and welfare of the residents and staff are not being protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is currently no registered manager for the service following the resignation of the previous manager seven months ago. All staff spoken with commented that the home needed a strong manager to provide clear leadership for all the staff. An area manager has been providing regular input into the home, and comments about this arrangement varied. The company need to reassure the Commission that they are addressing the requirements Mowbray Nursing Home DS0000063032.V357613.R01.S.doc Version 5.2 Page 24 from this inspection and listening to their staff to improve the service provision. The results from the most recent quality audit were available. Again, there was no indication that the results or negative comments had been investigated or followed up. Comments received included; • • • • • “Mom is often not washed properly”, “Very friendly atmosphere”, “Helpful, caring staff” “Could be improved cleanliness”, along with Several compliments about the food. Residents’ finances are not managed by the home. They are usually managed by their relative or advocate on their behalf. The home’s AQAA was received eight months ago and the areas identified for improvement from this have not been implemented. The home should ensure that a process of checking equipment (for example hoists, bedrails, radiators and wheelchairs) is established to identify any possible damage and reduce potential risks to residents and staff. At the time of the inspection the radiators in the extension were hot to touch and residents were stating that they were hot. Mowbray Nursing Home DS0000063032.V357613.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 X X 1 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 X X X X X X 1 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 X X 1 Mowbray Nursing Home DS0000063032.V357613.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14(1)a Requirement A thorough assessment must be carried out prior to the admission of any resident. This is to ensure that the home can meet the health and personal care needs of the residents who are admitted and to enable a “holistic” care plan to be formulated. Timescale for action 11/02/08 Immediate Requirement 11/02/08. 2 OP7 15(1) and (2) Service user plans must identify how all of each person’s needs in respect of health and welfare are to be met. These plans must be reviewed regularly and updated when any changes take place. This is to ensure that staff are aware of all aspects of people’s current health, personal and social care needs and that these can be properly met. Immediate Requirement 11/02/08 for the most vulnerable residents. 30/04/08 3 OP8 12(1) Service users must receive the basic personal care and nursing care that they need. 11/02/08 Immediate Requirement 11/02/08 for the most vulnerable residents. 4 OP27 18(1)(a) At all times there must be 11/02/08 suitably qualified, competent and DS0000063032.V357613.R01.S.doc Version 5.2 Page 27 Mowbray Nursing Home experienced persons working at the care home in such numbers as are appropriate for the health and welfare of service users. This requirement relates to nursing, care and ancillary staff. This is to ensure that the health and welfare needs of service users are met in a comprehensive, appropriate and timely way. 5 OP16 22(3) and 17(2) Immediate Requirement 11/02/08. 6 OP26 16 (1) (j) and (k) 7 OP31 8(1) 8 OP32 12 (5) (a) 9 OP19 23(2)(b) 23(2)(d) All complaints made to the home must be fully investigated and a record maintained with details of the actions taken in response. This is to ensure that people’s concerns are explored and resolved and that service improvements are made, if necessary. Adequate arrangements must be put in place for maintaining standards of hygiene and the home must be kept free from offensive odours. This will provide people with a more pleasant and safer environment to live in. A manager must be appointed to the home to ensure that the home is effectively managed and people’s health, safety and wellbeing is promoted. The care home must be managed in such a way as to maintain good personal and professional relationships between the management, residents and staff. This is to ensure that all staff are enabled to meet people’s health and welfare needs in an effective manner. The care home must be kept in a good state of repair with all parts clean and reasonably decorated. This is to ensure that people live DS0000063032.V357613.R01.S.doc 30/04/08 29/02/08 30/04/08 30/04/08 30/04/08 Mowbray Nursing Home Version 5.2 Page 28 10 OP28 18 1 (a) in a comfortable, safe and pleasant environment. The service must ensure that at least 50 of care staff have a NVQ Level 2 in care or equivalent. This is to ensure that people can have their needs met by a staff group that is adequately skilled. 30/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3 4. 5. 6. 7. Refer to Standard OP33 OP36 OP19 OP32 OP9 OP30 OP38 Good Practice Recommendations Systems should be put in place to review and maintain the quality of services within the home. Staff supervision should be formalised and staff should have the opportunity of an individual meeting to discuss any issues, which can then be recorded. To assist in monitoring the service, exit interviews should be completed with staff who leave, and a record maintained on their file. Staff should receive regular handovers and be informed about changes in the residents care needs. All handwritten entries on the medication administration record should have two signatures to reduce the risk of any mistakes. A review should be undertaken of the training needs of all staff including the need for nursing staff to update their skills in clinical practice. An audit of the premises should be undertaken to ensure that all aspects of safety are being addressed, including the regular servicing of equipment. Mowbray Nursing Home DS0000063032.V357613.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Mowbray Nursing Home DS0000063032.V357613.R01.S.doc Version 5.2 Page 30 - 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. 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