Inspection on 26/06/06 for Nada Nursing Home

This inspection was carried out on 26th June 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

Nada Nursing Home 05/04/07

Nada Nursing Home 04/09/06

Nada Nursing Home 19/01/06

Nada Nursing Home 07/06/05

Nada Nursing Home 27/10/04

Nada Nursing Home 29/04/04

Nada Nursing Home 09/02/04

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

CARE HOMES FOR OLDER PEOPLE Nada Nursing Home 451 Cheetham Hill Road Cheetham Hill Manchester M8 9PA Lead Inspector Nick Allen Key Unannounced Inspection 10:00 26th June 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 Nada Nursing Home DS0000021566.V296316.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. Nada Nursing Home DS0000021566.V296316.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nada Nursing Home Address 451 Cheetham Hill Road Cheetham Hill Manchester M8 9PA 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) 0161 720 7728 Mr Pierre Grenade Mr Pierre Grenade Care Home 28 Category(ies) of Dementia - over 65 years of age (0), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (0) Nada Nursing Home DS0000021566.V296316.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. The home is registered for a maximum of 28 residents of either sex over 60 years of age suffering from either mental disorder or dementia. The maximum number of residents requiring nursing care shall be 17 and the maximum number of residents requiring personal care only shall be 11. Registration is subject to compliance with the minimum staffing levels indicated in the Notice served in accordance with Section (25) 3 of the Registered Homes Act 1984 issued on 6th March 2002. Staffing for the residents assessed as requiring personal care only must comply with the minimum levels set out in the Residential Forum Guidelines for Staffing in Care Homes for Older People. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection Brief Description of the Service: Nada Nursing and Residential Care Home provides accommodation with nursing and personal care for a maximum of 28 older people. The care home is able to offer accommodation to 17 older people assessed as requiring nursing care and 11 residents assessed as requiring personal care only. At the time of the inspection there were 21 residents living at the home The home is owned and operated by Mr Pierre Grenade, who is both the registered person and the manager. The home is situated in the Cheetham Hill area of North Manchester close to local shops, Manchester City centre, social, cultural and recreational amenities. The home consists of a converted large detached house with a large, modern extension within its own small grounds. The home is able to offer off-the-road parking for approximately five vehicles in addition to the homes mini-bus. All rooms have wash hand basins and commode chairs. The home has two floors, which can be accessed by a passenger lift. There are six double and sixteen single bedrooms. There are no en-suite rooms. There are a number of communal areas for residents to choose from or, if they Nada Nursing Home DS0000021566.V296316.R01.S.doc Version 5.2 Page 5 prefer, they can spend time in their own rooms. The home offers a limited number of in house social activities The fees charged are currently in line with the fees set by Manchester City Council and range between £395 and £420 per week Nada Nursing Home DS0000021566.V296316.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection of Nada included an unannounced key site visit as part of the inspection process. Two inspectors carried out the inspection one being the specialist pharmacist inspector. The inspection was completed over a period of 3.5 days. The inspection also included time spent talking to the manager, the Clerical Officer and several residents. Documents including staff files, records and other relevant documentation were examined. Information was also obtained from documentation held on file at the office of the Commission for Social Care Inspection (CSCI). The inspectors also took into account information received from other sources such as the local authority and Immigration Office when writing the report. A pre-inspection questionnaire was sent to the home prior to the inspection but this was not returned. A tour of the building was conducted to make sure the building was safe and that the people who use the service are provided with a homely place to live. It was of some concern that a large number of requirements made at the last inspection had still not been completed. Those that are still to be done are listed at the end of this report. Due to the on going failure of the provider to comply with the regulations the Commission for Social Care Inspection intends to take action to address the issues. Since the last inspection the Commission for Social Care Inspection has not received any complaints about the service. Each section of this report contains a judgement about the quality of the service provided. In making the judgements, the inspectors have considered all the information made available; the unannounced site visit, information from the people who use the service, as well as information passed to the CSCI other sources such as the local authority. What the service does well: During the inspection, there appeared to be good social interaction between staff and residents, with evidence that residents were offered choices. Of the nine residents spoken to, all but one was positive about the home. Nada Nursing Home DS0000021566.V296316.R01.S.doc Version 5.2 Page 7 One said that they had lived at the home for some time and that “the big bloke was good “. This reference was to the provider. When asked about other staff, the person again commented positively. What has improved since the last inspection? What they could do better: At the last and previous inspections, requirements were made that the recruitment practices of the home must be improved in order to protect and safeguard residents. It is disappointing to note that the home’s recruitment practices continue to put residents at risk. Some staff had no Criminal Records Bureau check and references on staff were not adequate. As a result the provider/manager has been advised of the need to carry out an urgent review of the recruitment policies/procedures. Risk assessments covering Adult Protection also needed to be implemented together with robust practices ensuring that all residents are appropriately protected. At the previous inspection, a requirement was made for staff to receive the training to assist and support them in their work with vulnerable people. This inspection identified that staff training remains an issue that needs to be fully addressed. There was a need for the provider/manager to carry out an audit of existing training / qualifications of all staff currently employed at the home. This is necessary to ensure that the residents are assisted by staff who are competent, appropriately trained and qualified to enable them to provide care that meets residents’ needs and that they are able to recognise and address areas of risks. The home is required to have in place good systems for handling medication and a requirement was made at the last inspection for arrangements to be made concerning the safekeeping, recording and handling of medication. However, this remains outstanding and a number of concerns regarding the Nada Nursing Home DS0000021566.V296316.R01.S.doc Version 5.2 Page 8 management of medication were identified. The provider/manager has been advised in a separate letter of the action that needs to be taken to ensure medication is safely managed in order to avoid any risk in the systems and to the residents. Requirements made about medication can be found at the end of this report. Staff members also need training in handling and managing medication to make sure that they understand fully the risks and how to manage medication safely. Those residents care plans and risk assessments seen during the visit provided very little information to staff on how individual needs should be met. This could place residents at risk of inappropriate care and support being offered. Both the care plans and risk assessments must be reviewed and updated for each resident living in the home. The home did not promote residents dignity, nor was it addressing the wide and diverse range of needs identified during the inspection which included diversity, health and cultural needs. During the tour of the building it was noted that the home did not provide residents with a comfortable, homely environment and one that ensure their safety. Fixtures and fittings together with the décor were in a poor state of repair with carpets in some parts of the home requiring replacement. Some redecoration had taken place but this was minimal. Those residents who smoked were not being properly supervised which presented a potential risk not just to the individuals concern but also to the other residents living at the home. As part of the general upgrading of the home the provider/manager needs to undertake a complete audit of the home to assist identify those items that need to be replaced. The provider will need to purchase appropriate furniture and equipment to ensure the home is both well equipped and safe for the resident. 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. Nada Nursing Home DS0000021566.V296316.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nada Nursing Home DS0000021566.V296316.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,6 Quality in this outcome area is poor. This judgement has been made using the available evidence including a visit to the service. Prospective residents are not provided with appropriate information about the home and costs and individual needs are not fully assessed prior to admission. EVIDENCE: Since the last inspection, the home’s Statement of Purpose and Service User Guide have been re written. However, the documents did not provide sufficient detail of the services provided at the home so that prospective residents and their families could make an informed decision about whether this home was appropriate and whether the prospective resident’s needs would be met if they choose to live at Nada. At the last inspection a requirement was made that no new resident should be admitted into the home until a full assessment of need had been carried out by a person competent to do so to ensure the home was an appropriate service to Nada Nursing Home DS0000021566.V296316.R01.S.doc Version 5.2 Page 11 meet those identified needs. There was no evidence available to confirm that pre-admission assessment of needs had been carried out and the requirement has been reiterated in this report. Of those residents’ files seen none contained details of contractual arrangements with the home e.g. terms and conditions of residency. This could mean that an individual resident could be unsure or unaware of how much it was costing them to live in the home. The service did not provide intermediate care. Nada Nursing Home DS0000021566.V296316.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using the available evidence including a visit to the service Care plans were in place but were not used to meet identified needs. The wellbeing and dignity of individual residents was, at times, compromised and the home did not demonstrate that it was able to meet the diverse needs of the residents. EVIDENCE: The care plan of one resident was examined. This was dated 27/05/05 and identified that this person required support and supervision when enjoying a cigarette. The plan also stated that smoking must only take place in the ‘designated area (smoking lounge) and UNDER supervision’. Both the plan and risk assessment had been regularly reviewed by the provider/manager and no changes made. However, during the visit, this particular resident was found to be in their room, smoking a cigarette with a full ashtray on the floor and was not being supervised. From the information contained within the care plan and risk assessment this placed this resident individual and others living in the home at significant risk. Nada Nursing Home DS0000021566.V296316.R01.S.doc Version 5.2 Page 13 Residents spoken to told the inspector that they saw the GP when they were ill. The home is located close to a Local GP practice. All of the residents used the local practice. Some residents spoken to said that they went to the dentist if they needed one. One resident said that the “nurses” cut their toenails. The provider/manager said that a chiropodist visited the home when necessary. However, this was not supported by evidence seen on residents’ files examined or from the home’s own records and documentation assessed. The residents also made comments that included “The staff are OK” and “they look after me “ Although there was evidence of staff treating residents with some dignity, concerns were raised with the provider/manager regarding the state of dress of a particular female resident. The resident was observed to be wearing illfitting clothing that was badly damaged from cigarette burns. In addition, the resident had no protective footwear on at the time. It was noted at the time of the visit that an all male staff team was on duty. This matter was discussed with the provider/manager in relation to the impact on the female residents’ choice, dignity and respect. The provider/manager said that “night members of staff have helped the patient and they would be responsible for helping her to dress”. It became apparent from discussions that the resident would have been dressed early morning prior to the night staff going off duty. The importance of promoting and preserving residents’ dignity was impressed upon the provider/manager who was advised that the practice observed did not support or promote this individual resident’s dignity and a review of care practices and of the resident’s clothing must be carried out. During the visit it was seen that the senior member of staff on duty was ‘trying’ to communicate with a particular resident recently admitted to the home. It was evident from the way in which the member of staff was conducting himself (by shouting and gesticulating) at the resident that communication was a problem. The person in charge was seen to ‘wave his arm’ to another member of staff indicating he wanted them to come over and try to communicate with the resident. Further discussion with the person in charge indicated that there was only one member of staff (a domestic) who could communicate with the resident in his first language and they were not on duty at that particular time. Information contained within the file of this resident also confirmed that he had been discharge from hospital following a fractured femur. There was no Nada Nursing Home DS0000021566.V296316.R01.S.doc Version 5.2 Page 14 evidence to show that the home had made any arrangements for an occupational therapist or physiotherapist to visit the resident prior to or after admission into Nada, although the provider/manager said a referral had been made. New policy documentation had been introduced relating to the safe storage and administration of medications. These had been written in response to requirements made at the last inspection. A number of issues concerning the safe handling, recording keeping and overall management of medication were found. For example, the actual and recorded quantity of some medication did not tally and a member of staff spoken to by the pharmacist inspector admitted that they had signed the Medication Administration Record incorrectly which places residents at risk. A separate letter has been sent to the provider/manager setting out all the shortfalls and the action he needs to take to address the issues. The requirements made in relation to medication can be found at the end of this report. There was no evidence that staff had received any training on medication or the new medication policy and as a result, a requirement has been made. Nada Nursing Home DS0000021566.V296316.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to the service Residents are supported to maintain some choices and preferences of lifestyle including choice of meals. However, nutritional intake is not monitored and the setting in which meals are taken is poor. EVIDENCE: Residents said that they have choices in their routines and daily living activities. They are able to join in with the planned activities such as bingo or quizzes and are able to have quiet time if they wish. There was evidence of this seen during the inspection, however there was no documented evidence to support the observed activities and interaction. This was a requirement made at the last inspection when the provider/manager was required to record activities and residents’ interests. The mid-day meal was served during the inspection. Overall, the food served provided residents with an appropriately balanced diet in sufficient quantities to satisfy those residents. Nada Nursing Home DS0000021566.V296316.R01.S.doc Version 5.2 Page 16 The menu board was displayed allowing residents to identify the meals for the day and providing them with a choice of food. A number of residents spoken to said that they were happy with the food and enjoyed meal times. One resident said that they “Get enough to eat and likes the food”. Some residents were observed to require assistance with their meals, this varied from assistance with eating to verbal prompting to remind the resident to eat their meal. To ensure appropriate nutritional intake meal supplements were given but details of this had not been recorded in the residents’ file and therefore proper nutritional screening was not being maintained. This information is required to ensure that residents’ health and well-being is appropriately monitored and maintained. Although the provider/manager has indicated that he has replaced some of the dining room furniture, the overall appearance of this room was poor. There was an offensive odour of stale urine in the area and the room required upgrading and redecoration. The dining room did not provide a homely/comfortable atmosphere in which residents could take their meals in comfort. It was noted that cupboards in the dinning room was used to store bedding and the provider/manager was advised to find a more suitable storage space for these items. Nada Nursing Home DS0000021566.V296316.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is poor. This judgement has been made using the available evidence including a visit to the service Management of dealing with complaints and the protection of residents from abuse is poor and places people at risk. EVIDENCE: At the last inspection a requirement was made that the home must maintain a record of complaints. No complaints had been made to the service and a complaints book was in place. There was no evidence of the complaints procedure being display for residents and their relatives and visitors to know what to do if they have a complaint. However, one resident spoken to said that if he wanted to he “knew who to complain to”. Since the last inspection, the CSCI was informed via the local authoritycontracting unit that some of the staff working at the home did not have the correct or appropriate documentation enabling them to work in the country. This resulted in the involvement of Immigration Officers. During the discussions, with the provider/manager he said that on receipt of the information about the staff members, action was taken and the staff involved suspended . There was no evidence to suggest that the provider/manager was aware that the documentation was false. It should be noted however, that a complaint to Nada Nursing Home DS0000021566.V296316.R01.S.doc Version 5.2 Page 18 CSCI in 2004 had also raised concerns about the employment practices at the home regarding work permits and student visas. This resulted in CSCI obtaining advise on the matter from the Home Office. This inspection and previous inspections of this home continue to identify serious shortfall in the home’s recruitment and vetting procedures. Repeated requirements have been made that the provider/manager must put in place robust procedures so as to protect and safeguard the residents but the provider/manager has continued to fail to take the appropriate action to address the concerns. For example, a member of staff who is employed as a senior staff member with responsibility for managing shifts and to deputise when the provider/manager was absent from the home was found to have worked at the home for over 2 years without a satisfactory Criminal Records Bureau (CRB) check. At the time of the inspection the provider/manager said he had now requested the relevant checks. Additionally, a member of staff with an adverse CRB disclosure had been employed at the home. The provider/manager said that he was aware of an allegation that had been made about the individual staff member at their previous place of employment but that the staff member had stated that the allegations were false. However, there was no recorded information of the discussions that took place between the staff and the provider/manager about the disclosure During the discussion on this matter the provider/manager went on to say that the Protection of Vulnerable Adults (POVA) 1st check had been made prior to the staff member taking employment at the home and that the outcome of this check was that no adverse information was recorded. The provider/manager had taken up references on the staff member, including a reference from the last employer. However, the member of staff had worked less than three (3) months and there was not further or additional information from the staff records to show that the provider/manager had made any attempt to obtain any other reference that would support the staff member’s application to work in a care home. The provider/manager was advised to take immediate action to safe-guard residents. Following the inspection, the provider reported that this member of staff was no longer working at the home. The outcome for residents living in Nada is that while the home had copies of the Adult Protection procedures ‘No Secrets’. there was no evidence of these being implemented. Staff members spoken to were aware of the need to report incidents or concerns to the provider/manager but they appeared unclear as to the overall process. It is important that staff are provided with relevant training so that they are able to respond appropriately to any allegation of abuse or suspected abuse and therefore protecting residents. Nada Nursing Home DS0000021566.V296316.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22, 24,25,26 Quality in this outcome area is poor. This judgement has been made using the available evidence including a visit to the service The home is poorly maintained, with poor standards of hygiene and some furnishings are inadequate to meet residents’ needs. EVIDENCE: There was a strong odour of urine throughout the home. This was particularly noticeable in the lounge, dining room and corridor area on the ground floor. The provider/manager indicated that some residents had problems with their bladder but there was no record or evidence of management strategies being put in place or how the care plan will address the concerns were noted. In addition, the ground floor corridor was noted to be ‘smokey’ with a strong stale smell of tobacco. One resident who smoked was in their bedroom and the door was open. Observations indicated that the resident was not safe to undertake this task without the supervision of staff. This matter was discussed Nada Nursing Home DS0000021566.V296316.R01.S.doc Version 5.2 Page 20 with the provider/manager who confirmed that the resident should not smoke in their bedroom and that the care plan identified that the resident must be supervised when taking a cigarette. However, an ashtray was found in the bedroom and there was evidence to suggest the resident was left unsupervised. The risk identified was discussed with the provider/manager who said that he would put pressure on staff to get them to follow the instructions. The impression formed from the discussion with the provider/manager was that he was not in control of what was taking place within the home with regard to residents’ care and he was reminded that as the registered provider/manager it was his responsibility to make sure residents are protected and that their well-being is promoted and their individual needs addressed. Although the provider/manager said that some areas of the home had been re painted or “touched up” and this was supported via observations made. However, it was found that further substantial refurbishment was required to bring the home up to an adequate standard. The provider/manager said during the tour of the building that only “essential work” was being completed such as redecoration of a few bedrooms. Some residents spoken to during the inspection did however, say they had been able to bring in things to personalise their room if they wished. During a tour of the building it was noted that several areas of the home was in a poor state of repair. For example, the wallpaper in some of the bedrooms was ripped and torn in places. Some bedroom furniture appeared old and scratched in places. Carpets on the ground floor were in a particularly poor state and needed to be replaced. In an attempt to improve the appearance of the smoking room, in line with the requirement made at the last inspection, the old furniture had been removed. Upright wooden chairs had been used as replacements but these did not provide residents with appropriate seating. The smoking lounge did not have any curtains in place and during discussions with the provider/manager he said that they been removed for safety and that he was awaiting the purchase of fire retardant ones. This is unacceptable as it meant that those residents who used this room could, in theory, be seen from outside the room which overlooked the car park. This again raised concerns about the home’s ability to maintain residents’ dignity and privacy as well as respect for the residents. There were no records maintained of work undertaken within the home and the overall outcome for residents is that the home is not maintained to provide the residents with a safe and comfortable environment in which to live. A requirement to undertake risk assessments on the aids, adaptations and equipment used in the home was made at the last two inspections. This has not been completed. Nada Nursing Home DS0000021566.V296316.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using the available evidence including a visit to the service The home’s recruitment procedure and those covering staff training are poor. This places residents at risk and has resulted in unsuitable staff being employed in the home. EVIDENCE: On the day of the inspection there were sufficient numbers of staff on duty to meet the needs of the resident. In addition to nursing and care staff there was a fulltime cook and a domestic on duty. Of those staff files examined none contained the appropriate documentation detailed in Schedule 2 of the Care Homes Regulations 2001. This included inappropriate references, CRB’s and application forms. Details of this are recorded in the Complaints and Protection section of this report. It was of concern during the inspection and in discussion with the provider/manager, that he appeared unconcerned about these issues and of the implications of not having sound recruitment practices. The registered provider/manager stated that staff received supervision on a regular basis and evidence was provided to show that staff files did contain details of supervision given. Further discussion with staff also confirmed that staff did receive supervision from the registered provider/manager. Nada Nursing Home DS0000021566.V296316.R01.S.doc Version 5.2 Page 22 The administrator said that the home had difficulties in identifying a training provider. An audit of staff training, requested at the last inspection, had not been undertaken. Although the registered provider/manager stated that he was aware that this needed to be done he could provide no evidence that relevant training was actively being sought or planned for staff. The overall outcome for residents is that they are not provided care by a competent trained staff team, who are able to offer them both care and protection. This places residents at risk. Nada Nursing Home DS0000021566.V296316.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,38 Quality in this outcome area is poor. This judgement has been made using the available evidence including a visit to the service The management of the home is ineffective and fails to maintain the health, safety and welfare of residents and staff. EVIDENCE: There was no evidence of an appropriate job description for the registered manager and, when questioned, he said that his role was “to manage” although, from evidence seen during the visit, he appeared to basically oversee the general running of the home. Nada Nursing Home DS0000021566.V296316.R01.S.doc Version 5.2 Page 24 The home has no clearly defined management structure, which created some difficulty for staff as to who they should pass information to. Although those staff spoken with knew the registered manager was in overall charge of the home they were unclear whom they should take direction from in his absence. From observation made during the visit it appeared that staff passed information to whoever was the first to be seen which could include the manager, his wife, his daughter (the administrator) or, the nurse in charge. This could place residents at risk from important information not being appropriately shared or breaches of confidentiality taking place. Those staff files examined were difficult to check because they were not compiled in any particular order which made it difficult to assess and evaluate the information contained in them. Recruitment processes were poor and the provider/manager was unclear as to the procedures to follow when recruiting staff. He stated that it consisted of sending a form, an interview and checks. However, discussion with the administrator for the home indicated that she was aware of the need to implement appropriate systems to further develop this. Maintenance of the home was poor and repair work is undertaken ‘as and when’ required and there is no improvement plan in place. Discussion took place with the provider/manager about the number of outstanding requirements from previous inspections and why these had not been completed within the timescales given? He said that the Commission had made “too many” and with short time frames. He claimed that this put him under pressure to complete them. However, a number of these requirements are outstanding from 2004 and there was no clear evidence that the provider/manager has taken a pro-active approach to meet the regulations nor is there evidence to indicate that he has made any attempt to re-negotiate timescales with or discuss his concerns with the Commission. Nada Nursing Home DS0000021566.V296316.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 2 2 2 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 1 2 X X X 2 2 1 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X X X x 1 Nada Nursing Home DS0000021566.V296316.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 OP1 Regulation 4&5 Requirement The registered person must ensure that up to date information about the home is available to all prospective residents in the form of a statement of purpose and a service users’ guide. A copy of both updated documents must be provided to the Commission. All residents must be provided with a written statement of the terms and conditions of residency. No resident must be admitted into the home unless a suitably qualified person has carried out appropriate assessments of needs and confirmed the home can meet those needs. Previous timescale of 08/12/04 and 07/07/05 had not been met. Care plans must included details of residents personal and social needs and these must be recorded on individual files. Previous timescale of 08/12/04 and 07/08/05 not met. Nada Nursing Home DS0000021566.V296316.R01.S.doc Version 5.2 Page 27 Timescale for action 28/07/06 2 OP2 5 28/07/06 3 OP3 14 28/08/06 4 OP7 15 28/07/06 5 OP9 13 The registered person must ensure that arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Previous timescale of 08/12/04,07/07/05 and 01/03/06 had not been met. The registered person must make arrangements for medication policies and procedures to be made accessible to all staff members. The registered person must ensure accountability for all medication is evidenced by clear and accurate record keeping. The registered person must ensure that medication is stored within the manufacturers recommended temperatures and that nurses are aware of what action to take in the event of medication being stored incorrectly. The registered person must ensure that medication that has been stored badly is replaced with a fresh supply. The registered person must ensure medication is administered in strict accordance with prescribe directions at all times. The registered person must ensure that all nurses administering medication undergo medication training. The registered person must ensure that all nurses administering medication must have their competency to do so assessed. The registered person must ensure the supplying pharmacy is contacted to discuss supply of DS0000021566.V296316.R01.S.doc 26/06/06 6 OP9 13 26/06/06 7 OP9 13 26/06/06 8 OP9 13 26/06/06 9 OP9 13 26/06/06 10 OP9 13 26/06/06 11 OP9 13 26/07/06 12 OP9 13 26/07/06 13 OP9 13 26/06/06 Nada Nursing Home Version 5.2 Page 28 14 OP9 13 15 OP10 12 16 OP10 12 & 16 medication. The registered person must 26/06/06 ensure that staff administering medication follow the guidance issued by the Royal Pharmaceutical Society and Nursing and Midwifery Council in respect of the safe receipt, administration and disposal of medicines in the home. The registered person must 30/06/06 ensure that care plans are written to include details of how staff will maintain and promote individuals dignity. It is required that the home 28/07/06 implements a policy on privacy and dignity which includes such matters as opening personal mail etc. Previous timescale 31/03/05 not met. Details of nutritional intake must be recorded on individual daily records. The registered person must develop and make public a clear complaints procedure The registered person must introduce procedures, practices and training for staff that ensure Residents are protected from harm The registered person must provide furnishings and fixtures in the smoking lounge that are fit for their intended purpose. Previous timescale of 8.12.04, 07/08/05 and 1st/March/06 have not been met. 17 18 19 OP15 OP16 OP18 17 22 13 28/07/06 30/07/06 27/08/06 20 OP20 16, 23 01/07/06 21 OP22 23 A risk assessment must be conducted in respect of the aids, adaptations and equipment required to more fully meet the DS0000021566.V296316.R01.S.doc 28/07/06 Nada Nursing Home Version 5.2 Page 29 residents assessed needs. Previous timescale of 8.12.04 and 7/8/05 had not been met. 22 OP25 38 The registered person must 28/07/06 ensure that full risk assessments are completed on those residents who smoke. The outcomes of the risk assessments must be detailed, staff and residents must follow them. The registered person must 28/08/07 ensure that there are sufficient numbers of trained staff employed at the home. The registered person must 30/06/06 ensure that all necessary recruitment checks are undertaken on prospective staff prior to their employment at the home as specified in Schedule 2 of the Care Homes Regulations 2001. Previous timescale of 8.12.04 and 22/6/05 had not been met. 25 OP30 12,13,18 The registered person must take account the new requirements for the induction of staff and review and revise their own induction process. These details must be in the form of a written procedure. Previous timescale of 14/04/06 not met. 2. Each member of staff must have an individual training and development plan. 26 OP31 10 & 12 The registered person must clearly demonstrate how the home will be appropriately managed. DS0000021566.V296316.R01.S.doc 23 OP28 18 24 OP29 19, Schedule 2 28/07/06 30/07/06 Nada Nursing Home Version 5.2 Page 30 27 OP38 13 The registered person must 30/07/06 identify how he will implement procedures to protect and promote the welfare of residents. 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 OP7 OP9 Good Practice Recommendations The registered person should ensure that details of all visiting professionals are recorded in the individual files of those residents seen. The registered person should make sure that handwritten entries on the MARs are signed by the member of staff making the entry and countersigned by a second member of staff, to check the accuracy. It is recommended that the home appoint a designated member of staff to assume responsibility to act as an activity co-ordinator. It is recommended that the manager continues and successfully achieves the Registered Managers Award. It is recommended that the registered person conduct an audit of the home’s furnishings and decoration. A programme of maintenance and renewal of fabric and decoration with timescales should be produced and implemented. 2 OP12 2. 3. OP31 OP19 Nada Nursing Home DS0000021566.V296316.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Nada Nursing Home DS0000021566.V296316.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!