Inspection on 13/05/08 for New Thursby Nursing Home

This inspection was carried out on 13th May 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE New Thursby Nursing Home 604 Clifton Drive South Lytham St Annes Lancashire FY8 2RJ Lead Inspector Mrs Marie Cordingley Unannounced Inspection 13th May 2008 9:30 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 New Thursby Nursing Home DS0000070673.V356542.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. New Thursby Nursing Home DS0000070673.V356542.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service New Thursby Nursing Home Address 604 Clifton Drive South Lytham St Annes Lancashire FY8 2RJ 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) 01253 780088 Century Healthcare Limited Miss Christine Pratt Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places New Thursby Nursing Home DS0000070673.V356542.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home with Nursing- code N, to people of the following gender:Either. Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP The maximum number of people who can be accommodated is: 40 Date of last inspection N/A Brief Description of the Service: The New Thursby is registered with the Commission for Social Care Inspection to provide care and accommodation for up to 40 older people who require nursing care. The home is situated on Clifton Drive in St Annes, near Blackpool. There are 32 single bedrooms and 17 of these have en-suite facilities. Of the four double bedrooms, one has en-suite facilities. There are two lounges, two dining rooms and a large conservatory. All rooms and communal areas are furnished to a good standard and there are adequate toilets and bathrooms. Care is provided on a 24 hour basis including waking watch care throughout the night. The registered provider of the home is Century Healthcare who operate a number of care homes in the area. At the time of our key inspection we were advised that fees for care and accommodation at the home range from £412 to £636 and are assessed in accordance with individual need. All this information and more can be found in the Service User Guide which is available on request from the home. New Thursby Nursing Home DS0000070673.V356542.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of this service is 1 star. This means that people using this service experience adequate quality outcomes. The inspection of this home included a site visit which was carried out over one day. This visit was unannounced meaning that the manager, staff and residents did not know it would be taking place until the inspector arrived. During the visit we spent time talking with and observing residents, staff, the registered manager and a senior manager from Century Healthcare. In addition, we viewed a selection of paperwork including a sample of residents’ care plans and staff training records. We also carried out a tour of the home viewing residents’ bedrooms and communal areas. A specialist pharmacy inspector carried out a full medication inspection which included examination of the home’s procedures, stock of medicines and all records relating to residents’ medication. As part of the inspection we carried out a case tracking exercise, which involved us looking closely at the care provided to selected residents from the point that they moved into the home. Prior to our visit, we wrote to the registered manager and asked her to fill in a very detailed self assessment questionnaire. This questionnaire provided us with a lot of information about the home and its management, and was returned to us within agreed timescales. We also wrote to a selection of residents, their relatives and staff members and asked them to take part in a written survey. As part of the survey, people were asked to share their opinions about various aspects of the service provided. A number of completed surveys were returned to us. What the service does well: New Thursby Nursing Home DS0000070673.V356542.R01.S.doc Version 5.2 Page 6 We received a good response to our written survey and in general, people who took part in the survey were very positive about the home. We received some very positive comments including; ‘Staff take a personal interest in each individual and their families.’ ‘Very caring and generally capable staff.’ ‘Provides a high quality of care in clean and pleasant surroundings.’ ‘The staff are pleasant, efficient and helpful.’ ‘To date, the care and support has been excellent.’ ‘I am very comfortable and the care is very good.’ We observed carers throughout the day and noted that they went about their duties in a pleasant and professional manner. Carers and residents clearly got along well together and their interactions were pleasant. Staffing levels at the home have recently been increased and people we spoke with told us that they felt there were ample numbers of staff on duty each day to meet the needs of residents. Residents appeared comfortable and relaxed in their surroundings and those we talked with spoke highly of staff and the manager. One resident told us ‘’I am very happy to be here, I have never had to complain about anything, they are all so good.’’ People we consulted expressed satisfaction with the activities available and comments were made that this was an area which had improved considerably since the home had been taken over by new owners. During the inspection we found that residents regularly benefit from the chance to take part in a variety of activities both inside and outside the home. People also told us that they were pleased with the quality and variety of meals provided and it was noted that residents were offered a number of choices at each meal time. We saw evidence that people who live at the home are encouraged to be involved with decisions and residents’ meetings take place on a regular basis. There is a residents’ committee at the home who have recently been involved in plans to update the garden area and at the time of our visit, were managing the purchase of plants and other garden items. What has improved since the last inspection? This was the home’s first inspection since registration in November 2007. New Thursby Nursing Home DS0000070673.V356542.R01.S.doc Version 5.2 Page 7 What they could do better: The Service User Guide is an important document which assists people to make an informed choice about where to live. It is important that the guide accurately reflects the service provided at all times. We found during this inspection that there were some pieces of information missing from the guide and that it had not been updated to reflect recent changes in ownership. The Service User Guide should be constantly updated to provide the reader with an accurate picture of the home. In addition, we made a recommendation that the Service User Guide be made available in a variety of formats, for example audio and large print. When assessing residents’ care needs and planning their care, it is important to plan in a holistic and person centred manner. Gathering social history information about residents will assist staff in recognising and responding to people’s individuality. It is important that care plans accurately reflect the care required and provided. We found a number of examples where residents’ care plans had not been updated in important areas such as pressure care. However, we were also able to determine that appropriate care had been given in these circumstances, but there is a danger that residents’ care needs will not be properly addressed if their care plan does not provide staff with up to date, accurate guidance. Improvements need to be made in the handling of residents’ medicines. Records of medicines received into the home must be more detailed so that all medicines can be fully accounted for. Care plans must be completed and regularly reviewed for residents choosing to manage their own medicines, residents that regularly refuse medicines and for residents that receive medicines on a ‘when required’ or ‘variable’ basis to help ensure they are handled safely. There should be an effective system in place to audit medicines and staff competence to help ensure medicines are always handled safely. A legally compliant controlled drug cupboard must be available to store controlled drugs to help ensure they are not mishandled or misused. Medicines must be stored securely and at the right temperature to help prevent them being spoilt or mishandled. There are regular activities held both inside and outside the home that residents can take part in. However, there are some residents who may not benefit from the general activities that are held, for example due to their level New Thursby Nursing Home DS0000070673.V356542.R01.S.doc Version 5.2 Page 8 of dementia. Consideration needs to be given as to how stimulating and fulfilling activities can be provided to people with diverse needs. It is important that any complaint made is carefully recorded as well as action taken in response to the complaint and subsequent outcome. This is not only so that the manager can demonstrate that each complaint has been responded to effectively, but also to enable the manager to monitor complaints and identify any patterns or trends that could highlight an underlying issue. The home’s safeguarding policy and procedures need to be reviewed to ensure that they are in line with the Department of Health guidance ‘No Secrets.’ In addition, the procedure should be rewritten with all staff in mind, as currently, they are focused on registered nurses. Staff members we spoke to told us that they felt they were provided with adequate training to carry out their roles well. However, there was no record within the home available to tell us exactly what training each staff member had received. This needs to be addressed as soon as possible as the manager of the home needs to have easy access to this information so that she herself can monitor people’s training and allocate training resources effectively. 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. New Thursby Nursing Home DS0000070673.V356542.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 New Thursby Nursing Home DS0000070673.V356542.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. Standard 6 is not applicable to this home. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. An assessment is carried out for each person before they move into the home. However, they need to be more person centred so that carers have more insight and a greater understanding of each resident. EVIDENCE: A Service User Guide is provided to people at the point that they express an interest in moving to the home. This document includes a variety of information, for example details of facilities and services available within the home, as well as information about staffing and daily routines such as meal times and activities. New Thursby Nursing Home DS0000070673.V356542.R01.S.doc Version 5.2 Page 11 However, at the time of our visit we noted that there were some pieces of information missing. In addition, the guide had not been updated to reflect recent changes in ownership. We made a recommendation that this be addressed and that the guide be updated in line with the National Minimum Standards. In discussion, it was confirmed that the Service User Guide is currently only produced in a standard written format. We advised the manager that the guide should be made available in various formats, for example large print and audio, to ensure that everyone has equal access to the information. There are processes in place to ensure that pre admission assessments are carried out with people before they move into the home. This means that the manager can ensure that a person’s needs will be met and that the home is right for them before they move in. It also means that staff have a good understanding of the care needs of new residents and can provide the right level of care straight away. As part of our case tracking exercise we viewed a number of residents’ pre admission assessments. The home uses a standard format for these assessments which includes all areas of daily living and also provides areas where details about people’s social histories such as previous employment, relationships and hobbies can be detailed. We found that in some cases not all areas of the assessments had been fully completed. We noted that where information was missing, it was generally in relation to people’s social histories and in some cases, assessments didn’t address people’s needs in this area. This sort of information is very important because it helps carers recognise and value people’s individuality so that they can plan people’s care in a person centred way which is in line with their unique needs and wishes. As such we have made a requirement in relation to this matter. New Thursby Nursing Home DS0000070673.V356542.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ care plans don’t always consistently reflect the care they need which means there is a danger that they will not receive the right level of support. Some poor practice when administering and recording medicines is placing the health and wellbeing of residents at unnecessary risk. EVIDENCE: We viewed a selection of residents’ care plans as part of our case tracking exercise. Whilst the actual format for care planning was of a good standard and very comprehensive, we found that in some cases, large parts of care plans had not been completed. The areas that were not completed were in most cases, in relation to social aspects of care such as hobbies and pastimes, religion and relationships. New Thursby Nursing Home DS0000070673.V356542.R01.S.doc Version 5.2 Page 13 Some care plans had not been updated for long periods of time. For example, we viewed the care plan of one resident who had been admitted to the home several months earlier with a pressure sore. There was no update on the care plan as to how this had been addressed. However, further investigation showed that the resident’s pressure sore had completely healed due to the good standard of care she had been given by staff at the home. We tracked the care of one resident who had some complex behavioural needs. Whilst the resident appeared content and relaxed during our visit, we noted that his complex needs had not been addressed in his care plan. It is important to address these areas so that staff can be aware of what might cause the person to become anxious or distressed. Care plans should also detail positive approaches and strategies so that carers can deal with challenging situations confidently and consistently. Risk assessments are carried out as part of the home’s routine admission procedures, in areas such as falling and developing pressure sores. In one example we noted that a resident had been assessed as being at high risk of developing pressure sores. However, no guidance in terms of preventative action had been noted on his daily care plan. However, staff were carrying out preventative pressure care for the resident as part of general good practice. As part of the inspection a specialist pharmacist inspector looked at how medicines were handled. We looked at the medicines stock and records and observed part of the morning medicines round. The majority of medicines were packaged in a blister system supplied by the pharmacy, this helped staff administer them in an organised way. We found that medicines contained in this system were usually administered correctly. We checked the records of medicines receipt and found that they were not dated and so it was not possible to accurately account for all medicines, this was particularly difficult for medicines contained in traditional packets and bottles. All medicines must be fully accounted for to show that they are being administered to residents correctly and to help prevent mishandling. Staff said, the records showed and we observed that most medicines were given at the correct time in relation to food intake, notably an earlier morning medicines round was ensuring medicines that needed to be given before food were given correctly. Giving medicines at the right time helps them work correctly. We looked at how residents were supported when they looked after their own medicines. Some paperwork was in place for one resident but this was not detailed and a care plan had not been written to help ensure they receive the support they need. It was not possible to check how much medicine this resident was having, as the records were not accurately completed. Having an accurate up to date care plan helps ensure residents receive the right amount of support. New Thursby Nursing Home DS0000070673.V356542.R01.S.doc Version 5.2 Page 14 We looked at a sample of care plans and the daily records to ensure medicines were correctly detailed in them. We found some of these lacked sufficient information, of particular concern was the lack of detail of how medicines used for anxiety were to be handled. Several residents were regularly refusing their medicines but this was not being managed properly and their care plans did not say how staff were handling the situation. We found several care plans had not been correctly reviewed and one resident who had been suffering with depression had no care plan to ensure they received the right amount of support. Having detailed up to date care plans is important to help ensure residents receive their medicines correctly. We checked the stocks and records of controlled drugs (medicines that can be misused). Although a secure cupboard was being used for storage it was not compliant with the law, we gave some advice to the manager on how to put this right. We checked the controlled drug records and noted one recent recording mistake, which we told the manager about. Secure storage and witnessed records help ensure controlled drugs are not mishandled or misused. We looked at how medicines were stored. A secure well-organised room was used for storage and a suitable trolley was used for transporting medicines around the home. We discussed a security issue with the manager and how this could be improved. A lockable fridge was available for storing medicines that required cold storage. However this was too cold on the inspection day and had been for several weeks, as a result of this some medicines would have been frozen, which would have spoilt them. We therefore advised the manager to get fresh supplies as soon as possible. We saw some evidence of regular monthly checks being carried out by senior managers. However these checks had not identified the type of mistakes we had found because they were not detailed enough in the right areas. We asked the manager how she checked whether staff were competent when handling medicines, she said no ‘formal’ systems were in place and that staff were not regularly observed. Checks on medicines handling are important because they help ensure medicines are administered as prescribed and help ensure staff are competent. New Thursby Nursing Home DS0000070673.V356542.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at this home benefit from a varied activities programme and regular opportunity to take part in outings. However, more planning around people’s individual needs in relation to activities would be of further benefit. EVIDENCE: We received some very positive comments about activities from people who took part in our written survey, and those we spoke to during our visit. A number of people we consulted felt that the activities on offer at the home had improved greatly since the home’s new owners had taken over. The home employs a dedicated activities organiser who works every afternoon. We spoke to this staff member who told us about the numerous activities offered to residents on a daily basis. These include arts and crafts, quizzes and regular exercise classes. At the time of our visit there was a musician entertaining the residents, who is a regular visitor to the home. New Thursby Nursing Home DS0000070673.V356542.R01.S.doc Version 5.2 Page 16 The residents’ committee have recently made plans to update the garden area and funds have been made available to the committee for the purchase of a greenhouse, plants and other equipment. Residents are planning to be involved in the design and ongoing maintenance of the new garden. As well as group activities the activities organiser gave us a number of examples of how activities are offered to people on a one to one basis. For example, one resident who liked to go out for a walk in the afternoon was supported to do so on most days. The home has a vehicle for the use of residents and since the home changed ownership, the opportunity to take part in trips out has been offered more frequently. Recently, some residents have enjoyed trips out to local garden centres, an animal sanctuary and Fairhaven Lake. Not all residents’ care plans contained information about their preferences in relation to activities and hobbies and in one example, it appeared that little consideration had been given to the resident’s individual experience of Dementia. We advised the manager to consider ways in which people with diverse needs could be fully included in social events at the home and provided with stimulating and enjoyable activities. People who responded to our written survey and those we spoke to during our visit, were very complimentary about the quality and variety of meals provided. We viewed menus which demonstrated that people are provided with a varied and nutritious diet, menus also showed that there were various choices available at each meal time. We noted that the daily menu and the options available were written on a board within the home. Whilst this arrangement would be useful for some residents, there are others who would have difficulty accessing information in this format. We asked the manager to consider additional ways in which people could be made aware of choices available to them such as pictorial menus or other visual prompts. New Thursby Nursing Home DS0000070673.V356542.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are processes in place to enable people to raise complaints, however if complaints are not properly recorded there is a danger they won’t be dealt with effectively. Safeguarding procedures need to be reviewed to ensure that all staff are aware of their responsibilities and the action they should take if any such concerns are identified. EVIDENCE: The home has a complaints procedure in place which advises how to go about making a complaint and details the action that will be taken by the manager in this event. The complaints procedure is written in a clear and easy to understand way but is currently only available in a standard written format. We made a recommendation that the procedure be made available in a variety of formats for example, large print and audio, so everyone has equal access to the information. A record should be kept in the home of all complaints made, action taken and the subsequent outcome. According to this record there had not been any complaints made within the home but we later became aware that a concern had been previously raised by a residents’ family member. In discussion, we New Thursby Nursing Home DS0000070673.V356542.R01.S.doc Version 5.2 Page 18 were able to determine that the concern had been dealt with appropriately and that the people raising the issue had been satisfied with the outcome, however we advised the manager that she must ensure all complaints are properly recorded. In accordance with the Care Homes Regulations, 2001, all homes must have a written policy and procedures in place relating to the prevention of abuse. These are generally referred to as safeguarding procedures. We viewed the home’s safeguarding procedures and found that these didn’t contain all the necessary information. For example, they failed to describe the roles of other agencies such as local social services departments and the police. In addition, they didn’t contain any guidance to staff on how to refer safeguarding issues properly. We also found that the safeguarding policy and procedures were very much focused on qualified nursing staff. For example, the policy stated that it was ‘part of a registered nurse’s duty to safeguard residents’ but there was no reference to the responsibility of health care assistants or other staff members. This is of concern as it may lead non nursing staff to believe that the policy does not apply to them. However, we spoke to a number of nursing and non nursing staff during our visit and found that they had a good understanding of the area and were able to give examples of abuse and bad practice. In addition, people we spoke with confirmed that they would report any such incident and were confident that the manager would take appropriate action. Some staff members were unsure if they had carried out specific training in this area but confirmed that it had been covered during their induction. We discussed this with the manager and advised that safeguarding should be part of all staff members’ core training. New Thursby Nursing Home DS0000070673.V356542.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at the home are provided with a good standard of accommodation. EVIDENCE: We carried out a tour of the home and found that all areas were warm, clean and comfortable. In addition, the home was generally well maintained and furnished to a good standard. The home’s new owners have carried out a number of improvements since taking over and further improvements are planned for the future. This includes New Thursby Nursing Home DS0000070673.V356542.R01.S.doc Version 5.2 Page 20 the redesign and improvement of the garden area which is a project that a number of residents are involved in. There are a number of communal areas for people to use including a large conservatory and several lounges. We also viewed residents’ bedrooms and found that these were nicely personalised with people’s own possessions such as photographs and ornaments. We noted during our tour that not all bedrooms had locks on them. We were advised that every resident is offered a lockable bedroom door on their admission and this is provided if requested. People who responded to our written survey told us that they felt the home was kept fresh and clean. We also found that all areas were clean during our visit. There are procedures in place for the prevention of cross infection and in discussion, staff showed a good understanding of these. The manager was aware of the Department of Health guidance ‘Essential Steps.’ We advised her to review the home’s infection control procedures to ensure that they are in line with the guidance. New Thursby Nursing Home DS0000070673.V356542.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive their care from adequate numbers of well supported staff. However, systems for monitoring staff training need to be improved so as to ensure that all staff are receiving the appropriate training at the correct times. EVIDENCE: We viewed the personnel files of several staff members and found that in general, robust procedures are followed to ensure that only suitable people are employed at the home. All potential staff members are asked to provide a full employment history and references from previous employers, wherever possible. Prior to commencing employment all candidates must undergo a police check and are also checked against the Protection of Vulnerable Adults register. However, in one of the staff members’ files we viewed, references were available but it was unclear what the relationship was between the staff member and the people who had provided the references. We advised the manager to make sure that this be determined and made clear on the person’s file. New Thursby Nursing Home DS0000070673.V356542.R01.S.doc Version 5.2 Page 22 We viewed staffing rotas and talked with residents and carers about staffing levels. People told us that staffing levels had recently been increased and that they felt there were plenty of staff on duty at any one time to meet the needs of residents. The atmosphere in the home was relaxed and staff were observed going about their duties in a pleasant and professional manner. Staff we spoke to told us that they felt very well supported by the manager of the home and found her extremely approachable. Staff members we talked to told us that they felt they had received good levels of training and described numerous courses they had been on. However, it was very difficult for us to assess the overall level of training provided to staff as there were no records in the home with this information on. A training matrix had been provided by Century Healthcare for this purpose but the manager had not completed it. We advised the manager that this information needed to be collated as soon as possible so that she could monitor training and make arrangements for necessary training to be provided to each staff member at the right time. Some staff members we spoke to confirmed that they held National Vocational Qualifications in care at level 2 or above. However it was confirmed by the manager that the number of staff holding the qualification has now fallen below 50 (the national target). However, this is partly due to the recent increases in staffing levels and plans are in place to address the issue as soon as possible. New Thursby Nursing Home DS0000070673.V356542.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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to be involved in decisions about the running of the home and their views are taken into account when developing the service. EVIDENCE: The manager of the home has been in post for several years and is an experienced, registered nurse. The manager is currently in the process of obtaining the Registered Manager’s Award. People who responded to our written survey and those we spoke to during our visit spoke highly of the manager describing her as very approachable. New Thursby Nursing Home DS0000070673.V356542.R01.S.doc Version 5.2 Page 24 In discussion with the manager it was apparent that she is committed to providing a good quality service and she responded positively to the requirements and recommendations we made as a result of our findings. There are a number of systems in place to help the manager and representatives of Century Healthcare monitor quality. These quality assurance systems are in place to identify areas for improvements and development and also recognise areas in which the service performs particularly well. However, at the time of our visit the manager was not able to produce the policy and procedures relating to quality assurance. We advised the manager that she should familiarise herself with these procedures so that she has a full understanding of how they work. We saw evidence that residents’ views are taken into account throughout the inspection. A residents’ committee is in place at the home and has been responsible for planning the improvement of the home’s garden area. Residents’ and relatives’ meetings are held regularly as well as satisfaction surveys. We were also able to determine that results from satisfaction surveys are carefully analysed and action taken where necessary to address issues raised. For example, the recent increase in staffing levels was partly due to the fact that some residents had stated in a survey that they sometimes had to wait quite a while before their call bells were answered. No personal monies are kept at the home for any resident, families or advocates attend to this. Safety and maintenance certificates were sampled and the manager was aware of the responsibilities for maintaining all health and safety certificates of service for fire equipment, electric, gas and nurse call systems. It was also confimed that the home has a fire risk assessment in place which is available to all staff residents and visitors. New Thursby Nursing Home DS0000070673.V356542.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 x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 2 x x 3 New Thursby Nursing Home DS0000070673.V356542.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 OP1 Regulation 6 (a) Requirement Timescale for action 31/07/08 2. OP1 5 (1) (a – f) 3. OP7 15 (1) & (2) (a-d) 4. OP9 13(2) The home’s Service User Guide must be kept under regular review so that it provides up to date and accurate information. The home’s Service User Guide 31/07/08 must include all the information as stated in regulation 5 (a-f) to help ensure that people can make an informed decision about moving to the home. Residents’ care plans must 31/07/08 provide an accurate and up to date picture of their care needs so that carers understand the level of support they require. A legally compliant controlled 16/06/08 drug cupboard must be available to store controlled drugs to help ensure they are not mishandled or misused. Medicines must be stored securely and at the right temperature to help prevent them being spoilt or mishandled. 16/06/08 5. OP9 13(2) 6. OP9 13(2) Records of medicines received 16/06/08 into the home must be more detailed so that all medicines can be fully accounted for. DS0000070673.V356542.R01.S.doc Version 5.2 Page 27 New Thursby Nursing Home 7. OP9 13(2) Care plans must be completed and regularly reviewed for residents choosing to manage their own medicines, residents that regularly refuse medicines and for residents that receive medicines on a ‘when required’ or ‘variable’ basis to help ensure they are handled safely. There should be an effective system in place to audit medicines and staff competence to help ensure medicines are always handled safely. 16/06/08 8. OP9 24(1) 16/06/08 9. OP16 22 (3) 10. OP18 11. OP29 12 OP28 Any complaints or concerns raised must be recorded and dealt with appropriately in line with the company’s written complaints procedures. 13 (6) The home’s Safeguarding policy and procedures must outline the correct processes and be relevant for all staff members to help ensure that residents are protected from abuse. 19 (1) (c ) Sources of references for potential employees must be ascertained to help safeguard residents. 18 (1) (c) A minimum of 50 of care staff (i) must hold National Vocational Qualifications in care at level 2 or above to help ensure that people receive their care from suitably qualified carers. 31/05/08 30/06/08 31/05/08 31/03/09 New Thursby Nursing Home DS0000070673.V356542.R01.S.doc Version 5.2 Page 28 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. 8. Refer to Standard OP1 OP3 OP12 OP30 OP30 OP15 OP16 OP26 Good Practice Recommendations The Service User Guide should be made available in a variety of formats so that everyone has equal access to the information. Pre admission assessments should contain more detail to help staff have more understanding about individual residents. Individual care plans should address the area of activities and pastimes so that people’s individual needs in this area are understood and addressed. A training matrix should be in place so that the manager can monitor people’s training and allocate training resources effectively. Carers’ core training should be reviewed to cover additional areas such as caring for people with dementia and abuse awareness. Consideration should be given as to how people who are not able to make use of a written menu can be made aware of choices available. For example, pictorial menus. The home’s complaints procedure should be made available in a variety of formats for example, large print and audio. The Department of Health guidance ‘Essential Steps’ should be obtained and the home’s infection control procedures reviewed to ensure they are in line with the guidance. The registered manager should obtain the Registered Manager’s Award. The registered manager should familiarise herself with Century Healthcare’s quality assurance procedures so as to ensure that she is working in accordance with them. 9. 10. OP31 OP33 New Thursby Nursing Home DS0000070673.V356542.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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